1. Effectiveness of single-dose azithromycin to treat latent yaws: a longitudinal comparative cohort study
- Author
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Sibauk Bieb, Reman Kolmau, August Kapa, Wendy Houinei, Oriol Mitjà, Charmie Godornes, Camila González-Beiras, James Wangi, Sergi Sanz, Sheila A. Lukehart, Raymond Paru, Quique Bassat, Haina Abel, and Kingsley Asiedu
- Subjects
Male ,medicine.medical_specialty ,Adolescent ,genetic structures ,030231 tropical medicine ,Population ,Azithromycin ,Polymerase Chain Reaction ,Rapid plasma reagin ,Serology ,Cohort Studies ,Papua New Guinea ,03 medical and health sciences ,0302 clinical medicine ,Clinical trials ,Radiation victims ,Internal medicine ,medicine ,Clinical endpoint ,Humans ,Longitudinal Studies ,Treponema pallidum ,030212 general & internal medicine ,Child ,education ,skin and connective tissue diseases ,education.field_of_study ,medicine.diagnostic_test ,Transmission (medicine) ,business.industry ,lcsh:Public aspects of medicine ,Absolute risk reduction ,lcsh:RA1-1270 ,General Medicine ,Anti-Bacterial Agents ,Surgery ,body regions ,Víctimes de radiacions ,Child, Preschool ,Yaws ,Female ,business ,medicine.drug ,Cohort study ,Assaigs clínics - Abstract
BACKGROUND: Treatment of latent yaws is a crucial component of the WHO yaws eradication strategy to prevent relapse and the resulting transmission to uninfected children. We assessed the effectiveness of single-dose azithromycin to treat patients with latent yaws. METHODS: This population-based cohort study included children (age /=1:8) latent or active yaws, between April, 2013, and May, 2015. Latent yaws was defined as lack of suspicious skin lesions or presence of ulcers negative for Treponema pallidum subsp pertenue on PCR, and active yaws was defined as ulcers positive for T pertenue on PCR. All children received one oral dose of 30 mg/kg azithromycin. The primary endpoint was serological cure, defined as a two-dilution decrease in rapid plasma reagin titre by 24 months after treatment. Treatment of latent yaws was taken to be non-inferior to that of active yaws if the lower limit of the two-sided 95% CI for the difference in rates was higher than or equal to -10%. This study is registered with ClinicalTrials.gov, number NCT01955252. FINDINGS: Of 311 participants enrolled, 273 (88%; 165 with latent yaws and 108 with active yaws) completed follow-up. The primary endpoint was achieved in 151 (92%) participants with latent yaws and 101 (94%) with active yaws (risk difference -2.0%, 95% CI -8.3 to 4.3), meeting the prespecified criteria for non-inferiority. INTERPRETATION: On the basis of decline in serological titre, oral single-dose azithromycin was effective in participants with latent yaws. This finding supports the WHO strategy for the eradication of yaws based on mass administration of the entire endemic community irrespective of clinical status. FUNDING: Newcrest Mining Limited and ISDIN laboratories.