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[JAKARTA] The WHO has announced that it will replace its current yaws disease strategy of using penicillin injections with administering oral antibiotics, as part of efforts to eradicate the disfiguring illness by 2020.

The WHO announced its decision to shift to using the oral antibiotic azithromycin at a meeting at its Geneva, Switzerland, headquarters earlier this month (5–7 March) after researchers in Papua New Guinea found this method was just as effective as penicillin injections. Their research was published in The Lancet earlier this year (28 January).

Kingsley Asiedu, a leading yaws expert with the WHO, told SciDev.Net that an oral tablet is easier and simpler to administer, especially for children.

"The use of azithromycin is also feasible for developing countries because of the availability of a generic version — which [costs] only 25 US cents for a 500 milligram tablet," he added.

Yaws is a bacterial skin disease that can cause extensive disfigurement — particularly of the nose — and other disabilities unless treated early. It is most common in communities with poor sanitation, and the majority of infections occur in children under the age of 15.

It was nearly eliminated half a century ago after a UN-led control project to deliver benzathine penicillin injections cut the number of cases from 50 million in the 1950s to just 2.5 million by 1964.

But the success of the UN programme was also its undoing — by the 1990s few people had even heard of yaws, and eradication efforts were neglected.

Today the disease has footholds in Indonesia, Papua New Guinea, the Solomon Islands, Timor Leste and Vanuatu, and Sub-Saharan African countries including Cameroon, Congo, Ghana, Sierra Leone and Togo. There are also pockets of incidence in the Amazon region.

It is not known how many people are infected with yaws disease, but the WHO is part of a global initiative to eradicate it by 2020. The WHO is coordinating the initiative's implementation, in collaboration with international donors and governments in countries where the disease remains entrenched.

I Nyoman Kandun, an epidemiologist from Indonesia, said eradication efforts needed to involve every relevant level of government, right down to district level.

"The problem in Indonesia is weak commitment — both in [the] central and district governments," said Nyoman, adding that eradication efforts would also need to address poverty and access to clean water.

Tjandra Yoga Aditama, director of General Disease Control and Environmental Health at Indonesia's Ministry of Health, told SciDev.Net that the country was keen to assist the WHO in eradicating yaws, and had allocated a budget to administer azithromycin in Southern Timor, where there was a high incidence of the disease.  

Link to abstract in The Lancet


The Lancet doi:10.1016/S0140-6736(11)61624-3 (2012)

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