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THE DISEASES − CHAPTER 4
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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.