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 <20 years) living on Lihir Island, Papua New Guinea, with high-titre (rapid plasma reagin titre ≥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.

中文翻译：

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单剂量阿奇霉素治疗潜伏性偏航的有效性：一项纵向比较队列研究

背景

潜在偏航的治疗是世界卫生组织消灭偏航策略的重要组成部分，以防止复发以及由此传染给未感染的儿童。我们评估了单剂量阿奇霉素治疗潜伏性偏航患者的有效性。

方法

这项基于人群的队列研究包括了2013年4月至5月之间居住在巴布亚新几内亚利希尔岛（Lihir Island）的儿童（年龄<20岁），他们有高滴度（快速血浆血红蛋白滴度≥1：8）潜伏性或活动性偏航。 2015年。潜在的偏航被定义为缺乏可疑的皮肤病变或存在PCR阴性的梅毒螺旋体亚种百日咳的溃疡，活动偏航被定义为T百日咳阳性的溃疡在PCR上。所有儿童均接受一剂30 mg / kg阿奇霉素的口服剂量。主要终点是血清学治愈，定义为治疗后24个月血浆血脂快速滴度降低了2倍。如果两侧95％CI的比率差异的下限高于或等于-10％，则认为潜伏偏航的治疗不劣于主动偏航的治疗。该研究已在ClinicalTrials.gov上注册，编号为NCT01955252。

发现

在311名参与者中，有273名（88％； 165名潜伏偏航和108名活跃偏航）完成了随访。达到预定标准的151名（92％）潜在偏航参与者和101名（94％）活跃偏航参与者达到了主要终点（风险差异为-2·0％，95％CI -8·3至4·3）。对于非自卑。

解释

根据血清学滴度的下降，口服单剂量阿奇霉素对潜伏偏航的参与者有效。这一发现支持了世卫组织基于整个流行社区的大规模管理而根除偏头痛的世界卫生组织战略，无论其临床状况如何。

资金

纽克雷斯特矿业有限公司和ISDIN实验室。