Subacute Sclerosing Panencephalitis in Papua New Guinean Children: The Cost of Continuing Inadequate Measles Vaccine Coverage

Abstract

IntroductionSubacute sclerosing panencephalitis (SSPE) is a late, rare and usually fatal complication of measles infection. Although a very high incidence of SSPE in Papua New Guinea (PNG) was first recognized 20 years ago, estimated measles vaccine coverage has remained at ≤70% since and a large measles epidemic occurred in 2002. We report a series of 22 SSPE cases presenting between November 2007 and July 2009 in Madang Province, PNG, including localized clusters with the highest ever reported annual incidence.Methodology/Principal FindingsAs part of a prospective observational study of severe childhood illness at Modilon Hospital, the provincial referral center, children presenting with evidence of meningo-encephalitis were assessed in detail including lumbar puncture in most cases. A diagnosis of SSPE was based on clinical features and presence of measles-specific IgG in cerebrospinal fluid and/or plasma. The estimated annual SSPE incidence in Madang province was 54/million population aged <20 years, but four sub-districts had an incidence >100/million/year. The distribution of year of birth of the 22 children with SSPE closely matched the reported annual measles incidence in PNG, including a peak in 2002.Conclusions/SignificanceSSPE follows measles infections in very young PNG children. Because PNG children have known low seroconversion rates to the first measles vaccine given at 6 months of age, efforts such as supplementary measles immunisation programs should continue in order to reduce the pool of non-immune people surrounding the youngest and most vulnerable members of PNG communities.

Subacute sclerosing panencephalitis: clinical phenotype, epidemiology, and preventive interventions

“…2 The global incidence of SSPE is not known, but a study from the USA extrapolated data and concluded a risk of 6.5 to 11 cases of SSPE for each 100 000 cases of measles. 6 Similarly high incidence rates are reported in India, which are assumed to be related to crowded living environments and poor vaccination coverage. 4 A study from California found that the incidence of SSPE was 1 in 1367 for children younger than 5 years of age and 1 in 607 for those younger than 1 year of age when they had contracted measles.…”

Severe Anemia in Papua New Guinean Children from a Malaria-Endemic Area: A Case-Control Etiologic Study

“…Children with severe anemia (hemoglobin concentration <50 g/L) were identified as part of an observational study of all children aged 0.5–10 years admitted to the pediatric ward of Modilon Hospital, the tertiary referral hospital for Madang Province, between October 2006 and November 2009 [20], [21]. Healthy non-anemic children (hemoglobin concentration >100 g/L), matched where possible by age and sex, were recruited as controls from community-based immunization clinics.…”

Prevalence and Implications of Cerebrospinal Fluid Leukocytosis in Papua New Guinean Children Hospitalized with Severe Malaria

“…After excluding children who did not have an admission lumbar puncture and those with a primary or co-incident non-malarial illness caused by locally prevalent bacterial, viral, or fungal pathogens as confirmed by blood/CSF culture, and/or specific antigen, serologic, and/or polymerase chain reaction testing, as well as Indian ink staining, [5][6][7] children with blood slide-positive malaria confirmed by polymerase chain reaction were assigned to one of three sub-groups: 1) cerebral malaria (Blantyre coma score 2 8 and 1,000 P. falciparum or 250 P. vivax asexual parasites/μL); 2) malaria with cerebral involvement (parasitemia as in sub-group 1 but a Blantyre coma score of 3 or 4 and/or complex febrile seizures); and 3) malaria admissions (any parasite density and a normal level of consciousness with or without other signs of severity, 8 including single convulsions). Complex seizures were defined as multiple ( 2 episodes), prolonged ( 15 minutes), or focal (unilateral).…”