Trial of Three Rounds of Mass Azithromycin Administration for Yaws Eradication.
Trial of Three Rounds of Mass Azithromycin Administration for Yaws Eradication.
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DOI：
10.1056/nejmoa2109449
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发表时间：
2022-01-06
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影响因子：
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通讯作者：
Mitjà O
中科院分区：
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作者：
John LN;Beiras CG;Houinei W;Medappa M;Sabok M;Kolmau R;Jonathan E;Maika E;Wangi JK;Pospíšilová P;Šmajs D;Ouchi D;Galván-Femenía I;Beale MA;Giacani L;Clotet B;Mooring EQ;Marks M;Vall-Mayans M;Mitjà O
梅毒螺旋体亚种香水会引起雅司病。需要更好地控制并有望消除雅司病的战略。我们在巴布亚新几内亚的一个雅司病流行地区进行了一项开放标签集群随机社区试验。38个病房随机接受一次大规模药物给药（MDA），随后两次针对活跃病例的靶向治疗（对照组）或3次MDA（实验组），间隔6个月。在18个月的调查中测量了活动性和潜伏性雅司病流行率的差异。19个病房（30,438人）被随机分配到对照组，19个病房（26,238人）被随机分配到实验组。对照组服用24,848剂阿奇霉素（基线时为22,033剂，6个月和12个月期间有207名患有雅司样病变的参与者和2,608名接触者），而实验组为59,852剂。18个月时，对照组的活动性雅司病患病率从0.46%（102/22,033）降至0.16%(47/29,954)，试验组从0.43%（87/20,331）降至0.04% (10/25,987)（RR 3.54; 95%CI 1.72-7.27）。在两个研究组中，其他感染性溃疡的患病率也有类似程度的下降。对照组和实验组994名和945名儿童18月龄潜伏雅司病患病率分别为6.54%（5.00-8.08）和3.28% (2.14-4.42)（RR为2.03;1.12-3.7）。实验组发现3例大环内酯类耐药。这些数据表明，在降低雅司病社区患病率方面，间隔6个月使用三轮阿奇霉素丙二醛比使用一轮阿奇霉素丙二醛并进行两轮靶向治疗效果更好。需要监测抗菌素耐药性的出现和传播。（ClinicalTrials.gov号码：NCT03490123）
Treponema pallidum subsp. pertenue causes yaws. Strategies to better control and hopefully eliminate yaws are needed. We conducted an open-label cluster-randomized community trial in a yaws-endemic area of Papua New Guinea. Thirty-eight wards were randomized to receive either one mass drug administration (MDA) round followed by two target treatment of active cases rounds (control arm) or three MDA rounds (experimental arm) at 6-month intervals. The difference in the prevalence of active and latent yaws were measured at 18-month surveys. Nineteen wards (30,438 individuals) were randomized to the control arm and 19 (26,238 individuals) to the experimental arm. 24,848 azithromycin doses were administered in the control arm (22,033 at baseline, 207 participants with yaws-like lesions and 2,608 contacts at 6-month and 12-month), compared to 59,852 doses in the experimental arm. At 18 months, the prevalence of active yaws had decreased from 0.46% (102/22,033) to 0.16% (47/29,954) in the control arm and from 0.43% (87/20,331) to 0.04% (10/25,987) in the experimental arm (RR 3.54; 95%CI 1.72–7.27). The prevalence of other infectious ulcers decreased to a similar extent in the two study arms. The prevalence of latent yaws at 18 months, assessed in 994 and 945 children in the control and experimental arms, was 6.54% (5.00–8.08) and 3.28% (2.14–4.42), respectively (RR 2.03; 1.12–3.7). Three cases with resistance to macrolides were found in the experimental arm. These data show that three rounds of azithromycin MDA 6 months apart are better than one round of azithromycin MDA with two rounds of targeted treatment for decreasing the community prevalence of yaws. Monitoring for the emergence and spread of antimicrobial resistance is needed. (ClinicalTrials.gov number, NCT03490123.)