title: Impact of Community Mass Treatment with Azithromycin for Trachoma Elimination on the Prevalence of Yaws.
abstract: BACKGROUND
  Community mass treatment with 30 mg/kg azithromycin is central to the new WHO strategy for eradicating yaws. Both yaws and trachoma--which is earmarked for elimination by 2020 using a strategy that includes mass treatment with 20 mg/kg azithromycin--are endemic in the Pacific, raising the possibility of an integrated approach to disease control. Community mass treatment with azithromycin for trachoma elimination was conducted in the Solomon Islands in 2014.
  
  
  METHODS
  We conducted a study to assess the impact of mass treatment with 20 mg/kg azithromycin on yaws. We examined children aged 5-14 years and took blood and lesion samples for yaws diagnosis.
  
  
  RESULTS
  We recruited 897 children, 6 months after mass treatment. There were no cases of active yaws. Serological evidence of current infection was found in 3.6% (95% CI= 2.5-5.0%). This differed significantly between individuals who had and had not received azithromycin (2.8% vs 6.5%, p=0.015); the prevalence of positive serology in 5-14 year-olds had been 21.7% (95% CI=14.6%-30.9%) 6 months prior to mass treatment. Not receiving azithromycin was associated with an odds of 3.9 for infection (p=0.001). National figures showed a 57% reduction in reported cases of yaws following mass treatment.
  
  
  CONCLUSIONS
  Following a single round of treatment we did not identify any cases of active yaws in a previously endemic population. We found a significant reduction in latent infection. Our data support expansion of the WHO eradication strategy and suggest an integrated approach to the control of yaws and trachoma in the Pacific may be viable.
authors.affiliation: Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; The Hospital for Tropical Diseases, Mortimer Market Centre, London, United Kingdom.
authors.forename: Michael
authors.initials: M
authors.lastname: Marks
authors.affiliation: Ministry of Health and Medical Services, Honiara, Solomon Islands.
authors.forename: Ventis
authors.initials: V
authors.lastname: Vahi
authors.affiliation: Ministry of Health and Medical Services, Honiara, Solomon Islands.
authors.forename: Oliver
authors.initials: O
authors.lastname: Sokana
authors.affiliation: Molecular Diagnostics and Typing Laboratory, Laboratory Reference and Research Branch, Division of Sexually Transmitted Disease Prevention (DSTDP), Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Kai-Hua
authors.initials: KH
authors.lastname: Chi
authors.affiliation: Ministry of Health and Medical Services, Honiara, Solomon Islands.
authors.forename: Elliot
authors.initials: E
authors.lastname: Puiahi
authors.affiliation: World Health Organization, Western Pacific Region Office, Honiara, Solomon Islands.
authors.forename: Georgina
authors.initials: G
authors.lastname: Kilua
authors.affiliation: Molecular Diagnostics and Typing Laboratory, Laboratory Reference and Research Branch, Division of Sexually Transmitted Disease Prevention (DSTDP), Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Allan
authors.initials: A
authors.lastname: Pillay
authors.affiliation: Ministry of Health and Medical Services, Honiara, Solomon Islands.
authors.forename: Tenneth
authors.initials: T
authors.lastname: Dalipanda
authors.affiliation: Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Christian
authors.initials: C
authors.lastname: Bottomley
authors.affiliation: Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; The Hospital for Tropical Diseases, Mortimer Market Centre, London, United Kingdom.
authors.forename: Anthony W
authors.initials: AW
authors.lastname: Solomon
authors.affiliation: Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; The Hospital for Tropical Diseases, Mortimer Market Centre, London, United Kingdom.
authors.forename: David C
authors.initials: DC
authors.lastname: Mabey
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017963:Azithromycin / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008542:Melanesia / Q000453:epidemiology; D015995:Prevalence; D012621:Seasons; D014141:Trachoma / Q000453:epidemiology / Q000517:prevention & control*; D015001:Yaws / Q000453:epidemiology / Q000517:prevention & control*
chemical_list: D000900:Anti-Bacterial Agents; D017963:Azithromycin