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Yaws
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==Eradication== [[File:COLLECTIE TROPENMUSEUM Een Europeaan vaccineert Indonesische patiënten met neosalvarsaan tegen de ziekte framboesia TMnr 10006691.jpg|250px|thumb|European doctor treats an Indonesian woman for yaws, early- to mid-20th-century.<!--no date on photo, but film processing method pretty much eliminates the late 20th and 21st century. Also seems fairly clear from the objects in the picture...-->]] [[File:Anbumani Ramadoss and the Minister of State for Health & Family Welfare, Smt. Panabaka Lakshmi releasing the document "Yaws elimination in India – a step towards eradication", in New Delhi on September 19, 2006.jpg|thumb|upright=1.5|After eliminating yaws in India, the Indian government releases a report called "Yaws elimination in India – a step towards eradication". 2006]] {{Multiple image | width = | footer = Yaws before and after treatment with [[neosalvarsan]], an obsolete treatment | image1 = COLLECTIE TROPENMUSEUM Een framboesia tropica-patiënt voor de behandeling met neosalvarsaan TMnr 10006692.jpg | alt1 = | caption1 = | image2 = COLLECTIE TROPENMUSEUM Een framboesia tropica-patiënt na de behandeling met neosalvarsaan TMnr 10006693.jpg | alt2 = | caption2 = }} A series of WHO yaws control efforts, which began shortly after the creation of the WHO in 1948, succeeded in eradicating the disease locally from many countries, but have not lasted long enough to eradicate it globally. The Global Control of Treponematoses (TCP) programme by the WHO and the [[United Nations Children's Fund|UNICEF]] was launched in 1952 and continued until 1964. A 1953 questionnaire-based estimate was that there were 50–150 million yaws cases in 90 countries.<ref name="global"/> The global prevalence of yaws and the other endemic treponematoses, [[nonvenereal endemic syphilis|bejel]] and [[pinta (disease)|pinta]], was reduced by the Global Control of Treponematoses (TCP) programme between 1952 and 1964 from about 50 million cases to about 2.5 million (a 95% reduction).<ref name="who_yaws2012">{{cite web |title=WHO renews efforts to achieve global eradication of yaws by 2020 |url=https://www.who.int/news/item/19-10-2012-who-renews-efforts-to-achieve-global-eradication-of-yaws-by-2020}}</ref> However, "premature integration of yaws and other endemic treponematoses activities into weak primary health-care systems, and the dismantling of the vertical eradication programmes after 1964, led to the failure to finish with the remaining 5% of cases"<ref name="who_yaws2012"/> and also led to a resurgence of yaws in the 1970s, with the largest number of case found in the Western Africa region.<ref name=Capuano2011>{{cite journal |last1=Capuano |first1=C |last2=Ozaki |first2=M |title=Yaws in the Western Pacific Region: A Review of the Literature |journal=Journal of Tropical Medicine |year=2011 |volume=2011 |page=642832 |pmid=22235208 |doi=10.1155/2011/642832 |doi-access=free |pmc=3253475}}</ref><ref name=Rinaldi2008>{{cite journal |author=Rinaldi A |title=Yaws: a second (and maybe last?) chance for eradication |journal=[[PLOS Neglected Tropical Diseases]] |volume=2 |issue=8 |page=e275 |year=2008 |pmid=18846236 |doi=10.1371/journal.pntd.0000275 |doi-access=free |pmc=2565700}}</ref> Following the cessation of this program, resources, attention and commitment for yaws gradually disappeared, and yaws remained at a low prevalence in parts of Asia, Africa, and the Americas with sporadic outbreaks. With few cases, mainly affecting poor, remote communities with little access to treatment, yaws became poorly known, yaws knowledge and skills died out even among health professionals, and yaws eradication was not seen as a high priority. Although a single injection of long-acting penicillin or other [[beta-lactam]] antibiotic cures the disease and is widely available, and the disease is highly localised, many eradication campaigns ended in complacency and neglect; even in areas where transmission was successfully interrupted, re-introduction from infected areas occurred. Yaws eradication remained a priority in South-East Asia.<ref name="return">{{cite journal |last1=Asiedu |first1=Kingsley |title=The return of yaws |journal=Bulletin of the World Health Organization |date=July 2008 |volume=86 |issue=7 |pages=507–8 |pmid=18670660 |doi=10.2471/blt.08.040708 |doi-access=free |pmc=2647480}}</ref><ref name=Asiedu2008/> In 1995, the WHO estimated 460,000 worldwide cases.<ref name=WHO2017>{{cite web |title=Integrating neglected tropical diseases in global health and development |url=http://www.who.int/neglected_diseases/resources/9789241565448/en/ |access-date=12 September 2017}}</ref> In the Philippines, yaws stopped being listed as a [[notifiable disease]] in 1973; as of 2020, it is still present in the country.<ref name=Philippines>{{cite journal |last1=Dofitas |first1=BL |last2=Kalim |first2=SP |last3=Toledo |first3=CB |last4=Richardus |first4=JH |title=Yaws in the Philippines: first reported cases since the 1970s. |journal=Infectious Diseases of Poverty |date=30 January 2020 |volume=9 |issue=1 |pages=1 |pmid=31996251 |doi=10.1186/s40249-019-0617-6 |doi-access=free |pmc=6990502}}</ref> [[India]] implemented a successful yaws eradication campaign that resulted in the 2016 certification by the WHO that India was free of yaws.<ref name=":0">{{cite journal |last=Friedrich |first=M. J. |title=WHO Declares India Free of Yaws and Maternal and Neonatal Tetanus |date=20 September 2016 |journal=JAMA |volume=316 |issue=11 |pages=1141 |issn=1538-3598 |pmid=27654592 |doi=10.1001/jama.2016.12649 |url=https://pubmed.ncbi.nlm.nih.gov/27654592}}</ref><ref name="Asiedu2008">{{cite journal |author=Asiedu K |title=Yaws eradication: past efforts and future perspectives |journal=[[Bulletin of the World Health Organization]] |volume=86 |issue=7 |pages=499–500 |year=2008 |last2=Amouzou |first2=B |last3=Dhariwal |first3=A |last4=Karam |first4=M |last5=Lobo |first5=D |last6=Patnaik |first6=S |last7=Meheus |first7=A |pmid=18670655 |doi=10.2471/BLT.08.055608 |pmc=2647478 |url=https://www.who.int/bulletin/volumes/86/7/08-055608/en/index.html |access-date=2 April 2009 |url-status=dead |archive-url=https://web.archive.org/web/20090421201956/http://www.who.int/bulletin/volumes/86/7/08-055608/en/index.html |archive-date=21 April 2009}}</ref><ref>{{cite web |archiveurl=https://web.archive.org/web/20081108054616/http://www.searo.who.int/LinkFiles/Yaws_yaws.pdf |title=World Health Organization South-East Asia | World Health Organization |archivedate=8 November 2008 |website=who.int |url=https://www.who.int/southeastasia |url-status=dead}}</ref> In 1996 there were 3,571 yaws cases in India; in 1997 after a serious elimination effort began the number of cases fell to 735. By 2003, the number of cases was 46. The last clinical case in India was reported in 2003 and the last latent case in 2006;<ref name="Akbar2011">{{cite news |last=Akbar |first=S |title=Another milestone for India: Yaws eradication |date=7 August 2011 |work=The Asian Age |url=http://www.asianage.com/health-fitness/another-milestone-india-yaws-eradication-116 |access-date=5 August 2012 |url-status=live |archive-url=https://web.archive.org/web/20111011105128/http://www.asianage.com/health-fitness/another-milestone-india-yaws-eradication-116 |archive-date=11 October 2011}}</ref> certification by the WHO was achieved in 2016.<ref name=":0"/><ref>{{cite journal |title=Yaws Eradication Programme (YEP) |publisher=NCDC, Dte. General of Health Services, Ministry of Health & Family Welfare, Government of India |url=http://www.ncdc.gov.in/index3.asp?sslid=330&subsublinkid=304 |access-date=18 January 2014 |url-status=live |archive-url=https://web.archive.org/web/20140202175956/http://www.ncdc.gov.in/index3.asp?sslid=330&subsublinkid=304 |archive-date=2 February 2014}}</ref> In 2012 the WHO officially targeted yaws for eradication by 2020 following the development of orally administered azithromycin as a treatment, but missed that target.<ref name=WHO2012>{{cite journal |title=Eradication of yaws – the Morges Strategy. |journal=Weekly Epidemiological Record |volume=87 |issue=20 |year=2012 |format=pdf |url=https://www.who.int/wer/2012/wer8720.pdf?ua=1 |access-date=6 May 2014 |url-status=live |archive-url=https://web.archive.org/web/20140508031005/http://www.who.int/wer/2012/wer8720.pdf?ua=1 |archive-date=8 May 2014}}</ref><ref name=Maurice2012>{{cite journal |last=Maurice |first=J |title=WHO plans new yaws eradication campaign |journal=The Lancet |year=2012 |pages=1377–78 |volume=379 |issue=9824 |pmid=22509526 |doi=10.1016/S0140-6736(12)60581-9 |doi-access=free |s2cid=45958274}}</ref><ref name=Rinaldi2012>{{cite journal |author=Rinaldi A |title=Yaws eradication: facing old problems, raising new hopes |journal=[[PLOS Neglected Tropical Diseases]] |volume=6 |issue=11 |page=e18372 |year=2012 |pmid=23209846 |doi=10.1371/journal.pntd.0001837 |doi-access=free |pmc=3510082}}</ref> The Morges approach (named after [[Morges]], Switzerland, where a meeting on it was held<ref>{{cite web |title=Summary report of a consultation on the eradication of yaws |website=WHO |url=http://www9.who.int/neglected_diseases/resources/who_htm_ntd_idm_2012.2/en/ |url-status=dead |archive-url=https://web.archive.org/web/20170422173656/http://www.who.int/neglected_diseases/resources/who_htm_ntd_idm_2012.2/en/ |archive-date=22 April 2017}}</ref>) involved mass treatment with [[azithromycin]]. This was safe, but ran into problems with antibiotic resistance, and did not fully interrupt transmission.<ref name="advances"/> The discovery that oral antibiotic [[azithromycin]] can be used instead of the previous standard, injected [[penicillin]], was tested on [[Lihir Island]] from 2013 to 2014;<ref>[http://www.trust.org/item/20130509121147-ausc2/ Drug and a syphilis test offer hope of yaws eradication] {{Webarchive|url=https://web.archive.org/web/20130813211123/http://www.trust.org/item/20130509121147-ausc2/ |date=13 August 2013}}, Thomas Reuter Foundation, accessed 10 May 2013</ref> a single oral dose of the macrolide antibiotic reduced disease prevalence from 2.4% to 0.3% at 12 months.<ref>{{cite journal |vauthors=Mitjà O, Houinei W, Moses P, Kapa A, Paru R, Hays R, Lukehart S, Godornes C, Bieb SV, Grice T, Siba P, Mabey D, Sanz S, Alonso PL, Asiedu K, Bassat Q |title=Mass treatment with single-dose azithromycin for yaws |journal=The New England Journal of Medicine |volume=372 |issue=8 |pages=703–10 |date=February 2015 |pmid=25693010 |doi=10.1056/NEJMoa1408586 |hdl=2445/68722 |hdl-access=free |s2cid=5762563}}</ref> The WHO now recommends both treatment courses (oral azithromycin and injected penicillin), with oral azithromycin being the preferred treatment.<ref name=WHO>{{cite web |title=Yaws |publisher=World Health Organization |date=12 January 2023 |accessdate=24 May 2024 |url=https://www.who.int/news-room/fact-sheets/detail/yaws}}</ref> {{as of|2020}}, there were 15 countries known to be endemic for yaws, with the recent discovery of endemic transmission in [[Liberia]] and the [[Philippines]].<ref name="who_yaws">{{cite web |title=Yaws |website=who.int |url=https://www.who.int/news-room/fact-sheets/detail/yaws}}</ref> In 2020, 82,564 cases of yaws were reported to the WHO, and 153 cases were confirmed. The majority of the cases are reported from [[Papua New Guinea]] and with over 80% of all cases coming from one of three countries in the 2010–2013 period: Papua New Guinea, Solomon Islands, and Ghana.<ref name="who_yaws"/><ref>{{cite journal |last1=Mitjà |first1=Oriol |last2=Marks |first2=Michael |last3=Konan |first3=Diby J P |last4=Ayelo |first4=Gilbert |last5=Gonzalez-Beiras |first5=Camila |last6=Boua |first6=Bernard |last7=Houinei |first7=Wendy |last8=Kobara |first8=Yiragnima |last9=Tabah |first9=Earnest N |last10=Nsiire |first10=Agana |last11=Obvala |first11=Damas |title=Global epidemiology of yaws: a systematic review |date=19 May 2015 |journal=The Lancet. Global Health |volume=3 |issue=6 |pages=e324–e331 |last16=Vestergaard |first16=Lasse S |last17=Bassat |first17=Quique |last18=Asiedu |first18=Kingsley |last15=Utzinger |first15=Jürg |last14=Zaixing |first14=Zhang |last13=Djupuri |first13=Rita |last12=Taleo |first12=Fasiah |pmid=26001576 |doi=10.1016/S2214-109X(15)00011-X |pmc=4696519}}</ref> A WHO meeting report in 2018 estimated the total cost of elimination to be US$175 million (excluding Indonesia).<ref name="who2018_yaws_meeting">{{cite book |title=Report of a global meeting on yaws eradication surveillance, monitoring and evaluation: Geneva, 29–30 January 2018 |date=2018 |publisher=World Health Organization |last1=Organization |first1=World Health |hdl=10665/276314}}</ref> In the South-East Asian Regional Office of the WHO, regional eradication efforts are focused on the remaining endemic countries in this region ([[Indonesia]] and [[East Timor]])<ref>{{cite journal |last1=Asiedu |first1=Kingsley |last2=Amouzou |first2=Bernard |last3=Dhariwal |first3=Akshay |last4=Karam |first4=Marc |last5=Lobo |first5=Derek |last6=Patnaik |first6=Sarat |last7=Meheus |first7=André |title=Yaws eradication: past efforts and future perspectives |journal=Bulletin of the World Health Organization |date=July 2008 |volume=86 |issue=7 |pages=499–499A |pmid=18670655 |doi=10.2471/BLT.08.055608 |pmc=2647478}}</ref><ref>{{cite book |title=Regional strategic plan for elimination of yaws from South-East Asia Region 2012-2020 |date=2013 |publisher=WHO Regional Office for South-East Asia |hdl=10665/205830}}</ref> after [[India]] was declared free of yaws in 2016.<ref>{{cite journal |last1=Friedrich |first1=M.J. |title=WHO Declares India Free of Yaws and Maternal and Neonatal Tetanus |journal=JAMA |date=20 September 2016 |volume=316 |issue=11 |pages=1141 |pmid=27654592 |doi=10.1001/jama.2016.12649}}</ref><ref name="who2018_yaws_meeting"/> Although yaws is highly localized and [[eradication of infectious diseases|eradication]] may be feasible, humans may not be the only [[reservoir of infection]].<ref name=Capuano2011/> {{Clear}}
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