Feature story |

Congo: Treating yaws in the Aka Pygmy population, a world first intervention

Photograph by Benoit Finck
In Congo's rainforest, MSF cured 15.000 pygmies affected by Yaws, a neglected disease, in 3 months (Sept - Oct 2012) using a new therapeutic regime (single dose oral antibiotic).

The Aka Pygmy communities living in the northern Congo have been ostracised in their home country for many years. They have almost no access to healthcare and, as a result, are still affected by a neglected disease: yaws.  MSF recently carried out a campaign for treating this disease, which turned out to be both a logistical feat and a world first in medical terms.

Yaws is a neglected tropical disease caused by a bacterium that affects the skin, bone and cartilage.
Yaws is a neglected tropical disease caused by a bacterium that affects the skin, bone and cartilage. Photograph by Benoit Finck

It was while carrying out medical consultations in the district of Bétou in the north-east of the country that MSF’s teams discovered cases of a forgotten disease among patients from the Aka community: yaws. “Yaws is an infectious disease caused by a bacterium and presenting highly contagious skin lesions”, explains Matthew Coldiron, an MSF doctor. Yaws ravaged Africa during the 1950s and a series of mass treatment campaigns didn’t manage to eradicate it altogether. “The disease persists in certain inter-tropical zones. Without treatment, it can attack bones, cartilage and joints and cause permanent disfigurement."

MSF-Epicentre with OCP decided to launch a universal treatment with azithromycin that can eradicate this illness among Aboriginal people (Pygmies) in the Bétou and Enyellé districts. During two months (in september and october 2012), three MSF teams have traveled on the Ubangi River, which separates the two Congos and trails through the rainforest.
During two months (September and October 2012), three MSF teams have travelled on the Ubangi River, which separates the two Congos and trails through the rainforest. Photograph by Lam Duc Hien

So, MSF decided to go and find these Aka communities and treat them in their home environment: the heart of the forest. The treatment campaign represented both a first in medical terms and a real logistical challenge. “It was the first time the new treatment recommended by the World Health Organization had been used”, explained Matthew Coldiron. "A single oral dose of the antibiotic azithromycin is all it takes to cure yaws. And as humans are the only reservoir of infection, we can eradicate the disease by treating all the existing cases”. MSF’s campaign therefore adopted a universal treatment strategy, i.e. treating the whole population concerned.

A real human and logistical challenge to achieve these Pygmy communities in their villages in the rainy season because it is the only time during which they are sedentary.
A real human and logistical challenge to reach these Pygmy communities in their villages is the rainy season because it is the only time during which they are sedentary. Photograph by Lam Duc Hien

Putting this strategy into practice was a logistical headache. The teams had to travel on foot, in pirogues or 4x4 vehicles to reach around 20,000 people scattered across a hundred or so villages. The campaign was run in two stages, September and October, and, over these two months, treated 17,400 people for yaws. The MSF teams also took the opportunity to provide some basic care (treatment for malaria, intestinal parasites and the cleaning of wounds) and vaccinate the children against measles. An epidemiological survey was carried out at the same time to determine the prevalence of the disease in the children.

“We are the first to use this new strategy. The idea now is to communicate on our experience with this disease and this new treatment, and also on the means needed to reach these isolated populations in the forest”, concludes Matthew Coldiron. "We hope that other actors will follow in our footsteps, as yaws is still present in other countries”.

n Congo's rainforest, MSF cured 15.000 pygmies affected by Yaws, a neglected disease, in 3 months (Sept - Oct 2012) using a new therapeutic regime (single dose oral antibiotic).
MSF cured 15.000 pygmies affected by Yaws, a neglected disease, in 3 months (Sept - Oct 2012) using a new therapeutic regime (single dose oral antibiotic). Photograph by Benoit Finck

The results of this campaign and of the epidemiological survey will be shared with the local authorities in the Congo, as well as with WHO and all the actors who could help eradicate this disease.

Humans are the only reservoir of this bacterial infection. A recent discovery that a single-dose of azithromycin (given orally) can cure the disease has raised the prospects of eradicating yaws altogether.  It affects many isolated communities whose populations Congo Pigmy North, away from the health care system.
Humans are the only reservoir of this bacterial infection. A recent discovery that a single-dose of azithromycin (given orally) can cure the disease has raised the prospects of eradicating yaws altogether. Photograph by Lam Duc Hien