Publications

Mass Treatment with Single-Dose Azithromycin for Yaws

CSRM Contributors:

Other Contributors:

  • Oriol Mitj√†, Wendy Houinei, Penias Moses, August Kapa, Raymond Paru, Russell Hays, Sheila Lukehart, Charmie Godornes, Sibauk Vivaldo Bieb, Tim Grice, Peter Siba, David Mabey, Sergi Sanz, Pedro L. Alonso, Kingsley Asiedu and Quique Bassat

Published by: New England Journal of Medicine

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.

CITATION

Mitja, Oriol, Houinei, Wendy, Moses, Penias, Kapa, August, Paru, Raymond, Hays, Russell, Lukehart, Sheila, Godornes, Charmine, Bieb, Sibauk Vivaldo, Grice, Tim, Siba, Peter, Mabey, David, Sanz, Sergi, Alonso, Pedro L, Asiedu, Kingsley and Bassat, Quique (2015) Mass treatment with single-dose azithromycin for yaws. New England Journal of Medicine, 372 8: 703-710. doi:10.1056/NEJMoa1408586