Cameroon investigates yaws outbreak among indigenous populations
21 July 2017 ¦ Geneva –– Cameroon’s Ministry of Public Health has announced it will further investigate an outbreak of yaws, which over the past few months, has affected hundreds of Baka and Bantu people in the Lomie Health District in the east of the country.
Neighbouring districts are also reported to be affected.
“We dispatched medicines and rapid diagnostic test materials to the region as soon as we were notified out this outbreak” said Dr Earnest Njih Tablah, Permanent Secretary of the National Leprosy, Yaws, Leishmaniasis, Leprosy and Buruli Ulcer Control Programme, Ministry of Public Health. “Our preliminary investigations revealed that cases were occurring in an insidious manner since January and peaked in to an epidemic by April and May, spreading to neighbouring areas of Ngoyla and Messok.”
A medical team sent to the areas carried out house to house investigation and treated all identified cases and their household contacts with benzathine penicillin injection. The team did not have access to tablets of the antibiotic, azithromycin, at the time of the outbreak.
“We treated 471 suspected cases mostly children (93.2%) and at least 4000 contacts, and carried out health education and awareness campaign in the communities” said Dr Njih Tabah. The Ministry of Public Health says it will further investigate the outbreak which may have spilled into neighbouring health districts such as Abong Mbang, Yokadouma, Moloundou, and Djoum. “WHO is providing technical and logistical assistance1 to support additional investigations and these include rapid diagnostic tests and oral azithromycin” said Dr Kingsley Asiedu, Medical Officer overseeing the yaws eradication programme. “We also recommend the treatment with azithromycin of all eligible individuals2 in any community suspected to be endemic.”
Yaws and azithromycin
WHO renewed efforts to eradicate yaws following the discovery in 2012 that a single dose of oral azithromycin is as effective as an injection of benzathine benzylpenicillin – the standard treatment against yaws for more than 60 years. An oral route makes it easier to accelerate the treatment of entire affected populations or of individuals living in areas at risk.
Since 2012 and until recently, WHO advocated for the donation of azithromycin to support its eradication programme. In April 2017, the Brazilian pharmaceutical company EMS announced it will donate generic azithromycin for the eradication of yaws.
Yaws is a chronic bacterial infection caused by infection with Treponema pallidum subsp. pertenue, an organism resembling that which causes venereal syphilis. The disease is found primarily in deprived communities in tropical and forested areas of Africa, Asia, Latin America and the Pacific. Poor socioeconomic conditions facilitate its spread.
The disease is found primarily in deprived communities in tropical and forested areas of Africa, Asia, Latin America and the Pacific. Poor socioeconomic conditions, overcrowding and lack of sanitation facilitate its spread.
Humans are the main reservoir of the infection and children are the worst affected.
Yaws clinically presents as lesions of the skin, bone and cartilage. Without treatment, it can lead to gross deformities and disabilities. Yaws forms part of a group of infections caused by treponemes that include endemic syphilis (bejel) and pinta.
1 Rapid point-of-care tests include dual treponemal and nontreponemal rapid tests can simplify diagnosis in the field as they are able to detect both present and past infections and guide immediate treatment.
2 One of WHO’s Morges Strategy is Total Community Treatment (TCT), which means the treatment of an entire community, irrespective of the number of active clinical cases. This approach is relevant in the case of an outbreak.