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Published on: November 16, 2016
Trial of Three Rounds of Mass Azithromycin Administration for Yaws Eradication
Lucy N John1, Camila G Beiras1, Wendy Houinei1
1From the National Department of Health, Aopi Centre (L.N.J., W.H.), the School of Medicine and Health Sciences, University of Papua New Guinea (L.N.J., O.M.), and the World Health Organization Representative Office in Papua New Guinea (J.K.W.), Port Moresby, the New Ireland Provincial Health Authority, Kavieng (M.S., E.J., E.M.), and Lihir Medical Center, International SOS, Lihir Island (R.K., O.M.) - all in Papua New Guinea; the Infectious Diseases Department and Fight AIDS and Infectious Diseases Foundation, Hospital Universitari Germans Trias i Pujol (L.N.J., C.G.B., D.O., B.C., M.V.-M., O.M.), the Genomes for Life-Genomes of Catalonia Lab Group, Institute for Health Science Research Germans Trias i Pujol (I.G.-F.), and the IrsiCaixa AIDS Research Institute (B.C.), Badalona, the Barcelona Institute for Global Health, Faculty of Medicine, University of Barcelona (L.N.J.), and the Institute for Research in Biomedicine, Barcelona Institute of Science and Technology (I.G.-F.), Barcelona, and Universitat de Vic-Universitat Central de Catalunya, Vic (B.C., O.M.) - all in Spain; the Department of Biology, Faculty of Medicine, Masaryk University, Brno, Czech Republic (M. Medappa, P.P., D.Š.); the Parasites and Microbes Programme, Wellcome Sanger Institute, Hinxton (M.A.B.), and the Clinical Research Department, London School of Hygiene and Tropical Medicine, and the Hospital for Tropical Diseases, University College London Hospitals, London (M. Marks) - all in the United Kingdom; the Department of Medicine, Division of Allergy and Infectious Diseases, and the Department of Global Health, University of Washington, Seattle (L.G.); and the Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (E.Q.M.).
Three rounds of mass azithromycin administration significantly reduced yaws prevalence compared to targeted treatment. Continued monitoring for antimicrobial resistance is crucial for yaws eradication efforts.
Area of Science:
- Tropical medicine
- Infectious diseases
- Public health
Background:
- Yaws, caused by *Treponema pallidum* subspecies *pertenue*, requires improved control strategies.
- Effective yaws elimination and eradication methods are essential.
Purpose of the Study:
- To compare the effectiveness of three rounds of mass azithromycin administration versus one round of mass administration followed by targeted treatment for yaws control.
- To assess the impact on active and latent yaws prevalence in Papua New Guinea.
Main Methods:
- An open-label, cluster-randomized trial involving 38 wards in Papua New Guinea.
- Intervention groups: Control (1 round mass + 2 targeted treatments) vs. Experimental (3 rounds mass azithromycin).
- Primary endpoints: Prevalence of active yaws and latent yaws in children at 18 months.
Main Results:
- The experimental group showed a significantly greater reduction in active yaws prevalence (0.04%) compared to the control group (0.16%).
- Latent yaws prevalence was lower in the experimental group (3.28%) than the control group (6.54%).
- Three cases of macrolide-resistant yaws emerged in the experimental group.
Conclusions:
- Three rounds of mass azithromycin administration are more effective in reducing community yaws prevalence than a strategy combining mass and targeted treatment.
- Surveillance for antimicrobial resistance is critical to prevent the spread of resistant *Treponema pallidum* subspecies *pertenue* strains.
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