Yaws essay

Yaws essay

Introduction

Yaws is a skin, bones, and joints infection, common in the tropics. Treponema pallidum bacteria cause the disease. The ailment is prevalent among children, and the WHO declares it “disfiguring and debilitating” (WHO, 2019). Yaws is one of the diseases that the WHO has targeted for eradication. Yaws imposes social and economic burdens on communities, and eradicating it will, therefore, make the world safer, especially for children who are at high risk of infection. However, several biological, technical, and social factors stand in the way of eradicating this infection. This paper examines the feasibility of eradicating Yaws, including the biological enablers and impediments of eradication, and the social and structural frameworks required to declare the infection eradicated from the world.

Global burden of yaws

An essential aspect of eradicating any disease is to understand its epidemiology (Kazadi et al., 2014). Yaws is particularly prevalent in the tropics, where the climatic conditions, including temperature and humidity, are favorable for the thriving of the pathogenic bacteria. According to Kazadi et al. (2014), the infection is prevalent in regions with substantial rainfall, averaging more than 1,300 mm annually. The WHO estimates that about 42 million people live in yaws’ endemic areas, including Africa, the Americas, Western Pacific, and South Asia. In 2017, an estimated 110,000 people died from yaws, a majority of them being children below the age of five (Roser et al., 2014). The WHO fears that there could be over twelve endemic countries, and seven of them are in Africa (Kazadi et al., 2014). Ghana, especially, is among the most endemic countries. Ghana reported over 20,000 incidences of yaws every year between 2007 and 2010. The tropical forests around the Central African Republic, Cameroon, and Congo, are also hotspots of the infection.

In South Asia, Indonesia is the most endemic country with close to 3,500 reported cases in 2012. Most regions in the Western Pacific long declared yaws eradicated, but there have been recent incidences, suggesting that the infection is still a threat. Several cases, for instance, are reported in Papua New Guinea, Vanuatu, and the Solomon Islands. These three regions reported 17,560, 1,718, and 12,372, respectively, in 2012. The Americas do not consider the malady a public health issue. However, few incidences occur in Guyana, Ecuador, and Colombia (Zoni et al., 2019).

According to current WHO reports, at least 15 countries are yaws-endemic, and over three of these have recently had an incidence. Over 76 countries previously marked endemic have not reported cases of yaws in recent years, but data is missing to verify that the disease is no more (WHO, 2019). India is among the countries that were previously endemic but have been declared free from the infection. In 2012, the WHO renewed worldwide interventions to stamp out yaws owing to an increased rate of incidences in the endemic regions. The goal is to eradicate the disease by 2020.

Biological factors

Biological factors that will enable eradication

Treponema pallidum is the bacteria that causes yaws. Biologically, this bacteria is only transmittable between human beings. The fact that the bacteria only have one host makes it eradicable (WHO, 2017). The lack of many hosts means that the world has only one host to protect. Vectors with many hosts require a lot of resources and time to eradicate because achieving eradication requiring the killing of the vector in all the hosts (Roser et al., 2014). Also, the vector has only a couple of hours to survive outside the human body. For example, the bacteria responsible for yaws can only live briefly outside the host’s body, which means that for transmission to occur, there must be direct contact with open wounds. The fact that the bacteria die quickly outside the human body means that it is not persistent in the environment, and this is a significant boost to eradication efforts (Klepac et al., 2015).

Additionally, the diagnosis of yaws is pretty straightforward. Affected individuals develop lesions that are external and very visible. Physical examination, therefore, is adequate to point clinicians in the right direction, especially in stages 1 and 2 of the disease. Besides physical examinations, clinicians also use a microscopic examination of affected tissues, such as samples from open wounds. Specialized blood tests, such as VDRL, are adequate to diagnose stage 3 yaws. Easy diagnosis is also vital in eradication efforts because clinicians require limited resources and time to confirm the presence of the bacteria or rule it out.

Biological factors that hinder eradication

One of the most significant biological impediments to eradicating yaws is that it is not possible to effectively culture Treponema pallidum. Culturing is an essential step in eliminating a disease because it allows researchers to manipulate the bacteria and observe its reactions to various treatments. Unfortunately for this bacteria, researchers have not been able to culture it effectively. According to Klepac et al. (2015), the “sensitivity and specificity of laboratory tests” is vital for sufficient examination of pathogens and the treatments that work best. Treponema pallidum only has a few hours to survive outside the host’s body, and this makes it challenging to alienate it for laboratory manipulations and tests.

Current interventions

The eradication approach to yaws uses the Total community treatment (TCT) strategy using the oral administration of azithromycin, a cheap antibiotic drug. According to the TCT strategy, people in an endemic region take the medication. The WHO advocates for over 90% administration in high-risk populations. Mass treatment, ranging between 2 to 3 rounds, can be sufficient to interrupt the vector from transmitting between individuals (WHO, 2019). The criteria used to confirm eradication involves confirming the absence of serologically-confirmed incidences following three consecutive years of serious surveillance. Also, the disease may be declared eradicated if PCR confirms zero cases of transmission. Sero-surveys many also help to indicate eradication. Currently, only India is officially confirmed to be free of the infection. The WHO is responsible for conducting surveys to identify incidences, and it works with countries in strategy development for eradication programs. The WHO also donates millions of azithromycin tablets to affected countries, which helps to make sure societies afford the treatment. Research is also underway to culture the bacteria, and this will allow better studying of the bacteria’s lifecycle.

Social factors that hinder eradication

One of the biggest social hindrances to eradicating yaws is that a lot of misperception exists concerning the disease (Roser et al., 2014). In developing countries, which make up a massive percentage of the endemic regions, for instance, information about the disease is limited. The lack of knowledge on the disease, including its causes and mode of transmission, hinders efforts to eradicate it. According to WHO, yaws is one of the neglected, yet eradicable conditions. The disease is often not given adequate attention, and this explains why data on its prevalence and incidence is sketchy as best. As such, many people do not know this disease, and they cannot, therefore, protect themselves against it. Many people in developed countries underestimate the impacts of the condition, which results in low uptake of treatment.

Inadequate surveillance is also a big problem (Marks, 2016). Many countries are not investing in active surveillance to monitor the prevalence of the disease, and this makes it difficult to determine the endemic regions accurately. Although many countries are yaws-endemic, data lacks to verify new cases. It is a shame that only India is so far officially declared free from this life-threatening ailment. Over 70 countries that have previously been tagged for surveillance do not have accurate data. A lack of focus on yaws shows that people do not take it seriously, and this makes it even more challenging to treat and eradicate it from the universe. Funding for research is also a significant problem; healthcare organizations do not invest adequate funds in research and development in yaws treatment and eradication. It was only until 2012 when new cases of infection were reported among the endemic regions did efforts to eradicate the sickness revive.

How to approach the eradication, including scientific evidence

One of the interventions required to eradicate yaws is to create awareness about its existence. Currently, information about the ailment is either sketchy or not available. Awareness creation should also follow intense surveillance to identify incidences when they occur. A lack of surveillance leaves people in the dark, not knowing which areas are endemic. The current endemic regions were market many years ago. Current research is required to identify the new endemic areas. Scientifically, it will be crucial to conduct culturing on the bacteria to establish its lifecycle and reaction to the medication. Until culturing is possible, it will be difficult to confirm eradication.

Conclusion

Yaws is a forgotten infection that is common among children. The WHO recognizes it as a severe infection, which may be life-limiting. The disease is prevalent in the tropics, and it is common in some parts of Africa, South Asia, and the Western Pacific. Several biological factors, including its hosts, lifecycle, persistence, culturing, and diagnosis, are crucial for determining the feasibility of yaws eradication. Social factors, such as awareness, surveillance, and funding, are also vital in understanding the eradication process. One of the scientific goals of elimination is to make culture possible.