Effect of a Single Mass Antibiotic Distribution on the Prevalence of Infectious Trachoma

Chidambaram, Jaya D.; Alemayehu, Wondu; Melese, Muluken; Lakew, Takele; Yi, Elizabeth; House, Jenafir; Cevallos, Vicky; Zhou, Zhaoxia; Maxey, Kathryn; Lee, Dong Hoon; Shapiro, Brett L.; Srinivasan, Muthiah; Porco, Travis C.; Whitcher, John P.; Gaynor, Bruce D.; Lietman, Thomas M.

doi:10.1001/jama.295.10.1142

Cited by 127 publications

(110 citation statements)

References 19 publications

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“…For example, an epidemiological study analyzing C. trachomatis urogenital cases discovered that after antibiotic intervention, the incidence of Chlamydia reinfection cases rose by 4.6% (219). These results have also been observed for trachoma (220,221).…”

Section: Postvaccination Protectionmentioning

confidence: 85%

Genital Chlamydia trachomatis: Understanding the Roles of Innate and Adaptive Immunity in Vaccine Research

Vasilevsky¹,

Greub

Nardelli-Haefliger

et al. 2014

Clin Microbiol Rev

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SUMMARY Chlamydia trachomatis is the leading cause of bacterial sexually transmitted disease worldwide, and despite significant advances in chlamydial research, a prophylactic vaccine has yet to be developed. This Gram-negative obligate intracellular bacterium, which often causes asymptomatic infection, may cause pelvic inflammatory disease (PID), ectopic pregnancies, scarring of the fallopian tubes, miscarriage, and infertility when left untreated. In the genital tract, Chlamydia trachomatis infects primarily epithelial cells and requires Th1 immunity for optimal clearance. This review first focuses on the immune cells important in a chlamydial infection. Second, we summarize the research and challenges associated with developing a chlamydial vaccine that elicits a protective Th1-mediated immune response without inducing adverse immunopathologies.

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Section: Postvaccination Protectionmentioning

confidence: 85%

Genital Chlamydia trachomatis: Understanding the Roles of Innate and Adaptive Immunity in Vaccine Research

Vasilevsky¹,

Greub

Nardelli-Haefliger

et al. 2014

Clin Microbiol Rev

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“…1,2 Results from studies conducted in areas with a high burden of trachoma show that a single dose of azithromycin is effective in treating chlamydial infections and preventing their recurrence. [3][4][5] Mass distribution of azithromycin (MDA) in trachoma-endemic communities has been adopted as a part of World Health Organization (WHO)-endorsed, multi-pronged strategy for reducing the risk of blindness in national trachoma control programs. 6,7 In addition to C. trachomatis, evidence from laboratory and experimental studies indicate that azithromycin is effective against infections caused by a broad spectrum of parasites and bacteria, including those pathogens responsible for sexually transmitted infections, acute respiratory infections, possibly malaria and bacterial enteric infections, which are prevalent in developing countries.…”

Section: Introductionmentioning

confidence: 99%

Association of Mass Treatment with Azithromycin in Trachoma-Endemic Communities with Short-Term Reduced Risk of Diarrhea in Young Children

Coles

Seidman

Levens

et al. 2011

The American Society of Tropical Medicine and Hygiene

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A cohort study was designed to assess the impact of mass distribution of azithromycin (MDA) for trachoma control on incidence over six months of pediatric diarrhea in eight communities in rural Tanzania. A single dose of azithromycin was offered to all residents in four communities, where trachoma prevalence was ≥ 10%. Four geographically matched communities had trachoma prevalences < 10% and did not receive MDA. All randomly selected children (n = 1036) were followed-up for six months post-MDA with bi-weekly surveillance at home. In the 0–1-month and 1–3-month periods, MDA exposure was associated with a 39% (rate ratio = 0.61, 95% confidence interval = 0.39–0.95) and 24% (rate ratio = 0.76, 95% confidence interval = 0.54–1.07) lower risk of diarrhea, respectively, compared with those unexposed, after adjustment for clustering and covariates. By the 3–6-month period, diarrhea incidence was comparable between groups. Thus, MDA was associated with a short-term reduction in diarrheal morbidity in children.

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“…The current reservoir of active disease and infection is in children; in villages where such infections are hyperendemic, C. trachomatis infections have been found in children who have been treated at least once though mass drug administration (MDA) (1,4). PCR is considered to be the current gold standard test, although there is no defined gold standard test for ocular C. trachomatis infections (5,6). The Roche Amplicor CT PCR assay (Roche Diagnostics, Indianapolis, IN) has been used in major trials to monitor infection following MDA (7).…”

mentioning

confidence: 99%

Comparison of the Abbott m 2000 RealTi m e CT Assay and the Cepheid GeneXpert CT/NG Assay to the Roche Amplicor CT Assay for Detection of Chlamydia trachomatis in Ocular Samples from Tanzania

et al. 2013

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The GeneXpert CT/NG assay (GeneXpert) and the Abbott m2000 RealTime CT (m2000) assay were compared to Amplicor for detecting ocular Chlamydia trachomatis. Discordant specimens were tested by the Aptima CT assay. The m2000 assay sensitivity was 100% (95% confidence interval [CI], 90% to 100%), and specificity was 98.46% (95% CI, 95.2% to 99.2%); GeneXpert sensitivity was 100% (95% CI, 90% to 100%), and specificity was 100% (95% CI, 98.1% to 100%). The m2000 and GeneXpert assays appear to perform as well as the Amplicor assay. The leading infectious cause of preventable blindness worldwide is trachoma, which occurs in resource-limited countries, including sub-Saharan Africa, and is caused by repetitive and untreated ocular Chlamydia trachomatis infections (1, 2, 3). The current reservoir of active disease and infection is in children; in villages where such infections are hyperendemic, C. trachomatis infections have been found in children who have been treated at least once though mass drug administration (MDA) (1, 4). PCR is considered to be the current gold standard test, although there is no defined gold standard test for ocular C. trachomatis infections (5, 6). The Roche Amplicor CT PCR assay (Roche Diagnostics, Indianapolis, IN) has been used in major trials to monitor infection following MDA (7). Testing for C. trachomatis infection is often difficult in regions associated with trachoma; the laboratory infrastructure is often deficient or nonexistent, and there is often a lack of trained personnel, equipment, funding, and cleanliness of testing areas. The Cepheid GeneXpert CT/NG Research Use Only (RUO) assay (GeneXpert) (Cepheid Inc., Sunnyvale, CA) is a rapid test designed to produce results relatively quickly, with little hands-on time required, and could be useful in areas where trachoma occurs. We evaluated the Abbott m2000 RealTime CT (m2000) assay (Abbott Molecular Diagnostics, Des Plaines, IL) for detection of C. trachomatis in ocular specimens from Tanzania as a means to reduce turnaround time for results and increase sample throughput. A first-generation GeneXpert CT/NG assay (GeneXpert) was subsequently evaluated as a potential method for testing ocular specimens in the field to expedite provision of immediate treatment of C. trachomatis ocular infections, pending demonstration of its performance in a laboratory setting.Duplicate ocular swab specimens (n ϭ 304) from the same eye were collected from children in Tanzania for the detection of C. trachomatis infection; collection was performed as previously described (8). Samples were shipped frozen in a dry state to the Johns Hopkins University (JHU) Research Laboratory in Baltimore, MD, and stored at Ϫ80°C until testing. Swabs were rehydrated with 1 ml of sterile molecular analysis-grade diethylpyrocarbonate (DEPC) water (Quality Biological, Inc., Gaithersburg, MD). One set of the duplicate specimens was tested by Amplicor (Roche Diagnostics) and GeneXpert (Cepheid) and, for discordance testing, by the GenProbe-Aptima CT (ACT) assay (Gen-Probe Hologi...

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Effect of a Single Mass Antibiotic Distribution on the Prevalence of Infectious Trachoma

Abstract: Ocular chlamydial infection was not eliminated in children aged 1 to 5 years after a single mass azithromycin distribution; it slowly returned over 24 months, although not to baseline levels. Repeated treatments or other effective measures will be necessary for elimination.

Cited by 127 publications

References 19 publications

Genital Chlamydia trachomatis: Understanding the Roles of Innate and Adaptive Immunity in Vaccine Research

Genital Chlamydia trachomatis: Understanding the Roles of Innate and Adaptive Immunity in Vaccine Research

Association of Mass Treatment with Azithromycin in Trachoma-Endemic Communities with Short-Term Reduced Risk of Diarrhea in Young Children

Comparison of the Abbott m 2000 RealTi m e CT Assay and the Cepheid GeneXpert CT/NG Assay to the Roche Amplicor CT Assay for Detection of Chlamydia trachomatis in Ocular Samples from Tanzania

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