- - - THE STORY OF 50 YEARS OF RESEARCH--.
Yaws: the "Back Room" Battle
r-- By Dr. C.J. HACKETT J
L
Venereal Diseases and Treponematoses Section, WHOU
NTIL Castellani-. a.· n .!ta. l.ian scie.n-THE
las.t a .. n·d g. re.atest st.ep in the con- tist working in Ceylon-reco- trol of yaws was the discovery of gnized Trepo~ma p~rtqnue as the ~ _ · _ penicilli_n h);'._ F'l1;,mjn~ apd .Florey cause of yaws 50 years ago, the m tlie 193o's and its application to most effective treatment of the syphilis by Mahoney in the United States disease was the local application of in 1943 and to yaws by F.N. Guimaraes mercurial ointment to the skin lesions. and other Brazilian workers in 1944.When the causal germ was fou';}d to be When long-acting penicillin preparations very c~osely rela_ted to that which had such as procaine penicillin G in oil with 2 % been d1sco~ere~ m the same year (1905) aluminium monostearate (PAM) became by Sch'.11;1dmn m Germany as the cause available, so that a single injection was at of syphihs_-Treponema pallidu"!-the close least as effective as six injections of arsenic relationship of the two diseases w'.1s and bismuth, the possibility of controlling yaws furt~e~ stressed and treatment u~ed m on a large scale became much more practical.
syphilis was thereafter more directly .
applied to yaws. At first this was The use of PAM m tlie co~trol of various preparations of mercury, in the yaws by mass treatment started m !949 form of ointments to be rubbed in or m . several \YHO- U~ICEF-a~sisted of solutions to be taken by mouth. national campaigns agamst the disease.
Ehrlich-in 1912 in Germany-di~-
THE
First International Symposium covered the first group of synthetic on Yaws Control was held in substances to prove effectiv~ in the treat- Bangkok in 1952. Workers from ment. of any. hur.1an dISea~e. They yaws control campaigns from all over contamed arsemc and the most important the world met tliere at the invitation of was neoarsphenamine or novarsenobillon the Government of Thailand and WHO(NAB). . to discuss what had been achieved in
1:his
weal'?? was fi;5t used with suc':ess yaws control based on modern principles agalilSt sypht!IS and it was soon appbed including the use of PAM. The results to yaws. . . . were extremely encouraging.1:'he res1;1lt of g1vmg this. substance to At this symposium the need was p~tients with ear!y yaws lesions. appear1:;d stressed for treating a wider range of mtraculous a~d it has been said that m persons than only those having clinical many count1;e_s wher'? yaws occurred lesions: treatment should include latent Western medtcme was mtroduced by the cases and contacts in the incubation treatmen~ ff yaws. . period at .the time of examination.
One mJec~10n rapidly healed . the The need, in many countries, to ear!y yaws !~tons but usual~y the patient, employ simply-trained auxiliary staff behevmg himself C;Ur~d! d~d not return in yaws campaigns was approved and for the course of six mJections that was recommended.
required. It was also recommended that a further
. international meeting on yaws control
T HE
next landmark ~ the tre~tment should be held in three years to consider of yaws was !he mtro~uctton . ~f again what had been achieved and to bismuth, after its value m syphilis make further recommendations.had been demonstrated by Sazerac and Levaditi in France in 1921.
The first world war delayed the full use by many tropical countries of oeoarsphenamine in yaws but, together with bismuth, there was now the opportunity to attempt to control the disease. However, at least six injections of each were required and without very good co-operation from the people and their chiefs it was unusual for more than an average of three injections to be received.
For the next 25 years arsenical and bismuth preparations were the most important treatment of yaws. Many attempts to control the disease were made.
Probably the greatest success followed the administration of bismuth at rural dispensaries-witliout payment-to all yaws patients who sought treatment.
It required 10-15 years greatly· to reduce the prevalence of the infection and the results were largely restricted to areas- within rn-15 miles of the dispen- sary.
The possibilities of success in such control measures were greatly reduced by the impracticability of giving an adequate course of injections to the patients and the lack of appreciation of the importance of latent cases and the essential need to treat them as well as the active cases of yaws.
T
HIS Second International Conference on Yaws Control is to be held, in November this year, in Enugu in the Eastern Region of Nigeria under the auspices of the Nigerian Government and WHO. Enugu is a very suitable place, for in that area a successful mass campaign against yaws is being carried out.The programme for the International Yaws Conference has been drawn up to deal with all aspects of field work as regards yaws and also tlie related endemic syphilis and other trepanematoses.
Workers from all over the world will contribute to the meetings from their expe- rience and, in return, will gather information from others which will have practical applica·
tion in their own countries. This second symposium will, as did the first one, summa- rize the achievements in the field of yaws control (but only since 1953) and will indicate the direction in which the yaws control activities should proceed.
This symposium thus comes at an important time, especially for Africa, where a number of yaws control cam- paigns are either in progress or are now being planned. It is intended that these and all other anti-yaws campaigns should benefit from the experience of the whole world.
