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102 THIRD WHO REPORT ON NEGLECTED TROPICAL DISEASES *** Fig. 4.6.1 Distribution of yaws, worldwide, 2013 Number of reported cases of yaws, 2008-2013, latest year available ≥ 10 000 Previously endemic (current status unknown) 1 000–9 999 No previous history of yaws < 1 000 Not applicable Transmission interrupted Fig. 4.6.2 Number of yaws cases reported to WHO, 2008–2013 Number of cases reported Thousands 90 80 70 60 50 40 30 20 10 0 2008 2009 2010 2011 2012 2013 Year Number of cases reported 2008 2009 2010 2011 2012 2013 Global 56 223 69 467 80 226 51 101 49 375 58 915
*** THE DISEASES − CHAPTER 4 103 Progress towards Roadmap targets In 2012, WHO developed the Morges Strategy for yaws eradication by 2020, which relies on the use of oral azithromycin as the main intervention (9). Two new treatment policies replace those developed in the 1950s: (i) delivering mass treatment to entire endemic communities irrespective of the number of active clinical cases, followed by regular surveillance until clinical cases are no longer identified; and (ii) delivering targeted treatment to all active clinical cases and their contacts (household, school and playmates), an approach that requires support from available health-care services. Oral azithromycin used in mass treatment can interrupt transmission within 6–12 months, as demonstrated in the Nsukka district of Nigeria (10). The Morges Strategy was piloted accordingly during 2012–2013 in selected districts in the Congo, Ghana, Papua New Guinea and Vanuatu (11). About 90 000 people have been treated, with coverage exceeding 90%. The experience gained from these pilot interventions will be used to guide implementation in endemic countries and inform timelines for scaling up eradication efforts according to the Roadmap’s targets and milestones (Table 4.6.1). Table 4.6.1 Targets and milestones for eradicating yaws Year Milestone 2017 50% of endemic countries report zero cases 2020 100% of endemic countries report zero cases Epidemiological assessments in various countries are in progress to help plan implementation of eradication activities towards the eradication objective. Research priorities The third WHO consultation on yaws eradication (March 2014) identified the following priorities for research: • Develop a non-treponemal luminex assay as part of a multiplex assay for NTDs in general and as a more refined tool to determine baseline and impact measures of mass treatment. • Continue to type T. pallidum subsp. pertenue strains from different geographical areas. • Attempt culture of H. ducreyi from leg ulcerations of children and determine antimicrobial susceptibilities. • Attempt to determine the etiology of non-yaws/H. ducreyi lesions using advanced molecular techniques.
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INVESTING TO OVERCOME THE GLOBAL IM
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*** FOREWORD ix FOREWORD BY THE DIR
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*** EXECUTIVE SUMMARY xi EXECUTIVE
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*** EXECUTIVE SUMMARY xiii for the
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*** EXECUTIVE SUMMARY xv Neglected
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*** THE RESOLUTION AND THE ROADMAP
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*** KEY INTERVENTIONS: SITUATION RE
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*** ANNEXES 179 ANNEXES
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*** ANNEXES 181 Annex 1a (cont’d)
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*** ANNEXES 183 WHA66.12 Recognizin
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*** ANNEXES 185 WHA66.12 3. REQUEST
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*** ANNEXES 187 Annex 3. Classifica
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*** ANNEXES 189 Annex 5. Medicines
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*** ANNEXES 191 WHO REGIONAL OFFICE
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