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1.
BMC Infect Dis ; 20(1): 392, 2020 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-32493291

RESUMO

BACKGROUND: The first yaws eradication campaign reduced the prevalence of yaws by 95%. In recent years, however, yaws has reemerged and is currently subject to a second, ongoing eradication campaign. Yet, the epidemiological status of Tanzania and 75 other countries with a known history of human yaws is currently unknown. Contrary to the situation in humans in Tanzania, recent infection of nonhuman primates (NHPs) with the yaws bacterium Treponema pallidum subsp. pertenue (TPE) have been reported. In this study, we consider a One Health approach to investigate yaws and describe skin ulcers and corresponding T. pallidum serology results among children living in the Tarangire-Manyara ecosystem, an area with increasing wildlife-human interaction in northern Tanzania. METHODS: To investigate human yaws in Tanzania, we conducted a cross-sectional study to screen and interview skin-ulcerated children aged 6 to 15 years, who live in close proximity to two national parks with high numbers of naturally TPE-infected monkeys. Serum samples from children with skin ulcers were tested for antibodies against the bacterium using a treponemal (Treponema pallidum Particle Agglutination assay) and a non-treponemal (Rapid Plasma Reagin) test. RESULTS: A total of 186 children aged between 6 and 15 years (boys: 10.7 ± 2.1 (mean ± SD), N = 132; girls: 10.9 ± 2.0 (mean ± SD), N = 54) were enrolled. Seven children were sampled at health care facilities and 179 at primary schools. 38 children (20.4%) reported active participation in bushmeat hunting and consumption and 26 (13.9%) reported at least one physical contact with a NHP. None of the lesions seen were pathognomonic for yaws. Two children tested positive for treponemal antibodies (1.2%) in the treponemal test, but remained negative in the non-treponemal test. CONCLUSIONS: We found no serological evidence of yaws among children in the Tarangire-Manyara ecosystem. Nevertheless, the close genetic relationship of human and NHPs infecting TPE strains should lead to contact prevention with infected NHPs. Further research investigations are warranted to study the causes and possible prevention measures of spontaneous chronic ulcers among children in rural Tanzania and to certify that the country is free from human yaws.


Assuntos
Anticorpos Antibacterianos/sangue , Úlcera Cutânea/patologia , Treponema pallidum/imunologia , Bouba/patologia , Adolescente , Animais , Criança , Estudos Transversais , Ecossistema , Feminino , Haplorrinos , Humanos , Masculino , Prevalência , Doenças dos Primatas/microbiologia , Doenças dos Primatas/patologia , Úlcera Cutânea/sangue , Úlcera Cutânea/microbiologia , Inquéritos e Questionários , Tanzânia/epidemiologia , Treponema pallidum/isolamento & purificação , Bouba/epidemiologia , Bouba/microbiologia
2.
N Z Med J ; 133(1513): 53-60, 2020 04 24.
Artigo em Inglês | MEDLINE | ID: mdl-32325468

RESUMO

AIMS: To determine the demographic and clinical features of patients with ocular disease consistent with syphilis and positive treponemal serology in Auckland, and to compare patients who lived in a Pacific nation before 1960 with all other patients with regard to these features, considering a possible history of yaws infection. METHODS: Retrospective review of subjects seen in uveitis and neuroophthalmology clinics at Auckland District Health Board between January 2006 and June 2019. RESULTS: Two thousand four hundred and ninety-three subjects were reviewed in uveitis clinics during the timeframe, of whom 45 were diagnosed with syphilitic uveitis (1.8%). Mean age was 56.2±14.8 years and 34 (75.5%) were male. Ethnicity was Caucasian in 16 (35.5%), Pacific peoples in 16 (35.5%), Maori in two (4.4%), Asian in six (13.3%) and other in five (11.1%). Pacific peoples were older at presentation (p=0.001) and 75.0% were aged >60 compared to 24.1% of non-Pacific peoples (p=0.002). Comparing Pacific people born prior to 1960 (aged >60) to the rest of the cohort, older Pacific subjects had lower RPR titres (median 3 vs 32 p=0.004), less optic nerve swelling (0% vs 28.0% eyes p=0.014) and less posterior uveitis (6.25% vs 32.0% eyes p = 0.033). No difference was observed in anterior and intermediate uveitis between the groups. No difference was observed in the resolution or recurrence of inflammation between the groups. CONCLUSION: Syphilitic uveitis is common in New Zealand, occurring in 1 in 55 patients seen in consultant uveitis clinics. Clinicians should consider a history of yaws in Pacific peoples presenting with ocular inflammation and positive treponemal serology. In these cases alternative causes of ocular pathology should be included as differentials. In cases of diagnostic uncertainty, the risk of treatment versus the potentially severe sequelae of untreated syphilis need to be considered.


Assuntos
Sífilis , Uveíte , Bouba , Adulto , Idoso , Erros de Diagnóstico , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Estudos Retrospectivos , Sífilis/diagnóstico , Sífilis/epidemiologia , Uveíte/diagnóstico , Uveíte/epidemiologia , Bouba/diagnóstico , Bouba/epidemiologia
3.
BMC Public Health ; 20(1): 517, 2020 Apr 17.
Artigo em Inglês | MEDLINE | ID: mdl-32303204

RESUMO

BACKGROUND: Neglected tropical diseases (NTDs) comprise 20 communicable diseases that are prevalent in rural poor and remote communities with less access to the health system. For effective and efficient control, the WHO recommends that affected countries implement integrated control interventions that take into account the different co-endemic NTDs in the same community. However, implementing these integrated interventions involving several diseases with different etiologies, requiring different control approaches and driven by different vertical programs, remains a challenge. We report here the results and lessons learned from a pilot test of this integrated approach based on integrated screening of skin diseases in three co-endemic health districts of Côte d'Ivoire, a West African country endemic for Buruli ulcer, leprosy and yaw. METHOD: This cross-sectional study took place from April 2016 to March 2017 in 3 districts of Côte d'Ivoire co-endemic for BU, leprosy and yaws. The study was carried out in 6 stages: identification of potentially co-endemic communities; stakeholder training; social mobilization; mobile medical consultations; case detection and management; and a review meeting. RESULTS: We included in the study all patients with skin signs and symptoms at the screening stage who voluntarily accepted screening. In total, 2310 persons screened had skin lesions at the screening stage. Among them, 07 cases were diagnosed with Buruli ulcer. There were 30 leprosy cases and 15 yaws detected. Other types of ulcerations and skin conditions have been identified and represent the majority of cases detected. We learned from this pilot experience that integration can be successfully implemented in co-endemic communities in Côte d'Ivoire. Health workers are motivated and available to implement integrated interventions instead of interventions focused on a single disease. However, it is essential to provide capacity building, a minimum of drugs and consumables for the care of the patients identified, as well as follow-up of identified patients, including those with other skin conditions. CONCLUSIONS: The results of this study show that the integration of activities can be successfully implemented in co-endemic communities under the condition of staff capacity building and minimal care of identified patients.


Assuntos
Úlcera de Buruli/epidemiologia , Hanseníase/epidemiologia , Programas de Rastreamento/métodos , Mycobacterium leprae , Mycobacterium ulcerans , Doenças Negligenciadas/epidemiologia , Treponema pallidum/imunologia , Bouba/epidemiologia , Adolescente , Adulto , Idoso , Úlcera de Buruli/diagnóstico , Úlcera de Buruli/microbiologia , Criança , Costa do Marfim/epidemiologia , Estudos Transversais , Doenças Endêmicas , Feminino , Humanos , Hanseníase/diagnóstico , Hanseníase/microbiologia , Masculino , Pessoa de Meia-Idade , Doenças Negligenciadas/diagnóstico , Doenças Negligenciadas/microbiologia , Projetos Piloto , Prevalência , População Rural , Bouba/diagnóstico , Bouba/microbiologia , Adulto Jovem
4.
Infect Dis Poverty ; 9(1): 26, 2020 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-32160927

RESUMO

BACKGROUND: Yaws is a chronic relapsing disease caused by Treponema pallidum subspecies pertunue, which can result in severe disability and deformities. Children below the age of 15 years in resource-poor communities are the most affected. Several non-specific factors facilitate the continuous transmission and resurgence of the disease. Endemic communities in rural Ghana continue to report cases despite the roll out of several intervention strategies in the past years. The objective of this study was to determine the factors associated with cutaneous ulcers among children in two yaws-endemic districts in Ghana. METHODS: A community-based unmatched 1:2 case-control study was conducted among children between 1 and 15 years. Data on socio-demographic, environmental and behavioral factors were collected using a structured questionnaire. Active case search and confirmation was done using the Dual Path Platform (DPP) Syphilis Screen and Confirm test kit. Data were analyzed using STATA 15. Logistic regression was done to determine the exposures that were associated with yaws infection at 0.05 significant level. RESULTS: Sixty-two cases and 124 controls were recruited for the study. The adjusted multivariable logistic regression model showed that yaws infection was more likely among individuals who reside in overcrowded compound houses (aOR = 25.42, 95% CI: 6.15-105.09) and with poor handwashing habits (aOR = 6.46, 95% CI: 1.89-22.04). Male (aOR = 4.15, 95% CI: 1.29-13.36) and increasing age (aOR = 5.90, 95% CI: 1.97-17.67) were also associated with yaws infection. CONCLUSIONS: Poor personal hygiene, overcrowding and lack of access to improved sanitary facilities are the factors that facilitate the transmission of yaws in the Awutu Senya West and Upper West Akyem districts. Yaws was also more common among males and school-aged children. Improving living conditions, access to good sanitary facilities and encouraging good personal hygiene practices should be core features of eradication programs in endemic communities.


Assuntos
População Rural , Úlcera Cutânea/microbiologia , Treponema pallidum/isolamento & purificação , Bouba , Adolescente , Estudos de Casos e Controles , Criança , Pré-Escolar , Aglomeração , Doenças Endêmicas , Feminino , Gana/epidemiologia , Humanos , Higiene , Lactente , Masculino , Vigilância da População , Úlcera Cutânea/diagnóstico , Úlcera Cutânea/epidemiologia , Inquéritos e Questionários , Sorodiagnóstico da Sífilis , Bouba/diagnóstico , Bouba/epidemiologia , Bouba/prevenção & controle , Bouba/transmissão
5.
Infect Dis Poverty ; 9(1): 1, 2020 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-31996251

RESUMO

BACKGROUND: Yaws is a chronic, highly contagious skin and bone infection affecting children living in impoverished, remote communities and caused by Treponema pallidum subspecies pertenue. The Philippines was thought to be free of yaws following the 1950s eradication campaign but it has been reported in the Liguasan Marsh area, Central Mindanao. This is the first documentation of yaws cases in the Philippines since the 1970s. We describe active and latent yaws recently detected in the Southern Philippines. CASE PRESENTATION: Cross-sectional surveys and screening of skin diseases were conducted in one randomly selected public elementary school per selected municipality in Liguasan Marsh, covering three municipalities per province. Yaws suspects underwent screening and confirmatory serologic tests for Treponema pallidum using Dual Path Platform Syphilis Screen and Confirm Assay (DPP) and Treponema pallidum Particle Agglutination (TPPA). Children with yaws skin lesions and reactive confirmatory tests for T. pallidum and non-treponemal antibodies were considered confirmed yaws cases. Four children aged 5-10 years old had confirmed secondary yaws in Tulunan Municipality, Cotabato Province and in Lambayong Municipality, Sultan Kudarat Province. All had secondary yaws lesions such as moist, cauliflower-like papillomas, thick yellow crusts on pink papules and nodules, whitish, papulosquamous papules and plaques, or hypopigmented patches with small papules on the periphery. Yaws papillomas and erosions were also found on the soles of the feet of one child. The index case had a skin punch biopsy of a partially treated papilloma on his axilla. Histopathological findings showed lichenoid psoriasiform dermatitis with plasma cells, consistent with yaws. CONCLUSIONS: The clinical, serological, and histopathological confirmation of four yaws cases among children has made the Philippines the 14th country endemic for yaws. This report can help health personnel recognize hidden cases of yaws based on skin signs and serological tests. Yaws remained unrecognized and unreported in the Philippines and in countries previously endemic for yaws probably due to the unsustained integration of the yaws program in the general health services and complacency after the 1950s eradication campaign. Our findings have provided the necessary evidence and stimulus to develop a yaws control and eradication program as one of the country's neglected tropical diseases.


Assuntos
Treponema/isolamento & purificação , Bouba/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Masculino , Filipinas/epidemiologia , Prevalência , Estudos Soroepidemiológicos , Testes Sorológicos
6.
Med Sante Trop ; 29(3): 327-332, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31573531

RESUMO

Burkina Faso shares its borders with six countries that regularly report cases of Buruli ulcer, yaws, and leprosy (Hansen disease), three neglected tropical diseases with dermatological manifestations. Treatment of leprosy has shown excellent results, and it appears to be essentially eliminated. The same cannot be said for Buruli ulcer or yaws, the epidemiology of which remains poorly elucidated. In this context, it was essential to review the situation of these three diseases through a joint survey in the health districts bordering the Côte d'Ivoire, Ghana and the irrigated areas around the dams of Kompienga and Bagré. Our team led a disease survey in these irrigated areas, and we report the results. To determine the current scale of the Buruli ulcer, leprosy, and yaws in the irrigated areas around these two dams and to formulate recommendations. This single-pass survey from April 10-18 was a transverse descriptive study, with sampling based on proximity to the dams. Overall, 1482 people were consulted. Among them, 413 (27.9%) presented dermatosis, distributed as follows: 28 suspected cases of yaws (6.8%), 7 suspected cases of Buruli ulcer (1.7%), 1 case of multibacillary leprosy (0.24%) in an 8-year-old girl, and 377 cases of other dermatoses, dominated by those of fungal origin. A large-scale investigation including all other irrigated areas might make it possible to understand the real situation.


Assuntos
Úlcera de Buruli/epidemiologia , Hanseníase/epidemiologia , Bouba/epidemiologia , Irrigação Agrícola , Burkina Faso/epidemiologia , Costa do Marfim/epidemiologia , Estudos Transversais , Feminino , Gana/epidemiologia , Humanos , Masculino
7.
Med Sante Trop ; 29(2): 155-158, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31379340

RESUMO

The incidence of neglected tropical diseases (NTD) can serve as an indicator for assessing the quality of healthcare systems because these diseases affect the poorest populations, living in areas where healthcare access is most difficult. The Central African Republic Ministry of Health, in collaboration with FAIRMED, decided to conduct the survey reported here in a village named/owned by the Central African Society of Agriculture and Wood Peeling (SCAD). The study took place from June 11-20, 2017. There were 137 clinical diagnoses of yaws, 102 of them positive on laboratory tests. Moreover, 79% were highly contagious forms. The prevalence of yaws in our study is higher than the 11% found in 2012 in the Lobaye region [4]. We also identified 57 cases of leprosy by screening; 68.42% (n= 39) were multibacillary. Among children younger than 15 years, 8 (16.66%) had grade 2 impairments. The screening rate for new cases is 13.333 per 10 000, quite substantially higher than the mean rate of 2.9 per 10 000 for the 121 countries and territories of this WHO region in 2016 [6]. Among the cases screened during the study, 51% (n=29/57) were already known to healthcare facilities. This study demonstrates the extent of the NTDs in Lobaye in the Central African Republic.


Assuntos
Hanseníase/epidemiologia , Bouba/epidemiologia , Adolescente , República Centro-Africana/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Doenças Endêmicas , Feminino , Humanos , Masculino , Saúde da População Urbana
8.
PLoS Negl Trop Dis ; 13(2): e0007125, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30802249

RESUMO

BACKGROUND: Yaws is targeted for eradication by 2020 in the WHA66.12 resolution of the World Health Assembly. The objective of this study was to describe the occurrence of yaws in the Americas and to contribute to the compilation of evidence based on published data to undertake the certification of yaws eradication. METHODOLOGY: A systematic review of the epidemiological situation of yaws in the Americas was performed by searching in MEDLINE, Embase, LILACS, SCOPUS, Web of Science, DARE and Cochrane Database of Systematic Reviews. Experts on the topic were consulted, and institutional WHO/PAHO library databases were reviewed. PRINCIPAL FINDINGS: Seventy-five full-text articles published between 1839 and 2012 met the inclusion criteria. Haiti and Jamaica were the two countries with the highest number of papers (14.7% and 12.0%, respectively). Three-quarters of the studies were conducted before 1970. Thirty-three countries reported yaws case count or prevalence data. The largest foci in the history were described in Brazil and Haiti. The most recent cases reported were recorded in eight countries: Suriname, Guyana, Colombia, Haiti, Martinique, Dominica, Trinidad and Tobago, and Brazil. Gaps in information and heterogeneity were detected in the methodologies used and outcome reporting, making cross-national and chronological comparisons difficult. CONCLUSIONS: The lack of recent yaws publications may reflect, in the best-case scenario, the interruption of yaws transmission. It should be possible to reach the eradication goal in the region of the Americas, but it is necessary to collect more information. We suggest updating the epidemiological status of yaws, especially in two countries that need to assess ongoing transmission. Twenty-four countries need to demonstrate the interruption of transmission and declare its status of yaws endemicity, and sixteen countries should declare if they are yaws-free. It is necessary to formally verify the achievement of this goal in Ecuador.


Assuntos
Erradicação de Doenças/métodos , Erradicação de Doenças/organização & administração , Saúde Global , Bouba/epidemiologia , América/epidemiologia , Brasil/epidemiologia , Colômbia/epidemiologia , Erradicação de Doenças/legislação & jurisprudência , Equador/epidemiologia , Haiti/epidemiologia , Humanos , Doenças Negligenciadas/epidemiologia , Doenças Negligenciadas/parasitologia , Organização Mundial da Saúde , Bouba/prevenção & controle
9.
Am J Trop Med Hyg ; 100(4): 940-942, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30719964

RESUMO

Yaws is a neglected tropical disease targeted for eradication by 2020. Kiribati, a Pacific Island nation, was previously endemic for yaws but lacks recent data from which its current endemicity status could be determined. This study tested antibody responses to Treponema pallidum to determine if transmission of yaws is taking place among children in Kiribati. Using a commercially available T. pallidum particle agglutination kit (Serodia®, Fujirebio Inc., Tokyo, Japan), we tested dried blood spots, collected during population-based trachoma prevalence surveys on Tarawa Atoll and Kiritimati Island, for long-lived treponemal antibodies. Dried blood spots from 1,420 children aged 1-9 years were tested. Only two were positive, suggesting T. pallidum is not being widely transmitted among children in the settings sampled. These data require support from additional surveys to demonstrate the absence of clinical signs of disease and molecular evidence of infection, to confirm that yaws is no longer endemic in Kiribati.


Assuntos
Anticorpos Antibacterianos/sangue , Bouba/sangue , Bouba/epidemiologia , Adolescente , Testes de Aglutinação , Criança , Pré-Escolar , Teste em Amostras de Sangue Seco , Doenças Endêmicas/estatística & dados numéricos , Feminino , Humanos , Lactente , Masculino , Micronésia/epidemiologia , Prevalência , Treponema pallidum
10.
PLoS Negl Trop Dis ; 12(12): e0006953, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30513075

RESUMO

BACKGROUND: The World Health Organization (WHO) has targeted yaws for global eradication. Eradication requires certification that all countries are yaws-free. While only 14 Member States currently report cases to WHO, many more are known to have a history of yaws and some of them may have ongoing transmission. We reviewed the literature and developed a model of case reports to identify countries in which passive surveillance is likely to find and report cases if transmission is still occurring, with the goal of reducing the number of countries in which more costly active surveillance will be required. METHODS: We reviewed published and unpublished documents to extract data on the number of yaws cases reported to WHO or appearing in other literature in any year between 1945 and 2015. We classified countries as: a) having interrupted transmission; b) being currently endemic; c) being previously endemic (current status unknown); or d) having no history of yaws. We constructed a panel dataset for the years 1945-2015 and ran a regression model to identify factors associated with some countries not reporting cases during periods when there was ongoing (and documented) transmission. For previously endemic countries whose current status is unknown, we then estimated the probability that countries would have reported cases if there had in fact been transmission in the last three years (2013-2015). RESULTS: Yaws has been reported in 103 of the 237 countries and areas considered. 14 Member States and 1 territory (Wallis and Futuna Islands) are currently endemic. 2 countries are believed to have interrupted transmission. 86 countries and areas are previously endemic (current status unknown). Reported cases peaked in the 1950s, with 55 countries reporting at least one case in 1950 and a total of 2.35 million cases reported in 1954. Our regression model suggests that case reporting during periods of ongoing transmission is positively associated with socioeconomic development and, in the short-term, negatively associated with independence. We estimated that for 66 out of the 86 previously endemic countries whose current status is unknown, the probability of reporting cases in the absence of active surveillance is less than 50%. DISCUSSION: Countries with a history of yaws need to be prioritized so that international resources for global yaws eradication may be deployed efficiently. Heretofore, the focus has been on mass treatment in countries currently reporting cases. It is also important to undertake surveillance in the 86 previously endemic countries for which the current status is unknown. Within this large and diverse group, we have identified a group of 20 countries with more than a 50% probability of reporting cases in the absence of active surveillance. For the other 66 countries, international support for active surveillance will likely be required.


Assuntos
Erradicação de Doenças , Bouba/epidemiologia , Certificação , Monitoramento Epidemiológico , Humanos , Estudos Longitudinais , Polinésia/epidemiologia , Organização Mundial da Saúde
11.
PLoS Negl Trop Dis ; 12(10): e0006840, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30372426

RESUMO

BACKGROUND: In the global program for the eradication of yaws, assessments of the prevalence of the disease are used to decide where to initiate mass treatment. However, the smallest administrative unit that should be used as the basis for making decisions is not clear. We investigated spatial and temporal clustering of yaws to help inform the choice of implementation unit. METHODOLOGY/PRINCIPAL FINDINGS: We analyzed 11 years of passive surveillance data on incident yaws cases (n = 1448) from Lihir Island, Papua New Guinea. After adjusting for age, sex, and trends in health-seeking, we detected three non-overlapping spatial-temporal clusters (p < 1 × 10(-17), p = 1.4 × 10(-14), p = 1.4 × 10(-8)). These lasted from 28 to 47 months in duration and each encompassed between 4 and 6 villages. We also assessed spatial clustering of prevalent yaws cases (n = 532) that had been detected in 7 biannual active case finding surveys beginning in 2013. We identified 1 statistically significant cluster in each survey. We considered the possibility that schools that serve multiple villages might be loci of transmission, but we found no evidence that incident cases of yaws among 8- to 14-year-olds clustered within primary school attendance areas (p = 0.6846). CONCLUSIONS/SIGNIFICANCE: These clusters likely reflect transmission of yaws across village boundaries; villages may be epidemiologically linked to a degree such that mass drug administration may be more effectively implemented at a spatial scale larger than the individual village.


Assuntos
Análise por Conglomerados , Transmissão de Doença Infecciosa , Bouba/epidemiologia , Bouba/transmissão , Adolescente , Criança , Feminino , Humanos , Incidência , Masculino , Papua Nova Guiné/epidemiologia , Análise Espaço-Temporal
14.
PLoS Negl Trop Dis ; 12(6): e0006584, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29939988

RESUMO

BACKGROUND: Neglected Tropical Diseases (NTDs) are a group of several communicable diseases prevalent in the tropical and subtropical areas. The co-endemicity of these diseases, the similarity of the clinical signs, and need to maximize limited financial and human resources have necessitated implementation of integrated approach. Our study aims to share the lessons of this integrated approach in the fight against Buruli ulcer (BU), leprosy and yaws in a rural district in Benin. METHODS: It is a cross-sectional study using a single set of activities data conducted from May 2016 to December 2016. Health workers and community health volunteers involved in this study were trained on integrated approach of the Buruli ulcer, leprosy and yaws. Village chiefs were briefed about the activity. The trained team visited the villages and schools in the district of Lalo in Benin. After the education and awareness raising sessions, all persons with a skin lesion who presented voluntarily to the team were carefully examined in a well-lit area which respected their privacy. Suspected cases were tested as needed. The socio-demographic information and the characteristics of the lesions were collected using a form. A descriptive analysis of the epidemiological, clinical and laboratory variables of the cases was made using Excel 2013 and SPSS version 22.00. PRINCIPAL FINDINGS: In the study period, 1106 people were examined. The median (IQR) age of those examined was 11 (8; 27) years. Of 34 (3.1%) suspected BU cases, 15 (1.4%) were confirmed by PCR. Only three cases of leprosy were confirmed. The 185 (16.7%) suspected cases of yaws were all negative with the rapid test. The majority of cases were other skin conditions, including fungal infections, eczema and traumatic lesions. CONCLUSION: The integrated approach of skin NTD allows optimal use of resources and surveillance of these diseases. Sustaining this skin NTD integrated control will require the training of peripheral health workers not only on skin NTD but also on basic dermatology.


Assuntos
Úlcera de Buruli/prevenção & controle , Hanseníase/prevenção & controle , Doenças Negligenciadas/prevenção & controle , Dermatopatias/prevenção & controle , Bouba/prevenção & controle , Adolescente , Adulto , Benin/epidemiologia , Úlcera de Buruli/epidemiologia , Criança , Estudos Transversais , Feminino , Humanos , Hanseníase/epidemiologia , Masculino , Doenças Negligenciadas/epidemiologia , Saúde Pública , População Rural , Dermatopatias/epidemiologia , Medicina Tropical , Voluntários , Bouba/epidemiologia , Adulto Jovem
15.
Lancet ; 391(10130): 1599-1607, 2018 04 21.
Artigo em Inglês | MEDLINE | ID: mdl-29428183

RESUMO

BACKGROUND: Yaws is a substantial cause of chronic disfiguring ulcers in children in at least 14 countries in the tropics. WHO's newly adopted strategy for yaws eradication uses a single round of mass azithromycin treatment followed by targeted treatment programmes, and data from pilot studies have shown a short-term significant reduction of yaws. We assessed the long-term efficacy of the WHO strategy for yaws eradication. METHODS: Between April 15, 2013, and Oct 24, 2016, we did a longitudinal study on a Papua New Guinea island (Lihir; 16 092 population) in which yaws was endemic. In the initial study, the participants were followed for 12 months; in this extended follow-up study, clinical, serological, and PCR surveys were continued every 6 months for 42 months. We used genotyping and travel history to identify importation events. Active yaws confirmed by PCR specific for Treponema pallidum was the primary outcome indicator. The study is registered with ClinicalTrials.gov, number NCT01955252. FINDINGS: Mass azithromycin treatment (coverage rate of 84%) followed by targeted treatment programmes reduced the prevalence of active yaws from 1·8% to a minimum of 0·1% at 18 months (difference from baseline -1·7%, 95% CI, -1·9 to -1·4; p<0·0001), but the infection began to re-emerge after 24 months with a significant increase to 0·4% at 42 months (difference from 18 months 0·3%, 95% CI 0·1 to 0·4; p<0·0001). At each timepoint after baseline, more than 70% of the total community burden of yaws was found in individuals who had not had the mass treatment or as new infections in non-travelling residents. At months 36 and 42, five cases of active yaws, all from the same village, showed clinical failure following azithromycin treatment, with PCR-detected mutations in the 23S ribosomal RNA genes conferring resistance to azithromycin. A sustained decrease in the prevalence of high-titre latent yaws from 13·7% to <1·5% in asymptomatic children aged 1-5 years old and of genetic diversity of yaws strains from 0·139 to less than 0·046 between months 24 and 42 indicated a reduction in transmission of infection. INTERPRETATION: The implementation of the WHO strategy did not, in the long-term, achieve elimination in a high-endemic community mainly due to the individuals who were absent at the time of mass treatment in whom yaws reactivated; repeated mass treatment might be necessary to eliminate yaws. To our knowledge, this is the first report of the emergence of azithromycin-resistant T p pertenue and spread within one village. Communities' surveillance should be strengthened to detect any possible treatment failure and biological markers of resistance. FUNDING: ISDIN laboratories, Newcrest Mining Limited, and US Public Health Service National Institutes of Health.


Assuntos
Antibacterianos/uso terapêutico , Azitromicina/uso terapêutico , Doenças Transmissíveis Emergentes/tratamento farmacológico , Administração Massiva de Medicamentos , Bouba/tratamento farmacológico , Adolescente , Criança , Pré-Escolar , Doenças Transmissíveis Emergentes/epidemiologia , Erradicação de Doenças , Farmacorresistência Bacteriana/genética , Feminino , Variação Genética , Humanos , Lactente , Estudos Longitudinais , Masculino , Papua Nova Guiné/epidemiologia , Reação em Cadeia da Polimerase , Prevalência , RNA Ribossômico 23S/genética , Resultado do Tratamento , Treponema pallidum/genética , Bouba/epidemiologia , Bouba/prevenção & controle
16.
Am J Epidemiol ; 187(4): 837-844, 2018 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-29140407

RESUMO

Yaws is a disabling bacterial infection found primarily in warm and humid tropical areas. The World Health Organization strategy mandates an initial round of total community treatment (TCT) with single-dose azithromycin followed either by further TCT or active case-finding and treatment of cases and their contacts (the Morges strategy). We sought to investigate the effectiveness of the Morges strategy. We employed a stochastic household model to study the transmission of infection using data collected from a pre-TCT survey conducted in the Solomon Islands. We used this model to assess the proportion of asymptomatic infections that occurred in households without active cases. This analysis indicated that targeted treatment of cases and their household contacts would miss a large fraction of asymptomatic infections (65%-100%). This fraction was actually higher at lower prevalences. Even assuming that all active cases and their households were successfully treated, our analysis demonstrated that at all prevalences present in the data set, up to 90% of (active and asymptomatic) infections would not be treated under household-based contact tracing. Mapping was undertaken as part of the study "Epidemiology of Yaws in the Solomon Islands and the Impact of a Trachoma Control Programme," in September-October 2013.


Assuntos
Antibacterianos/uso terapêutico , Azitromicina/uso terapêutico , Busca de Comunicante/estatística & dados numéricos , Bouba/tratamento farmacológico , Bouba/epidemiologia , Antibacterianos/administração & dosagem , Azitromicina/administração & dosagem , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/estatística & dados numéricos , Feminino , Humanos , Masculino , Melanesia , Modelos Estatísticos , Bouba/transmissão
17.
Lancet Glob Health ; 5(12): e1268-e1274, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-29107621

RESUMO

BACKGROUND: Treatment of latent yaws is a crucial component of the WHO yaws eradication strategy to prevent relapse and the resulting transmission to uninfected children. We assessed the effectiveness of single-dose azithromycin to treat patients with latent yaws. METHODS: This population-based cohort study included children (age <20 years) living on Lihir Island, Papua New Guinea, with high-titre (rapid plasma reagin titre ≥1:8) latent or active yaws, between April, 2013, and May, 2015. Latent yaws was defined as lack of suspicious skin lesions or presence of ulcers negative for Treponema pallidum subsp pertenue on PCR, and active yaws was defined as ulcers positive for T pertenue on PCR. All children received one oral dose of 30 mg/kg azithromycin. The primary endpoint was serological cure, defined as a two-dilution decrease in rapid plasma reagin titre by 24 months after treatment. Treatment of latent yaws was taken to be non-inferior to that of active yaws if the lower limit of the two-sided 95% CI for the difference in rates was higher than or equal to -10%. This study is registered with ClinicalTrials.gov, number NCT01955252. FINDINGS: Of 311 participants enrolled, 273 (88%; 165 with latent yaws and 108 with active yaws) completed follow-up. The primary endpoint was achieved in 151 (92%) participants with latent yaws and 101 (94%) with active yaws (risk difference -2·0%, 95% CI -8·3 to 4·3), meeting the prespecified criteria for non-inferiority. INTERPRETATION: On the basis of decline in serological titre, oral single-dose azithromycin was effective in participants with latent yaws. This finding supports the WHO strategy for the eradication of yaws based on mass administration of the entire endemic community irrespective of clinical status. FUNDING: Newcrest Mining Limited and ISDIN laboratories.


Assuntos
Antibacterianos/administração & dosagem , Azitromicina/administração & dosagem , Bouba/tratamento farmacológico , Bouba/epidemiologia , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Estudos Longitudinais , Masculino , Papua Nova Guiné/epidemiologia , Reação em Cadeia da Polimerase , Treponema pallidum/isolamento & purificação , Bouba/transmissão
18.
PLoS Negl Trop Dis ; 11(10): e0005985, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29073145

RESUMO

BACKGROUND: Yaws is a non-venereal treponemal infection caused by Treponema pallidum subspecies pertenue. The disease is targeted by WHO for eradication by 2020. Rapid diagnostic tests (RDTs) are envisaged for confirmation of clinical cases during treatment campaigns and for certification of the interruption of transmission. Yaws testing requires both treponemal (trep) and non-treponemal (non-trep) assays for diagnosis of current infection. We evaluate a sequential testing strategy (using a treponemal RDT before a trep/non-trep RDT) in terms of cost and cost-effectiveness, relative to a single-assay combined testing strategy (using the trep/non-trep RDT alone), for two use cases: individual diagnosis and community surveillance. METHODS: We use cohort decision analysis to examine the diagnostic and cost outcomes. We estimate cost and cost-effectiveness of the alternative testing strategies at different levels of prevalence of past/current infection and current infection under each use case. We take the perspective of the global yaws eradication programme. We calculate the total number of correct diagnoses for each strategy over a range of plausible prevalences. We employ probabilistic sensitivity analysis (PSA) to account for uncertainty and report 95% intervals. RESULTS: At current prices of the treponemal and trep/non-trep RDTs, the sequential strategy is cost-saving for individual diagnosis at prevalence of past/current infection less than 85% (81-90); it is cost-saving for surveillance at less than 100%. The threshold price of the trep/non-trep RDT (below which the sequential strategy would no longer be cost-saving) is US$ 1.08 (1.02-1.14) for individual diagnosis at high prevalence of past/current infection (51%) and US$ 0.54 (0.52-0.56) for community surveillance at low prevalence (15%). DISCUSSION: We find that the sequential strategy is cost-saving for both diagnosis and surveillance in most relevant settings. In the absence of evidence assessing relative performance (sensitivity and specificity), cost-effectiveness is uncertain. However, the conditions under which the combined test only strategy might be more cost-effective than the sequential strategy are limited. A cheaper trep/non-trep RDT is needed, costing no more than US$ 0.50-1.00, depending on the use case. Our results will help enhance the cost-effectiveness of yaws programmes in the 13 countries known to be currently endemic. It will also inform efforts in the much larger group of 71 countries with a history of yaws, many of which will have to undertake surveillance to confirm the interruption of transmission.


Assuntos
Técnicas e Procedimentos Diagnósticos/economia , Bouba/diagnóstico , Bouba/economia , Estudos de Coortes , Análise Custo-Benefício , Técnicas e Procedimentos Diagnósticos/instrumentação , Técnicas e Procedimentos Diagnósticos/estatística & dados numéricos , Erradicação de Doenças/economia , Monitoramento Epidemiológico , Humanos , Prevalência , Sensibilidade e Especificidade , Treponema pallidum/isolamento & purificação , Bouba/epidemiologia , Bouba/microbiologia
19.
PLoS Negl Trop Dis ; 11(9): e0005894, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28886021

RESUMO

BACKGROUND: Treponema pallidum subsp. pertenue (TPE) is the causative agent of yaws, a multi-stage disease, endemic in tropical regions of Africa, Asia, Oceania, and South America. To date, four TPE strains have been completely sequenced including three TPE strains of human origin (Samoa D, CDC-2, and Gauthier) and one TPE strain (Fribourg-Blanc) isolated from a baboon. All TPE strains are highly similar to T. pallidum subsp. pallidum (TPA) strains. The mutation rate in syphilis and related treponemes has not been experimentally determined yet. METHODOLOGY/PRINCIPAL FINDINGS: Complete genomes of two TPE strains, CDC 2575 and Ghana-051, that infected patients in Ghana and were isolated in 1980 and 1988, respectively, were sequenced and analyzed. Both strains had identical consensus genome nucleotide sequences raising the question whether TPE CDC 2575 and Ghana-051 represent two different strains. Several lines of evidence support the fact that both strains represent independent samples including regions showing intrastrain heterogeneity (13 and 5 intrastrain heterogeneous sites in TPE Ghana-051 and TPE CDC 2575, respectively). Four of these heterogeneous sites were found in both genomes but the frequency of alternative alleles differed. The identical consensus genome sequences were used to estimate the upper limit of the yaws treponeme evolution rate, which was 4.1 x 10-10 nucleotide changes per site per generation. CONCLUSIONS/SIGNIFICANCE: The estimated upper limit for the mutation rate of TPE was slightly lower than the mutation rate of E. coli, which was determined during a long-term experiment. Given the known diversity between TPA and TPE genomes and the assumption that both TPA and TPE have a similar mutation rate, the most recent common ancestor of syphilis and yaws treponemes appears to be more than ten thousand years old and likely even older.


Assuntos
Genoma Bacteriano , Treponema pallidum/genética , Treponema pallidum/isolamento & purificação , Bouba/microbiologia , Animais , Ásia/epidemiologia , Mapeamento Cromossômico , Escherichia coli/genética , Gana/epidemiologia , Humanos , Mutação , Papio/microbiologia , Análise de Sequência de DNA , América do Sul/epidemiologia , Fatores de Tempo , Treponema pallidum/classificação , Bouba/epidemiologia
20.
PLoS Negl Trop Dis ; 11(7): e0005820, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28759580

RESUMO

INTRODUCTION: Yaws is endemic in Ghana. The World Health Organization (WHO) has launched a new global eradication campaign based on total community mass treatment with azithromycin. Achieving high coverage of mass treatment will be fundamental to the success of this new strategy; coverage is dependent, in part, on appropriate community mobilisation. An understanding of community knowledge, attitudes and practices related to yaws in Ghana and other endemic countries will be vital in designing effective community engagement strategies. METHODS: A verbally administered questionnaire was administered to residents in 3 districts in the Eastern region of Ghana where a randomised trial on the treatment of yaws was being conducted. The questionnaire combined both quantitative and qualitative questions covering perceptions of the cause and mechanisms of transmission of yaws-like lesions, the providers from which individuals would seek healthcare for yaws-like lesions, and what factors were important in reaching decisions on where to seek care. Chi-square tests and logistic regression were used to assess relationships between reported knowledge, attitudes and practices, and demographic variables. Thematic analysis of qualitative data was used to identify common themes. RESULTS: A total of 1,162 individuals participated. The majority of individuals (n = 895, 77%) reported that "germs" were the cause of yaws lesions. Overall 13% (n = 161) of respondents believed that the disease was caused by supernatural forces. Participants frequently mentioned lack of personal hygiene, irregular and inefficient bathing, and washing with dirty water as fundamental to both the cause and the prevention of yaws. A majority of individuals reported that they would want to take an antibiotic to prevent the development of yaws if they were asymptomatic (n = 689, 61.2%), but a substantial minority reported they would not want to do so. A majority of individuals (n = 839, 72.7%) reported that if they had a yaws-like skin lesion they would seek care from a doctor or nurse. Both direct and indirect costs of treatment were reported as key factors affecting where participants reported they would seek care. DISCUSSION: This is the first study that has explored community knowledge, attitudes and practices in relation to yaws in any endemic population. The belief that 'germs' are in some way related to disease through a variety of transmission routes including both contact and dirty water are similar to those reported for other skin diseases in Ghana. The prominent role of private healthcare providers is an important finding of this study and suggests engagement with this sector will be important in yaws eradication efforts. Strategies to address the substantial minority of individuals who reported they would not take treatment for yaws if they were currently asymptomatic will be needed to ensure the success of yaws eradication efforts. The data collected will be of value to the Ghana Health Service and also to WHO and other partners, who are currently developing community mobilisation tools to support yaws eradication efforts worldwide.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Bouba/epidemiologia , Adulto , Antibacterianos/administração & dosagem , Feminino , Gana , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Inquéritos e Questionários , Treponema pallidum , Bouba/tratamento farmacológico
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