Papua New Guinea Medical Journal Volume 48, No 1-2, Mar-Jun 2005
PUBLICATIONS OF RELEVANCE TO PAPUA NEW GUINEA AND MELANESIA
Bibliographic Citation List generated from MEDLARS
1 Aghanwa HS. significantly lower in the blanket group (P = 0.031).
Attitude toward and knowledge about mental illness No difference was found between the contact and
in Fiji islands. the control groups (P = 0.93). Whether this apparent
Int J Soc Psychiatry 2004 Dec;50(4):361-375. reduced leprosy incidence in the first three years in
BACKGROUNDS: There is a dearth of the blanket group is due to a delayed development
information on the extent of knowledge about mental of leprosy or a complete clearance of infection needs
illness and attitudes toward the mentally ill in Fiji. to be determined.
AIMS: This study aimed to explore these aspects,
and also to determine the factors influencing them. 5 Bakker MI, Hatta M, Kwenang A, Faber WR, van
METHOD: Market vendors, peri-urban dwellers, Beers SM, Klatser PR, Oskam L.
white-collar and health workers from Greater Suva Population survey to determine risk factors for
were interviewed. The interview schedule used Mycobacterium leprae transmission and infection.
elicited socio-demographic characteristics, Int J Epidemiol 2004 Dec;33(6):1329-1336. Epub
knowledge of, and attitudes toward, mental illness. 2004 Jul 15.
RESULTS: A majority of the subjects attributed the BACKGROUND: Not every leprosy patient is
cause of mental illness to substance abuse, believed equally effective in transmitting Mycobacterium
in the diversity of mental illness, considered hospital leprae. We studied the spatial distribution of infection
as an important source of help and acknowledged (using seropositivity as a marker) in the population
the effectiveness of medication. Less than one-fifth to identify which disease characteristics of leprosy
of the subjects were willing to marry or employ patients are important in transmission. METHODS:
mentally ill persons. About 42% of the sample would Clinical data and blood samples for anti-M. leprae
be deterred by embarrassment from seeking help. ELISA were collected during a cross-sectional survey
Educational attainment was correlated with on five Indonesian islands highly endemic for leprosy.
knowledge about mental illness, except with A geographic information system (GIS) was used to
knowledge about early mental symptoms (p < 0.01). define contacts of patients. We investigated spatial
Prestigious occupation, single marital status, female clustering of patients and seropositive people and
gender, younger age and urban dwelling were used logistic regression to determine risk factors for
associated with positive disposition toward the seropositivity. RESULTS: Of the 3986 people
mentally ill (p < 0.01). Race was not significantly examined for leprosy, 3271 gave blood.
influential on almost all attitudinal variables. Seroprevalence varied between islands (1.7-8.7%)
CONCLUSION: Health education is capable of and correlated significantly with leprosy prevalence.
positively influencing knowledge about, and attitudes Five clusters of patients and two clusters of
toward, mental illness in Fiji. seropositives were detected. In multivariate
analysis, seropositivity significantly differed by
2 Allen L, Shrimpton R. leprosy status, age, sex, and island. Serological
The International Research on Infant status of patients appeared to be the best
Supplementation Study: implications for programs discriminator of contact groups with higher
and further research. seroprevalence: contacts of seropositive patients had
J Nutr 2005 Mar;135(3):666S-669S. an adjusted odds ratio (aOR) of 1.75 (95% CI 0.922-
3.31). This increased seroprevalence was strongest
3 Andrade AL, Martelli CM. for contact groups living < or =75 m of two
Globalisation of Hib vaccination – how far are we? seropositive patients (aOR = 3.07; 95% CI 1.74-
Lancet 2005 Jan 1-7;365(9453):5-7. 5.42). CONCLUSIONS: In this highly endemic area
for leprosy, not only household contacts of
4 Bakker MI, Hatta M, Kwenang A, Van Benthem seropositive patients, but also people living in the
BH, Van Beers SM, Klatser PR, Oskam L. vicinity of a seropositive patient were more likely to
Prevention of leprosy using rifampicin as harbour antibodies against M. leprae. Through
chemoprophylaxis measuring the serological status of patients and
Am J Trop Med Hyg 2005 Apr;72(4):443-448. using a broader definition of contacts, higher risk
An intervention study was implemented on five groups can be more specifically identified.
Indonesian islands highly endemic for leprosy to
determine whether rifampicin can be used as 6 Baravilala WR, Moulds RF.
chemoprophylaxis to prevent leprosy. The A Fijian perspective on providing a medical
population was actively screened before the workforce.
intervention and subsequently once a year for three Med J Aust 2004 Dec 6-20;181(11-12):602.
years. In the control group, no chemoprophylaxis
was given. In the contact group, chemoprophylaxis 7 Beadell JS, Gering E, Austin J, Dumbacher JP,
was only given to contacts of leprosy patients and in Peirce MA, Pratt TK, Atkinson CT, Fleischer RC.
the blanket group to all eligible persons. The cohort Prevalence and differential host-specificity of two
consisted of 3,965 persons. The yearly incidence avian blood parasite genera in the Australo-Papuan
rate in the control group was 39/10,000; the region.
cumulative incidence after three years was Mol Ecol 2004 Dec;13(12):3829-3844.
Papua New Guinea Medical Journal Volume 48, No 1-2, Mar-Jun 2005
The degree to which widespread avian blood 9 Berlioz-Arthaud A, Barr IG.
parasites in the genera Plasmodium and Laboratory-based influenza surveillance in New
Haemoproteus pose a threat to novel hosts depends Caledonia, 1999-2003.
in part on the degree to which they are constrained Trans R Soc Trop Med Hyg 2005 Apr;99(4):290-300.
to a particular host or host family. We examined the We aimed to evaluate the annual incidence of
host distribution and host-specificity of these influenza in New Caledonia and to identify the
parasites in birds from two relatively understudied circulating viral types and subtypes in order to gather
and isolated locations: Australia and Papua New information for the local vaccination programme and
Guinea. Using polymerase chain reaction (PCR), regional influenza surveillance. A surveillance
we detected infection in 69 of 105 species, network was set up in 1999; it included sentinel
representing 44% of individuals surveyed (n = 428). practitioners in Noumea and the virology department
Across host families, prevalence of Haemoproteus of the Pasteur Institute. Influenza circulated in New
ranged from 13% (Acanthizidae) to 56% Caledonia every year, regularly during the southern
(Petroicidae) while prevalence of Plasmodium hemisphere winter and occasionally during March-
ranged from 3% (Petroicidae) to 47% May. Isolates were generally consistent with world
(Ptilonorhynchidae). We recovered 78 unique surveillance, except in 1999, when a new A/H1N1
mitochondrial lineages from 155 sequences. variant was identified. This study emphasises the
Related lineages of Haemoproteus were more likely need for regular influenza surveillance, even when
to derive from the same host family than predicted performed on a limited scale. Importantly the optimal
by chance at shallow (average LogDet genetic time for local vaccination was found to be in
distance = 0, n = 12, P = 0.001) and greater depths December or January each year.
(average distance = 0.014, n = 11, P < 0.001) within
the parasite phylogeny. Within two major 10 Billo M, Fournet A, Cabalion P, Waikedre J, Bories
Haemoproteus subclades identified in a maximum C, Loiseau P, Prina E, deArias AR, Yaluff G,
likelihood phylogeny, host-specificity was evident up Fourneau C, Hocquemiller R.
to parasite genetic distances of 0.029 and 0.007 Screening of New Caledonian and Vanuatu
based on logistic regression. We found no significant medicinal plants for antiprotozoal activity.
host relationship among lineages of Plasmodium by J Ethnopharmacol 2005 Jan 15;96(3):569-575. Epub
any method of analysis. These results support 2004 Dec 1.
previous evidence of strong host-family specificity Sixty-seven extracts of 30 medicinal plants
in Haemoproteus and suggest that lineages of traditionally used in New Caledonia or Vanuatu by
Plasmodium are more likely to form evolutionarily- healers to treat inflammation, fever and in cicatrizing
stable associations with novel hosts. remedies were evaluated in vitro for their
antiprotozoal activity against Leishmania donovani,
8 Becker AE, Gilman SE, Burwell RA. Leishmania amazonensis and Trypanosoma cruzi.
Changes in prevalence of overweight and in body Among the selected plants, Pagiantha cerifera was
image among Fijian women between 1989 and 1998. the most active against both Leishmania species;
Obes Res 2005 Jan;13(1):110-117. four extracts were active against promastigotes of
OBJECTIVE: To investigate changes in Leishmania donovani at EC(50) values inferior to 5
prevalence of overweight and obesity and in body microg/ml. Garcinia pedicillata extract had an
image among ethnic Fijian women in Fiji during a EC(50) value of 12.5 microg/ml against intracellular
period of rapid social change and the relationship amastigotes of Leishmania amazonensis. Alone
between changes in body image and BMI. Amborella trichopoda reduced by more of 80% the
RESEARCH METHODS AND PROCEDURES: The trypomastigotes of Trypanosoma cruzi in the blood.
study design was a multiwave cohort study of BMI
in a traditional Fijian village over a 9.5-year period 11 Billo M, Cabalion P, Waikedre J, Fourneau C,
Bouttier S, Hocquemiller R, Fournet A.
from 1989 to 1998. Cohorts were identified in 1989
Screening of some New Caledonian and Vanuatu
(n=53) and in 1998 (n=50). Selection criteria medicinal plants for antimycobacterial activity.
included Fijian ethnicity, female gender, age of at J Ethnopharmacol 2005 Jan 4;96(1-2):195-200.
least 18 years, and residence in a specific coastal Twenty plants, belonging to sixteen families,
Fijian village in 1989 and 1998, respectively. used in traditional New Caledonian and Vanuatu
Assessments consisted of measurement of height medicine for treatment of symptoms potentially
and weight, collection of demographic data by written related to tuberculosis (cough, fever or inflammation)
survey, and administration of the Nadroga Language were screened for antimycobacterial activity. We
Body Image Questionnaire. RESULTS: The also screened an original endemic plant, Amborella
prevalence of overweight and obesity was trichopoda, only member of the monogeneric family
significantly different between the cohorts, increasing Amborellaceae and considered the most primitive
from 60% in 1989 to 84% in 1998 (p=0.014). In living angiosperm. In total, 55 extracts were
addition, the age-adjusted mean BMI was evaluated for inhibitory activity against
significantly higher in 1998 compared with 1989 Mycobacterium bovis BCG strain at a concentration
(p=0.011). Finally, there were significant between- of 100 microg/ml. Methanolic and dichloromethane
cohort differences in multiple measures of body extracts of Amborella trichopoda, Codiaeum
image, which were mostly independent of BMI. peltatum, Myristica fatua, and essential oils
Myoporum crassifolium showed an activity at this
DISCUSSION: At 84%, the prevalence of overweight
concentration. Methanolic extract of Amborella
and obesity in this community sample of Fijian trichopoda fruits presented a significant activity with
women is among the highest in the world. The a minimal inhibitory concentration included between
dramatically increased prevalence over the 9.5-year 1 and 2.5 microg/ml. In the same conditions, this
period studied corresponds with rapid social change activity was comparable with those of the reference
in Fiji and significant shifts in prevailing traditional drugs pyrazynamide and ethambutol, at 20 and 2.5
attitudes toward body shape. microg/ml, respectively.
Papua New Guinea Medical Journal Volume 48, No 1-2, Mar-Jun 2005
12 Boutlis CS, Weinberg JB, Baker J, Bockarie MJ, available in the literature were analyzed.
Mgone CS, Cheng Q, Anstey NM. Phylogenetic studies using different algorithms
Nitric oxide production and nitric oxide synthase (minimum evolution, neighbour joining, maximum
activity in malaria-exposed Papua New Guinean parsimony, and maximum likelihood) gave the same
children and adults show longitudinal stability and clear-cut results. Newly sequenced HTLV-I isolates
no association with parasitemia described in this report allocated in three well-defined
Infect Immun 2004 Dec;72(12):6932-6938. subtypes: Cosmopolitan, Central African, and a new
Individuals in areas of intense malaria distinct one that we termed ‘Maroni’ subtype (present
transmission exhibit resistance (or tolerance) to in the Maroni Basin, French Guiana, and West
levels of parasitemia in their blood that would Indies). Clearly, the most divergent PTLV-I strains
normally be associated with febrile illness in malaria- present in Asia- Australo-Melanesia as well as
naive subjects. The resulting level of parasitemia African and Asian STLV-I derived from the same
associated with illness (the pyrogenic threshold) is node in the phylogenetic tree as isolates of the
highest in childhood and lowest in adulthood. Clinical Central African subtype. In addition, we showed that
parallels between malarial and bacterial endotoxin within each PTLV-I subtype, groups of isolates may
tolerance have led to the supposition that both share be characterized by nonrandom and systematically
common physiological processes, with nitric oxide associated mutations.
(NO) proposed as a candidate mediator. The
hypotheses that NO mediates tolerance and blood 16 Cassar O, Capuano C, Meertens L, Chungue E,
stage parasite killing in vivo were tested by Gessain A.
determining its relationship to age and parasitemia Human T-cell leukemia virus type 1 molecular
cross-sectionally and longitudinally in a population variants, Vanuatu, Melanesia.
of 195 children and adults from Papua New Guinea Emerg Infect Dis 2005 May;11(5):706-710.
encountering intense malaria exposure. Despite Four of 391 Ni-Vanuatu women were infected
pharmacological clearance of asymptomatic with variants of human T-cell leukemia virus type 1
parasitemia, NO production and mononuclear cell (HTLV-1) Melanesian subtype C. These strains had
NO synthase (NOS) activity were remarkably stable env nucleotide sequences approximately 99% similar
within individuals over time, were not influenced by to each other and diverging from the main molecular
parasitemia, and varied little with age. These results subtypes of HTLV-1 by 6% to 9%. These strains
contrast with previous smaller cross-sectional were likely introduced during ancient human
studies. Baseline NO production and NOS activity population movements in Melanesia.
did not protect against recurrent parasitemia,
consistent with previous data suggesting that NO 17 Chen N, Wilson DW, Pasay C, Bell D, Martin LB,
does not have antiparasitic effects against blood Kyle D, Cheng Q.
stage infection in vivo. The NO indices studied were Origin and dissemination of chloroquine-resistant
markedly higher in specimens from study subjects Plasmodium falciparum with mutant pfcrt alleles in
than in samples from Australian controls, and NOS the Philippines.
activity was significantly associated with plasma Antimicrob Agents Chemother 2005 May;49(5):2102-
immunoglobulin E levels, consistent with induction 2105.
of NO by chronic exposure to other infections and/ The pfcrt allelic type and adjacent microsatellite
or host genetic factors. These results suggest that marker type were determined for 82 Plasmodium
NO is unlikely to mediate killing of blood stage falciparum isolates from the Philippines. Mutant pfcrt
parasites in this setting and is unlikely to be the allelic types P1a and P2a/P2b were dominant in
primary mediator in the acquisition or maintenance different locations. Microsatellite analysis revealed
of malarial tolerance. that P2a/P2b evolved independently in the
Philippines, while P1a shared common ancestry with
13 Brown H. Papua New Guinea chloroquine-resistant parasites.
Treating the injured and burying the dead.
Lancet 2005 Jan 15-21;365(9455):204-205. 18 Cortés A.
A chimeric Plasmodium falciparum Pfnbp2b/Pfnbp2a
14 Cameron J. gene originated during asexual growth.
Caring for mama and pikinini in Papua New Guinea. Int J Parasitol 2005 Feb;35(2):125-130. Epub 2004
Pract Midwife 2005 Feb;8(2):14-16. Dec 15.
The Plasmodium falciparum line 3D7-A has an
15 Capdepont S, Londos-Gagliardi D, Joubert M, unusual invasion phenotype, such that it can invade
Correze P, Lafon ME, Guillemain B, Fleury HJ. enzyme-treated and mutant red blood cells that are
New insights in HTLV-I phylogeny by sequencing and resistant to invasion by other parasite lines. 3D7-A
analyzing the entire envelope gene. has a chimeric Pfnbp2b gene that contains part of
AIDS Res Hum Retroviruses 2005 Jan;21(1):28-42. the repeat region of the paralogous gene Pfnbp2a.
The HTLV-I envelope plays a major role in the This chimeric gene originated by spontaneous gene
process of target cell infection. It is implied in the conversion during normal maintenance in culture,
recognition of the viral receptor(s), penetration of the indicating that ectopic recombination and gene
viral genetic material, and induction of host immunity conversion during asexual growth are potentially
to the virus. It is thus important to study the genetic important mechanisms participating in the evolution
variability of the viral env gene as well as its variation of paralogous genes in Plasmodium. However, the
in terms of evolution. In a new approach to these presence of the chimeric Pfnbp2b gene in 3D7-A
features, we sequenced the entire env gene of 65 was not associated with its peculiar invasion
HTLV-I isolates originating from Gabon, French phenotype.
Guiana, West Indies, and Iran, such isolates
representing all major HTLVI phylums but the 19 Cortés A, Mellombo M, Masciantonio R, Murphy
Australo-Melanesian one. The sequences obtained VJ, Reeder JC, Anders RF.
and all PTLV-I (HTLV-I and STLV-I) env sequences Allele specificity of naturally acquired antibody
Papua New Guinea Medical Journal Volume 48, No 1-2, Mar-Jun 2005
responses against Plasmodium falciparum apical to be the causative etiology, with serotype 1
membrane antigen 1. predominating.
Infect Immun 2005 Jan;73(1):422-430.
Antibody responses against proteins located on 22 d’Arcangues C, Piaggio G, Brache V, Aissa RB,
the surface or in the apical organelles of merozoites Hazelden C, Massai R, Pinol A, Subakir SB, Su-
are presumed to be important components of juan G; Study Group on Progestogen-induced
naturally acquired protective immune responses Vaginal Bleeding Disturbances.
against the malaria parasite Plasmodium falciparum. Effectiveness and acceptability of vitamin E and low-
However, many merozoite antigens are highly dose aspirin, alone or in combination, on Norplant-
polymorphic, and antibodies induced against one induced prolonged bleeding.
particular allelic form might not be effective in Contraception 2004 Dec;70(6):451-462.
controlling growth of parasites expressing alternative A study (ISRCTN 77665712) was undertaken to
forms. The apical membrane antigen 1 (AMA1) is a test the effectiveness and the acceptability of vitamin
polymorphic merozoite protein that is a target of E and low-dose aspirin, alone or in combination, as
naturally acquired invasion-inhibitory antibodies and treatment for prolonged vaginal bleeding induced by
is a leading asexual-stage vaccine candidate. We Norplant. A total of 486 Norplant users who were
characterized the antibody responses against AMA1 requesting treatment for bleeding lasting longer than
in 262 individuals from Papua New Guinea exposed 7 days were enrolled in five centers: Beijing, China;
to malaria by using different allelic forms of the full Jakarta, Indonesia; Santiago, Chile; Santo Domingo,
AMA1 ectodomain and some individual subdomains. Dominican Republic; and Tunis, Tunisia. They were
The majority of individuals had very high levels of randomized to one of four different 10-day oral
antibodies against AMA1. The prevalence and titer treatments: 200 mg vitamin E daily, 80 mg aspirin
of these antibodies increased with age. Although daily, both or a placebo. Treatment packs were
antibodies against conserved regions of the molecule designed to ensure blinding of both the subjects and
were predominant in the majority of individuals, most the clinical staff. Neither vitamin E nor low-dose
plasma samples also contained antibodies directed aspirin nor their combination was found to have any
against polymorphic regions of the antigen. In a few effect on reducing the length of the bleeding episode
individuals, predominantly from younger age groups, for which treatment was taken or on the vaginal
the majority of antibodies against AMA1 were bleeding patterns these women experienced during
directed against polymorphic epitopes. The D10 the year of follow-up.
allelic form of AMA1 apparently contains most if not
all of the epitopes present in the other allelic forms
tested, which might argue for its inclusion in future 23 Dale P, Sipe N, Anto S, Hutajulu B, Ndoen E,
AMA1-based vaccines to be tested. Some important Papayungan M, Saikhu A, Prabowa YT.
epitopes in AMA1 involved residues located in Malaria in Indonesia: a summary of recent research
domain II or III but depended on more than one into its environmental relationships.
domain. Southeast Asian J Trop Med Public Health 2005
A review of the literature was carried out to
20 Cortés A, Mellombo M, Mgone CS, Beck HP,
evaluate malaria and its environmental relationships.
Reeder JC, Cooke BM. Research, in 6 parts of Indonesia, addressed the
Adhesion of Plasmodium falciparum-infected red relationship between malaria incidence and physical
blood cells to CD36 under flow is enhanced by the and socioeconomic environmental factors, using
cerebral malaria-protective trait South-East Asian longitudinal and cross-sectional approaches.
ovalocytosis. Physical factors, which are generally important for
Mol Biochem Parasitol 2005 Aug;142(2):252- malaria, included rainfall, mosquito breeding and
257. Epub 2005 Apr 15. resting sites, their distance from human habitation,
and elevation, though the latter was not statistically
21 Corwin AL, Subekti D, Sukri NC, Willy RJ, Master significant. Housing conditions were occasionally
J, Priyanto E, Laras K. important. Social and economic factors of
A large outbreak of probable rotavirus in Nusa importance were income, education, use of bednets
Tenggara Timur, Indonesia. and pattern of outdoor activities, especially at night.
Am J Trop Med Hyg 2005 Apr;72(4):488-494. Use of repellents, mosquito coils and sleeping
An outbreak of acute diarrheal disease was arrangements were significant in some of the studies.
reported in Kupang, Nusa Tenggara, Indonesia, in
August 2002. An investigative team carried out a 24 De Boer MA, Peters LA, Aziz MF, Siregar B,
retrospective historical review of records, and a case- Cornain S, Vrede MA, Jordanova ES, Fleuren GJ.
control study involving data and specimen Human papillomavirus type 18 variants:
collections. Etiologic determination involving stool histopathology and E6/E7 polymorphisms in three
specimens was based on an enzyme-linked countries.
immunosorbent assay, with a reverse transcriptase- Int J Cancer 2005 Apr 10;114(3):422-425.
polymerase chain reaction performed for serotyping In cervical cancer, human papillomavirus type
purposes. Two thousand six hundred probable cases 18 (HPV 18) and HPV 16 are predominantly related
were identified from hospital records during the to adenocarcinomas (ADCs) and squamous cell
outbreak months of June, July, August, and carcinomas (SCCs), respectively. Here, we studied
September 2002. Previous enteric outbreaks were whether the geographically distributed HPV intratypic
recognized from the same months in the preceding variants are also associated with histologically
years and all annual outbreak episodes following a different tumors. A total of 44 HPV 18-positive and
period of prolonged, low rainfall. In contrast to 91 HPV 16-positive cervical carcinomas from
previous outbreaks discerned from trend analysis, Indonesian, Surinamese and Dutch patients were
the overwhelming burden of disease fell upon the histologically classified using hematoxilin and eosin,
pediatric population versus the young and old in periodic acid Schiff plus and Alcian Blue staining.
previous outbreak instances. Rotavirus was found Samples were sequenced and intratypic variants
Papua New Guinea Medical Journal Volume 48, No 1-2, Mar-Jun 2005
were classified into the known phylogenetic haplogroups P and Q.
branches. The Asian Amerindian HPV 18 variant Mol Biol Evol 2005 Jun;22(6):1506-1517. Epub 2005
was observed in 56% of ADCs compared to 15% of Apr 6.
SCCs (p < 0.006). The African HPV 18 variant was Modern humans have occupied New Guinea and
exclusively found in SCCs. By sequencing the HPV the nearby Bismarck and Solomon archipelagos of
18 E6 and E7 open reading frames, we found Island Melanesia for at least 40,000 years. Previous
predicted amino acid changes only in 8 samples. mitochondrial DNA (mtDNA) studies indicated that
Two amino acid changes were consistent throughout two common lineages in this region, haplogroups P
the African branch. In HPV 16-positive tumors, we and Q, were particularly diverse, with the
did not find a specific linkage between intratypic coalescence for P considered significantly older than
variants and histopathology. We conclude that HPV that for Q. In this study, we expand the definition of
18 intratypic variants are differentially associated with haplogroup Q so that it includes three major
adenocarcinoma and squamous cell carcinoma of branches, each separated by multiple mutational
the cervix. The findings described here stress the distinctions (Q1, equivalent to the earlier definition
biologic significance of intratypic HPV variants and of Q, plus Q2 and Q3). We report three whole-
might help explaining differences in the pathogenesis mtDNA genomes that establish Q2 as a major Q
of cervical ADCs and SCCs. branch. In addition, we describe 314 control region
sequences that belong to the expanded haplogroups
25 Duke T. P and Q from our Southwest Pacific collection. The
Slow but steady progress in child health in Papua coalescence dates for the largest P and Q branches
New Guinea. (P1 and Q1) are similar to each other (approximately
J Paediatr Child Health 2004 Dec;40(12):659-663. 50,000 years old) and considerably older than prior
estimates. Newly identified Q2, which was found in
26 Duke T, Oa O, Mokela D, Oswyn G, Hwaihwanje I, Island Melanesian samples just to the east, is
Hawap J. somewhat younger by more than 10,000 years. Our
The management of sick young infants at primary coalescence estimates should be more reliable than
health centres in a rural developing country. prior ones because they were based on significantly
Arch Dis Child 2005 Feb;90(2):200-205. larger samples as well as complete mtDNA-coding
AIMS: To investigate the epidemiology of illness region sequencing. Our estimates are roughly in
among young infants at remote health clinics in a accord with the current suggested dates for the first
rural developing country and to determine risk factors settlement of New Guinea-Sahul. The
for mortality that might be used as triggers for phylogeography of P and Q indicates almost total
emergency treatment or referral. METHODS: Multi- (female) isolation of ancient New Guinea-Island
site 12 month observational study of consecutive Melanesia from Australia that may have existed from
presentations of infants less than 2 months, and an the time of the first settlement. While Q subsequently
investigation of neonates who died in one district diversified extensively in New Guinea-Island
without accessing health care. RESULTS: Forty per Melanesia, it has not been found in Australia. The
cent of 511 young infant presentations occurred in only shared mtDNA haplogroup between Australia
the first week of life and most of these in the first 24 and New Guinea identified to date remains one minor
hours. Twenty five deaths were recorded: 18 in the branch of P.
health facilities and seven in villages. In addition
there were eight stillbirths. Clinical signs predicting 29 Gessner BD, Sutanto A, Linehan M, Djelantik IG,
death were: not able to feed, fast respiratory rate, Fletcher T, Gerudug IK, Ingerani, Mercer D,
apnoea, cyanosis, ‘too small’, ‘skin-cold’, and severe Moniaga V, Moulton LH, Moulton LH, Mulholland
abdominal distension. Signs indicating severe K, Nelson C, Soemohardjo S, Steinhoff M,
respiratory compromise were present in 25% of Widjaya A, Stoeckel P, Maynard J, Arjoso S.
young infants; failure to give oxygen therapy was a Incidences of vaccine-preventable Haemophilus
modifiable factor in 27% of deaths within health influenzae type b pneumonia and meningitis in
facilities. A high proportion of seriously ill young Indonesian children: hamlet-randomised vaccine-
infants were discharged from health facilities early
without adequate follow up. A common reason for
not seeking care for fatally ill neonates was the Lancet 2005 Jan 1-7;365(9453):43-52.
perception by parents that health staff would respond BACKGROUND: Most studies of Haemophilus
negatively to their social circumstances. influenzae type b (Hib) disease in Asia have found
CONCLUSIONS: Clinical signs with moderate low rates, and few Asian countries use Hib vaccine
positive predictive value for death may be useful in routine immunisation programmes. Whether Hib
triggers for emergency treatment and longer disease truly is rare or whether many cases remain
observation or urgent referral. The results of this undetected is unclear. METHODS: To estimate
study may be useful in planning strategies to address incidences of vaccine-preventable Hib pneumonia
high neonatal mortality rates in developing countries. and meningitis among children younger than 2 years
in Lombok, Indonesia, during 1998-2002, we
27 Duke T, Tefuarani N, Baravilala W. undertook a hamlet-randomised, controlled, double-
Getting the most out of health education in Papua blind vaccine-probe study (818 hamlets). Children
New Guinea. Report from the 40th Annual Papua were immunised (WHO schedule) with diphtheria,
New Guinea Medical Symposium. tetanus, pertussis (DTP) or DTP-PRP-T (Hib
conjugate) vaccine. Vaccine-preventable disease
Med J Aust 2004 Dec 6-20;181(11-12):606-607. incidences were calculated as the difference in rates
of clinical outcomes between DTP and DTP-PRP-T
28 Friedlaender J, Schurr T, Gentz F, Koki G, groups. Analyses included all children who received
Friedlaender F, Horvat G, Babb P, Cerchio S, at least one vaccine dose. FINDINGS: We enrolled
Kaestle F, Schanfield M, Deka R, Yanagihara R, 55073 children: 28147 were assigned DTP-PRP-T
Merriwether DA. and 26926 DTP. The proportion of pneumonia
Expanding southwest pacific mitochondrial outcomes prevented by vaccine ranged from less
Papua New Guinea Medical Journal Volume 48, No 1-2, Mar-Jun 2005
than 0 to 4.8%. Calculated incidences of vaccine- 94.25%. The results of the statistical analysis of the
preventable Hib disease (per 10(5) child-years of data obtained in this study revealed that the
observation) for outcome categories were: diagnostic specificity, the diagnostic positive
substantial alveolar consolidation or effusion, less predictive value and the diagnostic efficiency of the
than zero (-43 [95% CI -185 to 98]); all severe TB-Dot test were significantly higher (p < 0.05) than
pneumonia, 264 (95% CI less than zero to 629); all those of the ICT-TB test. However, the diagnostic
clinical pneumonia, 1561 (270 to 2853); confirmed sensitivity and the negative predictive value of both
Hib meningitis, 16 (1.4 to 31); meningitis with tests did not differ significantly (p > 0.05). Viewed
cerebrospinal-fluid findings consistent with a from the point of their practicability, it can be justified
bacterial aetiology, 67 (22 to 112); and admission that the ICT-TB test is a very practicable test, which
for suspected meningitis or presenting to a clinic with needs only 15 minutes and does not require special
convulsions, 158 (42 to 273). INTERPRETATION: instruments to perform the test, but is more
Hib vaccine did not prevent the great majority of expensive than the TB-Dot test. On the other hand,
pneumonia cases, including those with alveolar though the TB-Dot test is not very practicable and
consolidation. These results do not support a major relatively time consuming, it has a significantly higher
role for Hib vaccine in overall pneumonia-prevention degree of diagnostic value and is much cheaper
programmes. Nevertheless, the study identified high when compared to the ICT-TB test.
incidences of Hib meningitis and pneumonia;
inclusion of Hib vaccine in routine infant 32 Hastings MD, Maguire JD, Bangs MJ,
immunisation programmes in Asia deserves Zimmerman PA, Reeder JC, Baird JK, Sibley CH.
consideration. Novel Plasmodium vivax dhfr alleles from the
Indonesian Archipelago and Papua New Guinea:
30 Han ET, Song TE, Park JH, Shin EH, Guk SM, association with pyrimethamine resistance
Kim TY, Chai JY. determined by a Saccharomyces cerevisiae
Allelic dimorphism in the merozoite surface protein- expression system.
3alpha in Korean isolates of Plasmodium vivax. Antimicrob Agents Chemother 2005 Feb;49(2):733-
Am J Trop Med Hyg 2004 Dec;71(6):745-749. 740.
To study the genetic diversity of re-emerging In plasmodia, the dihydrofolate reductase
Plasmodium vivax in the Republic of Korea, (DHFR) enzyme is the target of the pyrimethamine
nucleotide sequence variations at the merozoite component of sulfadoxine-pyrimethamine (S/P).
surface protein-3alpha (PvMSP-3alpha) locus were Plasmodium vivax infections are not treated
analyzed using 24 re-emerging isolates and 4 intentionally with antifolates. However, outside
isolates from imported cases. Compared with the Africa, coinfections with Plasmodium falciparum and
well known Belem strain (Brazil), a large number of P. vivax are common, and P. vivax infections are
amino acid substitutions, deletions, and insertions often exposed to S/P. Cloning of the P. vivax dhfr
were found at the locus of the isolates examined. gene has allowed molecular comparisons of dhfr
The Korean isolates were divided into two allelic alleles from different regions. Examination of the
types; type I (15 isolates), similar to the Belem strain, dhfr locus from a few locations has identified a very
and type II (9), similar to the Chesson strain (New diverse set of alleles and showed that mutant alleles
Guinea). Isolates from imported cases were of the vivax dhfr gene are prevalent in Southeast
classified into three types; type III (1 from Malaysia), Asia where S/P has been used extensively. We have
similar to type B from western Thailand, type IV (1 surveyed patient isolates from six locations in
each from Indonesia and India), and type V (1 from Indonesia and two locations in Papua New Guinea.
Pakistan), both being new types. Our results have We sequenced P. vivax dhfr alleles from 114 patient
shown that the MSP-3alpha locus of re-emerging samples and identified 24 different alleles that
Korean P. vivax is dimorphic with two allelic types differed from the wild type by synonymous and
coexisting in the endemic area. nonsynonymous point mutations, insertions, or
deletions. Most importantly, five alleles that carried
31 Handojo I, Arifin MZ. four or more nonsynonymous mutations were
The immunoserological diagnosis of tuberculosis: a identified. Only one of these highly mutant alleles
comparison of two tests. had been previously observed, and all carried the
Southeast Asian J Trop Med Public Health 2005 57L and 117T mutations. P. vivax cannot be cultured
Jan;36(1):141-144. continuously, so we used a yeast assay system to
A comparative study of the diagnostic value of determine in vitro sensitivity to pyrimethamine for a
the ICT-TB test and the TB-Dot test, based on subset of the alleles. Alleles with four
laboratory examination, was carried out in 39 patients nonsynonymous mutations conferred very high
suffering from sputum positive pulmonary levels of resistance to pyrimethamine. This study
tuberculosis (25 males and 14 females, aged 16-50 expands significantly the total number of novel dhfr
years) and in 48 patients (27 males and 21 females, alleles now identified from P. vivax and provides a
aged 17-55 years) suffering from non-tuberculosis foundation for understanding how antifolate
pulmonary diseases, that had attended the resistance arises and spreads in natural P. vivax
Tembagapura Hospital and the TB Control Health populations.
Center Timika-Mimika, Papua. The diagnostic
sensitivity of the ICT-TB test was 87.18%, the 33 Hiawalyer G.
diagnostic specificity was 81.25%, the diagnostic A surveillance information system as a management
positive predictive value was 79.07%, the negative tool: a report from Papua New Guinea.
predictive value was 88.64%, and the diagnostic Soz Praventivmed 2005;50 Suppl 1:S31-S32.
efficiency was 83.91%. The diagnostic sensitivity To have a very good surveillance system, it is
of the TB-Dot test was 93.31%, the diagnostic paramount important to have a functional health
specificity was 95.83%, the diagnostic positive information system that could be easily used for
predictive value was 94.74%, the negative predictive monitoring and investigation of disease outbreaks.
value was 93.85%, and the diagnostic efficiency was In Papua New Guinea (PNG) a national health
Papua New Guinea Medical Journal Volume 48, No 1-2, Mar-Jun 2005
information system was developed, trialed and Jan 24.
implemented nationwide. Furthermore to have the A field-applicable assay for testing anthelmintic
system working linked to it must be the local health sensitivity is required to monitor for anthelmintic
system for sustainability and control. A public health resistance. We undertook a study to evaluate the
manual for disease surveillance in PNG was ability of three in vitro assay systems to define drug
developed and is now being used for surveillance. sensitivity of clinical isolates of the human hookworm
This paper describes how the health information parasite Necator americanus recovered from
system, particularly surveillance system was children resident in a village in Madang Province,
developed and implemented on the national scale, Papua New Guinea. The assays entailed
how it was integrated with other management observation of drug effects on egg hatch (EHA), larval
information systems and how information has been development (LDA), and motility of infective stage
used to support management decision-making and larvae (LMA). The egg hatch assay proved the best
informed policy decision. It will highlight some of method for assessing the response to benzimidazole
the hurdles that it has encountered while trying to anthelmintics, while the larval motility assay was
implement the system. PNG has one of the best suitable for assessing the response to ivermectin.
national health information systems as compared The performance of the larval development assay
to many developing countries but limited information was unsatisfactory on account of interference caused
generated from the system. There was also less by contaminating bacteria. A simple protocol was
feedback from all levels of the health sector. We developed whereby stool samples were subdivided
need to improve surveillance on the basic principles and used for immediate egg recovery, as well as for
of integration, focus, and sharing of work. There faecal culture, in order to provide eggs and infective
must be an appropriate and timely response and larvae, respectively, for use in the egg hatch assay
feedback. We need to improve on the current system and larval motility assay systems. While the assays
rather than building a new one. proved effective in quantifying drug sensitivity in
larvae of the drug-susceptible hookworms examined
34 Hombhanje FW, Hwaihwanje I, Tsukahara T, in this study, their ability to indicate drug resistance
Saruwatari J, Nakagawa M, Osawa H, Paniu MM, in larval or adult hookworms remains to be
Takahashi N, Lum JK, Aumora B, Masta A, Sapuri determined.
M, Kobayakawa T, Kaneko A, Ishizaki T.
The disposition of oral amodiaquine in Papua New 38 Laman M, Ripa P, Vince J, Tefuarani N.
Guinean children with falciparum malaria. Can clinical signs predict hypoxaemia in Papua New
Br J Clin Pharmacol 2005 Mar;59(3):298-301. Guinean children with moderate and severe
AIMS: We assessed the disposition of oral pneumonia?
amodiaquine (AQ) and CYP2C8 polymorphism in Ann Trop Paediatr 2005 Mar;25(1):23-27.
20 children with falciparum malaria. METHODS: AQ Pulse oximetry was performed on 77 children
and DEAQ concentrations were determined with admitted with acute lower respiratory tract infections
SPE-HPLC method. CYP2C8 genotypes were (ALRI) to the children’s ward in Port Moresby General
assessed by PCR-RFLP method. RESULTS: AQ Hospital, Papua New Guinea over a 4-month period
was not detectable beyond day 3 postdose. Cmax in 2002. Clinical findings were correlated with
for DEAQ was reached in 3.0 days. The mean different levels of hypoxaemia, <93%, <90% and
values for t1/2, MRT, and AUCtotal were 10.1 days, <85%. Cyanosis, head nodding and drowsiness
15.5 days and 4512.6 microg l(-1) day, respectively. were good predictors of hypoxia but lacked
All the children were CYP2C8* homozygous. sensitivity. Decisions to use oxygen based on these
CONCLUSION: Our data are consistent with those signs would therefore result in a significant number
previously reported, and the AQ regimen seems of children with hypoxia not receiving oxygen. Pulse
pharmacokinetically adequate in the absence of oximetry is the best indicator of hypoxaemia in
CYP2C8 polymorphism. children with ALRI and, although relatively expensive,
its use might be cost-effective in controlling oxygen
35 Kevau IH, Vince JD, McPherson JV. requirements.
Tailoring medical education in Papua New Guinea
to the needs of the country. 39 Lawrence G, Leafasia J, Sheridan J, Hills S, Wate
Med J Aust 2004 Dec 6-20;181(11-12):608-610. J, Wate C, Montgomery J, Pandeya N, Purdie D.
Control of scabies, skin sores and haematuria in
36 Klapsing P, MacLean JD, Glaze S, McClean KL, children in the Solomon Islands: another role for
Drebot MA, Lanciotti RS, Campbell GL. ivermectin.
Ross River virus disease reemergence, Fiji, 2003- Bull World Health Organ 2005 Jan;83(1):34-42. Epub
2004. 2005 Jan 21.
Emerg Infect Dis 2005 Apr;11(4):613-615. OBJECTIVE: To assess the effects of a 3-year
We report 2 clinically characteristic and programme aimed at controlling scabies on five small
serologically positive cases of Ross River virus lagoon islands in the Solomon Islands by monitoring
infection in Canadian tourists who visited Fiji in late scabies, skin sores, streptococcal skin
2003 and early 2004. This report suggests that Ross contamination, serology and haematuria in the island
River virus is once again circulating in Fiji, where it children. METHODS: Control was achieved by
apparently disappeared after causing an epidemic treating almost all residents of each island once or
in 1979 to 1980. twice within 2 weeks with ivermectin (160-250
microg/kg), except for children who weighed less
37 Kotze AC, Coleman GT, Mai A, McCarthy JS. than 15 kg and pregnant women, for whom 5%
Field evaluation of anthelmintic drug sensitivity using permethrin cream was used. Reintroduction of
in vitro egg hatch and larval motility assays with scabies was controlled by treating returning residents
Necator americanus recovered from human clinical and visitors, whether or not they had evident scabies.
isolates. FINDINGS: Prevalence of scabies dropped from
Int J Parasitol 2005 Apr 1;35(4):445-453. Epub 2005 25% to less than 1% (P < 0.001); prevalence of sores
Papua New Guinea Medical Journal Volume 48, No 1-2, Mar-Jun 2005
from 40% to 21% (P < 0.001); streptococcal two-locus haplotypes were examined in 367
contamination of the fingers in those with and without unrelated Melanesians living on the islands of
sores decreased significantly (P = 0.02 and 0.047, Vanuatu and New Caledonia. Diversity at all HLA
respectively) and anti-DNase B levels decreased (P class-I and class-II loci was relatively limited. In
= 0.002). Both the proportion of children with class-I loci, three HLA-A allelic groups (HLA-A*24,
haematuria and its mean level fell (P = 0.002 and P HLA-A*34 and HLA-A*11), seven HLA-B alleles or
< 0.001, respectively). No adverse effects of the allelic groups (HLA-B*1506, HLA-B*5602, HLA-B*13,
treatments were seen. CONCLUSION: The results HLA-B*5601, HLA-B*4001, HLA-B*4002 and HLA-
show that ivermectin is an effective and practical B*2704) and four HLA-C alleles or allelic groups
agent in the control of scabies and that control (HLA-Cw*04, HLA-Cw*01, HLA-Cw*0702 and HLA-
reduces the occurrence of streptococcal skin disease Cw*15) constituted more than 90% of the alleles
and possible signs of renal damage in children. observed. In the class-II loci, four HLA-DRB1 alleles
Integrating community-based control of scabies and (HLA-DRB1*15, HLA-DRB1*11, HLA-DRB1*04 and
streptococcal skin disease with planned HLA-DRB1*16), three HLA-DRB3-5 alleles (HLA-
programmes for controlling filariasis and intestinal DRB3*02, HLA-DRB4*01 and HLA-DRB5*01/02)
nematodes could be both practical and produce great and five HLA-DQB1 alleles (HLA-DQB1*0301, HLA-
health benefits. DQB1*04, HLA-DQB1*05, HLA-DQB1*0601 and
HLA-DQB1*0602) constituted over 93, 97 and 98%
40 Lehmann D, Vail J, Firth MJ, de Klerk NH, Alpers of the alleles observed, respectively. Homozygosity
MP. showed significant departures from expected levels
Benefits of routine immunizations on childhood for neutrality based on allele frequency (i.e. excess
survival in Tari, Southern Highlands Province, Papua diversity) at the HLA-B, HLA-Cw, HLA-DQB1 and
New Guinea. HLA-DRB3/5 loci on some islands. The locus with
Int J Epidemiol 2005 Feb;34(1):138-148. Epub 2004 the strongest departure from neutrality was HLA-
Nov 23. DQB1, homozygosity being significantly lower than
BACKGROUND: Non-specific beneficial as well expected on all islands except New Caledonia. No
as deleterious effects of childhood immunizations consistent pattern was demonstrated for any HLA
have been reported in areas of high mortality. This locus in relation to malaria endemicity.
study aimed to determine the effects of diphtheria-
tetanus-whole-cell-pertussis (DTP), BCG, hepatitis 42 McGain F, Limbo A, Williams DJ, Didei G, Winkel
B, and measles vaccines on mortality in the KD.
highlands of Papua New Guinea (PNG). METHODS: Snakebite mortality at Port Moresby General
Demographic events for children born in 1989-1994 Hospital, Papua New Guinea, 1992-2001.
who were under monthly demographic surveillance Med J Aust 2004 Dec 6-20;181(11-12):687-691.
in Tari were recorded from birth until age 2 years, OBJECTIVE: Fatal snakebites at Port Moresby
out-migration, death, or the end of the study period. General Hospital (PMGH), Papua New Guinea
Data on BCG, hepatitis B, DTP, measles and (PNG), were examined to identify interventions that
pneumococcal polysaccharide vaccination were may improve patient survival. DESIGN:
collected monthly from clinic records. To allow for Retrospective case series. SUBJECTS AND
different characteristics of immunized and non- SETTING: Inpatients at PMGH who presented with
immunized children, analysis included conditioning snakebite, had evidence of envenomation, and died
on a propensity score for vaccination, adjusting for as inpatients between 1 January 1992 and 31
differences in children’s background characteristics. December 2001. OUTCOME MEASURES: Number
RESULTS: In all, 101/3502 children (3%) who had and cause of fatalities; ventilation bed-days;
at least one vaccine died between ages 29 days and antivenom timing, dose and price. RESULTS: 87
24 months were compared to 112/546 (21%) who deaths occurred among 722 snakebite admissions
had none. BCG was associated with lower mortality to the intensive care unit (ICU). Of these 722
in the 1-5 month age group (hazard ratio [HR] = 0.17, patients, 82.5% were ventilated, representing 45%
95% CI: 0.09, 0.34), measles vaccine with lower of all ventilated ICU patients and 60% (3430/5717)
mortality at age 6-11 months (HR = 0.42, 95% CI: of all ICU ventilator bed-days. The median duration
0.17, 1.01), and pneumococcal polysaccharide of ventilation in fatal snakebite cases was
vaccine with lower mortality at age 12-23 months significantly less than in non-fatal cases for children
(HR = 0.42, 95% CI: 0.19, 0.93). One or more doses (3.0 v. 4.5 days) and adults (3.0 v. 5.0 days). The
of DTP was associated with lower overall mortality case-fatality rate for children (14.6%) was
(HR = 0.27, 95% CI: 0.16, 0.44), particularly in the significantly greater than that for adults (8.2%). Sixty
1-5 month age group (HR = 0.19, 95% CI: 0.10, fatalities were examined in detail: 75% received
0.34), and also in those who had had prior BCG (HR blood products; 53% received antivenom (mostly a
= 0.45, 95% CI: 0.22, 0.91). CONCLUSION: Routine single ampoule of polyvalent), but only 5% received
immunizations are effective in reducing overall antivenom < or = 4 hours post-bite. Major causes
mortality in young children in an area of high of death included respiratory complications (50%),
mortality. In particular, DTP, whether considered probable intracerebral haemorrhage (17%), and
separately or in addition to BCG, was associated renal failure (10%). Antivenom unit costs increased
with a lowering of overall mortality, in contrast to significantly over the decade; in 2000 an ampoule
findings reported from Guinea-Bissau. of polyvalent antivenom was 40-fold more expensive
in PNG than in Australia on a gross domestic product
41 Maitland K, Bunce M, Harding RM, Barnardo MC, (A dollars) per capita basis. CONCLUSIONS:
Clegg JB, Welsh K, Bowden DK, Williams TN. Management of severe snakebite is a major
HLA class-I and class-II allele frequencies and two- challenge for PMGH. Improved antivenom
locus haplotypes in Melanesians of Vanuatu and New procurement and use policies (including increased
Caledonia. use of appropriate monovalent antivenoms),
Tissue Antigens 2004 Dec;64(6):678-686. combined with targeted snakebite education
HLA class-I and class-II allele frequencies and interventions (community- and hospital-based), are
Papua New Guinea Medical Journal Volume 48, No 1-2, Mar-Jun 2005
key interventions to reduce the ongoing toll from (hemoglobin level < 7.5 g/dL) from 0.0-3.3% to 3.8-
snakebite. 18.4%. These massive increases in morbidity have
devastating impact on the affected communities and
43 Mosley LM, Sharp DS, Singh S. highlight that malaria epidemics are a serious and
Effects of a tropical cyclone on the drinking-water increasing public health problem in the highlands of
quality of a remote Pacific island. Papua New Guinea.
Disasters 2004 Dec;28(4):405-417.
The effect of a cyclone (Ami, January 2003) on 45 Owen IL.
drinking-water quality on the island of Vanua Levu, Parasitic zoonoses in Papua New Guinea.
Fiji was investigated. Following the cyclone nearly J Helminthol 2005 Mar;79(1):1-14.
three-quarters of the samples analysed did not Relatively few species of zoonotic parasites have
conform to World Health Organisation (WHO) been recorded in humans in Papua New Guinea. A
guideline values for safe drinking-water in terms of greater number of potentially zoonotic species,
chlorine residual, total and faecal coliforms, and mostly nematodes, occur in animals but are yet to
turbidity. Turbidity and total coliform levels be reported from humans. Protozoa is the best
significantly increased (up 56 and 62 per cent, represented group of those infecting man, with
respectively) from pre-cyclone levels, which was Giardia duodenalis, Cryptosporidium parvum,
likely due to the large amounts of silt and debris Cyclospora cayetanesis, Toxoplasma gondii,
entering water-supply sources during the cyclone. Sarcocystis spp., Entamoeba polecki, Balantidium
The utility found it difficult to maintain a reliable coli and, possibly, Blastocystis hominis. The only
supply of treated water in the aftermath of the zoonotic helminths infecting humans include the
disaster. Communities were unaware they were trematode Paragonimus westermani, the cestodes
drinking water that had not been adequately treated. Hymenolepis nana, H. diminuta and the sparganum
Circumstances permitted this cyclone to be used as larva of Spirometra erinacea, and the nematodes
a case study to assess whether a simple paper-strip Trichinella papuae and Angiostrongylus cantonensis
water-quality test (the hydrogen sulphide, H(2)S) kit and, possibly, Ascaris suum. Other groups
could be distributed and used for community-based represented are Acanthocephala
monitoring following such a disaster event to better (Macracanthorhynchus hirudinaceus)), insects
protect public health. The H(2)S test results (Chrysomya bezziana, Cimex sp., Ctenocephalides
correlated well with faecal and total coliform results spp.), and mites (Leptotrombidium spp. and, possibly
as found in previous studies. A small percentage of Sarcoptes scabiei, and Demodex sp.). One leech
samples (about 10 per cent) tested positive for faecal (Phytobdella lineata) may also be considered as
and total coliforms but did not test positive in the being zoonotic. The paucity of zoonotic parasite
H(2)S test. It was concluded that the H(2)S test species can be attributed to long historical isolation
would be well suited to wider use, especially in the of the island of New Guinea and its people, and the
absence of water-quality monitoring capabilities for absence until recent times of large placental
outer island groups as it is inexpensive and easy to mammals other than pig and dog. Some zoonotic
use, thus enabling communities and community helminths have entered the country with recent
health workers with minimal training to test their own importation of domestic animals, in spite of
water supplies without outside assistance. The quarantine regulations, and a few more (two
importance of public education before and after cestodes, one nematode and one tick) are poised
natural disasters is also discussed. to enter from neighbouring countries, given the
opportunity. Improvement in water supplies, human
44 Mueller I, Namuigi P, Kundi J, Ivivi R, Tandrapah hygiene and sanitation would reduce the prevalence
T, Bjorge S, Reeder JC. of many of these parasites, and thorough cooking
Epidemic malaria in the highlands of Papua New of meat would lessen the risk of infection by some
Am J Trop Med Hyg 2005 May;72(5):554-560.
As part of a larger study into the epidemiology 46 Poka H.
of malaria in the highlands of Papua New Guinea, Practising in rural Papua New Guinea.
outbreak investigations were carried out at the end Med J Aust 2004 Dec 6-20;181(11-12):609.
of the 2002 rainy season in 11 villages situated
between 1,400 and 1,700 meters above sea level 47 Pozio E, Owen IL, Marucci G, La Rosa G.
that had reported epidemics. Locations and timing Inappropriate feeding practice favors the
of these epidemics corresponded largely to those transmission of Trichinella papuae from wild pigs to
reported in the pre-control era of the 1960s and saltwater crocodiles in Papua New Guinea.
1970s. On average, 28.8% (range = 10.3-63.2%) Vet Parasitol 2005 Feb 28;127(3-4):245-251. Epub
of people in each of the 11 villages were found to be 2004 Dec 16.
infected with malaria. Plasmodium falciparum The recent discovery of Trichinella zimbabwensis
accounted for 59% of all identified infections and P. in farmed crocodiles (Crocodilus niloticus) of
vivax for 34%. The majority (53%) of infections were Zimbabwe and its ability to infect mammals, and the
symptomatic. Although symptomatic infections were development of both T. zimbabwensis and Trichinella
most common in children 2-9 years of age (36%), papuae in experimentally infected reptiles led to an
even in adults a prevalence of 20% was observed. investigation of Trichinella infection in saltwater
A comparison with earlier non-epidemic data in three crocodiles (Crocodylus porosus) and in wild pigs
of the villages without easy access to health care (Sus scrofa) of Papua New Guinea, to see if T.
showed markedly increased levels of morbidity, with papuae also, is present in both cold- and warm-
6-10-fold increases in parasite prevalence, a 3-fold blooded animals. Of 222 crocodiles examined, 47
increase in both measured and reported fevers, and animals (21.2%), all from Kikori, Gulf Province, were
a 12-fold increase in enlarged spleens. The average positive for non-encapsulated larvae in the muscles.
hemoglobin levels were reduced by 2.3-3.5 g/dL, with The greatest number of larvae was found usually in
a concurrent increase in moderate to severe anemia the biceps, with an average of 7 larvae/g. One
Papua New Guinea Medical Journal Volume 48, No 1-2, Mar-Jun 2005
isolate from a crocodile infected successfully both in Mozambique, 10 in Indonesia, and 9 in South
laboratory rats and mice. Of 81 wild pigs examined, Africa. At all study sites, the majority of RSV cases
9 from Bensbach river area (Western Province) and occurred in infants. CONCLUSION: These studies
1 from Kikori area (Gulf Province) were positive for demonstrate that RSV contributes to a substantial
non-encapsulated larvae in the muscles. Trichinella but quite variable burden of LRI in children aged < 5
larvae from both saltwater crocodiles and wild pigs years in four developing countries. The possible
have been identified by multiplex-PCR analysis as explanations for this variation include social factors,
T. papuae. The sequence analysis of the region such as family size and patterns of seeking health
within the large subunit ribosomal DNA, known as care; the proportion of children infected by human
the expansion segment V, has shown the presence immunodeficiency syndrome (HIV); and differences
of a molecular marker distinguishing T. papuae in clinical definitions used for obtaining samples. The
isolates of Bensbach river area from those of Kikori age distribution of cases indicates the need for an
area. This marker could be useful to trace back the RSV vaccine that can protect children early in life.
geographical origin of the infected animal. The
epidemiological investigation carried out in the Kikori 51 Rodgers-Bird QM.
area has shown that local people catch young Challenges of Solomon Island medical students: a
crocodiles in the wild and keep them in holding pens graduation vote of thanks. Letter
for several months, before sending them to the Aust J Rural Health 2005 Apr;13(2):128.
crocodile farm in Lae (Morobe Province). They feed
the crocodiles primarily with wild pig meat bought at
the local market and also with fish. These results 52 Sa JM, Nomura T, Neves J, Baird JK, Wellems
stress the importance of using artificial digestion for TE, del Portillo HA.
routinely screening of swine and crocodiles, and of Plasmodium vivax: allele variants of the mdr1 gene
adopting measures for preventing the spread of do not associate with chloroquine resistance among
infection, such as the proper disposal of carcasses isolates from Brazil, Papua, and monkey-adapted
and the adequate freezing of meat. strains.
Exp Parasitol 2005 Apr;109(4):256-259.
48 Ratu Sade K. We describe here the sequence of the
The status of emergency medicine in Makira Ulawa Plasmodium vivax mdr1 gene from 10 different
Province, Solomon Islands. isolates differing in chloroquine sensitivity. The
Emerg Med Australas 2005 Apr;17(2):167-169. deduced amino acid sequence of PvMDR1 shares
This Perspective reports on the challenges that more than 70% similarity with other malarial MDR
face a solo doctor in a provincial hospital in the proteins and it displays consensus motifs of an ABC
Solomon Islands following the civil disturbances of family transporter including two transmembrane
1998-2003. The Health Service is seriously domains and two ATP binding cassettes. Similarity
constrained by a paucity of funding, supplies and and dendrogram analyses revealed that sequences
personnel. In spite of that, a rudimentary service could be grouped according to their geographical
can be provided and lives can be saved using simple origin. Within each geographical group however,
techniques and basic resources. Further training of no correlation was found between chloroquine
nurses, midwives and doctors is required. resistance and specific mutations.
Emergency medicine, as a generalist discipline,
provides a foundation to improve the delivery of care 53 Schultz R.
to the acutely ill and injured in these circumstances. A two-year placement in the Solomon Islands.
Med J Aust 2004 Dec 6-20;181(11-12):604-605.
49 Reeder JC.
Papua New Guinea: targeting research to things that 54 Suligoi B, Danaya RT, Sarmati L, Owen IL, Boros
matter. S, Pozio E, Andreoni M, Rezza G.
Med J Aust 2004 Dec 6-20;181(11-12):610-611. Infection with human immunodeficiency virus, herpes
simplex virus type 2, and human herpes virus 8 in
50 Robertson SE, Roca A, Alonso P, Simoes EA, remote villages of southwestern Papua New Guinea.
Kartasasmita CB, Olaleye DO, Odaibo GN, Am J Trop Med Hyg 2005 Jan;72(1):33-36.
Collinson M, Venter M, Zhu Y, Wright PF. To investigate the spread of human
Respiratory syncytial virus infection: denominator- immunodeficiency virus (HIV) and other sexually
based studies in Indonesia, Mozambique, Nigeria transmitted viruses, two serosurveys (the first in 1999
and South Africa. among 56 adults and the second in 2001 among
Bull World Health Organ 2004 Dec;82(12):914-922. 351 adults) were conducted in remote villages of
Epub 2005 Jan 5. the southwestern part of Papua New Guinea. Only
OBJECTIVE: To assess the burden of respiratory one individual was positive for antibodies to HIV. In
syncytial virus (RSV)-associated lower respiratory 2001, the seroprevalence of human herpes virus 8
infections (LRI) in children in four developing (HHV-8) was 32.2%, and the seroprevalence of
countries. METHODS: A WHO protocol for herpes simplex virus type 2 (HSV-2) was 27.4%.
prospective population-based surveillance of acute Both prevalence rates increased with age, and were
respiratory infections in children aged less than 5 lower in the villages near the Bensbach River. The
years was used at sites in Indonesia, Mozambique, seropositivity of HSV-2 was independently correlated
Nigeria and South Africa. RSV antigen was identified with HHV-8 infection. Our data show that the
by enzyme-linked immunosorbent assay performed inhabitants of the southwestern region of Papua New
on nasopharyngeal specimens from children Guinea currently experience an extremely low
meeting clinical case definitions. FINDINGS: Among circulation of HIV. However, the high prevalence of
children aged < 5 years, the incidence of RSV- infectious agents that can be sexually transmitted,
associated LRI per 1000 child-years was 34 in such as HSV-2 and to a lesser extent HHV-8,
Indonesia and 94 in Nigeria. The incidence of RSV- indicates the presence of behavioral patterns that
associated severe LRI per 1000 child-years was 5 may facilitate the spread of HIV in this area of
Papua New Guinea Medical Journal Volume 48, No 1-2, Mar-Jun 2005
currently low endemicity. discharge and 41 were lost to follow-up. Major
neurological sequelae were found in 50 (63 per cent)
55 Temple V, Mapira P, Adeniyi K, Sims P. of surviving children, and 27 (34 percent) had multiple
Iodine deficiency in Papua New Guinea (sub-clinical severe complications. In rural Papua New Guinea
iodine deficiency and salt iodization in the highlands meningitis causes high rates of mortality and severe
of Papua New Guinea). long-term disability in a high proportion of survivors.
J Public Health (Oxf) 2005 Mar;27(1):45-48. Epub High-level resistance to chloramphenicol is likely to
2004 Nov 25. be part of the reason for this, but widespread
Data on the status about iodine nutrition in availability of third-generation cephalosporins for the
children in Papua New Guinea (PNG) are scarce. treatment of meningitis, although urgently required,
This study attempts to determine the mean daily per will not overcome the other problems of delayed
capita consumption of salt, the iodine content of salt presentation with established complications. There
in the households and retail shops and the urinary is a need for the introduction of conjugate
iodine concentration in children (6-12 years) in Hella Haemophilus influenzae vaccine, and affordable
Region, Southern Highland Province (SHP), PNG. vaccination strategies against Streptococcus
The mean daily consumption of salt was 2.62 +/- pneumoniae. Richer countries could sponsor these
1.29 g. The iodine content of salt was >30 p.p.m. in vaccines in developing countries, and apply pressure
95 per cent of households and 100 per cent of retail on vaccine producers to lower the costs.
shops. The median urinary iodine concentration of
48.0 mg/l for all the children indicates moderate 58 Wood DM, Alsahaf H, Streete P, Dargan PI, Jones
iodine deficiency. The median urinary iodine AL.
concentrations for the male (67.0 mg/l) and female Fatality after deliberate ingestion of the pesticide
(44.0 mg/l) children indicate mild and moderate rotenone: a case report.
iodine deficiency, respectively. 68.42 per cent of the Crit Care 2005 Jun;9(3):R280-284. Epub 2005 Apr
male and 81.82 per cent of the female children have 29.
urinary iodine concentration <100 mg/l, indicating Rotenone is a pesticide derived from the roots
that iodine deficiency is a potential public health of plants from the Leguminosae family. Poisoning
problem in the Hella region. These results indicate following deliberate ingestion of these plant roots
a need for further assessment of the implementation has commonly been reported in Papua New Guinea.
of the universal salt iodization strategy for the However, poisoning with commercially available
elimination of iodine deficiency in the SHP, PNG. rotenone in humans has been reported only once
previously following accidental ingestion in a 3.5-
56 Tokudome S, Soeripto, Triningsih FX, Ananta I, year-old child. Therefore, the optimal management
Suzuki S, Kuriki K, Akasaka S, Kosaka H, of rotenone poisoning is not known. After deliberate
Ishikawa H, Azuma T, Moore MA. ingestion of up to 200 ml of a commercially available
Rare Helicobacter pylori infection as a factor for the 0.8% rotenone solution, a 47-year-old female on
very low stomach cancer incidence in Yogyakarta, regular metformin presented with a reduced level of
Indonesia. consciousness, metabolic acidosis and respiratory
Cancer Lett 2005 Feb 28;219(1):57-61. compromise. Metformin was not detected in
To elucidate factors associated with the very low premortem blood samples obtained. Despite
risk of gastric neoplasia in Yogyakarta, Indonesia, intensive supportive management, admission to an
approximately 1/50 of the level in Japan, we recruited intensive care unit, and empirical use of N-
52 male and 39 female participants from the general acetylcysteine and antioxidant therapy, she did not
populace in the city of Yogyakarta in October 2003. survive. Poisoning with rotenone is uncommon but
Helicobacter pylori IgG antibodies were found in only is potentially fatal because this agent inhibits the
5% (0-13) (95% confidence interval) and 4% (0-9) mitochondrial respiratory chain. In vitro cell studies
for Javanese males and females, respectively, and have shown that rotenone-induced toxicity is reduced
were statistically lower than the 62% (58-65) and by the use of N-acetylcysteine, antioxidants and
57% (53-60), respectively, in Japanese. potassium channel openers. However, no animal
Furthermore, positive findings of pepsinogen test studies have been reported that confirm these
were only 0 and 2% (0-6) for males and females, in findings, and there are no previous reports of
Yogyakarta, and were again significantly lower than attempted use of these agents in patients with acute
the 23% (22-25) and 22% (20-23), in Japan. The rotenone-induced toxicity.
very low incidence of stomach cancer in Yogyakarta
may be due to a low prevalence of H. pylori infection 59 Wuster W, Dumbrell AJ, Hay C, Pook CE, Williams
and chronic atrophic gastritis. DJ, Fry BG.
Snakes across the Strait: trans-Torresian
57 Wandi F, Kiagi G, Duke T. phylogeographic relationships in three genera of
Long-term outcome for children with bacterial Australasian snakes (Serpentes: Elapidae:
meningitis in rural Papua New Guinea. Acanthophis, Oxyuranus, and Pseudechis).
J Trop Pediatr 2005 Feb;51(1):51-53. Epub 2004 Dec Mol Phylogenet Evol 2005 Jan;34(1):1-14.
15. We analyze the phylogeny of three genera of
This study was undertaken to evaluate the long- Australasian elapid snakes (Acanthophis-death
term neurological outcome for survivors of bacterial adders; Oxyuranus-taipans; Pseudechis-
meningitis in rural Papua New Guinea. Children who blacksnakes), using parsimony, maximum likelihood,
were discharged from Nonga Base Hospital in and Bayesian analysis of sequences of the
Rabaul with a diagnosis of bacterial meningitis mitochondrial cytochrome b and ND4 genes. In
between 1992 and 2000 were evaluated in their Acanthophis and Pseudechis, we find evidence of
home villages or on review at hospital. Neurological multiple trans-Torresian sister-group relationships.
and developmental complications were documented. Analyses of the timing of cladogenic events suggest
The outcomes for 80 of 121 eligible children were crossings of the Torres Strait on several occasions
determined; eight had died following hospital between the late Miocene and the Pleistocene.
Papua New Guinea Medical Journal Volume 48, No 1-2, Mar-Jun 2005
These results support a hypothesis of repeated land kavalactone, kawain, in kava extracts as causing
connections between Australia and New Guinea in strong antiproliferative and apoptotic effect in human
the late Cenozoic. Additionally, our results reveal bladder cancer cells. Flavokawain A results in a
undocumented genetic diversity in Acanthophis and significant loss of mitochondrial membrane potential
Pseudechis, supporting the existence of more and release of cytochrome c into the cytosol in an
species than previously believed, and provide a invasive bladder cancer cell line T24. These effects
phylogenetic framework for a reinterpretation of the of flavokawain A are accompanied by a time-
systematics of these genera. In contrast, our dependent decrease in Bcl-x(L), a decrease in the
Oxyuranus scutellatus samples from Queensland association of Bcl-x(L) to Bax, and an increase in
and two localities in New Guinea share a single the active form of Bax protein. Using the primary
haplotype, suggesting very recent (late Pleistocene) mouse embryo fibroblasts Bax knockout and wild-
genetic exchange between New Guinean and type cells as well as a Bax inhibitor peptide derived
Australian populations. from the Bax-binding domain of Ku70, we showed
that Bax protein was, at least in part, required for
60 Zi X, Simoneau AR. the apoptotic effect of flavokawain A. In addition,
Flavokawain A, a novel chalcone from kava extract, flavokawain A down-regulates the expression of X-
induces apoptosis in bladder cancer cells by linked inhibitor of apoptosis and survivin. Because
involvement of Bax protein-dependent and both X-linked inhibitor of apoptosis and survivin are
mitochondria-dependent apoptotic pathway and main factors for apoptosis resistance and are
suppresses tumor growth in mice. overexpressed in bladder tumors, our data suggest
Cancer Res 2005 Apr 15;65(8):3479-3486. that flavokawain A may have a dual efficacy in
Consumption of the traditional kava preparation induction of apoptosis preferentially in bladder
was reported to correlate with low and uncustomary tumors. Finally, the anticarcinogenic effect of
gender ratios (more cancer in women than men) of flavokawain A was evident in its inhibitory growth of
cancer incidences in three kava-drinking countries: bladder tumor cells in a nude mice model (57% of
Fiji, Vanuatu, and Western Samoa. We have inhibition) and in soft agar.
identified flavokawain A, B, and C but not the major