Open Access Research article

Spatio-temporal epidemiology of the cholera outbreak in Papua New Guinea, 2009–2011

Paul F Horwood1*, Stephan Karl2, Ivo Mueller2, Marinjho H Jonduo1, Boris I Pavlin3, Rosheila Dagina4, Berry Ropa4, Sibauk Bieb4, Alexander Rosewell3, Masahiro Umezaki5, Peter M Siba1 and Andrew R Greenhill16

Author Affiliations

1 Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea

2 Walter and Eliza Hall Institute, Melbourne, Australia

3 World Health Organization, Port Moresby, Papua New Guinea

4 Papua New Guinea National Department of Health, Port Moresby, Papua New Guinea

5 Department of Human Ecology, The University of Tokyo, Tokyo, Japan

6 School of Applied and Biomedical Sciences, Federation University, Churchill, Victoria, Australia

For all author emails, please log on.

BMC Infectious Diseases 2014, 14:449  doi:10.1186/1471-2334-14-449

Published: 20 August 2014



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.


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.


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.


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.

Cholera; Vibrio cholerae; Spatio-temporal distribution; Cluster analysis; Papua New Guinea