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BACKGROUND: Yaws is a chronic, non-venereal, highly contagious skin and bone infection affecting children living in impoverished, remote communities and caused by Treponema pallidum subspecie pertenue. Social stigma and economic losses due to yaws have been reported anecdotally in the Southern Philippines but have not been well-documented. OBJECTIVE: To describe and compare the psychological, social, and economic effects of yaws from the perspective of patients, contacts, and key informants in two areas of the Philippines. MATERIALS AND METHODS: Yaws and contacts were identified through clinicoseroprevalence surveys conducted in the Liguasan Marsh area, Mindanao, Southern Philippines in 2017 and among the Aetas, an indigenous people community in Quezon province, Luzon region in 2020. Skin examinations and serologic tests confirmed the diagnosis of active, latent, or past yaws among the children and adults. Trained health personnel conducted in-depth interviews of those affected by yaws and their guardians, household contacts, and key informants, such as health workers regarding their perceptions, feelings, health-seeking behaviors, and effects of yaws on their lives. RESULTS: A total of 26 participants were interviewed: 17 from Mindanao and 9 from Luzon. Aside from the physical discomforts and embarrassment, yaws was considered stigmatizing in Mindanao, because positive non-treponemal tests or treponemal antibody tests were associated with syphilis and promiscuity. These have led to loss of employment and income opportunities for adults with latent or past yaws. In contrast, the Aetas of Luzon did not perceive yaws as stigmatizing, because it was a common skin problem. Plantar yaws interfered with the Aeta's gold panning livelihood due to the pain of wounds. CONCLUSIONS: Yaws is not merely a chronic skin and bone disease. It can lead to significant psychosocial and economic problems as well. Yaws is a generally forgotten disease in the Philippines. There is no yaws surveillance and control program. Treatments are not readily available for the populations affected, thus perpetuating the infection and negative effects. SIGNIFICANCE OF STUDY: This is the first study to document the psychosocial and economic effects of yaws among Filipinos. Information campaigns about yaws and a yaws control program are needed to reduce stigma and discrimination.

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BACKGROUND: Yaws is a chronic, highly contagious skin and bone infection affecting children living in impoverished, remote communities. It is caused by Treponema pallidum subsp. pertenue. We report the prevalence of active yaws among elementary schoolchildren based on clinical and serological criteria in selected municipalities of Southern Philippines. METHODS: From January to March 2017, exploratory cross-sectional surveys and screening of skin diseases were conducted in the Liguasan Marsh area of the provinces Maguindanao, Sultan Kudarat, and Cotabato. We included 9 municipalities and randomly selected one public elementary school per municipality. Members of students' households and the communities were also examined and treated. Yaws suspects and contacts had blood tests for treponemal and non-treponemal antibodies using Dual Pathway Platform and Treponema pallidum particle agglutination (TPPA) tests. RESULTS: A total of 2779 children and adults were screened for any skin disease: 2291 students, 393 household members, and 95 community members. Among 210 yaws suspects and contacts, 150 consented to serologic tests. The estimated prevalence of active yaws among schoolchildren screened was 1 out of 2291 (0.04%). Among 2532 children who were 14 years old and younger, 4 (0.2%) had active yaws. Eight adult household contacts and community members had latent yaws and 2 had past yaws. Five out of 9 municipalities were endemic for yaws. CONCLUSIONS: This study confirmed that the Philippines is endemic for yaws but at a low level in the schools surveyed. This is an under-estimation due to the limited sampling. The lack of proper disease surveillance after the eradication campaign in the 1960's has made yaws a forgotten disease and has led to its resurgence. Yaws surveillance is needed to determine the extent of yaws in the Philippines and to help develop a strategy to eradicate yaws by 2030.

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BACKGROUND: Yaws is a chronic, highly contagious skin and bone infection affecting children living in impoverished, remote communities and caused by Treponema pallidum subspecies pertenue. The Philippines was thought to be free of yaws following the 1950s eradication campaign but it has been reported in the Liguasan Marsh area, Central Mindanao. This is the first documentation of yaws cases in the Philippines since the 1970s. We describe active and latent yaws recently detected in the Southern Philippines. CASE PRESENTATION: Cross-sectional surveys and screening of skin diseases were conducted in one randomly selected public elementary school per selected municipality in Liguasan Marsh, covering three municipalities per province. Yaws suspects underwent screening and confirmatory serologic tests for Treponema pallidum using Dual Path Platform Syphilis Screen and Confirm Assay (DPP) and Treponema pallidum Particle Agglutination (TPPA). Children with yaws skin lesions and reactive confirmatory tests for T. pallidum and non-treponemal antibodies were considered confirmed yaws cases. Four children aged 5-10 years old had confirmed secondary yaws in Tulunan Municipality, Cotabato Province and in Lambayong Municipality, Sultan Kudarat Province. All had secondary yaws lesions such as moist, cauliflower-like papillomas, thick yellow crusts on pink papules and nodules, whitish, papulosquamous papules and plaques, or hypopigmented patches with small papules on the periphery. Yaws papillomas and erosions were also found on the soles of the feet of one child. The index case had a skin punch biopsy of a partially treated papilloma on his axilla. Histopathological findings showed lichenoid psoriasiform dermatitis with plasma cells, consistent with yaws. CONCLUSIONS: The clinical, serological, and histopathological confirmation of four yaws cases among children has made the Philippines the 14th country endemic for yaws. This report can help health personnel recognize hidden cases of yaws based on skin signs and serological tests. Yaws remained unrecognized and unreported in the Philippines and in countries previously endemic for yaws probably due to the unsustained integration of the yaws program in the general health services and complacency after the 1950s eradication campaign. Our findings have provided the necessary evidence and stimulus to develop a yaws control and eradication program as one of the country's neglected tropical diseases.

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BACKGROUND: Glutathione is an important intracellular anti-oxidant involved in different cellular and body functions. In recent years, glutathione-containing products have become extremely popular as evidenced by the proliferation of these products especially for 'skin whitening'. The investigators conducted this exploratory study in preparation for further investigations to validate the efficacy and safety of glutathione-containing products. OBJECTIVES: 1) To describe the different glutathione products, their claims on efficacy and safety, as advertised on the Internet; 2) To report the best current evidence on the claims of efficacy and safety of glutathione supplements and glutathione-containing products for the skin. METHOD: An online search for glutathione distributors was conducted from February to March 2008 to find out their claims on the efficacy and safety of glutathione-containing supplements or IV glutathione. For the search of the best current evidence on glutathione products, various electronic databases were searched up to September 2008 for any human clinical trials or reports of adverse events. Key informants were also interviewed. RESULTS: From the Internet search, there were 20 brands oftopical glutathione products, 21 oral preparations, and 2 injectable glutathione products. There were also a variety of glutathione formulations available, mainly capsules containg glutathione plus other antioxidants. All products claimed a skin 'whitening' effect. There were no published human clinical trials, whether quasi-experimental or controlled trials (ex. RCTs) supporting the claims of skin whitening or skin rejuvenating effects of glutathione. There was one unpublished randomized controlled trial and one local clinical trial ongoing in the Philippines. No adverse events associated with glutathione products were reported in published literature. Anecdotal reports of adverse effects were gathered during key informant interviews. CONCLUSIONS: The evidence on whitening and skin rejuvenation effects and safety is insufficient because these are based on testimonials and anecdotal reports, all of which are at high risk of bias. The magnitude of glutathione's skin whitening effect nor its side-effects have not yet been established. RECOMMENDATIONS: Good quality, randomized, controlled trials are needed to validate claims of skin 'whitening' from the use of glutathione supplementation or glutathione skin products. Health professionals and consumers should document and report adverse events related to glutathione-containing products for the sake of public safety.

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