Yaws is a bacterial infection that affects skin, bone, and cartilage, especially in remote, tribal areas of India. It can be cured by a single dose of penicillin. India launched a Yaws Eradication Programme in 1996 to interrupt transmission of the disease and achieve eradication, as defined by no seropositivity in children, by mass treatment of affected communities. The programme is coordinated nationally and implemented in endemic states, using existing healthcare systems to detect cases and provide penicillin treatment to cases and contacts in order to eliminate the disease from the country.

1. NATIONAL YAWS ERADICATION PROGRAMME
YAWS: Elimination To Eradication
INTRODUCTION:
India has achieved eradication of two human scourges, smallpox and guinea worm disease, since
independence. National efforts are now going on to eradicate/eliminate others. One disease,
which is amenable for eradication, is yaws and the disease has been eliminated from the country
in 2006. This disease primarily affects tribal population living in remote, hilly and forest areas
having difficult terrain. It is responsible not only for great deal of misery to the affected people
but also contributes significantly to the economic strain of the already impoverished segments of
our society.
DESCRIPTION ABOUT YAW:
Yaws belongs to a group of chronic bacterial infections (endemic treponematoses, nonvenereal
spirochetal diseases) caused by treponemes. Other diseases belonging to this group are bejel
(endemic syphilis) and pinta. Yaws is the most common of all and occurs primarily in the warm,
humid and tropical areas of Africa, Central and South America, the Caribbean, Indian peninsula
and the equatorial islands of South-East Asia
Yaws is characterized by a primary skin lesion (Early Yaws) which usually occurs in children
and adolescents in endemic situation. These lesions may persist for 3-6 months and heal
spontaneously, often leaving a scar. Nocturnal bone pain and tenderness of the tibia and other
long bones due to periostitis are common. Usually after 5 years of onset of illness, destructive
lesions of the skin, bone and cartilage (late yaws) may appear which are non-infectious but may
make a person disabled. The organism responsible for yaws is Treponema pallidum subspecies
pertenue. It is morphologically and immunologically identical to T. pallidum (the organism that
causes venereal syphilis).
TRANSMISSION:
Yaws is transmitted by direct (person-to-person) contact with the exudates and serum from
infectious lesions.
DIFFERENTIAL DIAGNOSIS:
Yaws simulates the lesions of scabies, impetigo, skin tuberculosis, tinea versicolor, tropical
ulcer, leprosy and psoriasis. It may also accompany these diseases. Penicillin treatment (drug of
choice) is very useful in differential diagnosis because of miraculous relief seen in yaws but not
in other skin diseases. Most latent and incubating cases are found in clusters around an infectious
case and can usually be diagnosed by epidemiological tracing.

2. DIAGNOSTIC EVALUATION:
Serological tests to detect treponemal antibodies will be useful in diagnosis of yaws only if
sexual transmitted syphilis is excluded. In field situation, these tests support a clinico-
epidemiological diagnosis of yaws but are not as specific as the dark-field examination.
Commonly used tests are Venereal Disease Research Laboratory (VDRL) test and the rapid
plasma reagin (RPR) test which are inexpensive, rapid and simple to perform. It takes time for
sero-positivity to appear after the onset of disease and hence, initial (mother) case may be sero-
negative.
TREATMENT :
Treatment is same for cases and contacts. Penicillin (Injection Benzathine Pencillin) is the drug
of choice. Though reaction to penicillin in tribal areas is rare but intradermal skin test to detect
penicillin hypersensitivity should be performed in every case.
In patients allergic to penicillin, alternate drugs such as Tetracycline and Erythromycin may be
used.
The potential for eradication of yaws exists with the following factors in favour:
 Man is the only reservoir of infection;
 a “magic bullet” is available for intervention i.e., a single injection of long-acting
penicillin, which is easily
 available at low cost, has no toxicity and is a stable preparation and;
 the infection was localized to small pockets.
 No case has been reported after 2003.
The following factors need active pursuance and action to achieve the target of eradication:
 There are 5-10 times more latent cases than clinical cases;
 there are no visible lesions during the latent stage, but infectious relapses may occur
which can cause new outbreaks; therefore, after an initial control effort, communities
must be frequently re-surveyed to detect remaining cases;
 serological surveillance is needed to establish that transmission of infection has been
interrupted.
 Endemic treponematoses can serve as an indicator for the effectiveness of primary health
care.
 Effective Primary health care services should lead to the eradication of endemic
treponematoses. Where these are still prevalent, control efforts can be used as a catalyst
for developing primary health care services.
 Cure and eradication could induce a feeling of great achievement in workers and
considerably enhance their respect in the community.

3. GLOBAL OVERVIEW: Since the creation of WHO in 1948, the fight against endemic
treponematoses (yaws, bejel and pinta) has been a priority for the Organization. In the period
1952-1964, WHO in close collaboration with UNICEF, launched the global endemic
treponematoses control programme (TCP), which became a real success story. More than 50
million patients were treated in 46 countries, reducing the overall prevalence of these diseases by
more than 95%. The control strategy subsequently changed from a vertical programme to be
integrated into the basic health services. These basic health services were to cope with the
remaining “last cases” of endemic treponematoses in the community until eradication has been
achieved. The goal of eradication was not attained and a number of foci of transmission
remained. By the end of the 1970s a resurgence of the endemic treponematoses had occurred in
many areas of the world. The necessity for renewed efforts was recognized by the World Health
Assembly and expressed in WHA Resolution 31.58.
YAWS ERADICATION PROGRAMME
Introduction
Yaws is a disfiguring and debilitating non-venereal disease. It is a highly infectious disease
transmitted by direct (person-to-person) contact. Skin shows early lesions, which on healing
show little scarring. Disease can be progressive involving bone and cartilage and causing
disability. Yaw does not have extra human reservoir of infection and can be cured by single
injection of long acting penicillin (Benzathine Benzyl). Yaws occur in remote, hilly and forest
areas that have limited acceptability to health care services. Cases of Yaws have been reported
from 27 districts in 9 states (Andhra Pradesh, Assam, Bihar, Gujarat, Madhya Pradesh,
Maharashtra, Orissa, Tamil Nadu, and Uttar Pradesh).
Clinical Features
a) Primary/ early stage - Primary sore (mother yems) appears as a large papule, about 6 cm in
diameter, or as a vesicle on the knee or near the mouth. The scabs becomes macule and later a
papilloma. Infective serous fluid exudes from the lesion.
b) Secondary Stage - After 6-8 weeks rashes resemble a raspberry "framboesia" develop. They
fall off without pain. Periosteum and bone may be involved.
c) Tertiary or later stage - It occurs after about 5 years or more and is characterised by
gummatous lesion near bones and joints. Gondou, a swelling by the side of nasal bridge and
gandosa ulcerative lesion on palate are two special form of the stage.
Treatment
Benzathine penicillin G is the drug of choice in a dose of 1.2 million units for all cases and
contacts, and half that dose (0.6 million units) for children under 10 years of age. In penicillin
sensitive cases, erythromycin or tetracycline is used in recommended doses for a period of 15
days.
TheWHOrecommended3modesoftreatments:

4. 1. Total mass treatment: In areas where yaws is hyperendemic (>10% prevalence of clinically
active yaws) treatment is given to all irrespective of disease status of person.
2. Juvenile Mass Treatment: In mesoendemic communities 6% - 10% prevalence), treatment is
given to all cases and to all children under 15 years of age and other obvious contacts of
infectious cases.
3. Selective Mass Treatment: In hypoendemic (<5% prevalence), treatment is confined to cases,
their household and other obvious contacts of infectious cases.
National Health Policy
"Eradication of Yaws by 2005"
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; and
2. Eradication of Yaws (i.e. no sero reactivity to RPR/VDRL in children below 5 years of age)
from the country.
The Government of Andhra Pradesh, Gujarat, Madhya Pradesh, Orissa have taken several
initiatives for interruption of infection by mass administration of single dose of penicillin in the
affected areas. "Yaws Cells" have been established in Division of Epidemiology to coordinate all
activities.
Programme Strategy
1.Manpowerdevelopment
2.Detectionofcases
3.Treatmentofcasesandcontacts
4. IEC involving multi-sectors approach
Operation Component
The case detection is carried out by active surveillance, i.e. house-to-house visit by trained
paramedical workers and treatment of cases and contacts simultaneously and immediately after
detection. In such cases, a coloured recognition cards are given to patient.
Programme management

5. The National Institute of communicable Diseases (NICD) has been identified as the nodal
agency for planning, guidance, coordination, monitoring and evaluation of the programme. The
programme is implemented by the State Health Directorate of yaws endemic states utilising
existing health care delivery system with the coordination and collaboration of Department of
Tribal Welfare and other related institutions, Director General of Health Services, Ministry of
Health forms the task force to coordinate and review programme.
PREPARED BY
DR.ANJALATCHI
HOD’S OF COMMUNITY HEALTH NURSING
ERAS COLLEGE OF NURSING ,LUCKNOW