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YAWS – EPIDEMIOLOGY, PREVENTION AND CONTROL
Dr. Priya AroraAssoc. Prof
Deptt. Of Community MedicineACMS
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• Chronic, Contagious, highly infectious, Non-venereal disease caused by Spirochaete Treponema pallidum.
• Usually begins in early childhood.• Primary skin lesion followed by generalised
eruption and a late stage of destructive and disfiguring and debilitating lesions of skin and bone.
• Chronic disease showing relapses over several years.
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GEOGRAPHIC DISTRIBUTION
• Exclusively confined to the belt between the Tropic of Cancer and Capricorn.
• Significant public health problem in Africa, South-east Asia and Central America in the past
• Resurgence in certain areas of Africa• Persistent low level in India till a decade ago.
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INDIA• Reported from tribal communities living in
hilly forests and difficult to reach areas in 49 districts of 10 states.
• States affected – Andhra Pradesh, Assam, Chhattisgarh, Gujrat, Jharkhand, Madhya Pradesh, Maharashtra, Orissa, Tamil Nadu, U.P.
• Number of cases brought down from 3500 in 1996 to zero in 2004.
• Certfication of disease free status in 2011
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AGENT• Treponema pertenue• Resembles T. pallidum culturally and
morphologically• Occurs in the epidermis of lesions, lymph glands,
spleen and bone marrow.Reservoir-Man is the only known reservoirMost latent cases found in cluster around an
infectious caseSource of infection-Skin lesions and exudates from early lesions
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HOST FACTORS
AGE-Primarily a disease of childhood and
adolescence.GENDER -M > FIMMUNITY –No natural immunity.
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ENVIRONMENTAL FACTORS
CLIMATE –Endemic in warm and humid climate.SOCIAL FACTORS –More common in tribal people Poor personal hygiene, overcrowding, low std. of
living predisposing factors
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MODE OF TRANSMISSION
DIRECT CONTACTFOMITESVECTORS
INCUBATION PERIOD –9 – 90 DAYS
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CLINICAL FEATURES• EARLY YAWS- - Primary lesion (Mother Yaws) appears at the site of
inoculation after 3-5 weeks. - Seen on exposed parts of body - Lymph glands are enlarged. - With in next 3-6 weeks generalised eruption appears
consists of large yellow, crusted, granulomatous eruptions .
-During next five years, mucous membrane, periosteal snd bone lesions develop, subside and relapse.
- The early lesions are highly infectioous
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• LATE YAWS - Destructive and deforming lesions of skin,
bone and periosteum develop. CRAB Yaws – lesions of palm and soles Gangosa – lesions of soft palate, hard palate
and nose
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CONTROL OF YAWS
1. SURVEY-Clinical survey of all families in endemic area.Should not cover less than 95% of total population.2. TREATMENTSingle dose of Azithromycin or single long acting
Penicillin will cure infectionSimultaneous treatment of cases and their likely
contacts in the community will interrupt transmission
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• WHO has recommended 3 treatment policies-TOTAL MASS TREATMENT- In hyperendemic
areas(> 10% prevalence of clinically active Yaws). Entire population treated with Pen G.JUVENILE MASS TREATMENT – In mesoendemic
areas(5-10% prevalence). Treatment given to cases, contacts and all
children below 15 yearsSELECTIVE MASS TREATMENT – In hypoendemic
areas(<5% prevalence) Treatment to cases, household and other obvious
contacts
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3. RESURVEY AND TREATMENT-Resuveys every6-12 months to assess problem
magnitude.4. SURVEILLANCE-Surveillance and Containment measures for
affected villages, households and contacts of known Yaws cases.
Epidemiological investigations to trace possible sources of infection, prophylactic treatment of contacts, follw up of cases
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5. ENVIRONMENT IMPROVEMENT
6. ERADICATION EFFORTS-TOTAL COMMUNITY TREATMENTTOTAL TARGETTED TREATMENT
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• YAWS ERADICATION PROGRAMME • The programme was started in 1996-97 in Koraput districts of Orissa then extended to endemic states as a centrally sponsored health scheme with the objectives of:
1. Interrupting the transmission of yaws infection (no case) in the country
2. Eradication of Yaws (i.e. no sero reactivity to RPR/VDRL in children below 5 years of age) from the country.