![]() Whilst adults are the main reservoir of venereal syphilis, young children and their contacts act as the reservoirs of yaws and bejel, whilst active cases, predominantly in young adults, are thought to be the main reservoir of pinta. 25, 26 Flies have been postulated to mechanically transfer yaws and pinta 2 but there is no definitive proof that this occurs. 25, 26 All three diseases are thought to be spread via direct skin to skin contact, 2 whilst indirect contact via shared objects such as utensils has been additionally implicated in the transmission of bejel. Yaws and pinta are both found in warm and humid environments, 24 whilst bejel is found in drier climes. The collection of accurate prevalence data is a high priority for control efforts for both of these diseases. 18, 22, 23 Except for these case reports there are almost no recent systematic data on the prevalence of either bejel or pinta in many countries where they were previously thought to be of public health significance, which is likely to reflect in part the difficulty in reaching the isolated communities affected by these diseases. 21 Cases of all three diseases in non-endemic countries have been reported in immigrant populations. 18 Bejel has been reported from both the Sahel region of Africa and the Arabian peninsula, and was previously reported to be endemic in the Bedouin population of Saudi Arabia 19, 20 recent reports suggest ongoing transmission in isolated, rural populations. Pinta is restricted to Latin America, in particular Mexico and Colombia, 16, 17 although there are case reports of it occurring in Cuba where it was previously thought to have been eliminated. Integration of confirmatory diagnostic tests in to national reporting structures will be needed to support the current WHO yaws eradication program. Many countries report clinical cases without serological confirmation. ![]() Endemic countries report cases of yaws annually to WHO. 13, 14 India interrupted transmission in 2004 and declared elimination in 2006 15 following a sustained programme which began in 1996. Yaws was previously reported to be endemic in South America and the Caribbean, but control programmes in the mid-twentieth century are thought to have successfully eliminated yaws from most countries in the region except Guyana. 7– 12 Papua New Guinea, the Solomon Islands and Ghana have each reported more than 20 000 cases of yaws in recent years. Yaws is currently thought to be endemic in 14 countries, mostly in West Africa, South East Asia and the Pacific. 6 Despite these efforts the disease was not eliminated and the number of cases reported worldwide has continued to climb in recent years. 5 The disease subsequently rebounded in a number of countries in the 1970s, and a second World Health Assembly resolution was passed in 1978 leading, in some places, to renewed control efforts. Between 19 WHO and UNICEF coordinated a global treatment programme for the control of endemic treponemal diseases which was thought to have reduced the global burden by as much as 98%. ![]() 5 In 1949, soon after WHO was established, the World Health Assembly passed a resolution to support the control and elimination of the endemic treponematoses. In the mid-twentieth century, as many as 50 million individuals were thought to be infected by yaws. This figure is available in black and white in print and in color at Transactions online. Penicillin has long been considered the mainstay of treatment for the endemic treponemal diseases but the recent discovery that azithromycin is effective in the treatment of yaws has renewed interest in these most neglected of the NTDs, and raised hopes that global eradication may finally be possible.Ĭountries where endemic treponemal diseases have recently been reported. ![]() Current diagnostic techniques are unable to distinguish the different causative species but newer molecular techniques are now making this possible. As with venereal syphilis, the clinical manifestations of the endemic treponemal diseases are variable and can be broken down in to early stage and late stage disease. Each disease is restricted to a specific ecological niche but all predominantly affect poor, rural communities. Adequate data on the epidemiology of bejel and pinta is lacking. Despite previous worldwide eradication efforts the prevalence of yaws has rebounded in recent years and the disease is now a major public health problem in 14 countries. The endemic treponemal diseases, consisting of yaws, bejel (endemic syphilis) and pinta, are non-venereal infections closely related to syphilis, and are recognized by WHO as neglected tropical diseases (NTDs). ![]()
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