title: Spatio-temporal epidemiology of the cholera outbreak in Papua New Guinea, 2009-2011.
abstract: BACKGROUND
  Cholera continues to be a devastating disease in many developing countries where inadequate safe water supply and poor sanitation facilitate spread. From July 2009 until late 2011 Papua New Guinea experienced the first outbreak of cholera recorded in the country, resulting in >15,500 cases and >500 deaths.
  
  
  METHODS
  Using the national cholera database, we analysed the spatio-temporal distribution and clustering of the Papua New Guinea cholera outbreak. The Kulldorff space-time permutation scan statistic, contained in the software package SatScan v9.2 was used to describe the first 8 weeks of the outbreak in Morobe Province before cholera cases spread throughout other regions of the country. Data were aggregated at the provincial level to describe the spread of the disease to other affected provinces.
  
  
  RESULTS
  Spatio-temporal and cluster analyses revealed that the outbreak was characterized by three distinct phases punctuated by explosive propagation of cases when the outbreak spread to a new region. The lack of road networks across most of Papua New Guinea is likely to have had a major influence on the slow spread of the disease during this outbreak.
  
  
  CONCLUSIONS
  Identification of high risk areas and the likely mode of spread can guide government health authorities to formulate public health strategies to mitigate the spread of the disease through education campaigns, vaccination, increased surveillance in targeted areas and interventions to improve water, sanitation and hygiene.
authors.affiliation: Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea. paul.horwood@hotmail.com.
authors.forename: Paul F
authors.initials: PF
authors.lastname: Horwood
authors.forename: Stephan
authors.initials: S
authors.lastname: Karl
authors.forename: Ivo
authors.initials: I
authors.lastname: Mueller
authors.forename: Marinjho H
authors.initials: MH
authors.lastname: Jonduo
authors.forename: Boris I
authors.initials: BI
authors.lastname: Pavlin
authors.forename: Rosheila
authors.initials: R
authors.lastname: Dagina
authors.forename: Berry
authors.initials: B
authors.lastname: Ropa
authors.forename: Sibauk
authors.initials: S
authors.lastname: Bieb
authors.forename: Alexander
authors.initials: A
authors.lastname: Rosewell
authors.forename: Masahiro
authors.initials: M
authors.lastname: Umezaki
authors.forename: Peter M
authors.initials: PM
authors.lastname: Siba
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Greenhill
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D002771:Cholera / Q000453:epidemiology*; D016000:Cluster Analysis; D003140:Communicable Disease Control; D003906:Developing Countries; D004196:Disease Outbreaks; D005260:Female; D005843:Geography; D006801:Humans; D006920:Hygiene; D007223:Infant; D008297:Male; D008875:Middle Aged; D010219:Papua New Guinea / Q000453:epidemiology; D011634:Public Health; D062211:Spatio-Temporal Analysis; D014611:Vaccination; D014871:Water Microbiology; D014881:Water Supply; D055815:Young Adult