WHO certifies India as Yaws, Maternal and Neonatal Tetanus free

• WHO declares India as Yaws free, a chronic disfiguring and debilitating childhood infectious disease
• The disease occurs mainly in poor communities in warm, humid, tropical areas of Africa, Asia, and Latin America
• About three-quarters of people affected are children under 15 years of age

Sept 10, 2016: Yaws is a chronic disfiguring and debilitating childhood infectious disease which spreads through the direct contact with the skin of an infected person but now India has the distinction of being the first country to be officially acknowledged as yaws free. A few decades back India witnessed 1-2 lakh neonatal tetanus cases annually, which have been now reduced to one per 1,000 live births.

Neonatal tetanus is a form of generalized tetanus that occurs in newborn. It usually occurs through infection of the unhealed umbilical stump, particularly when the stump is cut with a non-sterile instrument. Neonatal tetanus mostly occurred in developing countries, particularly those with the least developed health infrastructure.

This disease primarily affects tribal population living in remote hilly areas having difficult terrain. It is responsible not only for misery among the affected people but also contributes significantly to the economic strain of the already impoverished segments of our society.

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The disease begins with a round hard swelling of the skin, 2 to 5 centimeters in diameter. The center may break open and form an ulcer. The initial skin lesion typically heals after 3 to 6 months. After weeks to years, joints and bones may become painful, fatigue may develop and new skin lesions may appear. The skin of the palms of the hands and the soles of the feet may become thick and break open. After five years or more large areas of skin may die leaving scars.

In India, literature on yaws is rather scarce. Reports suggest, that yaws to be non-existent in India till 1887 and the first cases were first noticed among tea plantation laborers in Assam. From Assam, yaws later got spread to the states of Orissa, Chhattisgarh, Madhya Pradesh and other areas.

The disease was reported from the communities living in hilly and forested areas in the tribal inhabited districts in states of Chhattisgarh, Orissa, Andhra Pradesh and Maharashtra. Madhya Pradesh, Tamilnadu, Assam, Jharkhand, Uttar Pradesh and Gujarat are other states.

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In the 1950s,a mass campaign launched with assistance from WHO and UNICEF resulted in marked reduction of yaws cases in India and disease prevalence was brought down from 14.0 per cent to below 0.1 per cent in many areas. Following this dramatic decline in disease transmission, active anti-yaws activities were abandoned in the majority of the States. In 1977, yaws resurgence occurred in Madhya Pradesh.

In 1981, the National Institute of Communicable Diseases (NICD), Delhi undertook a rapid survey to assess the situation; data indicated that transmission of yaws continued to occur in some areas of the country. In addition, a new focus was suspected in Dang district of Gujarat. In 1985, NICD collected information using mailed questionnaire method from various districts of five states (Andhra Pradesh, Madhya Pradesh, Orissa, Maharashtra and Tamil Nadu).

The data suggested that problem of yaws continued to linger on in India albeit at a low level. In 1995, NICD prepared a project document on Yaws Eradication Programme in India, which was approved by Government of India for initiating the programme in Koraput district (undivided) of Orissa and was then expanded to cover all the yaws-endemic states of the country. The disease was finally declared as eliminated on 19th Sept 2006.

Both yaws and maternal and neonatal tetanus eliminations were achieved using the existing health system and health workforce. Sustained political commitment and clear policies, unified strategies, close supervision and monitoring the frontline workers; and invaluable support of partners, particularly for Maternal and neonatal Tetanus- were the key factors that have helped to achieve the target.

Poonam Khetrapal Singh, regional director of WHO South-East Asia Regional Office said, India has achieved this milestone because of education and early treatment of vulnerable population. The achievements will not only improve the health of marginalized communities but will also enhance their socio-economic status and contribute to India's wider development.

– prepared by Aakash Mandyal of NewsGram with inputs from various sources.