New technologies for use in the surveillance and control of yaws.

In the Republic of Ghana, treponemal antigen tests performed on finger-prick blood from patients with yaws proved to be as sensitive as those tests performed on whole sera, and this mode of collection was more economical and acceptable than venipuncture. Under field conditions, dark-field microscopic examination of suspect yaws lesions was difficult as compared with collection of serous exudate in heparinized capillary tubes examined later in a reference laboratory. Direct staining of lesion exudate fixed on microscope slides with fluorescein-conjugated human or mouse monoclonal antibody against Treponema pallidum was more sensitive than dark-field examination. However, these techniques could not distinguish between the early lesions of venereal syphilis and those of yaws. An equally sensitive technique used a cloned segment of the T. pallidum (Nichols strain) genome to detect homologous DNA in lesion exudate fixed on nitrocellulose filter paper. The fixation of lesion exudates on microscope slides or nitrocellulose papers may prove to be the easiest method of collecting and transporting such materials to reference laboratories.

Yaws in Ghana.

The final results of a three-year campaign against yaws in the Republic of Ghana, which was introduced in an attempt to reduce an unusually high prevalence, are summarized. The campaign started in January 1981 and officially ended in December 1983. Serious economic and technical constraints slowed the progress of work after the first year and reduced the total population covered. In spite of the shortcomings, the program provided penicillin treatment to 77,818 patients with active yaws (4.04% of those examined during the campaign) as well as chemoprophylaxis for an additional 1,556,360 contacts. The campaign staff compiled detailed information on the epidemiology of yaws in Ghana. A second attack phase using simple equipment and vehicles such as motorcycles and bicycles could be implemented with greater efficiency and could reduce costs.

Impact of the control of endemic treponemal diseases in Ghana on other diseases.

A program for control of yaws and yellow fever in the Republic of Ghana was initiated with the aims of reducing the sharp increase in the prevalence of yaws and preventing epidemics of yellow fever. In addition, the program included health education and mass immunization with single doses of measles, tetanus, and tuberculosis vaccines. An evaluation of the first three years of the program indicates that the multidisciplinary approach has benefited a large segment of the population, which previously has had little or no access to medical care. This control program has also had an impact on other diseases and conditions.

Yellow fever in Ghana, 1977-80.

The 3-year yellow fever epidemic in Ghana that started in 1977 and tailed off in 1980 appears to be the heaviest on record. In all, 827 cases and 189 deaths were reported (a fatality rate of 22.8%), the patients coming from many villages scattered over 4 regions in the country. The distribution of cases and other epidemiological characteristics are described in this article.

Resurgence of yaws in Ghana.

This paper reports on the first 1 1/2 years of a new effort to control yaws in Ghana, where the disease has been resurgent since a previous mass campaign ended over 10 years ago.

BCG complications: an analysis of 36 cases.

BCG administration is known to be a safe procedure. However of late, with increased immunization activities, a few complications following BCG administration have been noted and reported. 36 cases of BCG complications observed over a 4-year period were analyzed by age and sex distribution and by severity of lesion. The most common forms of lesions seen were localized subcutaneous abscesses and regional lymphoadenitis. More serious forms of complications such as mediastinal involvement, BCG lung infiltration and BCG papillitis occurred less frequently.

The expanded program in immunization. Ghana's experience.

The expanded programme on immunization feasibility studies is currently running into its second year of operations. The objectives of the study are to test the possibility of increased coverage using both fixed centre and mobile field teams for the vaccination of children under the age of 2 years against measles, poliomyelitis, diphtheria, pertussis, tuberculosis and smallpox and also to test the immunological response to two doses of pertussis and two doses of oral polio. Reports so far indicate some success in the areas of training and manpower development as well as the development of the cold chain system which is considered to be the most important requirement for an efficient, expanded immunization programme. It goes without saying that the progress of the study has been marked by some technical, social and administrative constraints.