Mass treatment with azithromycin may be effective in eradicating yaws

1. Mass treatment with single-dose azithromycin was successful in decreasing the prevalence of active and latent yaws.

Evidence Rating Level: 1 (Excellent)      

Study Rundown: Yaws is an infectious disease caused by Treponema pallidum pertuneu. It is usually spread by skin-to-skin contact and mainly affects children in humid tropical regions. The disease is chronic, relapsing, and can result in disfiguring and painful lesions of the skin and bones. A major campaign in the 1950s and 1960s used mass treatment of affected communities with long-acting, injectable penicillin to eradicate Yaws. They were able to reduce the number of cases by 95% worldwide. Recently, however, the disease has reappeared in Africa, Asia, and the western Pacific.

This study was conducted to evaluate the effectiveness of this strategy on the population of Lihir Island in Papua New Guinea. The study found that one round of mass treatment was able to significantly reduce the transmission and endemicity of yaws in villages with high rates of infection. Of importance, the study found that mass treatment of 80% of the population was not adequate to eliminate all transmission of the disease, underlying the importance of 100% coverage in future treatments. In addition, this study was conducted on island communities, where eradication of disease is easier to achieve than on the mainland. These factors would need to be addressed as the WHO continues this initiative to eradicate yaws.

Click to read the study in NEJM

Relevant Reading: Yaws

In-Depth: This study was conducted from April 2013 to May 2014 in the villages of Lihir Island, New Ireland Province, Papua New Guinea. 83.8% of the population older than 2 months of age were offered a single oral dose of azithromycin. They found that the prevalence of infectious active yaws fell from 2.4% at baseline to 0.3% at 6 months and remained at 0.3% at 12 months (p<0.001). The prevalence of high-titer latent yaws decreased from 18.3% at baseline to 6.5% at 12 months (p<0.001).

54 participants of 316 surveyed (17.1%) reported adverse events. All adverse events were mild: nausea or abdominal pain, diarrhea, and vomiting. Of the 28 villages the study covered, 81.8% were screened by 6 months and 82.2% at 12 months.

Image: PD

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