Regional Consultation on Yaws Eradication

Regional Consultation on Yaws Eradication was convened virtually from 18 to 20 May 2021 by the WHO Regional Office for South-East Asia (SEARO). The Consultation was attended by 46 participants from India, Indonesia, Thailand, Sri Lanka and Timor-Leste, including officials from health ministries, technical experts and partner agencies. The main discussion points included the current status of yaws in countries, challenges in yaws eradication and prioritization of key activities to accelerate yaws eradication.

General objective of the Consultation:

1. To update epidemiological and programmatic situation of yaws in historical or currently endemic countries in the WHO South-East Asia Region.
2. To share the experiences of India on yaws elimination, verification process and post-elimination surveillance.
3. To update the Member States with the latest WHO guidance on yaws eradication.
4. To agree on and recommend the ways forward to achieve yaws elimination in the South-East Asia Region by 2030.

• Yaws surveillance and its integration within the programmes related to broader skin diseases and other programmes such as school health (adapted to country context) should be strengthened.
• Passive case detection is not sufficient to identify most cases. Active case-finding should be pursued, integrated with other community outreach activities. The primary focus of active case detection should be in remote areas where access to health services is limited.
• Advocay activities should be strengthened, especially targeting policy-makers.
• Awareness generation using IEC (information, education ad communication) materials should be promoted at the community level.
• As part of yaws elimination in the SE Asia Region, all countries should make yaws a notifiable disease.

Country-specific recommendations

• High coverage of “total community treatment” (TCT) (preferably >90%) is essential; if not achieved, then additional rounds of TCT will be needed. Active surveillance and “total targeted treatment” (TTT ) should follow TCT.
• Districts verified to be free of yaws should still maintain awareness and surveillance to guard against importation of cases from other areas with disease.
• Azithromycin resistance could potentially occur after repeated TCT and, therefore, close montoring is needed during the implementation period. This calls for the establishment of post-treatment follow-up, to be carried out four weeks after treatment. Any presumed clinical treatment failure after azithromycin should be treated with benzathine penicillin and swabs taken for confirmation by polymerase chain reaction ( PCR).
• Independent evaluation of the programme should be done every two years.

• Testing capacity including PCR should be expanded to achieve elimination by 2023.
• A system to verify and dispel rumours should be established.
• Community-based active case-finding such as a community survey and skin screening through mobile clinics or the school health programme should be bolstered.

• These three Member States should enhance surveillance and awareness generation as part of any programme on skin diseases, especially among children under 15 years of age. Any suspected case should be confirmed by RDT/DPP, recorded and reported.

• Provide laboratory support (RDT, DPP, PCR) to Member States.
• Continue to provide technical and logistic support to help Member States in the Region to achieve interruption of transmission and certification at the earliest possible time ahead of the 2030 target.
• This type of regional meeting should be regularly held to track progress in the Region on yaws eradication by 2030. For Indonesia and Timor-Leste in particular, national meetings to review and track progress should be organized annually.
• Capacity-building and facilities for azithromycin resistance surveillance should be provided to Member States with a focus on Indonesia and Timor-Leste.