Pertussis outbreak in Papua New Guinea: the challenges of response in a remote geo-topographical setting

Abstract

A large outbreak of pertussis was detected during March 2011 in Goilala, a remote district of the Central Province in Papua New Guinea, characterized by rugged topography with no road access from the provincial headquarters. This outbreak investigation highlights the difficulties in reporting and responding to outbreaks in these settings. The suspected pertussis cases, reported by health workers from the Ononge health centre area, were investigated and confirmed for the presence of Bordetella pertussis DNA using the polymerase chain reaction (PCR) method. There were 205 suspected pertussis cases, with a case-fatality rate (CFR) of 3%. All cases were unvaccinated. The Central Province conducted a response vaccination programme providing 65% of children less than five years of age with diphtheria-pertussis-tetanus-HepB-Hib vaccine at a cost of US$ 12.62 per child. The incurred cost of vaccination in response to this outbreak was much higher than the US$ 3.80 per child for routine outreach patrol. To prevent further outbreaks of vaccine-preventable diseases in these areas, local health centres must ensure routine vaccination is strengthened through the "Reaching Every District" initiative of the National Department of Health.