World Health Organization, Port Moresby, National Capital District (NCD), Papua New Guinea ; School of Public Health and Community Medicine, The University of New South Wales, New South Wales, Sydney, NSW, Australia.
PLoS One. 2013 Sep 2;8(9):e72566. doi: 10.1371/journal.pone.0072566. eCollection 2013.
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.
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).
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.
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.
2004 年 10 月，巴布亚新几内亚的马纳姆岛火山爆发，导致 10000 多名村民逃往国内流离失所者（IDP）营地，其中包括来自杜古拉巴村的 550 人。2010 年 3 月，由于土地准入问题发生暴力冲突后，IDP 逃离营地，四个月后，该人群中并发急性水样腹泻和异常神经投诉。
回顾性病例对照研究旨在确定周围神经病的危险因素。从急性水样腹泻病例中采集直肠拭子。通过电感耦合等离子体质谱法（ICP-MS）分析头发和血清中的金属和类金属。
在疫情爆发期间，550 名村民中有 17 人死亡，粗死亡率是人道主义危机的 21 倍。霍乱弧菌 O1 埃尔托弧 Ogawa 在人群中得到证实。获得社区一级补液对于死亡率至关重要。在有神经症状的病例中诊断出周围神经病。均衡饮食可显著预防神经病。在饮食中富含微量营养素的食物数量减少与周围神经病之间存在剂量反应关系。在周围神经病患者中发现铜、铁、硒和锌缺乏症。
霍乱可能导致本可预防的过度死亡。周围神经病不是由霍乱引起的，但霍乱可能会加剧现有的营养缺乏症。周围神经病可能是由复杂的微量营养素缺乏引起的，这些缺乏与非多样化的饮食有关，这可能会增加该人群的脆弱性，但不能排除新的与锌相关的神经病。通过解决流离失所的根本原因并确保获得耕地和及时重新安置，可以预防再次发生。
