Neglected tropical diseases

India’s triumph over yaws adds momentum to global eradication

14 July 2016 | Geneva −− WHO has urged 13 countries that remain endemic for yaws to accelerate efforts to implement the new global strategy and achieve interruption of transmission by 2020. The call followed the official celebration of India’s yaws-free status.

“Highly targeted awareness and early treatment campaigns in vulnerable communities enabled treatment of yaws cases and interruption of disease transmission” said Dr Poonam Khetrapal Singh, WHO Regional Director for South-East Asia, while commending India’s capacity and commitment to eliminating neglected tropical diseases, which serves as an example to other countries1.

India eliminated yaws after years of sustained campaign using injectable benzathine penicillin to treat affected individuals and their close contacts in the community.

“This is yet another impressive public health achievement for India” said Dr Dirk Engels, Director of the WHO Department of Control of Neglected Tropical Diseases. “It demonstrates how sustained control, awareness, surveillance and, most importantly, community involvement can work to defeat the disease in the remaining 13 endemic countries2.”

Today’s event at the National Media Centre in New Delhi also celebrated the elimination of maternal and neonatal tetanus (MNTE) as a public health problem in India. This means that MNTE has been reduced to less than one case per 1000 live births in all 675 districts across the country. A few decades ago, India reported 150 000–200 000 neonatal tetanus cases annually.

According to Dr Khetrapal Singh, the lessons learnt from the elimination of yaws and MNT in India should inform the design and implementation of future disease control programmes in the country.

WHO recognition

In May 2016, WHO officially recognized India for being the first Member State to “achieve this important milestone” under the 2012 WHO roadmap on neglected tropical diseases.

Over the past 15 years, India has witnessed unprecedented improvement in health systems, both in terms of infrastructure and human resources. Prior to becoming yaws-free, India was declared polio-free in 2014.

Timeline of India’s triumph over yaws

In 2004, the Ministry of Health and Family Welfare reported interruption of indigenous yaws transmission after 7 years of intensive implementation of eradication activities.

On 19 September 2006 – and after 3 consecutive years of reporting of zero cases – the Government of India declared yaws elimination in the country.

Active case searches and serosurveys were maintained with no new cases or evidence of transmission. Following a formal request by the Government of India in March 2015, an independent International Verification Team confirmed interruption of transmission in October 2015.

Elimination of both yaws and MNTE was achieved using the existing health system, national resources and health workforce.

India’s sustained political commitment and clear public health policies, unified strategies, close supervision and monitoring, tireless efforts of the frontline workers, and invaluable support of partners, particularly for MNTE, were key factors for these public health achievements.

New tool, new thrust for global eradication

The finding in 2012 that a single-dose of azithromycin is as effective as injectable benzathine penicillin has improved prospects for accelerated eradication of yaws. Oral administration of azithromycin on a large-scale to entire eligible populations is feasible and obviates the need for injections, which require administration by trained health-care workers.

Earlier this week (12 July 2016), as part of the high-level political forum on the Sustainable Development Goals – Leaving no-one behind – the United Nations Department of Public Information screened Where the roads end, a documentary that recounts the discovery, success and potential of oral treatment against yaws. During the panel discussions that followed, the lead researcher Dr Oriol Mitjà appealed to governments, philanthropic organizations and pharmaceutical companies to make azithromycin tablets available free of charge to affected populations so that the world can finally triumph over yaws.3

Yaws – a neglected disease of poverty

Yaws is a chronic skin disease that mostly affects poor children who have inadequate or no access to health care and live in unhygienic conditions. Transmission is from person to person. There is no vaccine against yaws. Prevention is based on interruption of transmission through early diagnosis and treatment of individuals and their contacts. Health education and improvement in personal hygiene are essential components of prevention.

2 Benin, Cameroon, Central African Republic, Congo, Côte d’Ivoire, Democratic Republic of the Congo, Ghana, Indonesia, Papua New Guinea, Solomon Islands, Timor-Leste, Togo and Vanuatu.