Complete Local Elimination of Infectious Trachoma from Severely Affected Communities after Six Biannual Mass Azithromycin Distributions
Received 10 December 2008; received in revised form 22 April 2009; accepted 23 April 2009. published online 10 September 2009.
Objective
To determine whether infectious trachoma can be completely eliminated from severely affected villages.
Design
Cross-sectional survey of 2 villages previously enrolled and monitored over 42 months as part of a larger, group-randomized clinical trial.
Participants
A total of 758 individuals residing in 2 villages with high baseline trachoma prevalence, of a total population of 768 (98.7%).
Methods
All members of the 2 villages were offered 6 biannual mass treatments with oral azithromycin. At 42 months, each current village member was examined. The right upper tarsal conjunctiva was everted and swabbed. Samples were processed for evidence of Chlamydia trachomatis RNA.
Main Outcome Measures
Clinical activity by World Health Organization simplified grading scale for trachoma and laboratory evidence of chlamydial RNA.
Results
Average antibiotic coverage over the study period was 90% and 94% in the 2 villages. Clinical trachoma activity in children aged 1 to 5 years decreased from 78% and 83% in the 2 villages before treatment to 17% and 24% at 42 months. Polymerase chain reaction (PCR) evidence of infection in the same age group decreased from 48% to 0% in both villages at 42 months. When all age groups were examined, there were zero cases with evidence of chlamydial RNA among 758 total villagers tested.
Conclusions
Biannual mass distribution of azithromycin can locally eliminate ocular chlamydial infection from severely affected communities.
Financial Disclosure(s)
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Available online: September 10, 2009.
1F.I. Proctor Foundation, University of California, San Francisco, California
2Department of Ophthalmology, University of California, San Francisco, California
4Department of Laboratory Medicine, University of California, San Francisco, California
5Department of Epidemiology and Biostatistics, University of California, San Francisco, California
6Institute for Global Health, University of California, San Francisco, California
Correspondence: Thomas M. Lietman, MD, 513 Parnassus Ave., Room S309 Medical Sciences, University of California, San Francisco, San Francisco, CA 94143-0412
Manuscript no. 2008-1477.
Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Financial support was provided by That Man May See, the Osher Foundation, the International Trachoma Initiative, the Bodri Foundation, Research to Prevent Blindness, and the Harper Inglis Trust. The International Trachoma Initiative donated the azithromycin and GenProbe donated the APTIMA test kits used in this study. The sponsor or funding organizations had no role in the design or conduct of this research.
ABSTRACT