The island nation of Papua New Guinea is struggling to contain its first cholera outbreak in 50 years, which has killed at least 40 people and sickened 2,000 over the past several months, a top World Health Organization official said.

The disease, which has spread through several provinces, could become endemic if the government does not do more to educate people and ensure they have access to clean water, WHO representative Eigil Sorenson told The Associated Press by telephone this week.

"There is no sign the epidemic is contained," he said. "Most of the deaths have occurred in newly affected areas before awareness of the disease has reached the community."

Cholera, primarily a water-born disease that causes severe diarrhea, usually occurs in settlements with poor water sanitation.

Sorenson said the outbreak could become a major challenge for the health care system of the country, which shares a border with Indonesia.

The outbreak started in July in northeastern Morobe province, according to Enoch Posamai, executive manager of the country's Public Health Department. The disease was first reported in temporary settlements around the provincial capital of Lae, and then spread to neighboring provinces, where remote villages are now seeing cases.

WHO epidemiologist Alexander Rosewell said it was not clear why the disease had suddenly returned to the impoverished nation.

Sorenson said greater efforts were needed to get piped water to the settlements.

"The government can do more than what is being done at the moment," Posamai said. "We don't pay much attention to the whole issue of the water supply and sanitation, and particularly awareness on the part of the communities."

Posamai, who is coordinating the effort to fight the outbreak, said the government should try to ensure that all communities have proper water supplies and sanitation facilities. He said organizations such as the Red Cross, Oxfam and Medicines Sans Frontieres were helping to warn people about cholera.