Concurrent Outbreaks of Cholera and Peripheral Neuropathy Associated with High Mortality among Persons Internally Displaced by a Volcanic Eruption

Abstract

BackgroundIn October 2004, Manam Island volcano in Papua New Guinea erupted, causing over 10 000 villagers to flee to internally displaced person (IDP) camps, including 550 from Dugulaba village. Following violence over land access in March 2010, the IDPs fled the camps, and four months later concurrent outbreaks of acute watery diarrhea and unusual neurological complaints were reported in this population.Materials and MethodsA retrospective case-control study was conducted to identify the risk factors for peripheral neuropathy. Rectal swabs were collected from cases of acute watery diarrhea. Hair and serum metals and metalloids were analyzed by Inductively Coupled Plasma-Mass Spectrometry (ICP-MS).ResultsThere were 17 deaths among the 550 village inhabitants during the outbreak period at a crude mortality rate 21-fold that of a humanitarian crisis. Vibrio cholerae O1 El Tor Ogawa was confirmed among the population. Access to community-level rehydration was crucial to mortality. Peripheral neuropathy was diagnosed among cases with neurological symptoms. A balanced diet was significantly protective against neuropathy. A dose-response relationship was seen between peripheral neuropathy and a decreasing number of micronutrient- rich foods in the diet. Deficiencies in copper, iron, selenium and zinc were identified among the cases of peripheral neuropathy.ConclusionsCholera likely caused the mostly preventable excess mortality. Peripheral neuropathy was not caused by cholera, but cholera may worsen existing nutritional deficiencies. The peripheral neuropathy was likely caused by complex micronutrient deficiencies linked to non-diversified diets that potentially increased the vulnerability of this population, however a new zinc-associated neuropathy could not be ruled out. Reoccurrence can be prevented by addressing the root cause of displacement and ensuring access to arable land and timely resettlement.

Orthopedic Surgery and Post-Operative Cognitive Decline in Idiopathic Parkinson’s Disease: Considerations from a Pilot Study

“…The Hopkins Verbal List Learning-Revised (HVLT-R;[40]) is a 12-item word list that assesses learning and memory. The words were orally presented at the rate of one word per 2 seconds.…”

Surveillance strategies for the detection of disease outbreaks in the Pacific islands: meta‐analysis of published literature, 2010–2019

“…Of 860 articles identified by the search, 37 reports describing 39 outbreaks met the inclusion criteria (Figure 1). There was seven reported outbreaks in PNG [8,13–18]; six in each of Solomon Islands, [19–25] French Polynesia, [25–30] and FSM [31–36]; three in each of American Samoa[37–39] and Marshall Island[40–42]; two from Fiji [43,44] and Guam [45,46] and one in each of Kiribati, [47] Tuvalu, [48] New Caledonia, [30] and Wallis and Futuna [30]. The aetiological agents responsible for the outbreaks were dengue virus ( n = 7), [25,19,23,26,34,39,41] influenza virus ( n = 5), [16,30,31] chikungunya virus ( n = 3), [17,28,29] Hepatitis A causing Hepatovirus ( n = 3), [35,44,40] Shigella spp .…”

“…The aetiological agents responsible for the outbreaks were dengue virus ( n = 7), [25,19,23,26,34,39,41] influenza virus ( n = 5), [16,30,31] chikungunya virus ( n = 3), [17,28,29] Hepatitis A causing Hepatovirus ( n = 3), [35,44,40] Shigella spp . ( n = 3), [13,16,38] Vibrio cholerae ( n = 2), [18,15,14,46] mumps virus ( n = 2), [32,45] Rotavirus ( n = 2), [21,47] Zika virus ( n = 2), [27,37] measles Rubeola virus ( n = 1), [33] Mumps, circulating vaccine‐derived poliovirus type 1 ( n = 1), [8] and Rickettsia parasite causing scrub typhus ( n = 1) [20]. In addition, outbreaks of unspecified enteric disease ( n = 3), [36,42,48] peripheral neuropathy syndrome associated with malnutrition ( n = 1), [15] congenital rubella syndrome ( n = 1), [24] severe acute respiratory illness ( n = 1), [43] and a clinically diagnosed measles outbreak ( n = 1) [22] were reported (Table 1).…”

Serum essential trace elements and toxic metals in Chinese diabetic retinopathy patients

“…We used inductively coupled plasma-mass spectrometry (ICP-MS, Series 7700, Agilent Technologies Inc., USA) to measure the isotopes 55 Mn, 66 Zn, 111 Cd, and 133 Cs in serum samples carefully, according to Rosewell et al's study, [ 13 ] to avoid metal/metalloid contamination.…”