Cholera in Papua New Guinea and the importance of safe water sources and sanitation.

WPSAR Vol 3, No 1. 2012 | doi: 10.5365/wpsar.2011.2.4.014 www.wpro.who.int/wpsar 1 a Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea. Submitted: 30 November 2011; Published: 27 March 2012 doi: 10.5365/wpsar.year.2011.2.4.014 Until recently cholera had never been reported in Papua New Guinea despite the close proximity of cholera-endemic countries and the presence of environmental and social characteristics that are considered risk factors for cholera outbreaks. The current outbreak began in July 20091 and rapidly spread throughout the coastal regions of the country. Initial characterization studies using variable-number tandem repeat analysis indicate that the outbreak was a recent clonal incursion from South-East Asia. By mid-2011 the outbreak had resulted in the reporting of more than 15 500 cases of cholera and over 500 deaths: a case fatality ratio (CFR) of approximately 3.2%.2 Following an outbreak of cholera, interventions such as the introduction of oral rehydration therapy aim to reduce the CFR to below 1%. This elevated CFR is likely a reflection of the inaccessibility of much of the country, the lack of health care services available in remote regions and the general unpreparedness for an outbreak of this kind. This premise is supported by the differences in CFRs between the relatively well-serviced National Capital District (0.1%) and more remote regions such as the Western Province (8.8%).