The new problem of typhoid fever in Papua New Guinea: how do we deal with it?

Abstract

This paper reviews some of the issues relating to typhoid fever in Papua New Guinea. Before the mid-1980s only sporadic cases of typhoid were reported but it is now one of the greatest public health problems in the highlands and some urban areas. In one study near Goroka an annual incidence rate of 1208 per 100,000 people was found, with settlers from other areas at greater risk than the local landowners. Problems relating to management included differentiation from other diseases, the limitations of the Widal test and poor compliance among outpatients. In Papua New Guinea it appears that transmission is largely from person to person, with little evidence for water-borne transmission. The prolonged convalescent excretion of Salmonella typhi and the difficulties this poses for control of the disease are discussed. Prevention will only be achieved in the long term by improvements in hygiene and sanitation, though more immediate control could be achieved by vaccination with an appropriate vaccine.

PIP: Few cases of typhoid fever were reported in Papua New Guinea (PNG) before 1960 and only sporadic cases were reported during the 1960s. However, typhoid fever has now become a major public health problem in the country, endemic throughout the Highlands Region and in some of the larger coastal towns such as Port Moresby. In 1993 and 1994, there were 4485 and 4551 people, respectively, reported to have been admitted with typhoid fever throughout PNG, with 87% and 73% of these cases, respectively, occurring in the Highlands Region. The vast majority of the remainder of patients were in the National Capital District, Central, or Morobe Provinces. No data are available on the number of outpatient cases. The transmission of typhoid fever in PNG appears to be mainly from person to person, with little evidence of water-borne transmission. Problems posed by the prolonged convalescent excretion of Salmonella typhi are discussed. Typhoid fever will be prevented over the long term by improvements in hygiene and sanitation, although more immediate control could be achieved through vaccination with an appropriate vaccine.