From the National Department of Health, Aopi Centre (L.N.J., W.H.), the School of Medicine and Health Sciences, University of Papua New Guinea (L.N.J., O.M.), and the World Health Organization Representative Office in Papua New Guinea (J.K.W.), Port Moresby, the New Ireland Provincial Health Authority, Kavieng (M.S., E.J., E.M.), and Lihir Medical Center, International SOS, Lihir Island (R.K., O.M.) - all in Papua New Guinea; the Infectious Diseases Department and Fight AIDS and Infectious Diseases Foundation, Hospital Universitari Germans Trias i Pujol (L.N.J., C.G.B., D.O., B.C., M.V.-M., O.M.), the Genomes for Life-Genomes of Catalonia Lab Group, Institute for Health Science Research Germans Trias i Pujol (I.G.-F.), and the IrsiCaixa AIDS Research Institute (B.C.), Badalona, the Barcelona Institute for Global Health, Faculty of Medicine, University of Barcelona (L.N.J.), and the Institute for Research in Biomedicine, Barcelona Institute of Science and Technology (I.G.-F.), Barcelona, and Universitat de Vic-Universitat Central de Catalunya, Vic (B.C., O.M.) - all in Spain; the Department of Biology, Faculty of Medicine, Masaryk University, Brno, Czech Republic (M. Medappa, P.P., D.Š.); the Parasites and Microbes Programme, Wellcome Sanger Institute, Hinxton (M.A.B.), and the Clinical Research Department, London School of Hygiene and Tropical Medicine, and the Hospital for Tropical Diseases, University College London Hospitals, London (M. Marks) - all in the United Kingdom; the Department of Medicine, Division of Allergy and Infectious Diseases, and the Department of Global Health, University of Washington, Seattle (L.G.); and the Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (E.Q.M.).
N Engl J Med. 2022 Jan 6;386(1):47-56. doi: 10.1056/NEJMoa2109449.
subspecies causes yaws. Strategies to better control, eliminate, and eradicate yaws are needed.
In an open-label, cluster-randomized, community-based trial conducted in a yaws-endemic area of Papua New Guinea, we randomly assigned 38 wards (i.e., clusters) to receive one round of mass administration of azithromycin followed by two rounds of target treatment of active cases (control group) or three rounds of mass administration of azithromycin (experimental group); round 1 was administered at baseline, round 2 at 6 months, and round 3 at 12 months. The coprimary end points were the prevalence of active cases of yaws, confirmed by polymerase-chain-reaction assay, in the entire trial population and the prevalence of latent yaws, confirmed by serologic testing, in a subgroup of asymptomatic children 1 to 15 years of age; prevalences were measured at 18 months, and the between-group differences were calculated.
Of the 38 wards, 19 were randomly assigned to the control group (30,438 persons) and 19 to the experimental group (26,238 persons). A total of 24,848 doses of azithromycin were administered in the control group (22,033 were given to the participants at round 1 and 207 and 2608 were given to the participants with yaws-like lesions and their contacts, respectively, at rounds 2 and 3 [combined]), and 59,852 doses were administered in the experimental group. At 18 months, the prevalence of active yaws had decreased from 0.46% (102 of 22,033 persons) at baseline to 0.16% (47 of 29,954 persons) in the control group and from 0.43% (87 of 20,331 persons) at baseline to 0.04% (10 of 25,987 persons) in the experimental group (relative risk adjusted for clustering, 4.08; 95% confidence interval [CI], 1.90 to 8.76). The prevalence of other infectious ulcers decreased to a similar extent in the two treatment groups. The prevalence of latent yaws at 18 months was 6.54% (95% CI, 5.00 to 8.08) among 994 children in the control group and 3.28% (95% CI, 2.14 to 4.42) among 945 children in the experimental group (relative risk adjusted for clustering and age, 2.03; 95% CI, 1.12 to 3.70). Three cases of yaws with resistance to macrolides were found in the experimental group.
The reduction in the community prevalence of yaws was greater with three rounds of mass administration of azithromycin at 6-month intervals than with one round of mass administration of azithromycin followed by two rounds of targeted treatment. Monitoring for the emergence and spread of antimicrobial resistance is needed. (Funded by Fundació "la Caixa" and others; ClinicalTrials.gov number, NCT03490123.).
亚种 引起雅司病。需要采取更好的控制、消除和消灭雅司病的策略。
在巴布亚新几内亚雅司病流行地区进行的一项开放性标签、基于社区的集群随机试验中，我们将 38 个病房（即集群）随机分为两组，一组接受一轮阿奇霉素大规模给药，随后两轮对活动性病例进行靶向治疗（对照组），另一组接受三轮阿奇霉素大规模给药（实验组）；第一轮在基线时进行，第二轮在 6 个月时进行，第三轮在 12 个月时进行。主要终点是整个试验人群中活动性雅司病的患病率（通过聚合酶链反应检测证实），以及无症状 1 至 15 岁儿童亚组中潜伏性雅司病的患病率（通过血清学检测证实）；在 18 个月时进行测量，并计算组间差异。
在 38 个病房中，有 19 个被随机分配到对照组（30438 人），19 个被分配到实验组（26238 人）。对照组共给予 24848 剂阿奇霉素（第一轮给予 22033 剂，第二轮和第三轮分别给予 207 剂和 2608 剂给有雅司病样病变和接触者），实验组给予 59852 剂。在 18 个月时，对照组的活动性雅司病患病率从基线时的 0.46%（22033 人中的 102 人）降至 0.16%（29954 人中的 47 人），实验组从基线时的 0.43%（20331 人中的 87 人）降至 0.04%（25987 人中的 10 人）（经聚类调整的相对风险，4.08；95%置信区间[CI]，1.90 至 8.76）。两组的其他传染性溃疡患病率均降至相似水平。对照组 994 名儿童中有 6.54%（95%CI，5.00 至 8.08）和实验组 945 名儿童中有 3.28%（95%CI，2.14 至 4.42）患有潜伏性雅司病（经聚类和年龄调整的相对风险，2.03；95%CI，1.12 至 3.70）。实验组发现了 3 例对大环内酯类药物耐药的雅司病病例。
与一轮阿奇霉素大规模给药后两轮靶向治疗相比，每 6 个月进行三轮阿奇霉素大规模给药可更大程度地降低社区雅司病的患病率。需要监测抗生素耐药性的出现和传播。（由“la Caixa”基金会和其他机构资助；临床试验.gov 编号，NCT03490123。）
