Papua New Guinea reached elimination of leprosy at the national level in 2000 with a prevalence of 0.7/10,000 population. In a District Health Centre on Karkar Island in the Madang Province of Papua New Guinea there have been 5 cases reported in the last 15 years, the last of which was 10 years ago. We report a case of leprosy that was overlooked at the Outpatient Department resulting in delayed treatment due to the lack of trained staff and the unavailability of appropriate drugs. The patient was referred to the Disease Control Unit at the Modilon Provincial Hospital and commenced on multi-drug therapy 5 weeks after the initial diagnosis. This case report highlights the importance of continuous health care provider training and community awareness on diseases that have been eliminated in some provinces but not others.

Yaws is a chronic infectious disease caused by Treponema pallidum subsp. pertenue, which causes disease of the skin, bones and joints and is spread by skin-to-skin contact. Most cases are seen in young children living in rural remote communities in coastal areas. A major campaign to eradicate yaws between 1953 and 1958, by mass treatment of affected communities with long-acting, injectable penicillin, reduced the number of cases by 95% in Papua New Guinea (PNG), but yaws has reappeared in recent years. In the period 2008- 2015 PNG reported >25,000 cases per year, and the country is currently home to about 40% of all the cases of yaws in the world. In 2012, one oral dose of azithromycin was shown to be as effective as intramuscular penicillin in the treatment of the disease, and the World Health Organization launched a new initiative to eradicate yaws by 2020. The new treatment policy recommends mass azithromycin treatment of the entire population in endemic areas. Continued vigilance for the development of macrolide resistance in T. pallidum ssp. pertenue will be important as the drug is introduced into public health practice.