The public health challenge of dengue fever in Papua New Guinea

Dengue Fever (DF) is a mosquito-borne disease of public health concern in both tropical and subtropical countries, especially influenced by rainfall, temperature and unplanned rapid urbanization [1]. World Health Organization (WHO) member states have reported on average 2.4 million cases of DF annually over the past 5 years [1]. Even with these figures, other data suggests the number of dengue infections could be as high as 390 million annually, of which up to 96 million show clinical manifestation[1]. Global reporting has therefore not been good, and Papua New Guinea (PNG) is one of the countries that have not yet reported national DF surveillance data. DF does not feature among the leading burden of diseases reported in PNG’s National Health Plan 2011-2020, and it is not clear whether lack of reliable reporting was the reason. In 2015, DF was reported as being only rarely diagnosed and possibly having a low index of clinical suspicion in PNG. That same report further stated that dengue haemorrhagic fever (DHF) has not been reported in PNG for over a decade [2]. Three reports of the DF situation in the Western Pacific region from 2010 to 2012 state that there was no DF-specific surveillance in PNG [3-5]. However, DF's presence was verified from case importation to Queensland for which surveillance in Queensland is actively conducted [6]. DF surveillance in PNG is challenged by geographical isolation of its remote, mountainous, coastal, and island sparsely distributed and diverse rural communities [7]. This situation limits access, provision and coverage of health services. These challenges only add to those posed by DF itself, resulting in a paucity of information about its presence in PNG