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Total community treatment with azithromycin effective in yaws reduction
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A single round of total community treatment with azithromycin in a subdistrict of Ghana endemic for yaws was effective in reducing the prevalence of this disease 12 months after treatment, according to study results published in PLoS Neglected Tropical Diseases.
“Although one round of [total community treatment (TCT)] was unable to stop transmission, we achieved a significant reduction in the disease,” Cynthia Kwakye-Maclean, program manager of the Ghana Yaws Eradication Programme, said in a news release. “With little effort through total targeted treatment, or perhaps another round of TCT, we could possibly end yaws.”
In 2012, WHO published a yaws eradication strategy that recommended TCT (equivalent to mass treatment for other neglected tropical diseases) of affected communities with single doses of azithromycin. Ongoing active surveillance, case finding and treating missed, new or imported cases and their contacts are part of follow-up.
A prospective, observational study was conducted by the researchers in a subdistrict of Ghana that is highly endemic for yaws between October 2013 and December 2014.
The researchers surveyed school children aged 5 to 15 years for yaws seroprevalence and prevalence of skin lesions before and 1 year after TCT. The baseline survey was given at 10 primary schools in the subdistrict, whereas the post-TCT survey was given at 10 other primary schools.
Local health care workers or members of national yaws eradication program supervised 13 teams of two trained volunteers from affected communities who conducted the TCT program.
Between November and December 2013, there was a 5-day period in which the teams offered a single oral dose of 30 mg/kg per body weight of azithromycin to all members of 36 targeted communities who were aged 6 months and older. Children aged younger than 6 months received the tablets crushed and mixed with water. During the treatment period, 89% of 16,287 residents in the subdistrict received azithromycin.
Children who received the azithromycin had a decrease in the prevalence of dual seropositivity from 10.9% to 2.2% (OR = 0.19; 95% CI, 0.09-0.37). There was a reduction of prevalence of serologically confirmed skin lesions consistent with active yaws from 5.7% to 0.6% (OR = 0.10; 95% CI, 0.25-0.35).
Resistance to macrolides against Treponema pallidum subsp. pertenue was not evident at treatment follow-up.
“Our findings provide additional evidence that one round of TCT with azithromycin with high coverage, around 90%, as part of the WHO Morges Strategy, is highly effective in providing a sustained and significant decrease in the prevalence of yaws 12 months after mass treatment from endemic communities, even if they adjoin other untreated endemic areas,” the researchers concluded. “Because 6-monthly resurveys using field staff may be costly, perhaps, if the initial coverage is more than 90%, in some places, a practical approach is to use trained village volunteers for ongoing active community surveillance and health promotion activities for yaws, especially, in the post-TCT phase similar to the experience of the guinea worm eradication program.” – by Bruce Thiel
Disclosures: The authors report no relevant financial disclosures.
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