India is now Yaws And Maternal and Neonatal Tetanus Elimination (MNTE) free - WHO

The World Health Organization (WHO) has acknowledged India as the world's first Yaws-free country and also declared it free from maternal and neonatal tetanus
India was validated for Maternal and Neonatal Tetanus Elimination (MNTE) in April 2015, much ahead of the global target date of December 2015.
About Yaws

• Yaws is a chronic disfiguring and debilitating childhood infectious disease caused by Treponema pallidum subspecies pertenue.
• It is one of the first diseases targeted by WHO and UNICEF for eradication nearly in the 1950s.
• The disease affects skin, bone and cartilage. Humans are currently believed to be the only reservoir, and transmission is from person to person.
• Yaws is cured by a single oral dose of an inexpensive antibiotic azithromycin.
• Yaws forms part of a group of chronic bacterial infections commonly known as the endemic treponematoses. These diseases are caused by spiral bacteria of the genus Treponema, which also includes endemic syphilis (bejel) and pinta. Yaws is the most common of these infections.
• The disease is found primarily in poor communities in warm, humid and tropical forest areas of Africa, Asia, Latin America and the Pacific.
• About 75-80% of people affected are children under 15 years of age, and they constitute the main reservoir of infection. Peak incidence occurs in children aged 6–10 years, and males and females are equally affected.
• Reports suggest that yaws was non-existent in India till 1887 when the cases were first noticed among tea plantation labourers in Assam. From Assam, yaws later spread to the states of Orissa, Chattishgarh, Madhya Pradesh and other areas.
• In India, the disease is mostly known by the name of the tribes affected most in any region. Thus for example, the disease is called ‘Madia Roga’ and ‘Gondi Roga’ in Bastar area of Chattishgarh and Sironcha area of Maharashtra respectively and ‘Koya rogam’ in Andhra Pradesh and Orissa. Some synonyms of yaws are based on its clinical features e.g. it is called ‘Domaru Khahu’ in Assam which indicates a fig like eruption. ‘Chakawar’ is a term used for chronic ulcers so commonly seen in Central India and part of Uttar Pradesh.
• The disease was reported from the communities living in hilly and forested areas in the tribal inhabitied districts in states of Chattishgarh, Orissa, Andhra Pradesh and Maharashtra. Madhya Pradesh, Tamilnadu, Assam, Jharkhandr, Uttar Pradesh and Gujarat are other states from where cases had been reported earlier.

Maternal and Neonatal Tetanus (MNT) elimination

• Maternal and neonatal tetanus is a disease that strikes down the poorest and most vulnerable, especially singling out women and their newborns living in areas with limited access to health services and poor hygiene. The disease, which is often transmitted when the umbilical cord is cut under unsanitary conditions, is characterized by wrenching muscle spasms, initially in the jaw. In remote rural areas of developing countries, with limited or no access to treatment facilities, almost all newborns infected with tetanus die.
• The MNT Elimination Initiative aims to reduce MNT cases to such low levels that the disease is no longer a major public health problem. Unlike polio and smallpox, tetanus cannot be eradicated (tetanus spores are present in the environment worldwide), but through immunization of pregnant women and other women of reproductive age (WRA) and promotion of more hygienic deliveries and cord care practices, MNT can be eliminated (defined as less than one case of neonatal tetanus per 1000 live births in every district).
• In 1988, WHO estimated that 787,000 newborns died of neonatal tetanus (NT). Thus, in the late 1980s, the estimated annual global NT mortality rate was approximately 6.7 NT deaths per 1000 live births - clearly a substantial public health problem
• In 1989, the 42nd World Health Assembly called for elimination of neonatal tetanus by 1995
• The following year, the 1990 World Summit for Children listed neonatal tetanus elimination as one of its goals, and the goal was again endorsed by the 44th World Health Assembly in 1991
• Due to slow implementation of the recommended MNT elimination strategies, the target date for MNT elimination was postponed to 2000. In 1999, when progress towards the attainment of the global elimination goal was reviewed by UNICEF, WHO and UNFPA, the Initiative was re-constituted and elimination of maternal tetanus was added to the goal with a 2005 target date, which was later shifted to 2015.
• India is one of the most populous countries in the world, with 327 million women of childbearing age and 26 million children born every year.
• In 1988, tetanus killed as many as 160,000 young children in India. The drop ever since has been extraordinary. The elimination of MNT as a public health problem means that the annual rate is less than 1 per 1000 live births.
• India’s remarkable achievement in eliminating maternal and neonatal tetanus shows that by making a strong commitment to investing in public health their youngest citizens and mothers will enjoy their right to health, thereby making us all stronger

By: Vishal