Mass treatment with single-dose azithromycin for yaws

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

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Author 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
Bassat, Quique
Title Mass treatment with single-dose azithromycin for yaws
Journal name New England Journal of Medicine   Check publisher's open access policy
ISSN 1533-4406
0028-4793
Publication date 2015-02-19
Year available 2015
Sub-type Article (original research)
DOI 10.1056/NEJMoa1408586
Open Access Status File (Publisher version)
Volume 372
Issue 8
Start page 703
End page 710
Total pages 8
Place of publication Waltham, United States
Publisher Massachussetts Medical Society
Language eng
Subject 2700 Medicine
Abstract 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.
Formatted 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.
Q-Index Code C1
Q-Index Status Confirmed Code
Grant ID 001
R01 AI042143
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2016 Collection
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