Mass Treatment for Yaws

Larry M. Baddour, MD reviewing Mitjà O et al. N Engl J Med 2015 Feb 19.

On a Papua New Guinean island where yaws was endemic, one round of oral azithromycin significantly reduced the prevalence of this disease.

Yaws — a highly contagious disease caused by Treponema pallidum subsp. pertenue — primarily afflicts children in poor rural areas of the tropics. The WHO has developed a strategy for community-wide treatment in endemic areas. Might oral azithromycin, which has demonstrated efficacy for treatment of yaws, replace long-acting injectable penicillin for use in such campaigns?

To answer this question, researchers conducted a longitudinal study in Lihir Island, Papua New Guinea (population, ~16,000), which has a relatively high prevalence of yaws. Residents aged ≥2 months were offered a single dose of azithromycin. Clinical and serologic screening to detect active infectious yaws and latent disease was performed at baseline and at 6 and 12 months following treatment.

Eighty-three percent of the inhabitants received the single azithromycin dose. Twelve months later, the prevalences of active infectious yaws overall, and of high-titer latent yaws among children aged 1 to 15 years, were dramatically reduced from baseline (from 2.4% to 0.3% and from 18.3% to 6.5%, respectively; P<0.001 for both). Household surveys conducted 1 week after treatment identified no serious drug-related adverse events. Samples collected at the three time points showed no evidence of macrolide-resistance mutations.

Citation(s):

Mitjà O et al. Mass treatment with single-dose azithromycin for yaws. N Engl J Med 2015 Feb 19; 372:703.