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@article{2251401,
author = {John, Lucy N and Beiras, Camila G and Houinei, Wendy and Medappa, Monica and Sabok, Maria and Kolmau, Reman and Jonathan, Eunice and Maika, Edward and Wangi, James K and Pospíšilová, Petra and Šmajs, David and Ouchi, Dan and GalvanandFemenia, Ivan and Beale, Mathew A and Giacani, Lorenzo and Clotet, Bonaventura and Mooring, Eric Q and Marks, Michael and VallandMayans, Marti and Mitja, Oriol},
article_location = {Waltham},
article_number = {1},
doi = {http://dx.doi.org/10.1056/NEJMoa2109449},
keywords = {Mass Azithromycin Administration; Yaws Eradication},
language = {eng},
issn = {0028-4793},
journal = {New England Journal of Medicine},
title = {Trial of Three Rounds of Mass Azithromycin Administration for Yaws Eradication},
url = {https://www.nejm.org/doi/10.1056/NEJMoa2109449},
volume = {386},
year = {2022}
}
TY - JOUR
ID - 2251401
AU - John, Lucy N - Beiras, Camila G - Houinei, Wendy - Medappa, Monica - Sabok, Maria - Kolmau, Reman - Jonathan, Eunice - Maika, Edward - Wangi, James K - Pospíšilová, Petra - Šmajs, David - Ouchi, Dan - Galvan-Femenia, Ivan - Beale, Mathew A - Giacani, Lorenzo - Clotet, Bonaventura - Mooring, Eric Q - Marks, Michael - Vall-Mayans, Marti - Mitja, Oriol
PY - 2022
TI - Trial of Three Rounds of Mass Azithromycin Administration for Yaws Eradication
JF - New England Journal of Medicine
VL - 386
IS - 1
SP - 47-56
EP - 47-56
PB - Massachussetts Medical Society
SN - 00284793
KW - Mass Azithromycin Administration
KW - Yaws Eradication
UR - https://www.nejm.org/doi/10.1056/NEJMoa2109449
N2 - BACKGROUND Treponema pallidum subspecies pertenue causes yaws. Strategies to better control, eliminate, and eradicate yaws are needed. METHODS In an open-label, cluster-randomized, community-based trial conducted in a yaws-endemic area of Papua New Guinea, we randomly assigned 38 wards (i.e., clusters) to receive one round of mass administration of azithromycin followed by two rounds of target treatment of active cases (control group) or three rounds of mass administration of azithromycin (experimental group); round 1 was administered at baseline, round 2 at 6 months, and round 3 at 12 months. The coprimary end points were the prevalence of active cases of yaws, confirmed by polymerase-chain-reaction assay, in the entire trial population and the prevalence of latent yaws, confirmed by serologic testing, in a subgroup of asymptomatic children 1 to 15 years of age; prevalences were measured at 18 months, and the between-group differences were calculated. RESULTS Of the 38 wards, 19 were randomly assigned to the control group (30,438 persons) and 19 to the experimental group (26,238 persons). A total of 24,848 doses of azithromycin were administered in the control group (22,033 were given to the participants at round 1 and 207 and 2608 were given to the participants with yaws-like lesions and their contacts, respectively, at rounds 2 and 3 (combined)), and 59,852 doses were administered in the experimental group. At 18 months, the prevalence of active yaws had decreased from 0.46% (102 of 22,033 persons) at baseline to 0.16% (47 of 29,954 persons) in the control group and from 0.43% (87 of 20,331 persons) at baseline to 0.04% (10 of 25,987 persons) in the experimental group (relative risk adjusted for clustering, 4.08; 95% confidence interval (CI), 1.90 to 8.76). The prevalence of other infectious ulcers decreased to a similar extent in the two treatment groups. The prevalence of latent yaws at 18 months was 6.54% (95% CI, 5.00 to 8.08) among 994 children in the control group and 3.28% (95% CI, 2.14 to 4.42) among 945 children in the experimental group (relative risk adjusted for clustering and age, 2.03; 95% CI, 1.12 to 3.70). Three cases of yaws with resistance to macrolides were found in the experimental group. CONCLUSIONS The reduction in the community prevalence of yaws was greater with three rounds of mass administration of azithromycin at 6-month intervals than with one round of mass administration of azithromycin followed by two rounds of targeted treatment. Monitoring for the emergence and spread of antimicrobial resistance is needed.
ER -
JOHN, Lucy N, Camila G BEIRAS, Wendy HOUINEI, Monica MEDAPPA, Maria SABOK, Reman KOLMAU, Eunice JONATHAN, Edward MAIKA, James K WANGI, Petra POSPÍŠILOVÁ, David ŠMAJS, Dan OUCHI, Ivan GALVAN-FEMENIA, Mathew A BEALE, Lorenzo GIACANI, Bonaventura CLOTET, Eric Q MOORING, Michael MARKS, Marti VALL-MAYANS and Oriol MITJA. Trial of Three Rounds of Mass Azithromycin Administration for Yaws Eradication. \textit{New England Journal of Medicine}. Waltham: Massachussetts Medical Society, 2022, vol.~386, No~1, p.~47-56. ISSN~0028-4793. Available from: https://dx.doi.org/10.1056/NEJMoa2109449.
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