Complete Local Elimination of Infectious Trachoma from Severely Affected Communities after Six Biannual Mass Azithromycin Distributions

Biebesheimer, Jesse B.; House, Jenafir; Hong, Kevin C.; Lakew, Takele; Alemayehu, Wondu; Zhou, Zhaoxia; Moncada, Jeanne; Roger, A. Nicoll; Keenan, Jeremy D.; Gaynor, Bruce D.; Schachter, Julius; Lietman, Thomas M.

doi:10.1016/j.ophtha.2009.04.041

Cited by 37 publications

(31 citation statements)

References 23 publications

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“…Treatment verification consistently showed high agreement between recorded treatment and personal history of recipients. Trachoma and infection fell over time consistent with good coverage in children as reported from studies elsewhere in other high prevalence villages [14], [15].…”

Section: Discussionsupporting

confidence: 83%

“…This did not happen when the starting prevalences of infection in the communities were, on average, 22%. Our experience was different than the experience with high coverage in small communities in Ethiopia, where after a single round of high coverage, infection fell from 50% to less than 5% at 6 months and after a second round at 6 months, disappeared [15]. Other studies in The Gambia and in a low prevalence community in Tanzania reported that one to two annual rounds was sufficient to eliminate infection [7], [16], but these communities started with low levels of infection.…”

Section: Discussioncontrasting

confidence: 82%

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A Randomized Trial of Two Coverage Targets for Mass Treatment with Azithromycin for Trachoma

et al. 2013

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BackgroundThe World Health Organization recommends at least 3 annual antibiotic mass drug administrations (MDA) where the prevalence of trachoma is >10% in children ages 1–9 years, with coverage at least at 80%. However, the additional value of higher coverage targeted at children with multiple rounds is unknown.Trial Design2×2 factorial community randomized, double blind, trial.Trial methods32 communities with prevalence of trachoma ≥20% were randomized to: annual MDA aiming for coverage of children between 80%–90% (usual target) versus aiming for coverage>90% (enhanced target); and to: MDA for three years versus a rule of cessation of MDA early if the estimated prevalence of ocular C. trachomatis infection was less than 5%. The primary outcome was the community prevalence of infection with C. trachomatis at 36 months.ResultsOver the trial's course, no community met the MDA cessation rule, so all communities had the full 3 rounds of MDA. At 36 months, there was no significant difference in the prevalence of infection, 4.0 versus 5.4 (mean adjusted difference = 1.4%, 95% CI = −1.0% to 3.8%), nor in the prevalence of trachoma, 6.1 versus 9.0 (mean adjusted difference = 2.6%, 95% CI = −0.3% to 5.3%) comparing the usual target to the enhanced target group. There was no difference if analyzed using coverage as a continuous variable.ConclusionIn communities that had pre-treatment prevalence of follicular trachoma of 20% or greater, there is no evidence that MDA can be stopped before 3 annual rounds, even with high coverage. Increasing coverage in children above 90% does not appear to confer additional benefit.

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Section: Discussionsupporting

confidence: 83%

Section: Discussioncontrasting

confidence: 82%

A Randomized Trial of Two Coverage Targets for Mass Treatment with Azithromycin for Trachoma

et al. 2013

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“…This finding has been mirrored in other communities following implementation of mass treatment [9]–[12] and in communitites where prevalence of TF is low [13]–[16]. It has been suggested that at least some of the TF now observed may be due to organisms other than C. trachomatis [4], [16].…”

Section: Introductionmentioning

confidence: 73%

Association between Ocular Bacterial Carriage and Follicular Trachoma Following Mass Azithromycin Distribution in The Gambia

et al. 2013

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BackgroundTrachoma, caused by ocular Chlamydia trachomatis infection, is the leading infectious cause of blindess, but its prevalence is now falling in many countries. As the prevalence falls, an increasing proportion of individuals with clinical signs of follicular trachoma (TF) is not infected with C. trachomatis. A recent study in Tanzania suggested that other bacteria may play a role in the persistence of these clinical signs.Methodology/Principal FindingsWe examined associations between clinical signs of TF and ocular colonization with four pathogens commonly found in the nasopharnyx, three years after the initiation of mass azithromycin distribution. Children aged 0 to 5 years were randomly selected from 16 Gambian communitites. Both eyes of each child were examined and graded for trachoma according to the World Health Organization (WHO) simplified system. Two swabs were taken from the right eye: one swab was processed for polymerase chain reaction (PCR) using the Amplicor test for detection of C. trachomatis DNA and the second swab was processed by routine bacteriology to assay for the presence of viable Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus and Moraxella catarrhalis. Prevalence of TF was 6.2% (96/1538) while prevalence of ocular C. trachomatis infection was 1.0% (16/1538). After adjustment, increased odds of TF were observed in the presence of C. trachomatis (OR = 10.4, 95%CI 1.32–81.2, p = 0.03), S. pneumoniae (OR = 2.14, 95%CI 1.03–4.44, p = 0.04) and H. influenzae (OR = 4.72, 95% CI 1.53–14.5, p = 0.01).Conclusions/SignificanceClinical signs of TF can persist in communities even when ocular C. trachomatis infection has been controlled through mass azithromycin distribution. In these settings, TF may be associated with ocular colonization with bacteria commonly carried in the nasopharnyx. This may affect the interpretation of impact surveys and the determinations of thresholds for discontinuing mass drug administration.

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“…Periodic mass ivermectin treatments for 13–17 years, along with vector control activities, have resulted in elimination of Onchocerca volvulus infection in some areas of Africa and the Americas, although not in others [14], [15], [16], [17]. Two biennial (once every two years) mass azithromycin distributions for trachoma eliminated ocular chlamydia infection in a single hypoendemic village in Tanzania, and six biannual (twice yearly) mass azithromycin treatments eliminated infection in two hyperendemic communities in Ethiopia, although elimination of larger geographical areas has proven more difficult [18], [19], [20], [21]. In a study of eight rounds of annual mass praziquantel plus mebendazole distributions in Cambodia, no schistosomiasis infections were detected in a sample of school-aged children during the fifth to seventh years of the study, though infection did re-emerge in the final year [22].…”

Section: Discussionmentioning

confidence: 99%

Elimination and Eradication of Neglected Tropical Diseases with Mass Drug Administrations: A Survey of Experts

et al. 2013

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BackgroundLymphatic filariasis, onchocerciasis, schistosomiasis, soil-transmitted helminths, and trachoma are the five most prevalent neglected tropical diseases in the world, and each is frequently treated with mass drug administrations. We performed a survey of neglected tropical diseases experts to elicit their opinions on the role of mass drug administrations for the elimination of these infections.Methodology/Principal FindingsWe sent an online survey to corresponding authors who had published an article about a neglected tropical disease from 2007 to 2011. Of 825 unique authors who were invited to complete the survey, 365 (44.2%) responded, including 234 (28.4%) who answered questions regarding one of the five most prevalent neglected tropical diseases. Respondents had varying opinions about the goals of programmatic activities for their chosen neglected tropical disease, with elimination or eradication identified as the most important goal by 87% of lymphatic filariasis respondents, 66% of onchocerciasis respondents, 55% of trachoma respondents, 24% of schistosomiasis respondents, and 21% of soil-transmitted helminth respondents. Mass drug administrations, other non-medication health measures, and education were generally thought to be more important for elimination than vector control, development of a new tool, or the presence of a secular trend. Drug resistance was thought to be a major limitation of mass drug administrations for all five neglected tropical diseases. Over half of respondents for lymphatic filariasis and trachoma thought that repeated mass drug administrations could eliminate infection within ten years of the initiation of mass treatments.Conclusions/SignificanceRespondents for lymphatic filariasis, onchocerciasis, and trachoma were more enthusiastic about the prospects of elimination and eradication than were respondents for schistosomiasis or soil-transmitted helminths. Mass drug administrations were generally believed to be among the most important factors for the success of elimination efforts for each of the five neglected tropical diseases, highlighting the opportunity for integrating drug distributions.

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Complete Local Elimination of Infectious Trachoma from Severely Affected Communities after Six Biannual Mass Azithromycin Distributions

Cited by 37 publications

References 23 publications

A Randomized Trial of Two Coverage Targets for Mass Treatment with Azithromycin for Trachoma

A Randomized Trial of Two Coverage Targets for Mass Treatment with Azithromycin for Trachoma

Association between Ocular Bacterial Carriage and Follicular Trachoma Following Mass Azithromycin Distribution in The Gambia

Elimination and Eradication of Neglected Tropical Diseases with Mass Drug Administrations: A Survey of Experts

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