Trachoma in the Pacific Islands: evidence from Trachoma Rapid Assessment

Mathew, Anu; Keeffe, Jill; Mesurier, Richard T Le; Taylor, Hugh R.

doi:10.1136/bjo.2008.151720

Cited by 22 publications

(28 citation statements)

References 12 publications

(12 reference statements)

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“…More recently, trachoma rapid assessments (TRA) conducted in the Pacific indicated the presence of trachoma in Fiji, Vanuatu, Solomon Islands, Nauru and Kiribati. Although TRAs do not give accurate estimates of disease prevalence, the TRA data suggested that, whilst TF levels appeared high, both TI and TT were surprisingly scarce [10]. …”

Section: Introductionmentioning

confidence: 99%

Low Prevalence of Conjunctival Infection with Chlamydia trachomatis in a Treatment-Naïve Trachoma-Endemic Region of the Solomon Islands

Butcher

Sokana²,

Jack³

et al. 2016

PLoS Negl Trop Dis

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BackgroundTrachoma is endemic in several Pacific Island states. Recent surveys across the Solomon Islands indicated that whilst trachomatous inflammation—follicular (TF) was present at levels warranting intervention, the prevalence of trachomatous trichiasis (TT) was low. We set out to determine the relationship between chlamydial infection and trachoma in this population.MethodsWe conducted a population-based trachoma prevalence survey of 3674 individuals from two Solomon Islands provinces. Participants were examined for clinical signs of trachoma. Conjunctival swabs were collected from all children aged 1–9 years. We tested swabs for Chlamydia trachomatis (Ct) DNA using droplet digital PCR. Chlamydial DNA from positive swabs was enriched and sequenced for use in phylogenetic analysis.ResultsWe observed a moderate prevalence of TF in children aged 1–9 years (n = 296/1135, 26.1%) but low prevalence of trachomatous inflammation—intense (TI) (n = 2/1135, 0.2%) and current Ct infection (n = 13/1002, 1.3%) in children aged 1–9 years, and TT in those aged 15+ years (n = 2/2061, 0.1%). Ten of 13 (76.9%) cases of infection were in persons with TF or TI (p = 0.0005). Sequence analysis of the Ct-positive samples yielded 5/13 (38%) complete (>95% coverage of reference) genome sequences, and 8/13 complete plasmid sequences. Complete sequences all aligned most closely to ocular serovar reference strains.DiscussionThe low prevalence of TT, TI and Ct infection that we observed are incongruent with the high proportion of children exhibiting signs of TF. TF is present at levels that apparently warrant intervention, but the scarcity of other signs of trachoma indicates the phenotype is mild and may not pose a significant public health threat. Our data suggest that, whilst conjunctival Ct infection appears to be present in the region, it is present at levels that are unlikely to be the dominant driving force for TF in the population. This could be one reason for the low prevalence of TT observed during the study.

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Section: Introductionmentioning

confidence: 99%

Low Prevalence of Conjunctival Infection with Chlamydia trachomatis in a Treatment-Naïve Trachoma-Endemic Region of the Solomon Islands

Butcher

Sokana²,

Jack³

et al. 2016

PLoS Negl Trop Dis

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“…Other Western Pacific Island countries have also reported similar findings (unpublished data, Mr O. Sokana, Dr C. Macleod; personal correspondence, Ms F. Taleo). 14,23 Interestingly, in Aboriginal communities in nearby Australia, blindness from trachoma is still a public health issue. 16 We could hypothesize that different C. trachomatis strains from the ones associated elsewhere with trachoma could be found in the Pacific, perhaps with gene polymorphisms (such as in the matrix metalloproteinases) 24 that are important to the scarring process.…”

Section: Discussionmentioning

confidence: 99%

“…A similar pattern has been seen in other Western Pacific countries such as the Solomon Islands, Vanuatu, and Fiji, where recent surveys have found a high prevalence of TF in the children, but with little TT seen in adults (unpublished data, Mr O. Sokana; personal correspondence, Ms F. Taleo). 14 However, in neighboring Australia, trachoma is still a significant cause of blindness in remote Indigenous communities. A 2008 population-based survey found trachoma in 60% of such communities, with TT present in 1.4% of Indigenous adults examined.…”

Section: Introductionmentioning

confidence: 99%

Population-Based Trachoma Mapping in Six Evaluation Units of Papua New Guinea

Macleod

Pahau

et al. 2016

Ophthalmic Epidemiology

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Purpose: We sought to determine the prevalence of trachomatous inflammation – follicular (TF) in children aged 1–9 years, and trachomatous trichiasis (TT) in those aged ≥15 years, in suspected trachoma-endemic areas of Papua New Guinea (PNG). Methods: We carried out six population-based prevalence surveys using the protocol developed as part of the Global Trachoma Mapping Project. Results: A total of 19,013 individuals were sampled for inclusion, with 15,641 (82.3%) consenting to participate. Four evaluation units had prevalences of TF in children ≥10%, above which threshold the World Health Organization (WHO) recommends mass drug administration (MDA) of azithromycin for at least three years; Western Province (South Fly/Daru) 11.2% (95% confidence interval, CI, 6.9–17.0%), Southern Highlands (East) 12.2% (95% CI 9.6–15.0%), Southern Highlands (West) 11.7% (95% CI 8.5–15.3%), and West New Britain 11.4% (95% CI 8.7–13.9%). TF prevalence was 5.0–9.9% in Madang (9.4%, 95% CI 6.1–13.0%) and National Capital District (6.0%. 95% CI 3.2–9.1%) where consideration of a single round of MDA is warranted. Cases of TT were not found outside West New Britain, in which four cases were seen, generating an estimated population-level prevalence of TT in adults of 0.10% (95% CI 0.00–0.40%) for West New Britain, below the WHO elimination threshold of 0.2% of those aged ≥15 years. Conclusion: Trachoma is a public health issue in PNG. However, other than in West New Britain, there are few data to support the idea that trachoma is a cause of blindness in PNG. Further research is needed to understand the stimulus for the active trachoma phenotype in these populations.

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“…In 2009, a trachoma rapid assessment was conducted in 17 sites in Tafea and Shefa province, indicating that trachoma was a likely to be significant public health burden [16]. A population-based prevalence survey was therefore required to determine the prevalence of TF in Vanuatu, to guide application of community-level interventions[17].…”

Section: Introductionmentioning

confidence: 99%

Integrated Mapping of Yaws and Trachoma in the Five Northern-Most Provinces of Vanuatu

et al. 2017

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Yaws and trachoma are targeted for eradication and elimination as public health problems. In trachoma-endemic populations mass administration of azithromycin can simultaneously treat yaws. We conducted a population-based prevalence survey in the five northernmost provinces of Vanuatu, where trachoma and yaws are suspected to be co-endemic. Clinical signs of trachoma were evaluated using the WHO simplified grading system, and skin examination with a serological rapid diagnostic test used to identify yaws. We enrolled 1004 households in 59 villages over 16 islands, and examined 3650 individuals of all ages for trachoma. The overall adjusted prevalence of trachomatous inflammation-follicular (TF) in 1–9 year-olds was 12.0% (95% Confidence Interval: 8.1–16.7%), and the overall adjusted prevalence of TT in those aged 15 years and greater was 0.04% (95% CI 0–0.14%). In multivariate analysis, the odds of children having TF was 2.6 (95% CI = 1.5–4.4) times higher in households with unimproved latrines, and independently associated with the number of children in the household (OR 1.3, 95% CI = 1.0–1.6 for each additional child). We examined the skin of 821 children aged 5–14 years. Two children had yaws, giving an estimated prevalence of active yaws in those aged 5–14 years of 0.2% (95% CI = 0.03–0.9%). Mass treatment with azithromycin is recommended in these provinces. Given the apparent low burden of yaws, integration of yaws and trachoma control programmes is likely to be useful and cost-effective to national programmes.

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Trachoma in the Pacific Islands: evidence from Trachoma Rapid Assessment

Abstract: The findings indicate that trachoma is present in all the Pacific Island countries screened. Further prevalence studies are required, and trachoma control measures should be considered.

Cited by 22 publications

References 12 publications

Low Prevalence of Conjunctival Infection with Chlamydia trachomatis in a Treatment-Naïve Trachoma-Endemic Region of the Solomon Islands

Low Prevalence of Conjunctival Infection with Chlamydia trachomatis in a Treatment-Naïve Trachoma-Endemic Region of the Solomon Islands

Population-Based Trachoma Mapping in Six Evaluation Units of Papua New Guinea

Integrated Mapping of Yaws and Trachoma in the Five Northern-Most Provinces of Vanuatu

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