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Department of Control of Neglected Tropical Diseases World Health Organization, Geneva

Eradication of Yaws 2020. NTD STAG MEETING 8-9 April 2014, WHO HQ Kingsley Asiedu. Update II. Department of Control of Neglected Tropical Diseases World Health Organization, Geneva. WHO estimate - endemic treponematoses - 1950. 1931 Nigeria.

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Department of Control of Neglected Tropical Diseases World Health Organization, Geneva

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  1. Eradication of Yaws 2020 NTD STAG MEETING 8-9 April 2014, WHO HQ Kingsley Asiedu Update II Department of Control of Neglected Tropical Diseases World Health Organization, Geneva

  2. WHO estimate - endemic treponematoses - 1950

  3. 1931 Nigeria Colonial Reports: Annual report on the social and economic progress of the people of Nigeria, 1931

  4. 1934 Gold Coast Colonial Reports: Annual report on the social and economic progress of the people of the Gold Coast 1934

  5. Yaws distribution in 1950

  6. Eradication definition 1960 • Epidemiological eradication • No indigenous infectious case has appeared in the population for 3 continuous years. • Basis of findings: • At all medical centers in the country where proper records of cases of the disease are kept; • At six-monthly medical examinations of all schoolchildren; • At annual surveys of randomly selected villages remote from medical facilities, schools and towns; • Reported from any reliable source of information. 1960

  7. Eradication definition 1960 • Complete eradication: • No indigenous active case has appeared in the population for a period of 3 years, information from below considered and no seroreactor in the age-group under 5 years having been found. • Basis of findings: • At all medical centers in the country where proper records of cases of the disease are kept; • At six-monthly medical examinations of all schoolchildren; • At annual surveys of randomly selected villages remote from medical facilities, schools and towns; • Reported from any reliable source of information. 1960

  8. 2012 Single dose – 30 mg/kg Lamduchien/MSF

  9. WHO strategy for • eradication of yaws 2012 Two treatment policies: Total community treatment (TCT) Total targeted treatment (TTT) surveillance

  10. Third consultation meeting on eradication of yaws 24-25 March 2014 • Purpose • To update the epidemiological data from participating countries • To review the results of the implementation of activities in 2013 and lessons learnt • To review the laboratory results and determine next course of action 38 participants Endemic countries Benin, Ghana, India, Indonesia, Papua New Guinea, Solomon Islands and Vanuatu Experts Australia, Belgium, Germany, Spain, United Kingdom and United States of America. WHO staff Headquarters, AFRO, SEARO and WPRO

  11. Activity 1: Pilot implementation of Morges strategyCongo, Ghana, Papua New Guinea and Vanuatu • 90 000 persons treated with azithromycin 2012-2013 • Coverage 95% • Azithromycin well-tolerated • No serious adverse events • Excellent results  enhanced cooperation from communities Lamduchien/MSF Lamduchien/MSF

  12. 2013 Lihir, PNG 90% Average tablets/person 3

  13. Activity 2:Evaluation of DPP® Syphilis Screen & ConfirmAssayfor yaws • Collaboration: CDC, Atlanta and PNG (Lihir) • Results promising. Test can be used for: • can be used confirm cases with active infection • can be use be used in surveys • Study its utility in one year impact assessment planned this year Negotiated price per test = US$2.00

  14. Activity3Molecular Detection of Azithromycin Resistance Markers • Settings: Ghana, PNG and Solomon Island and Vanuatu • Collaboration: CDC and University of Washington • Conclusions: The absence of A2058G/A2059G point mutations on 23S rRNA in TPE strains suggests that azithromycin can be used for mass treatment in these countries. Continuous monitoring post-MDA is a must. • Tech transfer: • Noguchi Institute, Ghana • PNG Institute for Medical Research • Others

  15. Activity 4Progress withassessment Benin Settings: Two remote districts (Djidja and Agbangnizoun) in Zou department in Benin. Findings: No seropositivity in 900 primary school children surveyed in 2 districts Solomon Islands: Combined trachoma/yaws survey completed last year • Prevalence in Western Province 20% • Prevalence in Choiseul Province 10% Philippines • Assessment planned in July 2014 in a suspected region

  16. Prevalence of yaws in WPRO today ? Yaws prevalence > 10% Yaws prevalence 5-10%

  17. Update from India, 1996 – 2013 Sero-surveys  no evidence of transmission What next? Dr Sudhir Kumar Jain Head, Department of Parasitic Diseases & Nodal Officer for Yaws Eradication Programme National Centre for Disease Control, Ministry of Health & Family Welfare, New Delhi, India

  18. Issue 1 Not all skin lesions/ulcers in the community are due to yaws H. Ducreyi may be susceptible to azithromycin

  19. Issue 2 Epidemiological significance in human transmission??

  20. Conclusions of the 2014 yaws meeting • The Morges strategy has been successfully implemented on pilot basis in 4 countries providing lessons for scale-up • Coverage (>90%) has been higher than anticipated • Rapid results enhanced community cooperation • DPP dual syphilis test will be useful in the yaws eradication efforts • Cost should be negotiated • The absence of A2058G/A2059G point mutations on 23S rRNA in TPE strains • Azithromycin can be used for yaws mass treatment • But continuous monitoring post-MDA is a must • Capacity to be built at Noguchi and PNGMR • Randomized controlled trial of 20mg vs 30mg/kg azithromycin in the treatment of yaws planned for 2014 in collaboration with LSHTM • to help resolve dosing issues in yaws/trachoma co-endemic areas • Current status of yaws in previously endemic countries be assessed: • WHO Regional Offices to check with countries

  21. Status known = 14 Status unknown = 71

  22. Moving forward • No major technical obstacles; expertise in place • 2 countries have reported interruption of transmission • Ecuador (2003) – needs verification • India (2003) – verification and certification • Gradual implementation of activities in 12 endemic countries to accumulate more experience • Assessment in 71 previously endemic countries • Operational research to support the eradication efforts

  23. Questions for the STAG • How do we proceed with assessing the status of yaws in over 71 previously endemic countries? • What synergies can we explore with other large-scale programmes for surveys? To reduce costs • Do we have certify all the 197 countries? How do we do this economically? • Should yaws be made a mandatory reporting? If so, how? • How do we secure azithromycin and funding to gradually scale up towards the 2020 target? • Do we need to establish a certification committee for yaws eradication or we should try to adapt the existing structure for Guinea Worm? • A champion for a high-visibility support for eradication efforts

  24. THANK YOU Yaws mass treatment campaign in Vanuatu 2013

  25. Performance Characteristics of Chembio DPP Treponemal Line (Vanuatu and Ghana) on Sera with RPR Titres ≥1:4 TPPA - Total + + 154 10 164 Chembio DPP Treponemal Line - 16 279 295 170 289 459 Sensitivity = 93.9 % Specificity = 96.5 %

  26. Performance Characteristics of Chembio DPP Non-treponemal Line (Vanuatu and Ghana) on Sera with RPR Titres ≥1:4 RPR ≥1:4 - Total + + 132 7 139 Chembio DPP Non-treponemal Line - 5 315 320 137 322 459 Sensitivity = 96.3 % Specificity = 97.8 %

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