In the Literature

The identification of variants of Treponema pallidum subspecies pertenue in Guyana in 1999 recently led to the apparent elucidation of the origin of the trepanomatoses [1]. This work derived from the identification of infection with clinical elements suggestive of both yaws and syphilis in children of the Akwio tribe, among whom there have apparently no further cases identified. Just 2 countries are currently considered to be afflicted with endemic yaws: Indonesia and TimorLeste (East Timor). India was recently declared by the World Health Organization (WHO) to have eradicated yaws. Yaws, as a consequence of being limited to humans (and, possibly, great apes), together with its areas of endemicity being highly localized and its readily curable nature, is a disease that would appear to be a prime candidate for eradication. The lessons derived from experience in India are instructive. Yaws was first identified in India in 1887. Arsenicals were administered in a mass control campaign in that country from 1935 to 1946. A WHO-UNICEF campaign administered 150 million “antiyaws treatments” in 46 countries, including India, from 1952 to 1964, with a resultant ∼95% overall reduction in prevalence. The prevalence in India during that campaign decreased from 14% to !0.1%. Then, in a story repeated with many other diseases of public health importance, the disease resurged in a number of countries, including parts of India, as attention was turned elsewhere. After the identification in 1977 of a number of cases in Madhya, Pradesh, the problem was eventually reexamined in India, and in the 1990s, a new eradication program was implemented. This multifaceted program included active surveillance and treatment of cases and contacts with a single dose of long-acting penicillin. This effort resulted in a decrease in the number of reported cases from 3571 in 1996, to 773 in 1997, and to 0 in 2004. On 19 September 2006, a formal declaration was issued, indicating that yaws had been eliminated in India. With continued active monitoring, it is hoped that it will be possible to declare the eradication of yaws in India in 2010. In the meantime, the WHO has set 2012 as the target date for the final elimination of yaws in Indonesia and Timor-Leste.