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Yaws: A Second (and Maybe Last?) Chance for Eradication

30 Oct 2008

Paul Chinnock

Source: PLoS Neglected Tropical Diseases (see original article)

Citation: Rinaldi A (2008). Yaws: A Second (and Maybe Last?) Chance for Eradication. PLoS Negl Trop Dis 2(8): e275.

2008 Andrea Rinaldi. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Yaws is becoming more common and yet it could be eradicated worldwide. An article in PLoS NTDs’ ‘Historical Profiles and Perspectives’ series discusses this paradoxical situation.

Yaws is a chronic, contagious, non-venereal infection caused by the spirochete Treponema pallidum subspecies pertenue. It is a disease of the poor mainly affecting populations living in rural areas of warm and humid subtropical countries, where conditions of overcrowding, poor water supply, and lack of sanitation and hygiene prevail. It can cause lasting severe and disfiguring damage to skin and bones. Children are most likely to be affected.

A massive treatment programme started in the 1950s eliminated yaws from many endemic areas but pockets of infection remain in South-East Asia (Indonesia, Timor-Leste, Papua New Guinea) and Africa (Ghana, Republic of the Congo). A resurgence of case numbers has been reported in several of these areas. Meanwhile, the disease has fallen off the global health priority list. The author of the article, Andrea Rinaldi, argues that yaws has not simply been neglected; it has been forgotten. He says, ‘The present situation calls for immediate action to wipe yaws out forever. Its history, on the other hand, has much to teach on how eradication campaigns should – and should not – be planned and conducted.’

Rinaldi provides a useful summary of the history, epidemiology and clinical manifestations of the disease. The history of eradication efforts is discussed in greater detail. The international campaign against the disease was one of the first programmes launched by the World Health Organization after its establishment in 1948. At that time an estimated 50 to 100 million people were afflicted by yaws worldwide. There has been no estimate of global prevalence since the 1990s (when the figure was 2.5 million) but currently, about 5,000 new cases are reported annually in South-East Asia, and as many as 26,000 cases were reported in 2005 in Ghana.

According to the article dedicated vertical programmes against yaws were dismantled before the final blow could be struck. The resources and commitment for yaws and its surveillance activities also disappeared.

There is still no vaccine against yaws but Rinaldi cites recent evidence from India suggests that yaws can be effectively controlled. The elimination of yaws as a public health problem was achieved in India in 2006 and it is hoped to achieve eradication there by the end of 2008. Rinaldi says that if the lessons from earlier eradication efforts are taken to heart then global eradication is also possible.

The article argues that the global health community needs the morale boost that eradication of a disease can provide, such as was seen when smallpox was eradicated in 1978. Yaws could be the best bet for such an achievement.