title: A cross-sectional study of 'yaws' in districts of Ghana which have previously undertaken azithromycin mass drug administration for trachoma control.
abstract: Yaws, caused by Treponema pallidum ssp. pertenue, is reportedly endemic in Ghana. Mass distribution of azithromycin is now the cornerstone of the WHO yaws eradication campaign. Mass distribution of azithromycin at a lower target dose was previously undertaken in two regions of Ghana for the control of trachoma. Ongoing reporting of yaws raises the possibility that resistance may have emerged in T. pallidum pertenue, or that alternative infections may be responsible for some of the reported cases. We conducted a cross-sectional survey in thirty communities in two districts of Ghana where MDA for trachoma had previously been conducted. Children aged 5-17 years with ulcerative lesions compatible with yaws were enrolled. Samples for treponemal serology and lesion PCR were collected from all children. 90 children with 98 lesions were enrolled. Syphilis serology was negative in all of them. PCR for T. pallidum ssp pertenue was negative in all children, but Haemophilus ducreyi DNA was detected in 9 lesions. In these communities, previously treated for trachoma, we found no evidence of ongoing transmission of yaws. H. ducreyi was associated with a proportion of skin lesions, but the majority of lesions remain unexplained. Integration of diagnostic testing into both pre and post-MDA surveillance systems is required to better inform yaws control programmes.
authors: Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors: Rosanna
authors: R
authors: Ghinai
authors: Department of Clinical Microbiology, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
authors: Philip
authors: P
authors: El-Duah
authors: Laboratory Reference and Research Branch, Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and Tuberculosis Prevention Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors: Kai-Hua
authors: KH
authors: Chi
authors: Laboratory Reference and Research Branch, Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and Tuberculosis Prevention Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors: Allan
authors: A
authors: Pillay
authors: Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom; Hospital for Tropical Diseases, University College London Hospitals NHS Trust, London, United Kingdom.
authors: Anthony W
authors: AW
authors: Solomon
authors: Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom; Hospital for Tropical Diseases, University College London Hospitals NHS Trust, London, United Kingdom.
authors: Robin L
authors: RL
authors: Bailey
authors: Public Health Division, Ghana Health Service, Accra, Ghana.
authors: Nsiire
authors: N
authors: Agana
authors: Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom; Hospital for Tropical Diseases, University College London Hospitals NHS Trust, London, United Kingdom.
authors: David C W
authors: DC
authors: Mabey
authors: Laboratory Reference and Research Branch, Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and Tuberculosis Prevention Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors: Cheng-Yen
authors: CY
authors: Chen
authors: Department of Clinical Microbiology, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
authors: Yaw
authors: Y
authors: Adu-Sarkodie
authors: Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom; Hospital for Tropical Diseases, University College London Hospitals NHS Trust, London, United Kingdom.
authors: Michael
authors: M
authors: Marks
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017963:Azithromycin / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D005869:Ghana; D006801:Humans; D008297:Male; D014141:Trachoma / Q000517:prevention & control*; D015001:Yaws / Q000517:prevention & control*
chemical_list: D000900:Anti-Bacterial Agents; D017963:Azithromycin
references: J Clin Microbiol. 2003 Sep;41(9):4231-7
references: 12958250
references: N Engl J Med. 2004 Jul 8;351(2):154-8
references: 15247355
references: J Clin Microbiol. 1996 Jan;34(1):49-54
references: 8748271
references: J Infect Dis. 1998 Jun;177(6):1608-13
references: 9607840
references: Bull World Health Organ. 2006 Aug;84(8):613-9
references: 16917648
references: Bull World Health Organ. 2008 Jul;86(7):499-499A
references: 18670655
references: J Clin Microbiol. 2009 Jun;47(6):1668-73
references: 19339468
references: Trans R Soc Trop Med Hyg. 2009 Oct;103(10):993-1000
references: 19286239
references: Lancet. 2012 Jan 28;379(9813):342-7
references: 22240407
references: J Clin Microbiol. 2013 Mar;51(3):908-13
references: 23284026
references: Clin Microbiol Infect. 2013 Oct;19(10):975-9
references: 23231450
references: Wkly Epidemiol Rec. 2012 May 18;87(20):189-94
references: 24340400
references: J Clin Microbiol. 2014 Aug;52(8):2776-81
references: 24850356
references: Lancet Glob Health. 2014 Apr;2(4):e235-41
references: 25103064
references: Lancet Glob Health. 2014 Jul;2(7):e415-21
references: 25103395
references: PLoS Negl Trop Dis. 2014 Sep;8(9):e3156
references: 25211018
references: Trans R Soc Trop Med Hyg. 2014 Oct;108(10):601-7
references: 25157125
references: Emerg Infect Dis. 2014 Oct;20(10):1705-7
references: 25271477
references: Am J Trop Med Hyg. 2015 Jan;92(1):134-8
references: 25404075