Author:
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Mitjà Villar, Oriol; Houinei, Wendy; Moses, Penias; Kapa, August; Paru, Raymond; Hays, Russell; Lukehart, Sheila A.; Godornes, Charmie; Bieb, Sibauk Vivaldo; Grice, Tim; Siba, Peter; Mabey, David C. W.; Sanz, Sergi; Alonso, Pedro; Asiedu, Kingsley; Bassat Orellana, Quique
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Abstract:
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BACKGROUND: Mass treatment with azithromycin is a central
component of the new World Health Organization (WHO) strategy to
eradicate yaws. Empirical data on the effectiveness of the
strategy are required as a prerequisite for worldwide
implementation of the plan. METHODS: We performed repeated
clinical surveys for active yaws, serologic surveys for latent
yaws, and molecular analyses to determine the cause of skin
ulcers and identify macrolide-resistant mutations before and 6
and 12 months after mass treatment with azithromycin on a Papua
New Guinean island on which yaws was endemic. Primary-outcome
indicators were the prevalence of serologically confirmed active
infectious yaws in the entire population and the prevalence of
latent yaws with high-titer seroreactivity in a subgroup of
children 1 to 15 years of age. RESULTS: At baseline, 13,302 of
16,092 residents (82.7%) received one oral dose of azithromycin.
The prevalence of active infectious yaws was reduced from 2.4%
before mass treatment to 0.3% at 12 months (difference, 2.1
percentage points; P<0.001). The prevalence of high-titer
latent yaws among children was reduced from 18.3% to 6.5%
(difference, 11.8 percentage points; P<0.001) with a
near-absence of high-titer seroreactivity in children 1 to 5
years of age. Adverse events identified within 1 week after
administration of the medication occurred in approximately 17%
of the participants, included nausea, diarrhea, and vomiting,
and were mild in severity. No evidence of emergence of
resistance to macrolides against Treponema pallidum subspecies
pertenue was seen. CONCLUSIONS: The prevalence of active and
latent yaws infection fell rapidly and substantially 12 months
after high-coverage mass treatment with azithromycin, with the
reduction perhaps aided by subsequent activities to identify and
treat new cases of yaws. Our results support the WHO strategy
for the eradication of yaws. (Funded by Newcrest Mining and
International SOS; YESA-13 ClinicalTrials.gov number,
NCT01955252.). |