Yaws in Oceania: New Tools for the Global Eradication Campaign
Yaws is a chronic infectious disease caused by Treponema pallidum subsp. pertenue, which causes disease of the skin, bones, and joints. Most cases are seen in young children living in remote communities in warm humid environments. The Pacific is a major f
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Yaws in Oceania: New Tools for the Global Eradication Campaign Oriol Mitjà and Michael Marks Abstract
Yaws is a chronic infectious disease caused by Treponema pallidum subsp. pertenue, which causes disease of the skin, bones, and joints. Most cases are seen in young children living in remote communities in warm humid environments. The Pacific is a major focus of yaws with Papua New Guinea, the Solomon Islands, and Vanuatu all classified as endemic. Azithromycin is now the first-line treatment for yaws, and community mass treatment with azithromycin is the central component of the new WHO yaws eradication strategy. Keywords
Yaws • Treponematosis • Eradication • Benzathine penicillin • Azithromycin
Introduction Yaws is a chronic infectious disease caused by Treponema pallidum subsp. pertenue, which is spread by skin-to-skin contact in warm humid environments. The disease consists of primary, secondary, and tertiary phases. The typical first sign of infection in the Pacific is a solitary ulcer, and bone involvement seems more common in this region than in other endemic regions of the world. Yaws has not been eliminated from Oceania despite previous control efforts. This infection remains endemic in Papua New Guinea (PNG), the Solomon Islands, and Vanuatu. Infections occur particularly among school-aged children, including a high proportion of cases in the secondary stage. The discovery that a single dose of oral azithromycin is effective in the treatment of yaws has prompted renewed interest in eradicating the disease from Oceania.
O. Mitjà, MD, PhD, DTMH (*) Barcelona Institute for Global Health, Hospital Clinic, University of Barcelona, Barcelona, Spain e-mail: [email protected] M. Marks, MBBS, MSc Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK © Springer International Publishing Switzerland 2016 A. Loukas (ed.), Neglected Tropical Diseases - Oceania, Neglected Tropical Diseases, DOI 10.1007/978-3-319-43148-2_5
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The aim of treatment of yaws is both to halt the progression of disease by curing the infection and to stop transmission to susceptible individuals. Tissue injury occurring during the early stages of infection resolves completely following adequate therapy, but tissue damage occurring during the late stages of infection is irreversible (Mitjà et al. 2013).
Epidemiology Yaws was the first disease to be targeted for eradication by the World Health Organization (WHO), and mass screening and treatment programs led by WHO and UNICEF in the 1950s reduced the global prevalence by more than 95 % (Perine et al. 1984). It has since reemerged as an important public health problem in several regions of the world, including Oceania. The Pacific represents a major focus of yaws cases worldwide. PNG (19,710 cases in 2013) and the Solomon Islands (14,909 in 2013) consistently report the most cases in the world. Vanuatu (1198 cases in 2013) is also affected. Close to 100 % of the population is
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