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Eastern Highlands, Papua New Guinea: At least 35 deaths due to unidentified diseases

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  • Eastern Highlands, Papua New Guinea: At least 35 deaths due to unidentified diseases

    Published Date: 2019-08-02 14:10:11
    Subject: PRO/EDR> Undiagnosed illness - Papua New Guinea: (EH) fatal, Klebsiella susp, RFI
    Archive Number: 20190802.6601497
    UNDIAGNOSED ILLNESS - PAPUA NEW GUINEA: (EASTERN HIGHLANDS) FATAL, KLEBSIELLA SUSPECTED, REQUEST FOR INFORMATION
    ************************************************** ************************************************** ************
    A ProMED-mail post
    http://www.promedmail.org
    ProMED-mail is a program of the
    International Society for Infectious Diseases
    http://www.isid.org

    Date: Thu 1 Aug 2019 12:55 PM NZST
    Source: Radio New Zealand (RNZ) [edited]
    https://www.rnz.co.nz/international/...sease-outbreak


    Papua New Guinea health officials have been dispatched to the Eastern Highlands after dozens of people reportedly died in a disease outbreak. The provincial governor, Peter Numu, told local media 35 people at the local hospital died from curable diseases. He said 11 died over the weekend [27-28 Jul 2019], although he didn't specify when the others died.

    PNG's Health Minister, Elias Kapavore, said health department officials alongside the World Health Organisation will arrive in Goroka town today [1 Aug 2019].

    "I think it is to do with the lack of infection control monitoring and prevention in the hospital that has led to this particular unfortunate scenario that has affected the lives of many of our people there." Mr Kapavore, who said he would fly to Goroka to look at the situation, noted that media reports linked the deaths to _Klebsiella_, a rare disease often caused by poor infection control.

    But according to him, the National Emergency Operations Centre hadn't received a formal report by the hospital or Provincial Health Authority regarding a disease outbreak. However the minister said the situation warranted investigation.

    --
    Communicated by:
    ProMED-mail from HealthMap Alerts


    [_Klebsiella pneumoniae_ is an enteric Gram-negative bacillus that has been known to cause hospital-acquired infections and infections in debilitated or immunocompromised patients. However, a distinctive syndrome caused by _K. pneumoniae_ was first seen in Taiwanese patients in the 1980's (https://www.ncbi.nlm.nih.gov/pubmed/7613255). Cases have since been reported worldwide.

    The syndrome is characterized by life-threatening community-acquired _K. pneumoniae_ infection in relatively healthy hosts that includes liver abscess and bacteremia complicated by the ability of the responsible _K. pneumoniae_ to spread hematogenously to the lungs, brain, meninges, eyes, prostate, bones, joints, and psoas (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2732457/).

    Approximately half of the reported patients had diabetes mellitus, with the remainder displaying no apparent underlying diseases. The _K. pneumoniae_ strains were susceptible to many antibiotics, but mortality rates were as high as 10% for liver abscess and 30-40% for those with metastatic meningitis.

    Colonies of the strains causing this illness were noted to be unusually mucoviscous with a positive "string test," defined as the formation of a mucoviscous string of over 5 mm in length when using a bacteriology inoculation loop to touch and stretch a colony grown overnight on an blood agar plate at 35 C [95 F] (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4685062/). The strains were called hypervirulent _K. pneumoniae_ or hvKP, and their capsular polysaccharide serotypes were found to be either K1 or K2. Whole genome sequencing indicated that the hypervirulent K1 isolates belonged to clonal complex 23 (CC23) that grouped into a distinct monophyletic clade, with global spread by multiple international transmissions (https://www.ncbi.nlm.nih.gov/pubmed/26199326). The hvKP carried siderophores, which confer the ability to more efficiently acquire iron in iron poor environments. A large virulence plasmid, which encodes the siderophores and a regulator of the mucoid phenotype, was detected in all hvKP clonal lineages (https://www.ncbi.nlm.nih.gov/pubmed/26199326). The latest development was the acquisition of the virulence plasmid by multidrug resistant hospital-associated ST11 _K. pneumoniae_.

    _Klebsiella_ have been known to develop multiple antimicrobial drug resistance, commonly due to production of beta-lactamases that destroy the class of beta-lactam antibiotics known as carbapenems, as well as all other beta-lactam antibiotics. These carbapenemases are referred to as KPCs, that is, _K. pneumoniae_ carbapenemases. Some multidrug resistant strains have also been found to produce extended-spectrum beta-lactamases (ESBLs). The genes that encode KPCs and ESBLs are plasmid-mediated, which readily facilitates horizontal gene transfer between bacteria. The genes that encode these beta-lactamases are often linked to genes that encode resistance to multiple other classes of antibiotics. The principal reservoir for these organisms is the gastrointestinal tract, and spread occurs from there on the contaminated hands of healthcare workers and environment.

    More information on this fatal outbreak would be appreciated from knowledgeable sources.

    The eastern part of the island of New Guinea forms the mainland of Papua New Guinea, which has been an independent country since 1975. The outbreak is said to be occurring in the Eastern Highlands. Goroka, with a population of about 19 000 residents, is the capital of the Eastern Highlands Province (https://en.wikipedia.org/wiki/Goroka). A map showing the location of Goroka can be found at https://goo.gl/maps/f1PxnS7c9vCogDtw8. - Mod.ML

  • #2
    Health authority boss confirms 3 deaths, not 35

    August 2, 2019The NationalMain Stories

    By ZACHERY PER

    THE Goroka Provincial Hospital management has confirmed that only three new-born babies with low birth weights had died from suspected klesbiella pneumonia.
    ...
    He denied media reports that more than 35 had died at the hospital from klesbsiella. The figure was given by EHP Governor Peter Numu at a media conference last week.
    ...

    https://www.thenational.com.pg/healt...deaths-not-35/
    "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
    -Nelson Mandela

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    • #3
      Numu stands by statement on number of deaths

      August 6, 2019The NationalMain Stories

      EASTERN Highlands Governor Peter Numu (pic) is standing by his statement that at least 35 people had died from an illness despite the hospital saying it was only three.

      He called on the Provincial Health Authority and the Goroka Hospital management to await a report by the team from the Health Department and World Health Organisation sent to Goroka to investigate the matter.

      The report is expected to be released this week, according to Health secretary Pascoe Kase.
      ...

      https://www.thenational.com.pg/numu-...ber-of-deaths/
      "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
      -Nelson Mandela

      Comment

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