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PubMed1998

[Medicine in Vanuatu: a voyage to the end of the earth to Espiritu Santo Island].

INTRODUCTION: The republic of Vanuatu, which was previously termed the Hebrides, has been independant since 1981. Colonization by both France and England has left its numerous marks on this country over the years. The authors spent the year 1997 on the Espiritu Santo Island and report their experience as practitioners at the northern district hospital. CURRENT KNOWLEDGE AND KEY POINTS: As Vanuatu is a developing country, medical practice is subject to changes in government, development aid provided by foreign countries and socio-economical conditions. Numerous chronic diseases with historical complications and malpractice are encountered. As well, numerous infectious diseases such as tuberculosis and malaria are still endemic. Means of fighting and preventing infections are great problems, with, for example, deficiencies in immunization programs. Though medical structures are well organized, due to its immature governments and assistance rather than cooperation policies of various helping countries, latitudinarianism is important and medical practice is not continuously organized. FUTURE PROSPECTS AND PROJECTS: Several objectives should be considered: epidemiological studies in order to reconstitute diseases profiles in this archipelago and, most of all, cooperation that would aim at training and education.

Adult↗
PubMed1987

The spectrum of renal histopathology in patients with significant proteinuria in Vanuatu.

Renal biopsies were performed on 21 of 27 Melanesian patients presenting with significant proteinuria in Vanuatu from 1983 to 1985. All patients had more than 2 g of proteinuria per 24 hours or clinical evidence of the nephrotic syndrome. The average age of the patients who were biopsied was 31 years. Three of the 21 patients had evidence of active malaria at the time of presentation, and all of these patients had Plasmodium falciparum. Renal histopathology revealed that six patients (29%) had amyloidosis and five patients (24%) had mesangiocapillary glomerulonephritis (type 1). Of particular note was the fact that only one patient had membranous glomerulonephropathy and only one patient had minimal change nephrotic syndrome, the two most common lesions reported in nephrotic patients in Europe and the United States. Thus, the spectrum of renal histopathology in patients presenting in Vanuatu with significant proteinuria is very different from that seen in Western Countries.

Amyloidosis↗
PubMed2003

Prevalence of sexually transmitted infections among antenatal women in Vanuatu, 1999-2000.

BACKGROUND: The epidemiology of sexually transmitted infections (STIs) and HIV in Vanuatu is poorly defined. GOAL: The goal was to determine the prevalence of laboratory-confirmed gonorrhea, chlamydia, trichomoniasis, syphilis seroreactivity, and HIV among pregnant women in Vila, Vanuatu. STUDY DESIGN: A cross-sectional survey of 547 pregnant women attending a first-visit antenatal hospital clinic in Vila. Laboratory testing included polymerase chain reaction on tampons for chlamydia, gonorrhea, and trichomoniasis; testing of sera for syphilis with rapid plasmid reagin; and enzyme-linked immunosorbent assay for HIV. RESULTS: The prevalence of trichomoniasis was 27.5% (150); of chlamydia, 21.5% (117); of gonorrhea, 5.9% (32); and of syphilis, 13 (2.4%). No HIV cases were detected; 214 women (40%) had > or =1 STI. Young age and single marital status were both significantly associated with infection (P < 0.001). CONCLUSION: Chlamydial infection and trichomoniasis are hyperendemic among pregnant women in Vila. Young, single women are at greatest risk for infection.

Adult↗
PubMed1995

Thalassaemia in Vanuatu, south-west Pacific: frequency and haematological phenotypes of young children.

The archipelago of Vanuatu situated in the South-West Pacific has a high frequency of alpha + thalassaemia and additionally on some of the islands there is a high frequency of beta thalassaemia. As part of a large cohort study to investigate the clinical effect of thalassaemia on malaria on the islands of Espiritu Santo and Maewo in Vanuatu, the gene frequencies of the thalassaemias were determined and blood counts were performed on a cohort of infants from birth to 3 years. The haematological phenotypes of the different thalassaemic genotypes are compared, providing a detailed description of the clinical manifestations of alpha + thalassaemia during early development. In addition, cross-sectional surveys of the population of the two islands were performed to establish the frequency of thalassaemia and other red cell polymorphisms and their geographical distribution.

Child, Preschool↗
PubMed1994

The Anopheles punctulatus group of mosquitoes in the Solomon Islands and Vanuatu surveyed by allozyme electrophoresis.

Four species within the Anopheles punctulatus group of mosquitoes (Diptera: Culicidae) were identified by allozyme analysis of samples collected from thirty-three localities in Guadalcanal, Makira, Malaita, Temotu and Western Provinces in the Solomon Islands and six localities on Efate, Espiritu Santo, Maewo and Malekula Islands in Vanuatu. Three of these species are members of the An.farauti complex. A key is given to identify five species of the An.punctulatus group known to occur in the Solomon Islands using their isoenzyme characteristics. An.farauti No. 1 was widespread in coastal areas of the Solomon Islands and was the only species detected in Vanuatu, including Efate Island (where Faureville is the type locality of An.farauti Laveran sensu stricto). An.farauti No. 2 and An.punctulatus were common in the Solomon Islands in more inland areas. An.farauti No. 7, reported here for the first time, was found as larvae in freshwater at six localities on north Guadalcanal. Three other members of the An.punctulatus group which have been reported previously from the Solomon Islands: An.koliensis, An.renellensis and an electrophoretic variant of An.farauti sensu lato, were not found in our samples. Previously recognized vectors of malaria and bancroftian filariasis in the Solomon Islands are An.farauti No. 1 (i.e. An.farauti s.s.), An.koliensis and An.punctulatus s.s. Adult females of An.farauti No. 2 and An.farauti No. 7 were not attracted to human bait in areas where their larvae occurred, indicating that these two species are not anthropophilic and therefore unlikely to transmit human pathogens.

Animals↗
PubMed1989

Cancer occurrence in Vanuatu in the South Pacific, 1980-86.

A total of 269 pathologically confirmed carcinoma cases (118 male, 151 female) were recorded in the seven year period 1980 to 1986 in Vanuatu, an island nation within the Melanesia region in the South Pacific. Cervical cancer was numerically the most important malignancy in females (25% of all female cancers). In males, liver cancer was the most commonly observed (14.4% of all male cancers). Almost one-half (44.4%) of the available paraffin blocks from liver carcinoma cases (18 cases) demonstrated positivity of HBV antigens in liver tissue. The most interesting feature was the high proportion of thyroid cancers, especially in females. It represented 12.1 percent of all cancers in female and 5.2 percent in male Melanesians in Vanuatu. These percentages were found to be even higher than among Hawaiians for whom the highest incidence rates in the world have been recorded. Since our study was based solely on pathologically diagnosed cases, the findings should be regarded as minimum estimates.

Adolescent↗
PubMed1990

Public-health epidemiology in Vanuatu.

Vanuatu, which formerly was known as the New Hebrides, is an archipelago in the southwest Pacific Ocean with a tropical humid climate. The national health system and the state of health of the population generally are satisfactory. The main diseases of public-health importance are malaria and tuberculosis. Their epidemiology and control are discussed. An epidemic of Plasmodium falciparum malaria, which commenced in 1980, is described; this possibly can be explained by an increase in chloroquine-resistant P. falciparum over the same period. Other diseases also are reviewed. Many tropical diseases of great significance elsewhere are not of much significance in Vanuatu. Medical advice for visiting travellers is provided.

Adolescent↗
PubMed2003

[Campaign to eradicate yaws on Santo Island, Vanuatu in 2001].

At the beginning of the 1960s a campaign was carried out to eradicate endemic trepanematosis in the South Pacific. During the year 2000, twenty cases of yaws were diagnosed on Santo Island in Vanuatu. Recrudescence of this disease was confirmed by a seroprevalence testing showing 20.9% positive VDRL in 273 serum tests. In view of these findings, the Health Minister in collaboration with the WHO office in Vanuatu undertook mass benzathine-benzylpenicilline treatment in the population of the Santo and Malo (SANMA) province. The objective was to treat at least 85% of the population. Treatment was administered to 36,414 of the 39,397 inhabitants identified in 587 villages during the campaign, i.e., 92.4%. Coverage varied from 87.6 to 97.3% depending on the zone. Positive VDRL was obtained in 96 of the 230 serum samples collected for suspicion of yaws. All documented cases of yaws were found in the southeastern part of the island. Treatment had a dramatic effect on lesions within 24 hours. Cooperation of the population and involvement of mobile units and primary health-care providers were key factors in the success of this campaign. Further action will include training of health care workers and improvement of sanitary conditions in villages. Seroprevalence testing to assess the effectiveness of this campaign is to be carried out in 2003.

Adolescent↗
PubMed1992

Dapsone syndrome in Vanuatu: a high incidence during multidrug treatment (MDT) of leprosy.

Side-effects of leprosy treatment with dapsone are said to be uncommon, with drug allergy occurring in only one of every several hundred patients treated with dapsone. The dapsone or sulphone syndrome (DDS) has been recognized since the earliest days of sulphone therapy but until recently its incidence had been decreasing. In Vanuatu, during the years 1988-1991, nine leprosy patients have developed the dapsone syndrome, four of whom have died. During the last 4 years only 37 patients were started on treatment, which is an incidence of the dapsone syndrome of 24% with a fatality rate of 11%. All the patients were being given multi-drug treatment (MDT) of daily dapsone (100 mg) and clofazimine (50 mg) and monthly rifampicin (600 mg) and clofazimine (300 mg). There has been speculation that the increased incidence of what was previously described as a rare reaction is due to the use of MDT, and the reasons for this are discussed. We feel the increase in the number of reactions in Vanuatu since starting MDT is probably due to the high starting dose of 100 mg of dapsone, possibly enhanced by the combination with clofazimine and rifampicin and a genetic susceptibility of the Melanesian population.

Adolescent↗
PubMed1992

Epidemiology of blindness and visual impairment in Vanuatu.

A population-based survey of blindness was conducted in Vanuatu. Data were gathered on a sample of 3520 of the approximately 150,000 inhabitants of Vanuatu aged at least 6 years, in order to estimate the prevalence and causes of blindness among the whole population. An overall prevalence of blindness of 4.0 per 1000 was found, 85% of which was due to cataract, an avoidable cause of this disability.

Adolescent↗
PubMed1990

Cancer occurrence in Vanuatu in the South Pacific, 1980-86.

In order to study the occurrence of cancer in the archipelago of Vanuatu (ex-New Hebrides) within the Melanesia region in the South Pacific, a pathology based study was carried out. A total of 269 pathologically confirmed cancer cases (118 male, 151 female) were recorded over a 7 year period (1980-1986). Cervical cancer was numerically the most important malignancy in females (25.2% of all female cancers). In males, liver cancer was the most commonly observed (14.4% of all male cancers). The most interesting feature was the high proportion of thyroid cancers, especially in females. It consisted of 12.1% of all cancers in female and 5.2% in male Melanesians in Vanuatu.

Female↗
PubMed1987

[Lymphatic filariasis in Vanuatu].

Lymphatic filariasis, in the Archipelago of Vanuatu, is due to Wuchereria bancrofti. The vector is Anopheles farauti, endophilic mosquito, which transmits also malaria. The level of endemicity was very high in the beginning of this century (microfilariae in blood: 60.9%, elephantiasis: 21%), and has dramatically decline now by detection and treatment of sick people (70 cases in 1986), mass chimioprophylaxis and protection against the vectors. But these actions must be continued to obtain the eradication of filariasis in the Vanuatu.

Animals↗
PubMed1988

[The chloroquine resistance of Plasmodium falciparum in Vanuatu (1980-1984): appearance, evolution, distribution].

Chloroquine resistance of P. falciparum was studied in Vanuatu from March 1981 to July 1984, with limited means, and a non-systematic procedure; it was first evidenced in 1980. In vivo chloroquine resistance criteria were those established by W. H. O. In vitro testing methods were the standard W. H. O. macro-test and micro-test. 124 in vivo chloroquine resistant cases were seen: 111 cases in hospital (63 R III, 28 R II and 20 R I) and 13 cases in field studies (1 R III, 4 R II and 8 R I). 87 in vitro chloroquine sensitivity tests were carried out. A high failure rate was apparently due to a defective batch of lyophilised culture medium. Out of the 25 isolates successfully tested, 22 showed in vitro chloroquine resistance (88%). Correlation between in vivo and in vitro resistance was good in 13 cases studied by both methods. Moreover, 13 in vitro mefloquine sensitivity tests evidenced a high sensitivity to this drug. Chloroquine resistant malaria thus appears to be extended to the whole country. Its prevalence remains unknown but was estimated at 60% at least in 1984. Moreover, a geographical spread of chloroquine resistance from north to south of the group was evidenced between 1980 and 1984, identical to that of the dramatic increase of P. falciparum incidence at the same period of time. Possible mechanisms of the advent of chloroquine resistance in Vanuatu are discussed.

Adolescent↗
PubMed1995

Multiple glucose 6-phosphate dehydrogenase-deficient variants correlate with malaria endemicity in the Vanuatu archipelago (southwestern Pacific).

In studying the relationship between genetic abnormalities of red blood cells and malaria endemicity in the Vanuatu archipelago in the southwestern Pacific, we have found that of 1,442 males tested, 98 (6.8%) were G6PD deficient. The prevalence of GdPD deficiency varied widely (0%-39%), both from one island to another and in different parts of the same island, and generally correlated positively with the degree of malaria transmission. The properties of G6PD from GdPD-deficient subjects were analyzed in a subset of 53 samples. In all cases the residual red-blood-cell activity was < 10%. There were three phenotypic patterns. PCR amplification and sequencing of the entire coding region of the G6PD gene showed that the first of these patterns corresponded to G6PD Union (nucleotide 1360C-->T; amino acid 454Arg-->Cys), previously encountered elsewhere. Analysis of samples exhibiting the second pattern revealed two new mutants: G6PD Vanua Lava (nucleotide 383T-->C; amino acid 128Leu-->Pro) and G6PD Namoru (nucleotide 208T-->C; amino acid 70Tyr-->His); in three samples, the underlying mutation has not yet been identified. Analysis of the sample exhibiting the third pattern revealed another new mutant: G6PD Naone (nucleotide 497G-->A; amino acid 166Arg-->His). Of the four mutations, G6PD Union and G6PD Vanua Lava have a polymorphic frequency in more than one island; and G6PD Vanua Lava has also been detected in a sample from Papua New Guinea. G6PD deficiency is of clinical importance in Vanuatu because it is a cause of neonatal jaundice and is responsible for numerous episodes of drug-induced acute hemolytic anemia.

Adolescent↗
PubMed1993

Improving vaccination coverage: the experience of the Expanded Programme on Immunization in Vanuatu.

This paper looks at the success of measures adopted to improve vaccination coverage of infants in the Republic of Vanuatu. In 1982 the Department of Health introduced an Expanded Programme on Immunization (EPI). Since the republic has over 80 inhabited islands, a scattered population, rough terrain and a lack of transport and communications infrastructure, achieving a high vaccination coverage rate proved difficult. Coverage of infants remained low until 1987. From that year onwards various strategies were employed to increase coverage, including 1) adopting the WHO-recommended diphtheria-pertussis-tetanus (DPT) and oral polio vaccine (OPV) vaccination schedule (6, 10 and 14 weeks) instead of the former schedule (3, 6 and 9 months); 2) improving the training, support and supervision of staff delivering maternal and child health (MCH) services; and 3) improving community involvement through social mobilization activities in areas of low coverage. Data on vaccination coverage of infants for the period 1984 to 1990 were compared. Over this period coverage of infants with 3 doses of DPT rose from 29% to 76%, with 3 doses of OPV from 29% to 78%, and with measles vaccine from 19% to 66%. These dramatic improvements have largely occurred since 1987. The results demonstrate the success of the measures adopted, and the experience of Vanuatu offers lessons in improving vaccination coverage for other countries in the region.

Community Participation↗
PubMed1998

Malaria epidemiology, glucose 6-phosphate dehydrogenase deficiency and human settlement in the Vanuatu Archipelago.

Vanuatu is located at the southeast margin of the malarious band extending from southeast Asia to eastern Melanesia. We analysed the malaria situation on different islands of Vanuatu, using passive case detection and malariometric survey data from 1985 to 1992, i.e. after the DDT residual programme ceased and before the impregnated bed-nets programme started on a larger scale. Malaria was mainly hypo-mesoendemic but with hyperendemic spots in certain years and on some islands. The transmission was generally more intense in the northern islands than in the south. In the late 1980s, annual parasite incidence per one thousand population (API) was around 180. The overall parasite rate was 11.9% with Plasmodium falciparum, P. vivax and P. malariae rate of 5.2, 6.7, and 0.1%, respectively. There was a seasonal fluctuation of P. falciparum incidence, whereas the P. vivax incidence was rather stable. Vivax malaria was confined to children less than 10 years old, while the intense in the northern islands than in the south. In the late 1980s, annual parasite incidence per one thousand population (API) was around 180. The overall parasite rate was 11.9% with Plasmodium falciparum, P. vivax and P. malariae rate of 5.2, 6.7, and 0.1%, respectively. There was a seasonal fluctuation of P. falciparum incidence, whereas the P. vivax incidence prevalence of P. falciparum only changed moderately with age. The mean rate of glucose 6-phosphate dehydrogenase (G6PD) deficiency among male subjects was in 7.4% but with a wide variation of 0-14.3% on different islands. A positive rank-order correlation was found between malaria incidence and G6PD deficiency rate on the different islands. A reasonable hypothesis is that malaria was introduced to the islands with the first human settlement 4000 years ago, with a geographical malaria distribution similar to the present situation. Different malaria endemicities possibly then selected different prevalences of G6PD deficiency over many generations.

Adolescent↗
PubMed1985

Diseases and parasites of cattle in Vanuatu.

A study of cattle diseases was carried out in Vanuatu from 1971 to 1981. Tuberculosis was discovered in 4 herds and eradication was completed by 1981. The number of farms with brucellosis reactors increased from 2 in 1976 to 7 in 1978 despite eradication measures. Antibodies to serovars Leptospira icterohaemorrhagiae, australis, sejroe and canicola were demonstrated by the microscopic agglutination test. Antibodies were demonstrated against infectious bovine rhinotracheitis/infectious pustular vulvovaginitis and bovine virus diarrhoea/mucosal disease complexes. Of the 18 parasites identified, Haemaphysalis longicornis, Haemonchus, sp, Oesophagostomum phlebotomum and Neoascaris vitulorum were the most prevalent. As brucelossis is the only serious disease present, Vanuatu is in a favourable situation with regard to cattle diseases.

Animals↗
PubMed1985

[Prevalence of the enterotoxigenic Escherichia coli colonization factors CFA/I, CFA/II and E8775 isolated in the South Pacific (New Caledonia, Republic of Vanuatu and Wallis and Futuna)].

We tested the expression of adherence properties of enterotoxigenic Escherichia coli (ETEC) strains isolated in New-Caledonia, Vanuatu and Wallis and Futuna by examining for the presence of colonization factor E8775 using an agglutination test and an immuno-diffusion technique with specific antisera. Approximately 19% of ETEC strains possessed CFA/I and 21% a CFA/II. The E8775 antigen was found on 1.8% of the strains. This last factor was found on strains of the serogroup 025 from Vanuatu. Two strains 078 usually CFA/I+ possessed a CFA/II and three strains of the serogroup 0126 possessed a CFA/I. The results of this study emphasis the need to continue the search for other mechanisms of adhesion used by ETEC strains without any of the three factors of colonization.

Antigens, Bacterial↗