title: In search of pigbel: gone or just forgotten in the highlands of Papua New Guinea?
abstract: Throughout the 1960s and 1970s, pigbel (enteritis necroticans) was the most common cause of death in children over the age of 1 year in hospitals in the highlands of Papua New Guinea (PNG). There has been recent widespread perception that after the successful vaccination program in the 1980s the disease virtually disappeared. A new vaccine is now available, but disease burden information is conflicting: despite almost no pigbel being reported from major hospitals there have been many reports of the disease from outlying health centres. This study aimed to provide information on the disease burden of pigbel in PNG, so that appropriate vaccine policy decisions could be made. We conducted a 12-month prospective study of all cases of acute abdomen in children presenting to 38 health facilities, 29 health centres and 9 hospitals in the highlands. Children were eligible for inclusion if they were aged 1-12 years and had abdominal pain of less than 2 weeks' duration. A standardized case definition of pigbel was used to distinguish cases of acute abdominal pain very likely to be due to pigbel from cases very likely to be accounted for by other diagnoses (such as gastroenteritis, typhoid, dysentery, intussusception, urinary tract infection and others). A total of 119 cases of acute abdomen were reported from 17 of the 38 health facilities involved. Of these 119 cases 11 met the criteria for pigbel and a further 8 were probable cases. There were 4 deaths among the 119 children with acute abdomen: 2 from definite pigbel, 1 from probable pigbel and the other due to complications of measles. In 2002 pigbel was the cause of between 9% and 16% of presentations with acute abdominal pain in children in the PNG highlands. The overall disease burden of pigbel was relatively small (19 definite or probable cases and 3 deaths in 12 months). However, there was substantial geographical clustering of cases: more than 50% of the definite cases occurred in children living within three electorates on the Western Highlands-Enga provincial border, no more than 40 km from each other. This study will be useful in planning pigbel vaccine policy and future surveillance.
authors.affiliation: Mt Hagen General Hospital, Western Highlands Province, Papua New Guinea.
authors.forename: Harry
authors.initials: H
authors.lastname: Poka
authors.forename: Trevor
authors.initials: T
authors.lastname: Duke
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000208:Acute Disease; D002648:Child; D002675:Child, Preschool; D003015:Clostridium Infections / Q000150:complications / Q000453:epidemiology* / Q000517:prevention & control; D003016:Clostridium perfringens; D004751:Enteritis / Q000453:epidemiology*; D006801:Humans; D007223:Infant; D032541:Mass Vaccination; D010219:Papua New Guinea / Q000453:epidemiology; D011446:Prospective Studies; D012189:Retrospective Studies; D012424:Rural Population; D014121:Toxoids
chemical_list: C035454:Clostridium perfringens toxoid; D014121:Toxoids