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Background: The Balimo region in Papua New Guinea has previously been identified as melioidosis-endemic with a predilection for children. Where health resources are scarce, seroepidemiology can be used to assess exposure to Burkholderia pseudomallei and therefore risk of acquiring melioidosis. Methods: Logistic regression was used to determine associations between indirect haemagglutination assay (IHA) seroreactivity with environmental and demographic/cultural factors to aid in determining risk factors associated with exposure to B. pseudomallei in children. Results: Of the 968 participants, 92.9% (899/968) were children, representing the majority of the community school population in the immediate Balimo region. Of these, 24.6% (221/899) were seropositive. Bathing in the lagoon (OR=2.679), drinking from the well or lagoon (OR=1.474), and being a member of the Siboko (OR=1.914) or Wagumisi (OR=1.942) clans were significantly associated with seropositivity. In the multivariate analysis, drinking from awell or lagoon (OR=1.713), and the Siboko (OR=2.341) and Wabadala (OR=2.022) clans were associated with seropositivity. Conclusions: This study in children supports observations that interactions with groundwater in this region are risk factors in acquiring melioidosis. Public health measures intended to limit this exposure may help reduce the risk of acquiring melioidosis in this remote community. Associations with clan structure may provide more cultural specific insights, however this requires further elucidation. [ABSTRACT FROM AUTHOR]

Melioidosis is being increasingly recognized as an important cause of severe, acute community-acquired pneumonia in various tropical regions. The chronic form of melioidosis can also mimic tuberculosis. Studies have established that, while uncommon in the Port Moresby region, melioidosis is an important cause of pneumonia and sepsis in the Balimo region of Western Province. Phylogenetic analyses of strains of Burkholderia pseudomallei from Papua New Guinea have shown them to be more closely related to strains of B. pseudomallei from Australia than to strains from Southeast Asia. This is consistent with the proposed origins of B. pseudomallei in Australia, with subsequent spread out of Australia to Southeast Asia during the last ice age. Further surveillance across Papua New Guinea is likely to unmask other locations where B. pseudomallei occurs in the environment and where melioidosis is currently not being diagnosed.