Concurrent outbreaks of cholera and peripheral neuropathy associated with high mortality among persons internally displaced by a volcanic eruption

Rosewell, Alexander, Clark, Geoff, Mabong, Paul, Ropa, Berry, Posanai, Enoch, Man, Nicola W. Y., Dutta, Samir R., Wickramasinghe, Wasa, Qi, Lixia, Ng, Jack C., Mola, Glen, Zwi, Anthony B. and MacIntyre, C. Raina (2013) Concurrent outbreaks of cholera and peripheral neuropathy associated with high mortality among persons internally displaced by a volcanic eruption. PLoS One, 8 9: e72566.1-e72566.6. doi:10.1371/journal.pone.0072566


Author Rosewell, Alexander
Clark, Geoff
Mabong, Paul
Ropa, Berry
Posanai, Enoch
Man, Nicola W. Y.
Dutta, Samir R.
Wickramasinghe, Wasa
Qi, Lixia
Ng, Jack C.
Mola, Glen
Zwi, Anthony B.
MacIntyre, C. Raina
Title Concurrent outbreaks of cholera and peripheral neuropathy associated with high mortality among persons internally displaced by a volcanic eruption
Journal name PLoS One   Check publisher's open access policy
ISSN 1932-6203
Publication date 2013-09
Sub-type Article (original research)
DOI 10.1371/journal.pone.0072566
Open Access Status DOI
Volume 8
Issue 9
Start page e72566.1
End page e72566.6
Total pages 6
Place of publication San Francisco, CA, United States
Publisher Public Library of Science
Collection year 2014
Language eng
Formatted abstract
Background: In 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 Methods: A 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).

Results: There 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.

Conclusions: Cholera 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.
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2014 Collection
National Research Centre for Environmental Toxicology Publications
 
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