Abstract
Yaws is a neglected tropical disease targeted for eradication by 2030. To achieve eradication, finding and treating asymptomatic infections as well as clinical cases is crucial. The proposed plan, the Morges strategy, involves rounds of total community treatment (i.e., treating the whole population) and total targeted treatment (TTT) (i.e., treating clinical cases and contacts). However, modeling and empirical work suggests asymptomatic infections often are not found in the same households as clinical cases, reducing the utility of household-based contact tracing for a TTT strategy. We use a model fitted to data from the Solomon Islands to predict the likelihood of elimination of transmission under different intervention schemes and levels of systematic nontreatment resulting from the intervention. Our results indicate that implementing additional treatment rounds through total community treatment is more effective than conducting additional rounds of treatment of at-risk persons through TTT.
Highlights
Yaws is a neglected tropical disease targeted for eradication by 2030
total community treatment (TCT) is designed for situations in which a large proportion of the population is infected, whereas TTT is intended to treat a small number of remaining cases once elimination of transmission (EOT) appears close
Increasing the number of rounds of TCT increases the probability of EOT more rapidly than including additional rounds of TTT
Summary
Yaws is a neglected tropical disease targeted for eradication by 2030. To achieve eradication, finding and treating asymptomatic infections as well as clinical cases is crucial. The proposed plan, the Morges strategy, involves rounds of total community treatment (i.e., treating the whole population) and total targeted treatment (TTT) (i.e., treating clinical cases and contacts). Yaws is an infectious disease found in South America, Asia, Africa, and Oceania It is caused by Treponema pallidum subspecies pertenue [1], an organism morphologically identical to T. pallidum subsp. Yaws can manifest as skin lesions, involvement of the bones and joints, and eventually irreversible disfigurement It is spread by direct contact between a susceptible person and lesions of infectious persons and affects persons 2–15 years of age. Secondary yaws lesions might appear near the initial lesion and persist >6 months These lesions heal spontaneously, leading to a noninfectious latent period that can last the remaining lifetime of the person [11]. Tertiary yaws lesions are rarely seen [12], but when they do manifest, they appear years after primary yaws and are often destructive but are noninfectious
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