The new eradication initiative
With the discovery of a single-dose oral azithromycin in 2012, WHO developed a new eradication strategy, also called The Morges Strategy, which provides two simplified treatment policies:
- Total community treatment (TCT): treatment of an entire endemic community, irrespective of the number of active clinical cases.
- Total targeted treatment (TTT): treatment of all active clinical cases and their contacts (household, school, and playmates).
The earlier global eradication initiative
Endemic treponematoses were among the first public health priorities of the World Health Organization after it was founded 1948, together with malaria, tuberculosis, and venereal infections.
While the first yaws international conference in Bangkok, Thailand focused on accelerated control, the second international conference in Enugu, Nigeria in 1955 shifted global focus from control to eradication.
Treatment policies were based on prevalence of clinically active yaws in the entire population of a village to determine the treatment policy as follows:
- in areas where prevalence exceeded 10%, the entire population were treated with benzathine penicillin,
- in places where prevalence was 5%–10%, all children aged under 15 years and their close contacts were treated, and
- in areas where prevalence was less than 5%, only household and other close contacts were treated.
Although contacts were defined as people having regular person-to-person interaction with patients with active infectious clinical yaws, it was difficult to fully define the extent of contacts and to treat all.