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N Engl J Med. 2015 Feb 19;372(8):703-10. doi: 10.1056/NEJMoa1408586.

Mass treatment with single-dose azithromycin for yaws.

Author information

1
From Lihir Medical Center, International SOS, Newcrest Mining, Lihir Island (O.M., P.M., A.K., R.P.), the Disease Control Branch, National Department of Health, Port Moresby (W.H., S.V.B.), and the Papua New Guinea Institute of Medical Research, Goroka, Eastern Highland Province (P.S.) - all in Papua New Guinea; Barcelona Institute for Global Health, Barcelona Center for International Health Research, Hospital Clinic, University of Barcelona, Barcelona (O.M., S.S., P.L.A., Q.B.); the College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, QLD (R.H.), and the Centre for Social Responsibility in Mining, Sustainable Minerals Institute, University of Queensland, Brisbane (T.G.) - both in Australia; the Departments of Medicine (S.L., C.G.) and Global Health (S.L.), University of Washington, Seattle; the Department of Clinical Research, London School of Hygiene and Tropical Medicine, London (D.M.); and the Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva (K.A.).

Abstract

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.).

PMID:
25693010
DOI:
10.1056/NEJMoa1408586
[Indexed for MEDLINE]
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