PAPUA NEW GUINEA
Capital: Port Moresby
Time Zone: +10 hours. No daylight saving time in 2008.
Tel. Country Code: 675
USADirect Tel.: 0
Electrical Standards: Electrical current is 220/50 (volts/hz). South Pacific Style Adaptor Plug. Grounding Adaptor Plug E.
• U.S. Embassy
Tel. (675) 321-1455
There is no resident Canadian government office in Papua New Guinea. Canadians in Papua New Guinea can obtain consular assistance and further information from the Australian High Commission in Port Moresby (under the Canada-Australia Consular Services Sharing Agreement) at the following address:
• Australian High Commission
Godwit Road, Waigani
Tel:  325-9333
Fax:  325-9239
• British High Commission
Port MoresbyPostal address: Locked Mail Bag 212, Waigani,
Tel:  325 1677
Emergency mobile number:  683 1627
HIV Test: Test required for a work permit or anyone seeking residency.
Required Vaccinations: A yellow fever vaccination certificate is required from all travelers older than 1 year arriving from infected areas.
Passport/Visa: Papua New Guinea is a developing country in the Southwest Pacific. The capital is Port Moresby. Tourist facilities outside major towns are limited. Crime is a serious concern throughout Papua New Guinea (please see the section on crime below).
ENTRY/EXIT REQUIREMENTS: Travelers must possess a valid passport, onward/return airline ticket, and proof of sufficient funds for the intended visit. Travelers may obtain temporary business or tourist visas (valid for stays of up to 30 days, with extensions allowed for an additional 30 days) upon arrival at Jackson’s International Airport in Port Moresby. All persons boarding international flights originating from Papua New Guinea pay a departure fee, which should be included in airline fares. Travelers may obtain more information on entry and exit requirements from the Embassy of Papua New Guinea, 1615 New Hampshire Ave., NW, Suite 300, Washington, DC 20009, Tel. 202-745-3680, fax 202-745-3679, E-mail firstname.lastname@example.org, or via the Papua New Guinea Embassy website at http://www.pngembassy.org/
VACCINATIONS: RECOMMENDED AND ROUTINE
Hepatitis A: Recommended for all travelers >1 year of age not previously immunized against hepatitis A.
Hepatitis B: Recommended for all travelers who might be exposed to blood or bodily fluids from unprotected sex with a high-risk partner; from injecting drug use with shared/re-used needles and syringes; from medical treatment with non-sterile (re-used) needles and syringes (increased risk in lesser-developed countries); from contact with open skin sores of an another person. Recommended for any traveler requesting protection against hepatitis B virus.
Influenza: Vaccination recommended for all travelers >6 months of age who have not received a flu shot in the previous 12 months.
Japanese Encephalitis: Recommended for travelers planning to visit rural farming areas for >4 weeks and under special circumstances, such as a known outbreak of Japanese encephalitis.
Routine Immunizations: Immunizations against tetanus-diphtheria, measles, mumps, rubella (MMR vaccine) and varicella (chickenpox) should be updated, if necessary, before departure. MMR protection is especially important for any female of childbearing age who may become pregnant.
• The new Tdap vaccine, ADACEL, which also boosts immunity against pertussis (whooping cough) should be considered when a tetanus-diphtheria booster is indicated.
Typhoid: Recommended for all travelers with the exception of short-term visitors who restrict their meals to major restaurants and hotels, such as business travelers and cruise passengers.
Yellow Fever: A yellow fever vaccination certificate is required for all travelers >1 year of age arriving from any country in the yellow fever endemic zones. Vaccination is not recommended or required otherwise.
HOSPITALS / DOCTORS
&Medical facilities range from hospitals in Port Moresby larger towns to health centers & aid posts in remote areas. Missionary stations also provide health-care facilities. Medical facilities vary in quality, but those in larger towns are adequate for routine problems & some emergencies. Equipment failures, sudden shortages of common medications, & reductions in services due to lack of government funding can mean routine treatments & procedures (such as x-rays) may be unavailable.
• All travelers should be up-to-date on their immunizations and are advised to carry a medical kit as well as antibiotics to treat travelers’ diarrhea or other infections; they should bring drugs for malaria prophylaxis, if needed according to their itinerary. Travelers who are taking regular medications should carry them properly labeled and in sufficient quantity to last for the duration of their trip; they should not expect to obtain prescription or over-the-counter drugs in local stores or pharmacies in this country – the equivalent drugs may not be available; may be of dubious origin; may be counterfeit, or of unreliable quality.
• Travelers are advised to obtain comprehensive travel insurance that provides for air ambulance transport to more advanced medical facility in Australia in the event of serious illness or injury that requires specialty care not available in this country.
Note: More sophisticated medical facilities are located in the Australian town of Cairns, Queensland. Australian visas are issued in Port Moresby, but in cases involving medical treatment, visa authorities require referral from local doctor, proof of acceptance by Australian doctor, & of patient’s ability to pay.
The U.S. Embassy maintains a list of doctors at: http://portmoresby.usembassy.gov/consular/acs.html
• Port Moresby General Hospital
3 Mile, Taurama Road
National Capital District
Tel:  324 8200
Accidents and Emergency:  324-8239
A hyperbaric chamber for divers is available in Port Moresby.
• Jacobi Medical Center
Johnston Pharmacy Building
Reke Street, Boroko
Tel:  325-5355
Fax  323-1670
General Practice, Dermatology, EN, Cardiac, Surgical,
Audiology, Dive and Aviation Medicine.
DESTINATION HEALTH INFO FOR TRAVELERS
AIDS/HIV: Papua New Guinea (PNG) has the highest incidence of HIV in the Pacific region. It is estimated that 2% of the adult population are now HIV positive. Heterosexual transmission is the predominant means of infection. While approximately equal numbers of men and women are currently affected, young women and older men are disproportionately affected. Significant HIV prevalence rates are found both in large urban areas, such as Port Moresby, and in rural pockets, typically around high risk settings including transport routes, mining and logging sites.
• Transmission of HIV can be prevented by avoiding: sexual contact with a high-risk partner; injecting drug use with shared needles; non-sterile medical injections; unscreened blood transfusions.
• The threat of HIV/AIDS should not be a primary concern for the traveler. However, there may be a concern for a subset of travelers who may be exposed to HIV, the virus that causes AIDS, through contact with another person’s body fluids or blood. Although travel has contributed in a general way to the global spread of AIDS, fear of traveling because of this disease is not warranted.
Accidents: The recent months have seen another two Australians die while walking the Kokoda trail in PNG. This brings this year’s tally to four and again has focused attention onto adequate preparation for this demanding 96km trek which sees approximately 50 people each year requiring medical evacuation.
The number of Australians attempting the Kokoda trail has risen from less than 100 per year in 2001 to nearly 6000 per year in the past couple of years. A medical clearance is required of participants by many trekking companies although the Kokoda Track Authority has not made this mandatory for tour operators to obtain a licence. Whilst a medical clearance is a sensible step in preparation for the trek, it is unlikely that a medical examination alone would accurately predict a person’s ability to undertake this trip.
The PNG government recommends a minimum three months preparation for the Kokoda trail and this timeframe is echoed by most trekking companies. More reputable companies will provide specific training programs and some include supervised training in the tour package.
Ultimately the responsibility for adequate preparation lies with the traveler regardless of the destination or type of trip planned. The frequency of deaths and serious illnesses on the Kokoda trail highlights the importance of travelers seeking appropriate advice well in advance of travelling. Source: Travel Medicine Alliance (Australia)
Accidents & Medical Insurance: Accidents and injuries are the leading cause of death among travelers under the age of 55 and are most often caused by motor vehicle and motorcycle crashes; drownings, aircraft crashes, homicides, and burns are lesser causes.
• Heart attacks cause most fatalities in older travelers.
• Infections cause only 1% of fatalities in overseas travelers, but, overall, infections are the most common cause of travel-related illness.
• MEDICAL INSURANCE: Travelers are advised to obtain, prior to departure, supplemental travel health insurance with specific overseas coverage. The policy should provide for direct payment to the overseas hospital and/or physician at the time of service and include a medical evacuation benefit. The policy should also provide 24-hour hotline access to a multilingual assistance center that can help arrange and monitor delivery of medical care and determine if medevac or air ambulance services are required.
Animal Hazards: Animal hazards include snakes, centipedes, scorpions, red back spiders, mouse spiders, funnel-web spiders (particularly aggressive and possesses a potent venom that can result in human fatalities). Bites by taipans (the world’s deadliest snake) are responsible for 80% of snake bites in the Central Province and the National Capital District of Papua New Guinea. An antivenom is available (CSL Taipan Antivenom). Other possible hazards include crocodiles, tigers, panthers, bears, wild pigs, and wild cattle. Large leeches, which are not poisonous but inflict slow-healing, easily infected bites, are abundant in the swamps and streams of this country.
Avian Influenza A (Bird Flu): There have been no reported cases of avian influenza (Bird Flu) in Papua New Guinea during the current series of outbreaks.
Cholera: In 2009 PNG has reported its first cholera outbreak ever in early September. The outbreak was in Morobe province, near Lae. Details are sketchy as surveillance and accurate diagnosis of medical issues is problematic in PNG. The first cases in Bukawa were not recognised as Cholera. Source: Travel Medical Alliance (Australia).
Cholera is an extremely rare disease in travelers from developed countries. Cholera vaccine is recommended only for relief workers or health care personnel who are working in a high-risk endemic area under less than adequate sanitary conditions, or travelers who work or live in remote, endemic or epidemic areas and who do not have ready access to medical care. Canada, Australia, and countries in the European Union license an oral cholera vaccine. The cholera vaccine is not available in the United States.
• The main symptom of more severe cholera is copious watery diarrhea.
• Antibiotic therapy is a useful adjunct to fluid replacement in the treatment of cholera by substantially reducing the duration and volume of diarrhea and thereby lessening fluid requirements and shortening the duration of hospitalization.
• A single 1-gm oral dose of azithromycin is effective treatment for severe cholera in adults. This drug is also effective for treating cholera in children. (NEJM:http://content.nejm.org/cgi/content/short/354/23/2452)
Crime/Personal Security: Crime and personal security are serious concerns on Papua New Guinea. All travelers should obtain a Papua New Guinea Consular Information Sheet from the U.S. State Department prior to departure.
Dengue Fever: Countrywide risk except for the deep mountain interior over 1,000 meters elevation. Urban areas and low-lying rural areas are considered at higher risk from December through February and May through September, the monsoon seasons.
Dengue fever is a mosquito-transmitted, flu-like viral illness widespread in Oceania. Symptoms consist of sudden onset of fever, headache, muscle aches, and a rash. A syndrome of hemorrhagic shock can occur in severe cases.
• Dengue is transmitted via the bite of an infected Aedes aegypti mosquito. Aedes mosquitoes feed predominantly during daylight hours. All travelers should take measures to prevent mosquito bites. Insect-bite prevention measures include applying a DEET or picaridin-containing repellent to exposed skin and applying permethrin spray or solution to clothing and gear. There is no vaccination or medication to prevent or treat this disease.
• You should consider the diagnosis of dengue if you develop an unexplained fever during or after being in this country.
A dengue fever map is at: http://www.nathnac.org/ds/c_pages/documents/dengue_map.pdf
Filariasis: Bancroftian filariasis is highly endemic in coastal and low-lying regions and some islands off the mainland. All travelers should take measures to avoid mosquito bites.
Hepatitis: Hepatitis A vaccine is recommended for all travelers not immune to hepatitis A. The hepatitis B (HBsAg) carrier rate in the general population varies from 5% to 25%, depending on the group studied. Vaccination against hepatitis B should be considered for stays over 3 months and by short-term travelers desiring maximum protection. Travelers should be aware that hepatitis B can be transmitted by unsafe sex and the use of contaminated needles and syringes.
All travelers not previously immunized against hepatitis A should receive the vaccine. Hepatitis A is transmitted through contaminated food and water. Travelers who will have access to safe food and water are at lower risk. Those at higher risk include travelers visiting friends and relatives, long-term travelers, and those visiting areas of poor sanitation. Hepatitis E is endemic,but levels are unclear. Transmission of HEV occurs primarily through contaminated drinking water. There is no vaccine.
• The hepatitis B (HBsAg) carrier rate in the general population varies from 5% to 25%, depending on the group studied. Hepatitis B is transmitted via infected blood or bodily fluids. Travelers may be exposed by needle sharing and unprotected sex; from non-sterile medical or dental injections, and acupuncture; from unscreened blood transfusions; by direct contact with open skin lesions of an infected person. The average traveler is at low risk for acquiring this infection. Vaccination against hepatitis B is recommended for: persons having casual/unprotected sex with new partners; sexual tourists; injecting drug users; long-term visitors; expatriates, and anybody wanting increased protection against the hepatitis B virus.
• Hepatitis C is endemic at low levels, with a prevalence of 0.6% in the general population.
Influenza: Influenza is transmitted year-round in the tropics. The flu vaccine is recommended for all travelers over age 6 months.
Insect-Bite Prevention: You should exercise insect-bite prevention measures, depending on your itinerary and planned activities. For maximum protection, apply a DEET-containing repellent to exposed skin (30% concentration recommended), apply permethrin spray or solution to your clothing and gear, and sleep under a permethrin-treated bednet (if available).
• Until recently, DEET-based repellents have been the gold standard of protection against mosquito and tick bites. The CDC and the World Health Organization now recommend 20% picaridin as an effective DEET alternative. You can achieve nearly 100% bite protection by using a properly-applied DEET or picaridin skin repellent and wearing permethrin-treated clothing.
Japanese Encephalitis (JE): Low risk for most travelers, but this disease is endemic and is reported sporadically from Normanby Islands and Western Province. JE also occurs in neighboring West Papua (Papua Barat in Indonesian; formerly called Irian Jaya).
The Centers for Disease Control and Prevention (CDC) recommends JE vaccination for travelers spending more than 30 days in an endemic environment, or less than 30 days in areas with epidemic transmission. However, the use of an arbitrary cutoff cannot protect all travelers. Advance knowledge of trip details, accommodation and purpose, as well as local geography, is warranted to give adequate advice. Is travel occurring during the peak transmission season? In general, travelers to rural areas (especially where there is pig rearing and rice farming) should be vaccinated if the duration of their trip exceeds 3 to 4 weeks. They may consider vaccination for trips of shorter duration if more intense exposure is anticipated, especially during unprotected outdoor activities in the evening. Vaccination is advised for expatriates living in this country.
• Japanese encephalitis is transmitted by night-biting Culex mosquitoes. All travelers should take measures to prevent mosquito bites, especially in the evening and overnight. Insect-bite prevention measures include applying a DEET-containing repellent to exposed skin, applying permethrin spray or solution to clothing and gear, and sleeping under a permethrin-treated bednet.
Malaria: High risk is present countrywide (including urban areas) year-round at elevations below 1,800 meters. Increased risk occurs along coastal areas and in the lowlands, especially during the wetter months, December through February. Multidrug-resistant P. falciparum is reported as well chloroquine- and primaquine-resistant P. vivax. Prophylaxis with atovaquone/proguanil (Malarone), doxycycline, mefloquine (Lariam), or primaquine is recommended.
A malaria map is located on the Fit for Travel website, which is compiled and maintained by experts from the Travel Health division at Health Protection Scotland (HPS). Go to www.fitfortravel.nhs.uk and select Malaria Map from the Papua New Guinea page on the Destinations menu.
• Malaria is transmitted via the bite of an infected Anopheles mosquito. Anopheles mosquitoes feed predominantly during the hours from dusk to dawn. All travelers should take measures to prevent evening and nighttime mosquito bites. Insect-bite prevention measures include applying a DEET- or picaridin-containing repellent to exposed skin, applying permethrin spray or solution to clothing and gear, and sleeping under a permethrin-treated bednet.
Marine Hazards: Ciguatera poisoning is prevalent and can result from eating coral reef fish such as grouper, snapper, sea bass, jack, and barracuda. The ciguatoxin is not destroyed by cooking. Fatal tetrodotoxin poisoning has occurred after the consumption of porcupine fish.
Swimming-related hazards include sharks, jellyfish, the Indo-Pacific man-of-war, stonefish, scorpion fish, stingrays, sea snakes, spiny sea urchins, sharp coral and poisonous cone shells. Swimmers should take sensible precautions to avoid these hazards. Stonefish, scorpion fish and stingrays congregate in shallow water along the ocean floor and can be difficult to see. Wearing booties may help protect you, but should not be relied upon as complete protection, as many of the spines are sufficiently rigid and long to penetrate wetsuits, booties, and gloves.
• The jellyfish population appears to be increasing, due in part to overfishing of jellyfish predators, rising water temperatures, and pollution. Jellyfish travel in groups, so looking before you leap into water may be protective.
Treatment guidelines for jellyfish stings: http://www.emedicine.com/derm/topic199.htm
• To avoid a shark attack, swim or dive with a group. Avoid swimming during hours of darkness or twilight, in fog, or in murky waters. Avoid swimming in the vicinity of sea lions, harbor seals or elephant seals. Avoid swimming near the mouths of rivers where sharks hunt for fish. When diving, minimize time spent at the surface. Wearing a wetsuit and fins or lying on a surfboard creates the silhouette of a seal to a shark below you. Shallow water is not a deterrent to sharks; attacks have occurred in less than 5 ft/1.5 m of water.
The most serious hazards:
Sea snakes: Sea snake venom is highly toxic and the mortality has been reported to be 25% in untreated cases. In severe envenomations, symptoms can occur within 5 minutes, but typically evolve over 8 hours. It is possible that the victim may not have been aware of the bite, since there is little or no pain on envenomation.
Symptoms often include anxiety, muscle aching, salivation and a sensation of tongue swelling, followed by nausea, vomiting, muscle spasms, ascending paralysis, ocular palsy and sometimes loss of vision. Respiratory collapse may ensue, and the need for endotracheal intubation and mechanical ventilation should be anticipated. Sea snake antivenom (older name: antivenin) should be administered in all actual and suspected cases.
• A sea snake bite is always a medical emergency, even if the victim does not appear ill.
• You must get the victim to an emergency department, as fast as possible.
• En route, attempt to keep the bite site in a resting position, while keeping the victim as still as possible.
• Apply a broad pressure bandage over the bite about as tight as an elastic wrap to a sprained ankle. This is intended to slow the spread of the venom through the lymphatic system. Apply a splint to the limb. Make sure that arterial circulation is not cut off, by making sure fingers or toes stay pink and warm.
• Never cut open a sea snake bite and try to suck venom from the victim.
• Sea snake toxin is not inactivated by changes in temperature or pH. Application of ice, hot packs, or vinegar only wastes time.
Read more: http://emedicine.medscape.com/article/771804-overview
The box jellyfish is the most dangerous jellyfish in the world. Box jellyfish belong to the class Cubozoa, and are not a true jellyfish (Scyphozoa), although they show many similar characteristics. When people talk about the extremely dangerous Australian box jellyfish they refer to the species Chironex fleckeri. Chironex fleckeri (sometimes simply called “the box Jellyfish”), is the best-known species of box jellyfish, and is only one of a category which actually contains about 19 different species. The name sea wasp is also applied to some species of Cubozoans, including the aforementioned Chironex fleckeri. Chironex fleckeri is present in the waters of Australia, the Indo-Pacific region, including Vietnam, Papua New Guinea, the Phillipines, and Hawaii. It amy be present in New Caledonia. Their exact distribution has not been fully determined.
The other species that is known to have caused deaths is Carukia barnesi, commonly called Irukandji. This tiny jellyfish is only about thumbnail size.
• Box jellyfish stings are extremely painful, potentially lethal and require treatment with antivenom. Cardio-respiratory arrest may occur within 20 minutes of envenomation. Four other varieties of jellyfish (jimble, Carukia, mauve stinger, and hairy stinger) should also be avoided.
Box jellyfish treatment and antivenom information:
The stonefish is a rather unattractive squat fish with a mostly rough “skin” that assists its superb camouflage as it sits on old coral or debris. There is a series of erectile dorsal spines, which, with the associated venom glands, provides the creature means of envenoming potential predators. Stonefish are mostly encountered in shallow water, where they may be stepped on by accident, or picked up by the unwary. Instant and severe pain is a constant feature of stings, followed by local swelling, which may be marked, tenderness and a blue discoloration of skin surrounding the sting site. Dizziness, nausea, hypotension, collapse, cyanosis and pulmonary edema have been described, though are by no means common. Tissue ischemia at the sting site is possible.
• Antivenom: Stonefish antivenom should only be given if there is clear evidence of envenomation. It should be given only IM, not IV.
• The use of stonefish antivenom in stings by other species of scorpionfish is not clearly recommended, but there is limited evidence that it may be beneficial (e.g. possibly bullrout stings, Notesthes robusta). The potential risks of immediate and delayed adverse reactions to antivenom should be carefully considered before using this antivenom for other than stonefish stings.
Emergency treatment guidelines for marine stings are here:
Clinical Toxicology Resources
University of Adelaide
Wilderness Medicine and Field Guide to Wilderness Medicine
Other Diseases/Hazards: Angiostrongyliasis, brucellosis (low incidence), hydatid disease, helminthic infections (ascariasis, hookworm disease, and strongyloidiasis are highly endemic in urban and rural areas), paragonimiasis, leprosy (highly endemic), Lyme disease, leptospirosis, melioidosis (rare), Murray Valley encephalitis (transmitted by mosquitoes), Ross River fever (mosquito-borne; low incidence), epidemic typhus (louse-borne; low endemicity), scrub typhus (mite-borne; risk elevated in grassy rural areas; low endemicity), tuberculosis (highly endemic), typhoid fever, and yaws (reported from the Bitapaka area on New Britain Island).
Rabies: There is no reported rabies from Papua New Guinea.
Road Safety: Traffic in Papua New Guinea moves on the left. Travel on highways outside of major towns can be hazardous. Motor vehicle accidents, especially where passengers are sitting in the open bed of a pickup truck, are one of the more common causes of serious injury in Papua New Guinea. Drivers and passengers are urged to wear seatbelts whenever possible. There is no countrywide road network, roads are generally in poor repair, and flat tires occur routinely as a result of debris on the roadways. Landslides can be a problem on some stretches of the Highlands Highway between Lae and Mount Hagen during the rainy season. Public transport in Papua New Guinea is unreliable and can be hazardous.
For further advice, see the bulletin on Overseas Road Safety from Smartraveller:
Snake Bite: The incidence of venomous snake bite in PNG is among the highest of any tropical region in the world.
Most data is based on studies carried out in Central Province in PNG, where the incidence of snake bite averages 215.5 victims per 100 000 people, and each year 7.9 victims per 100 000 people die due to snake bite.
The Papuan taipan is the most dangerous snake in PNG and is responsible for the majority of snake bite admissions to Port Moresby General Hospital. This snake has the third most toxic venom of any snake in the world. There are 5 other dangerous snake species found throughout PNG, including death adders, the Papuan blacksnake, the Papuan brown snake, New Guinean small eyed snake and the Papuan mulga snake.
• The Papuan taipan lives in grasslands, savannah woodlands to an altitude of 400m, as well as village gardens and residential areas. It is active during the day, especially early to late morning and mid to late afternoon.
• Death adders also live in a wide range of habitats, and are a major cause of snakebite throughout PNG outside of Central Province. Although death adders are nocturnal, bites tend to occur during the day when the sleeping snake is accidentally stepped on, often near pathways.
• The Black snake is active in the day, and lives in coastal swamps, marshland, monsoonal forests, bamboo thickets, rubber tree groves, rainforest and sometimes savannah woodland.
• The Brown snake is very aggressive, is active during the day and can be found in grassland and woodlands
• The New Guinean small eyed snake is nocturnal and lives in wet environments, monsoonal forests, swamps, and rainforests, as well as old overgrown coconut husk piles.
There are often an increased number of snake bites reported during the wet season
(November to April).
• Always wear footwear, ideally boots
• Wear long pants tucked into the boot
• Look before you tread
Snake bite first aid: First aid involves the pressure immobilisation method. There are 2 steps.
• Pressure immobilisation bandaging (PIB)
• Firmly bandage the entire bitten limb.
First apply the pressure bandage over the bite site, then down to toes/fingers,
followed by the rest of the limb. Apply over clothes if required to minimize
movement of the limb. Immobilise the limb with splints or slings and keep the victim still. This reduces the movement of venom from the bite site into the circulation.
Note: Over 95% of snakebites involve the limbs. Rarely, bites occur on the body, neck or head. In the situation, apply direct pressure with a firm pad of cloth over the snake bite.
For all bites, organise urgent transfer to hospital for assessment and management.
Most snake bites will not result in envenomation. However, when envenomation does occur, serious illness and death can follow. Snake venom can damage the nerves, blood clotting system, muscles and kidneys. This may show as droopy eyelids, difficulty speaking, swallowing and/or breathing, paralysis; blood clotting problems and haemorrhage.
Snake venom detection kits used within the hospital setting can identify the snake type and allow the administration of the specific antivenom. When kits are not available, a polyvalent snake antivenom, covering multiple snake types, can be administered.
Antivenom is an injection given in the vein, which aims to neutralise the effects of snake venom. Unfortunately, the antivenom may not be very effective at reversing the most serious, life-threatening effects of some snake venoms, particularly Papuan taipan venom. Antivenom is only ever given in a medical setting and is given to patients who become ill after being bitten by a snake. It should never be given to people who remain well after the bite. Antivenom is very expensive in PNG and supplies are often limited. Consequently antivenom administration in PNG is often reserved for the patients who are extremely unwell.
Source: Dr Lisa Chapman Stafford, Travel Medical Alliance (Australia)
Travelers’ Diarrhea: Medium to high risk. Outside of hotels and resorts, we recommend that you boil, filter or purify all drinking water or drink only bottled water or other bottled beverages and do not use ice cubes. Avoid unpasteurized milk and dairy products. Do not eat raw or undercooked food (especially meat, fish, raw vegetables—these may transmit intestinal parasites, as well as bacteria). Peel all fruits.
• Wash your hands with soap or detergent, or use a hand sanitizer gel, before you eat. Good hand hygiene helps prevent travelers’ diarrhea.
• A quinolone antibiotic, or azithromycin, combined with loperamide (Imodium), is recommended for the treatment of diarrhea. Diarrhea not responding to antibiotic treatment may be due to a parasitic disease such as giardiasis, amebiasis, or cryptosporidiosis.
• Seek qualified medical care if you have bloody diarrhea and fever, severe abdominal pain, uncontrolled vomiting, or dehydration.
Tuberculosis (TB): Tuberculosis is highly endemic in Papua New Guinea with an annual occurrence was greater than or equal to 40 cases per 100,000 population. Tuberculosis (TB) is transmitted following inhalation of infectious respiratory droplets. Most travelers are at low risk. Travelers at higher risk include those who are visiting friends and relatives (particularly young children), long-term travelers, and those who have close contact, prolonged contact with the local population. There is no prophylactic drug to prevent TB. Travelers with significant exposure should have PPD skin testing done to evaluate their risk of infection.
Typhoid Fever: In the Southern Highlands province of Erave, a total of 1,200 people contracted typhoid fever in 2006 and ProMED reports a doubling of the number of typhoid cases from the Daru region in late 2007. Typhoid is the most serious of the Salmonella infections. Typhoid vaccine is recommended for all unvaccinated people traveling to or working in the Southern and Western Pacific, especially if visiting smaller cities, villages, or rural areas and staying with friends or relatives where exposure might occur through food or water. Current vaccines against Salmonella typhi are only 50-80% protective and do not protect against Salmonella paratyphi. Travelers should practice strict food, water and personal hygiene precautions even if vaccinated.