1
|
Üstün Ç, Özçiftçi S. An ophthalmologist fought against trachoma in Turkey and his books from an archive: Dr Nuri Fehmi Ayberk and The Development of Ophthalmology in Turkey. JOURNAL OF MEDICAL BIOGRAPHY 2024; 32:181-185. [PMID: 37221868 DOI: 10.1177/09677720231177292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Dr Nuri Fehmi Ayberk is an influential figure in the Turkish ophthalmology in training new specialists in the field and contributing to the fight against trachoma. This article includes his short biography, studies, information and cover pictures of some of his works from the original archive of Ege University Faculty of Medicine, Department of History of Medicine and Ethics, Fatma-Ömer Ekimci Library. He took an active role in the establishment of the Turkish Ophthalmological Association in our country (1928) and served as a founding member. Conducting such studies on the biographies and rare books subgroup of the history of medicine is an important contribution to ensure that the biographies of physicians who have left their mark in the past and have achieved success in different specialties are narrated, remembered, and the information and cover pictures of their works in different archives meet with the reader.
Collapse
Affiliation(s)
- Çağatay Üstün
- Ege University, Faculty of Medicine, History of Medicine and Ethics, İzmir, Turkey
| | - Seçil Özçiftçi
- İzmir Katip Çelebi University, Faculty of Medicine, History of Medicine and Ethics, İzmir, Turkey
| |
Collapse
|
2
|
Mikhail E, Mohebbi M, Gokhale M, Azizoglu S, Suphioglu C. Development and validation of a health practitioner survey on ocular allergy. Sci Rep 2024; 14:9932. [PMID: 38689009 PMCID: PMC11061311 DOI: 10.1038/s41598-024-60837-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 04/28/2024] [Indexed: 05/02/2024] Open
Abstract
Survey studies have played a significant role in understanding the gaps in the knowledge and practices of health practitioners. However, there have been no such survey studies on Ocular Allergy (OA). Thus, the purpose of this study was to develop and validate a survey on OA to better understand the gaps in the diagnostic, treatment, and collaborative care approaches of health practitioners in OA. The survey is titled "Survey on Ocular Allergy for Health Practitioners (SOAHP)". SOAHP was developed in a five-stage process. First, item extraction via the use of a literature review, second, face and content validity, third, a pilot study, fourth, test-retest reliability, and fifth, finalisation of the survey. 65 items under 6 domains were initially generated in the item extraction phase. Content validity was conducted on 15 experts in the field. This was conducted twice to reach consensus whereby items and domains were added, edited, kept, or removed, resulting in 50 items under 7 domains. The pilot study was conducted on 15 participants from the five relevant health practitioner fields (Allergists/Immunologists, General Practitioners (GPs), Ophthalmologists, Optometrists and Pharmacists). This altered the survey further to 40 items under 7 domains. Test-retest reliability was conducted on 25 participants from the five health practitioner fields. Reliability was moderate to almost perfect for most (97%) investigated items. The finalised survey was 40 items under 7 domains. SOAHP is the first survey created to assess diagnostic, treatment and collaborative care approaches of Allergists/Immunologists, GPs, Ophthalmologists, Optometrists and Pharmacists on OA. SOAHP will be a useful tool in clinical research on OA.
Collapse
Affiliation(s)
- Ereeny Mikhail
- NeuroAllergy Research Laboratory (NARL), School of Life and Environmental Sciences, Deakin University, Waurn Ponds, Geelong, VIC, 3216, Australia.
- Deakin Optometry, School of Medicine, Deakin University, Waurn Ponds, Geelong, VIC, 3216, Australia.
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), Deakin University, Waurn Ponds, Geelong, VIC, 3216, Australia.
| | - Mohammadreza Mohebbi
- Biostatistics Unit, Faculty of Health, Deakin University, Geelong, VIC, 3216, Australia
| | - Moneisha Gokhale
- Deakin Optometry, School of Medicine, Deakin University, Waurn Ponds, Geelong, VIC, 3216, Australia
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), Deakin University, Waurn Ponds, Geelong, VIC, 3216, Australia
| | - Serap Azizoglu
- Deakin Optometry, School of Medicine, Deakin University, Waurn Ponds, Geelong, VIC, 3216, Australia
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), Deakin University, Waurn Ponds, Geelong, VIC, 3216, Australia
| | - Cenk Suphioglu
- NeuroAllergy Research Laboratory (NARL), School of Life and Environmental Sciences, Deakin University, Waurn Ponds, Geelong, VIC, 3216, Australia
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), Deakin University, Waurn Ponds, Geelong, VIC, 3216, Australia
| |
Collapse
|
3
|
Harte AJ, Ghasemian E, Pickering H, Houghton J, Chernet A, Sata E, Yismaw G, Zeru T, Tadesse Z, Callahan EK, Nash SD, Holland MJ. Unravelling Chlamydia trachomatis diversity in Amhara, Ethiopia: MLVA-ompA sequencing as a molecular typing tool for trachoma. PLoS Negl Trop Dis 2024; 18:e0012143. [PMID: 38662795 PMCID: PMC11075894 DOI: 10.1371/journal.pntd.0012143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 05/07/2024] [Accepted: 04/08/2024] [Indexed: 05/08/2024] Open
Abstract
Trachoma is the leading infectious cause of blindness worldwide and is now largely confined to around 40 low- and middle-income countries. It is caused by Chlamydia trachomatis (Ct), a contagious intracellular bacterium. The World Health Organization recommends mass drug administration (MDA) with azithromycin for treatment and control of ocular Ct infections, alongside improving facial cleanliness and environmental conditions to reduce transmission. To understand the molecular epidemiology of trachoma, especially in the context of MDA and transmission dynamics, the identification of Ct genotypes could be useful. While many studies have used the Ct major outer membrane protein gene (ompA) for genotyping, it has limitations. Our study applies a typing system novel to trachoma, Multiple Loci Variable Number Tandem Repeat Analysis combined with ompA (MLVA-ompA). Ocular swabs were collected post-MDA from four trachoma-endemic zones in Ethiopia between 2011-2017. DNA from 300 children with high Ct polymerase chain reaction (PCR) loads was typed using MLVA-ompA, utilizing 3 variable number tandem repeat (VNTR) loci within the Ct genome. Results show that MLVA-ompA exhibited high discriminatory power (0.981) surpassing the recommended threshold for epidemiological studies. We identified 87 MLVA-ompA variants across 26 districts. No significant associations were found between variants and clinical signs or chlamydial load. Notably, overall Ct diversity significantly decreased after additional MDA rounds, with a higher proportion of serovar A post-MDA. Despite challenges in sequencing one VNTR locus (CT1299), MLVA-ompA demonstrated cost-effectiveness and efficiency relative to whole genome sequencing, providing valuable information for trachoma control programs on local epidemiology. The findings suggest the potential of MLVA-ompA as a reliable tool for typing ocular Ct and understanding transmission dynamics, aiding in the development of targeted interventions for trachoma control.
Collapse
Affiliation(s)
- Anna J. Harte
- The London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ehsan Ghasemian
- The London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Harry Pickering
- The London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Joanna Houghton
- The London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | | | - Taye Zeru
- The Amhara Regional Health Bureau, Bahir Dar, Ethiopia
| | | | | | - Scott D. Nash
- The Carter Center, Atlanta, Georgia, United States of America
| | - Martin J. Holland
- The London School of Hygiene and Tropical Medicine, London, United Kingdom
| |
Collapse
|
4
|
Cesur S. Combination techniques towards novel drug delivery systems manufacturing: 3D PCL scaffolds enriched with tetracycline-loaded PVP nanoparticles. Eur J Pharm Biopharm 2024; 194:36-48. [PMID: 38036066 DOI: 10.1016/j.ejpb.2023.11.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 11/20/2023] [Accepted: 11/26/2023] [Indexed: 12/02/2023]
Abstract
Drug delivery systems based on synthetic and natural polymers offer a new approach with a capacity to control the release of bio-active agents within time. In this work, we present different designs of Polycaprolactone (PCL) 3D scaffolds containing Polyvinylpyrrolidone (PVP) nanoparticles that can store a hydrophilic drug. The drug delivery system, combined of PCL and PVP polymers fabricated by additive manufacturing, aims for a solution for longer and more stabled drug delivery carrier. The drug, planned to be released to the targeted area, is sprayed with the electrospray method inside PVP nanoparticles on the different layers of the fabricated PCL scaffolds 3D printing. This makes obtaining a layered and porous scaffold and drug-loaded nanoparticles within this structure easier. Obtained PCL scaffolds containing Tetracyclines (Tet) loaded PVP nanoparticles showed that drug encapsulation into the interlayer extended the release time and exhibited a controlled release profile for days. Moreover, produced scaffolds have good biocompatibility and no harmful effects. The combination of 3D scaffolds and drug-loaded nanoparticles aims to develop new functional scaffolds by targeting more efficient and longer-lasting drug delivery.
Collapse
Affiliation(s)
- Sumeyye Cesur
- Center for Nanotechnology & Biomaterials Application and Research (NBUAM), Marmara University, Turkey; Department of Metallurgical and Materials Engineering, Faculty of Technology, Marmara University, Turkey.
| |
Collapse
|
5
|
Ageed A, Khan M. Eliminating Trachoma in Africa: The Importance of Environmental Interventions. Cureus 2024; 16:e52358. [PMID: 38234389 PMCID: PMC10792353 DOI: 10.7759/cureus.52358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2024] [Indexed: 01/19/2024] Open
Abstract
Subsequent to the failure of the World Health Organisation (WHO) of achieving their target to eliminate trachoma by the year 2020, the most effective strategy in eliminating trachoma must be re-examined to accomplish the new target of eradication by the year 2030. Whilst antibiotic therapy is a core foundation of this elimination strategy, another important factor is the state of the environmental conditions in trachoma endemic countries. This manuscript aimed to identify the impact of environmental improvement strategies on the prevalence of trachoma and the significance of environmental improvement alongside the use of antibiotic treatment to achieve trachoma elimination. Two independent literature searches were conducted up until the 5th of July 2021. Two main databases were used to carry out these literature searches, namely, Ovid EMBASE and Ovid MEDLINE. All of the relevant references were found using MeSH and free text terms. Key terms used were 'trachoma', 'water', 'sanitation', 'hygiene' and 'environmental Improvement'. The exclusion criteria included non-African-based studies, review papers, protocols and case reports. A total of 17 studies were included for this review. Living within a close range of a water source was significantly associated with reduced risk of trachoma infection. Water obtained from piped water sources was associated with the lowest rates of active trachoma. Studies on facial cleanliness evidenced a strong association with reduced prevalence of trachoma. Whilst the provision of latrine facilities found was significantly associated with reduced prevalence of trachoma, there was no significant difference between the use of private latrine facilities over communal latrine facilities. The use of repeated scheduled antibiotic treatments over single-use antibiotic distribution had a greater impact both short term and long term on the prevalence rates of trachoma. Nonetheless, prevalence rates increased again following the commencement of treatment. Mass antibiotic treatment has been proven to have a greater impact on lowering the prevalence of trachoma initially, but this impact is not sustainable due to the rise in prevalence rates following the completion of treatment. A holistic approach, therefore, must be implemented with evidence showing that an emphasis on longer-term environmental methods should be implemented to compliment antibiotic distribution. Prioritisation of specific interventional measures should be tailored according to local epidemiology; nonetheless, these measures form the backbone of a trachoma elimination strategy to eliminate trachoma by the year 2030.
Collapse
Affiliation(s)
- Ahmed Ageed
- Hospital Medicine, University Hospitals of Leicester NHS Trust, Leicester, GBR
| | - Maaz Khan
- Medical Education, Royal Surrey County Hospital, Guildford, GBR
| |
Collapse
|
6
|
Gallenga CE, Maritati M, Del Boccio M, D’Aloisio R, Conti P, Mura M, Contini C, Gallenga PE. Why the SAFE- S Strategy for Trachoma? Are Musca sorbens or Scatophaga stercoraria Really the Culprit?-A Brief Historical Review from an Italian Point of View. Pathogens 2023; 12:1419. [PMID: 38133302 PMCID: PMC10748347 DOI: 10.3390/pathogens12121419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/24/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023] Open
Abstract
The biological history of Chlamydia trachomatis is intertwined with the evolution of the man. Infecting Elemental Bodies (EBs), having penetrated mucosal epithelial cells, wrap themselves in a cloak (ĸλαμις) of glycogen that ensures their obligatory intracellular survival and protects this differentiation into Reticulate Bodies (RBs) that feed on cellular ATP. Multiple chemokines and cytokines are involved under the direction of IL-6 in the florid phase and IL-17A in the scar phase. The WHO has successfully identified the SAFE strategy against trachoma (Surgery, Antibiotics, Facial cleansing, Environment) as the blueprint to eliminate the disease by 2020. Recently, interest has been increasingly focused on changing sexual attitudes in different areas of the world, leaving Musca sorbens, Scatophaga stercoraria, and stepsisters fairly blameless, but extolling the role of Chlamydia trachomatis in apparently "sterile" chronic prostatitis or conjunctivitis or, less frequently, in oropharyngitis and proctitis. The addition of an S (SAFE-S) standing for "sexual behavior" was then proposed to also attract the interest and attention not only of Ophthalmologists and Obstetricians/Gynecologists, Urologists/Andrologists, and the School Authorities for information on the prevention of sexually transmitted diseases, but also of Social Physicians and Pediatricians. This means that sexually transmitted infections should be screened in asymptomatic patients with risky sexual behavior or sexual contact with people diagnosed with a transmitted infection.
Collapse
Affiliation(s)
- Carla Enrica Gallenga
- Department of Medical Science, University of Ferrara, Eye Clinic University-Hospital, 44124 Ferrara, Italy
| | - Martina Maritati
- Department of Medical Science Infectious Diseases and Dermatology Section, University of Ferrara, 44124 Ferrara, Italy; (M.M.); (C.C.)
| | | | - Rossella D’Aloisio
- Department of Medical, Oral, and Biotechnological Sciences, G. d’Annunzio University Chieti-Pescara, 66100 Chieti, Italy;
| | - Pio Conti
- Molecular Immunopharmacology and Drug Discovery Laboratory, Tufts University Medical School, Boston, MA 02111, USA;
| | - Marco Mura
- Department of Traslational Medicine and for Romagna, Section Ophthalmology, University of Ferrara, 44124 Ferrara, Italy;
| | - Carlo Contini
- Department of Medical Science Infectious Diseases and Dermatology Section, University of Ferrara, 44124 Ferrara, Italy; (M.M.); (C.C.)
| | - Pier Enrico Gallenga
- Stenella cno Ophthalmology Laboratory, 65100 Pescara, Italy;
- Bioethical Committee of San Marino Republic, 47893 Borgo Maggiore, San Marino
| |
Collapse
|
7
|
Cheong HC, Sulaiman S, Looi CY, Chang LY, Wong WF. Chlamydia Infection Remodels Host Cell Mitochondria to Alter Energy Metabolism and Subvert Apoptosis. Microorganisms 2023; 11:1382. [PMID: 37374883 DOI: 10.3390/microorganisms11061382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/18/2023] [Accepted: 05/19/2023] [Indexed: 06/29/2023] Open
Abstract
Chlamydia infection represents an important cause for concern for public health worldwide. Chlamydial infection of the genital tract in females is mostly asymptomatic at the early stage, often manifesting as mucopurulent cervicitis, urethritis, and salpingitis at the later stage; it has been associated with female infertility, spontaneous abortion, ectopic pregnancy, and cervical cancer. As an obligate intracellular bacterium, Chlamydia depends heavily on host cells for nutrient acquisition, energy production, and cell propagation. The current review discusses various strategies utilized by Chlamydia in manipulating the cell metabolism to benefit bacterial propagation and survival through close interaction with the host cell mitochondrial and apoptotic pathway molecules.
Collapse
Affiliation(s)
- Heng Choon Cheong
- Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia
| | - Sofiah Sulaiman
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia
| | - Chung Yeng Looi
- School of Biosciences, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya 47500, Selangor, Malaysia
| | - Li-Yen Chang
- Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia
| | - Won Fen Wong
- Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia
| |
Collapse
|
8
|
Koca Ö. The Laboratory Diagnosis of Chlamydia Infections. Infect Dis (Lond) 2023. [DOI: 10.5772/intechopen.110464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Bacteria of the genus Chlamydia belong to the order Chlamydiales, within the family Chlamydiaceae. These intracellular parasites have a different biphasic reproductive cycle than other bacteria. The important Chlamydiaceae are Chlamydia trachomatis, Chlamydophila pneumoniae and Chlamydophila psittaci. Chlamydia trachomatis and Clamydophila pneumoniae are primary human pathogens. Chlamydia trachomatis is transmitted by sexual contact. It is the causative agent of LGV (lymphogranuloma venoreum) and ocular trachoma in humans. Chlamydophila pneumoniae causes bronchitis, atypical pneumonia, sinusitis, pharyngitis, and inflammatory atherosclerosis. Chlamydia psittaci is the causative agent of psittacosis (pneumonia). It primarily causes infection in birds and domestic animals, and sometimes in humans. Chlamydia trachomatis laboratory diagnosis is based on cytological examination (Giemsa), antigen detection (with enzyme-linked immunosorbent assay and direct immunofluorescence staining), nucleic acid-based tests (nucleic acid probe tests and nucleic acid amplification tests—NAAT), cell culture (in vivo and in vitro), and detection of antibodies (especially microimmunofluorescence—MIF and enzyme immunoassay—EIA, for the diagnosis of LGV). The most specific test in diagnosis is cell culture, and the most sensitive is nucleic acid-based test. NAAT and MIF tests are successful in the diagnosis of C. pneumoniae infections. The diagnosis of psittacosis is usually made by serological testing, and species-specific MIF testing should be performed to confirm.
Collapse
|
9
|
Duman I. Chlamydia Infection from Androgical Perspective. Infect Dis (Lond) 2023. [DOI: 10.5772/intechopen.110045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
Chlamydia trachomatis is a microorganism known for years to cause ocular, urogenital, and neonatal infections in humans. It usually causes urogenital system infections. The pathogen, which is the most common cause of urethritis in males, is one of the sexually transmitted microorganisms. As most males are asymptomatic, they do not realize they are infected and act as reservoirs. This causes the incidence of urethritis due to chlamydia to increase day by day. Chlamydia urethritis, which poses a risk to sexual partners, can cause serious complications if left untreated. In this section, we assess the approach to male urethritis due to chlamydia, which is very common in urology practice and can cause serious problems if left untreated.
Collapse
|
10
|
Nayel Y, Taylor M, Montasser AS, Elsherif M, Diab MM. Perceptions of ophthalmologists on the impact of trachoma in Egypt: a mixed-methods, nationwide survey. BMC Infect Dis 2023; 23:27. [PMID: 36650425 PMCID: PMC9847179 DOI: 10.1186/s12879-022-07862-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 11/09/2022] [Indexed: 01/18/2023] Open
Abstract
PURPOSE Understanding the perception and practices of ophthalmologists for trachoma is important to develop interventions aimed at disease elimination in Egypt. The survey investigated: (1) the views and practice patterns of Egyptian ophthalmologists for trachoma and (2) the influence of geographic location, setting, and years of practice on ophthalmologists' perceptions. METHODS A questionnaire sent to ophthalmologists currently working in Egypt collected information on: (1) demographics, (2) caseload and practice patterns for trachoma, (3) 13 Likert scale questions regarding the current state of trachoma, and (4) two open-ended written response questions. RESULTS Of the 500 recipients, 194 ophthalmologists participated. 98% of the respondents reported seeing trachoma patients in their practice. 28.8% agreed that trachoma is currently an active health problem in Egypt, with ophthalmologists in public practice having significantly higher agreement scores compared to private practitioners (p = 0.030). Rural ophthalmologists were significantly more likely to agree that a targeted trachoma control program is needed in their location of practice compared to their urban counterparts (p < 0.001). Open-ended questions revealed recurrent themes, including the rural distribution of trachoma patients and the high volume of patients with corneal opacity. CONCLUSION Ophthalmologists' experiences with trachoma in Egypt differed based on practice setting, years in practice, and location, and the overall perception of the impact of the disease remains low. However, there was widespread agreement that trachoma is present in communities across the country. Practitioners in rural areas and in the public sector shared a disproportionate burden of the trachoma caseload. The perspectives of such ophthalmologists must be emphasized in decision-making related to trachoma interventions.
Collapse
Affiliation(s)
- Yassin Nayel
- grid.464520.10000 0004 0614 2595American University of the Caribbean School of Medicine, Cupecoy, Sint Maarten
| | - Matilda Taylor
- grid.17091.3e0000 0001 2288 9830Faculty of Medicine, University of British Columbia, Vancouver, BC Canada
| | - Ahmed S. Montasser
- grid.412093.d0000 0000 9853 2750Department of Ophthalmology, Faculty of Medicine, Helwan University, Helwan, Egypt
| | - Mohamed Elsherif
- grid.22903.3a0000 0004 1936 9801Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Mostafa M. Diab
- grid.411170.20000 0004 0412 4537Department of Ophthalmology, Faculty of Medicine, Fayoum University, Al Fayoum, Egypt
| |
Collapse
|
11
|
Ouellette SP, Fisher-Marvin LA, Harpring M, Lee J, Rucks EA, Cox JV. Localized cardiolipin synthesis is required for the assembly of MreB during the polarized cell division of Chlamydia trachomatis. PLoS Pathog 2022; 18:e1010836. [PMID: 36095021 PMCID: PMC9499288 DOI: 10.1371/journal.ppat.1010836] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 09/22/2022] [Accepted: 08/29/2022] [Indexed: 11/18/2022] Open
Abstract
Pathogenic Chlamydia species are coccoid bacteria that use the rod-shape determining protein MreB to direct septal peptidoglycan synthesis during their polarized cell division process. How the site of polarized budding is determined in this bacterium, where contextual features like membrane curvature are seemingly identical, is unclear. We hypothesized that the accumulation of the phospholipid, cardiolipin (CL), in specific regions of the cell membrane induces localized membrane changes that trigger the recruitment of MreB to the site where the bud will arise. To test this, we ectopically expressed cardiolipin synthase (Cls) and observed a polar distribution for this enzyme in Chlamydia trachomatis. In early division intermediates, Cls was restricted to the bud site where MreB is localized and peptidoglycan synthesis is initiated. The localization profile of 6xHis tagged Cls (Cls_6xH) throughout division mimicked the distribution of lipids that stain with NAO, a dye that labels CL. Treatment of Chlamydia with 3’,6-dinonylneamine (diNN), an antibiotic targeting CL-containing membrane domains, resulted in redistribution of Cls_6xH and NAO-staining phospholipids. In addition, 6xHis tagged MreB localization was altered by diNN treatment, suggesting an upstream regulatory role for CL-containing membranes in directing the assembly of MreB. This hypothesis is consistent with the observation that the clustered localization of Cls_6xH is not dependent upon MreB function or peptidoglycan synthesis. Furthermore, expression of a CL-binding protein at the inner membrane of C. trachomatis dramatically inhibited bacterial growth supporting the importance of CL in the division process. Our findings implicate a critical role for localized CL synthesis in driving MreB assembly at the bud site during the polarized cell division of Chlamydia.
Collapse
Affiliation(s)
- Scot P. Ouellette
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Nebraska Medical Center, Omaha, Nebraska
- * E-mail: (SPO); (JVC)
| | - Laura A. Fisher-Marvin
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Nebraska Medical Center, Omaha, Nebraska
| | - McKenna Harpring
- Department of Microbiology, Immunology, and Biochemistry, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Junghoon Lee
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Nebraska Medical Center, Omaha, Nebraska
| | - Elizabeth A. Rucks
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Nebraska Medical Center, Omaha, Nebraska
| | - John V. Cox
- Department of Microbiology, Immunology, and Biochemistry, University of Tennessee Health Science Center, Memphis, Tennessee
- * E-mail: (SPO); (JVC)
| |
Collapse
|
12
|
Greenland K, Czerniewska A, Guye M, Legesse D, Ahmed Mume A, Shafi Abdurahman O, Abraham Aga M, Miecha H, Shumi Bejiga G, Sarah V, Burton M, Last A. Seasonal variation in water use for hygiene in Oromia, Ethiopia, and its implications for trachoma control: An intensive observational study. PLoS Negl Trop Dis 2022; 16:e0010424. [PMID: 35560031 PMCID: PMC9173637 DOI: 10.1371/journal.pntd.0010424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 06/07/2022] [Accepted: 04/18/2022] [Indexed: 11/18/2022] Open
Abstract
If facial hygiene practices vary seasonally this could have important implications for the design of interventions for trachoma control. This observational study was conducted to explore seasonal variation in hygiene behaviours in 9 households with at least one child aged 1-9 years-of-age in the West Arsi zone in rural Oromia, Ethiopia. Sixty-one household members were observed intensively over two days in the dry season (January), the rainy season (July) and during the harvest period (October) in 2018. Structured record forms were used to document household water availability and use. Daily water use per capita was very low in all seasons (3.1-4.2 litres). Around one third of water consumed in households in all seasons was associated with body washing. Soap was used during 44 of 677 (6%) of these observed occasions and half of all body washes (n = 340; 50%) included face washing. Overall, 95% of 58 individuals washed their faces at least once between 06:30h and 21:30h in the dry season (21% with soap), compared with 79% in the rainy season (2% with soap) (p = 0.013). Sixty-five percent of householders washed their faces during the harvest observation period (06:30h to 17:30h), none of whom used soap. Twenty-eight percent of 204 children aged 11 and under still had ocular or nasal discharge on their faces after washing. Seventy-three percent of those who washed their faces did so more than once in the dry season, compared with 33% in the rainy season (p<0.001). Face washing occurred throughout the day during the dry season, with a clear peak in the early morning and extra washes in the early evening. Face washing mainly took place in the early morning in the other two seasons. Genuine water scarcity in this area is likely to limit the impact of face washing interventions for trachoma control in the absence of water supply interventions. However, face washing was most common at the time of year when water is the hardest to come by, and seasonal differences in behaviour should be considered in any resulting intervention design.
Collapse
Affiliation(s)
- Katie Greenland
- Environmental Health Group, Department for Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Alexandra Czerniewska
- Environmental Health Group, Department for Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Meseret Guye
- The Fred Hollows Foundation, Addis Ababa, Ethiopia
| | | | | | - Oumer Shafi Abdurahman
- The Fred Hollows Foundation, Addis Ababa, Ethiopia
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Hirpha Miecha
- Oromia Regional Health Bureau, Addis Ababa, Ethiopia
| | | | | | - Matthew Burton
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Anna Last
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| |
Collapse
|
13
|
Lynch KD, Apadinuwe SC, Lambert SB, Hillgrove T, Starr M, Catlett B, Ware RS, Cama A, Webster S, Harding-Esch EM, Bakhtiari A, Butcher R, Cunningham P, Martin D, Gwyn S, Solomon AW, Garabwan C, Kaldor JM, Vaz Nery S. A national survey integrating clinical, laboratory, and WASH data to determine the typology of trachoma in Nauru. PLoS Negl Trop Dis 2022; 16:e0010275. [PMID: 35439248 PMCID: PMC9017947 DOI: 10.1371/journal.pntd.0010275] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 02/24/2022] [Indexed: 11/23/2022] Open
Abstract
Background The epidemiology of trachoma in several Pacific Islands differs from other endemic settings, in that there is a high prevalence of clinical signs of trachoma, particularly trachomatous inflammation—follicular (TF), but few cases of trichiasis and limited evidence of ocular chlamydial infection. This so-called “Pacific enigma” has led to uncertainty regarding the appropriate public health response. In 2019 alongside Nauru’s national trachoma population survey, we performed bacteriological and serological assessments of children to better understand the typology of trachoma and to determine whether there is a need for trachoma interventions. Methods We used two-stage cluster sampling, examining residents aged ≥1 year and collecting household-level water, sanitation, and hygiene (WASH) variables. Children aged 1–9 years provided conjunctival swabs and finger-prick dried blood spots to investigate the presence of Chlamydia trachomatis nucleic acid and anti-Pgp3 antibodies, respectively. Principal Findings In 818 participants aged 1–9 years, the age-adjusted TF prevalence was 21.8% (95% CI 15.2–26.2%); ocular C. trachomatis prevalence was 34.5% (95% CI 30.6–38.9), and anti-Pgp3 antibody prevalence was 32.1% (95% CI 28.4%–36.3%). The age- and gender-adjusted prevalence of trichiasis in ≥15-year-olds was 0.3% (95% CI 0.00–0.85), but no individual with trichiasis had trachomatous scarring (TS). Multivariable analysis showed an association between age and both TF (OR per year of age 1.3 [95% CI 1.2–1.4]) and anti-Pgp3 positivity (OR 1.2 [95% CI 1.2–1.3]). There were high rates of access to water and sanitation and no WASH variable was associated with the presence of TF. Conclusions TF, nucleic acid, and age-specific antibody prevalence collectively indicate that high levels of C. trachomatis transmission among children present a high risk of ocular damage due to trachoma. The absence of trichiasis with trachomatous scarring suggest a relatively recent increase in transmission intensity. In contrast to several neighbouring Pacific Island nations, Nauruan children are heavily affected by active trachoma and the cause is ocular infection with C. trachomatis. Comprehensive public health intervention to control trachoma in Nauru is required. The use of laboratory markers for current and previous C. trachomatis infection should be considered in baseline trachoma prevalence surveys as we approach global elimination of trachoma, and in settings with inconsistent findings during previous screening exercises.
Collapse
Affiliation(s)
- Kathleen D. Lynch
- UQ Centre for Clinical Research, University of Queensland, Brisbane, Australia
- * E-mail:
| | | | - Stephen B. Lambert
- UQ Centre for Clinical Research, University of Queensland, Brisbane, Australia
- National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia
| | | | - Mitchell Starr
- NSW State Reference Laboratory for HIV, St Vincent’s Centre for Applied Medical Research, St Vincent’s Hospital, Sydney, Australia
| | - Beth Catlett
- NSW State Reference Laboratory for HIV, St Vincent’s Centre for Applied Medical Research, St Vincent’s Hospital, Sydney, Australia
| | - Robert S. Ware
- Menzies Health Institute Queensland and School of Medicine, Griffith University, Brisbane, Australia
| | | | - Sara Webster
- The Fred Hollows Foundation, Melbourne, Australia
| | - Emma M. Harding-Esch
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Ana Bakhtiari
- International Trachoma Initiative, Task Force for Global Health, Decatur, Georgia, United States of America
| | - Robert Butcher
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Philip Cunningham
- NSW State Reference Laboratory for HIV, St Vincent’s Centre for Applied Medical Research, St Vincent’s Hospital, Sydney, Australia
| | - Diana Martin
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Sarah Gwyn
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Anthony W. Solomon
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | | | - John M. Kaldor
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Susana Vaz Nery
- The Kirby Institute, University of New South Wales, Sydney, Australia
| |
Collapse
|
14
|
Lynch KD, Brian G, Ahwang T, Newie T, Newie V, Perrett C, Wharton G, Brown A, Tozer S, Kaldor JM, Whop LJ, Andrews RM, Lambert SB. Discord between presence of follicular conjunctivitis and Chlamydia trachomatis infection in a single Torres Strait Island community: a cross-sectional survey. Aust N Z J Public Health 2022; 46:155-160. [PMID: 34978363 DOI: 10.1111/1753-6405.13179] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 08/01/2021] [Accepted: 09/01/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Recent surveys identified trachomatous inflammation - follicular (TF) at endemic levels in the Torres Strait Islands; however, local health staff do not report trachomatous trichiasis (TT) in adults. We undertook a cross-sectional survey involving eye examination and microbiological testing to better understand this disconnect. METHODS We examined 169 of 207 (82%) residents and collected ocular swabs for polymerase chain reaction (PCR) testing for Chlamydia trachomatis. Other viral PCR tests and bacterial culture were also performed. RESULTS TF prevalence in children aged 5-9 years was 23% (7/30). No ocular C. trachomatis was identified by PCR. For the 72 participants (43%) with follicles, bacterial culture was positive for 11 (15%) individuals. No individual had trachomatous trichiasis. CONCLUSIONS Follicular conjunctivitis consistent with TF was prevalent but ocular C. trachomatis and cicatricial trachoma were absent. Non-chlamydial infections or environmental causes of follicular conjunctivitis may be causing TF in this community. Implications for public health: In similar settings, reliance on simplified clinical assessment alone may lead to an overestimation of the public health problem posed by trachoma. Consideration should be given to incorporating C. trachomatis PCR, and in certain settings, a detailed clinical exam could be performed by an experienced ophthalmologist during prevalence surveys.
Collapse
Affiliation(s)
- Kathleen D Lynch
- Communicable Diseases Branch, Prevention Division, Queensland Health.,UQ Centre for Clinical Research, The University of Queensland
| | - Garry Brian
- Communicable Diseases Branch, Prevention Division, Queensland Health.,Torres and Cape Hospital and Health Service, Queensland
| | | | - Tomi Newie
- Torres and Cape Hospital and Health Service, Queensland
| | | | | | - Ghislaine Wharton
- Torres and Cape Hospital and Health Service, Queensland.,Cairns Eye & Laser Centre, Cairns, Queensland
| | - Anthony Brown
- Torres and Cape Hospital and Health Service, Queensland
| | - Sarah Tozer
- UQ Centre for Clinical Research, The University of Queensland
| | | | - Lisa J Whop
- Menzies School of Health Research, Charles Darwin University, Northern Territory.,National Centre for Epidemiology and Population Health, The Australian National University, Australian Capital Territory
| | - Ross M Andrews
- Menzies School of Health Research, Charles Darwin University, Northern Territory.,National Centre for Epidemiology and Population Health, The Australian National University, Australian Capital Territory
| | - Stephen B Lambert
- Communicable Diseases Branch, Prevention Division, Queensland Health.,UQ Centre for Clinical Research, The University of Queensland.,National Centre for Epidemiology and Population Health, The Australian National University, Australian Capital Territory
| |
Collapse
|
15
|
Amoah B, Fronterre C, Johnson O, Dejene M, Seife F, Negussu N, Bakhtiari A, Harding-Esch EM, Giorgi E, Solomon AW, Diggle PJ. Model-based geostatistics enables more precise estimates of neglected tropical-disease prevalence in elimination settings: mapping trachoma prevalence in Ethiopia. Int J Epidemiol 2021; 51:468-478. [PMID: 34791259 PMCID: PMC9082807 DOI: 10.1093/ije/dyab227] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 09/29/2021] [Indexed: 12/05/2022] Open
Abstract
Background As the prevalences of neglected tropical diseases reduce to low levels in some
countries, policymakers require precise disease estimates to decide whether the set
public health targets have been met. At low prevalence levels, traditional statistical
methods produce imprecise estimates. More modern geospatial statistical methods can
deliver the required level of precision for accurate decision-making. Methods Using spatially referenced data from 3567 cluster locations in Ethiopia in the years
2017, 2018 and 2019, we developed a geostatistical model to estimate the prevalence of
trachomatous trichiasis and to calculate the probability that the trachomatous
trichiasis component of the elimination of trachoma as a public health problem has
already been achieved for each of 482 evaluation units. We also compared the precision
of traditional and geostatistical approaches by the ratios of the lengths of their 95%
predictive intervals. Results The elimination threshold of trachomatous trichiasis (prevalence ≤ 0.2% in individuals
aged ≥15 years) is met with a probability of 0.9 or more in 8 out of the 482 evaluation
units assessed, and with a probability of ≤0.1 in 469 evaluation units. For the
remaining five evaluation units, the probability of elimination is between 0.45 and
0.65. Prevalence estimates were, on average, 10 times more precise than estimates
obtained using the traditional approach. Conclusions By accounting for and exploiting spatial correlation in the prevalence data, we
achieved remarkably improved precision of prevalence estimates compared with the
traditional approach. The geostatistical approach also delivers predictions for
unsampled evaluation units that are geographically close to sampled evaluation
units.
Collapse
Affiliation(s)
- Benjamin Amoah
- Centre for Health Informatics, Computing and Statistics, Lancaster Medical School, Lancaster University, Bailrigg, Lancaster, UK
| | - Claudio Fronterre
- Centre for Health Informatics, Computing and Statistics, Lancaster Medical School, Lancaster University, Bailrigg, Lancaster, UK
| | - Olatunji Johnson
- Centre for Health Informatics, Computing and Statistics, Lancaster Medical School, Lancaster University, Bailrigg, Lancaster, UK
| | - Michael Dejene
- Michael Dejene Public Health Consultancy Services, Addis Ababa, Ethiopia
| | - Fikre Seife
- Disease Prevention and Control Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia
| | | | - Ana Bakhtiari
- International Trachoma Initiative, Task Force for Global Health, Decatur, GA, USA
| | - Emma M Harding-Esch
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Emanuele Giorgi
- Centre for Health Informatics, Computing and Statistics, Lancaster Medical School, Lancaster University, Bailrigg, Lancaster, UK
| | - Anthony W Solomon
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Peter J Diggle
- Centre for Health Informatics, Computing and Statistics, Lancaster Medical School, Lancaster University, Bailrigg, Lancaster, UK
| |
Collapse
|
16
|
Flueckiger RM, Stelmach R, Burgert-Brucker CR, Courtright P, Kabona G, Mosher AW, Mwingira UJ, Harding JC, Simon A, Ngondi J. Evaluating Precision of a Trachomatous Trichiasis (TT) Super Survey with Modulating Sample Sizes in Tanzania. Ophthalmic Epidemiol 2021; 29:394-400. [PMID: 34380006 DOI: 10.1080/09286586.2021.1950775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
As trachoma programs move towards eliminating trachoma as a public health problem, the number of surveys necessary to evaluate the status of trachomatous trichiasis (TT) increases. Currently, the World Health Organization endorses a district-level population-based prevalence survey for trachoma that involves a two-stage cluster design. We explored the validity of implementing this survey design in larger geographic areas to gain cost efficiencies. We evaluated the change in precision due to combining geographically contiguous and homogenous districts into single evaluation units (EUs) and modulating the sample size by running simulations on existing datasets. Preliminary findings from two opportunities in Tanzania show variability in the appropriateness in conducting this survey across larger geographies. These preliminary findings stress the importance of determining what is meant by homogeneity in terms of TT before combining multiple districts into a single EU.
Collapse
Affiliation(s)
- Rebecca M Flueckiger
- Global Health Division, International Development Group, RTI International, Washington, USA
| | - Rachel Stelmach
- Global Health Division, International Development Group, RTI International, Washington, USA
| | | | - Paul Courtright
- Kilimanjaro Centre for Community Ophthalmology, Division of Ophthalmology, University of Cape Town, Cape Town, South Africa
| | - George Kabona
- Neglected Tropical Disease Control Program, Ministry of Health and Social Welfare, Dar Es Salaam, Tanzania
| | - Aryc W Mosher
- Bureau for Global Health, United States Agency for International Development, Washington, USA
| | - Upendo J Mwingira
- Neglected Tropical Disease Control Program, Ministry of Health and Social Welfare, Dar Es Salaam, Tanzania
| | | | - Alistidia Simon
- Neglected Tropical Disease Control Program, Ministry of Health and Social Welfare, Dar Es Salaam, Tanzania
| | - Jeremiah Ngondi
- Global Health Division, International Development Group, RTI International, Dar Es Salaam, Tanzania
| |
Collapse
|
17
|
Blumberg S, Prada JM, Tedijanto C, Deiner MS, Godwin WW, Emerson PM, Hooper PJ, Borlase A, Hollingsworth TD, Oldenburg CE, Porco TC, Arnold BF, Lietman TM. Forecasting Trachoma Control and Identifying Transmission-Hotspots. Clin Infect Dis 2021; 72:S134-S139. [PMID: 33905484 PMCID: PMC8201580 DOI: 10.1093/cid/ciab189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Tremendous progress towards elimination of trachoma as a public health problem has been made. However, there are areas where the clinical indicator of disease, trachomatous inflammation—follicular (TF), remains prevalent. We quantify the progress that has been made, and forecast how TF prevalence will evolve with current interventions. We also determine the probability that a district is a transmission-hotspot based on its TF prevalence (ie, reproduction number greater than one). Methods Data on trachoma prevalence come from the GET2020 global repository organized by the World Health Organization and the International Trachoma Initiative. Forecasts of TF prevalence and the percent of districts with local control is achieved by regressing the coefficients of a fitted exponential distribution for the year-by-year distribution of TF prevalence. The probability of a district being a transmission-hotspot is extrapolated from the residuals of the regression. Results Forecasts suggest that with current interventions, 96.5% of surveyed districts will have TF prevalence among children aged 1–9 years <5% by 2030 (95% CI: 86.6%–100.0%). Districts with TF prevalence < 20% appear unlikely to be transmission-hotspots. However, a district having TF prevalence of over 28% in 2016–2019 corresponds to at least 50% probability of being a transmission-hotspot. Conclusions Sustainable control of trachoma appears achievable. However there are transmission-hotspots that are not responding to annual mass drug administration of azithromycin and require enhanced treatment in order to reach local control.
Collapse
Affiliation(s)
- Seth Blumberg
- Francis I Proctor Foundation, University of California San Francisco, San Francisco, CA, USA.,Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Joaquin M Prada
- Faculty of Health and Medical Sciences, School of Veterinary Medicine, University of Surrey, Guildford, UK
| | - Christine Tedijanto
- Francis I Proctor Foundation, University of California San Francisco, San Francisco, CA, USA
| | - Michael S Deiner
- Francis I Proctor Foundation, University of California San Francisco, San Francisco, CA, USA
| | - William W Godwin
- Francis I Proctor Foundation, University of California San Francisco, San Francisco, CA, USA
| | - Paul M Emerson
- International Trachoma Initiative, The Task Force for Global Health, Decatur, Georgia, USA
| | - Pamela J Hooper
- International Trachoma Initiative, The Task Force for Global Health, Decatur, Georgia, USA
| | - Anna Borlase
- Nuffield Department of Medicine, Medical Sciences Division, University of Oxford, Oxford, UK
| | - T Deirdre Hollingsworth
- Nuffield Department of Medicine, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Catherine E Oldenburg
- Francis I Proctor Foundation, University of California San Francisco, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA.,Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - Travis C Porco
- Francis I Proctor Foundation, University of California San Francisco, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA.,Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - Benjamin F Arnold
- Francis I Proctor Foundation, University of California San Francisco, San Francisco, CA, USA.,Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - Thomas M Lietman
- Francis I Proctor Foundation, University of California San Francisco, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA.,Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA.,Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
| |
Collapse
|
18
|
Ouellette SP, Blay EA, Hatch ND, Fisher-Marvin LA. CRISPR Interference To Inducibly Repress Gene Expression in Chlamydia trachomatis. Infect Immun 2021; 89:e0010821. [PMID: 33875479 PMCID: PMC8373233 DOI: 10.1128/iai.00108-21] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 04/08/2021] [Indexed: 12/16/2022] Open
Abstract
The ability to inducibly repress gene expression is critical to the study of organisms, like Chlamydia, with reduced genomes in which the majority of genes are likely to be essential. We recently described the feasibility of a CRISPR interference (CRISPRi) system to inducibly repress gene expression in Chlamydia trachomatis. However, the initial system suffered from some drawbacks, primarily leaky expression of the anhydrotetracycline (aTc)-inducible dCas9 ortholog and plasmid instability, which prevented population-wide studies (e.g., transcript analyses) of the effects of knockdown. Here, we describe various modifications to the original system that have allowed us to measure gene expression changes within a transformed population of C. trachomatis serovar L2. These modifications include (i) a change in the vector backbone, (ii) the introduction of a weaker ribosome binding site driving dCas9 translation, and (iii) the addition of a degradation tag to dCas9 itself. With these changes, we demonstrate the ability to inducibly repress a target gene sequence, as measured by the absence of protein by immunofluorescence analysis and by decreased transcript levels. Importantly, the expression of dCas9 alone (i.e., without a guide RNA [gRNA]) had minimal impact on chlamydial growth or development. We also describe complementation of the knockdown effect by introducing a transcriptional fusion of the target gene 3' to dCas9. Finally, we demonstrate the functionality of a second CRISPRi system based on a dCas12 system that expands the number of potential chromosomal targets. These tools should provide the ability to study essential gene function in Chlamydia.
Collapse
Affiliation(s)
- Scot P. Ouellette
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Emmanuel A. Blay
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Nathan D. Hatch
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Laura A. Fisher-Marvin
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| |
Collapse
|
19
|
Brito CMGD, Medeiros ZMD, Barbosa CC, Montarroyos UR, Ferraz C, Vieira MDT, Lopes MDFC, Gouveia GC. Prevalence of trachoma in Pernambuco State, Brazil (2014-2015). Rev Inst Med Trop Sao Paulo 2021; 63:e29. [PMID: 33852712 PMCID: PMC8046508 DOI: 10.1590/s1678-9946202163029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 03/12/2021] [Indexed: 08/30/2023] Open
Abstract
To estimate the prevalence of cases of trachoma in the population at social risk
aged 1-9 years in Pernambuco State and its mesoregions. This was a
cross-sectional study in which secondary data from the National Household Survey
on Trachoma (2014-2015) were analyzed. The study covered 96 census tracts
distributed across the mesoregions of Pernambuco State (Metropolitan Region of
Recife, Zona da Mata, Agreste, Sertao do Sao Francisco and Sertao Pernambucano).
The study included all homes with children aged 1-9 years, and all of them were
examined for trachoma, using the WHO criteria. Among the total of 7,423 children
aged 1-9 years who participated in this survey, 446 presented with active
trachoma. Thus, the prevalence of trachoma in Pernambuco State, in children
between 1-9 years old was 6.65%, and it was higher among children aged 5-9 years
(7.12%) and among girls (7.23%). This result was seen in the majority of the
mesoregions studied, except in the Zona da Mata and Sertao do Sao Francisco,
where there were higher prevalences in the age group of 1-4 years (5.55%) and
among boys (5.90%). A tendency towards a higher prevalence between 1 and 6 years
of age was observed. The follicular trachoma continues to be an important public
health problem in Pernambuco State. It particularly affects poor people,
including those living in urban areas of the State.
Collapse
Affiliation(s)
- Cintia Michele Gondim de Brito
- Universidade de Pernambuco, Recife, Pernambuco, Brazil.,Secretaria de Saúde, I Região de Saúde, Departamento da Vigilância em Saúde, Recife, Pernambuco, Brazil
| | - Zulma Maria de Medeiros
- Universidade de Pernambuco, Recife, Pernambuco, Brazil.,Fundação Oswaldo Cruz, Instituto Aggeu Magalhães, Recife, Pernambuco, Brazil
| | - Celivane Cavalcanti Barbosa
- Secretaria de Saúde, I Região de Saúde, Departamento da Vigilância em Saúde, Recife, Pernambuco, Brazil.,Fundação Oswaldo Cruz, Instituto Aggeu Magalhães, Recife, Pernambuco, Brazil
| | | | | | | | | | | |
Collapse
|
20
|
Blumberg S, Borlase A, Prada JM, Solomon AW, Emerson P, Hooper PJ, Deiner MS, Amoah B, Hollingsworth TD, Porco TC, Lietman TM. Implications of the COVID-19 pandemic in eliminating trachoma as a public health problem. Trans R Soc Trop Med Hyg 2021; 115:222-228. [PMID: 33449114 PMCID: PMC7928550 DOI: 10.1093/trstmh/traa170] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/07/2020] [Accepted: 01/09/2021] [Indexed: 11/13/2022] Open
Abstract
Background Progress towards elimination of trachoma as a public health problem has been substantial, but the coronavirus disease 2019 (COVID-19) pandemic has disrupted community-based control efforts. Methods We use a susceptible-infected model to estimate the impact of delayed distribution of azithromycin treatment on the prevalence of active trachoma. Results We identify three distinct scenarios for geographic districts depending on whether the basic reproduction number and the treatment-associated reproduction number are above or below a value of 1. We find that when the basic reproduction number is <1, no significant delays in disease control will be caused. However, when the basic reproduction number is >1, significant delays can occur. In most districts, 1 y of COVID-related delay can be mitigated by a single extra round of mass drug administration. However, supercritical districts require a new paradigm of infection control because the current strategies will not eliminate disease. Conclusions If the pandemic can motivate judicious, community-specific implementation of control strategies, global elimination of trachoma as a public health problem could be accelerated.
Collapse
Affiliation(s)
- Seth Blumberg
- Francis I Proctor Foundation, University of California, San Francisco, San Francisco, CA, USA
| | | | - Joaquin M Prada
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Anthony W Solomon
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Paul Emerson
- International Trachoma Initiative, Task Force for Global Health, Decatur, GA, USA
| | - Pamela J Hooper
- International Trachoma Initiative, Task Force for Global Health, Decatur, GA, USA
| | - Michael S Deiner
- Francis I Proctor Foundation, University of California, San Francisco, San Francisco, CA, USA
| | - Benjamin Amoah
- Lancaster Medical School, Lancaster University, Bailrigg, Lancaster, UK
| | | | - Travis C Porco
- Francis I Proctor Foundation, University of California, San Francisco, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Thomas M Lietman
- Francis I Proctor Foundation, University of California, San Francisco, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA.,Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA.,Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
| |
Collapse
|
21
|
Insights from mathematical modelling and quantitative analysis on the proposed 2030 goals for trachoma. Gates Open Res 2021; 3:1721. [PMID: 34027309 PMCID: PMC8111938 DOI: 10.12688/gatesopenres.13086.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2021] [Indexed: 01/21/2023] Open
Abstract
Trachoma is a neglected tropical disease and the leading infectious cause of blindness worldwide. The current World Health Organization goal for trachoma is elimination as a public health problem, defined as reaching a prevalence of trachomatous inflammation-follicular below 5% in children (1-9 years) and a prevalence of trachomatous trichiasis in adults below 0.2%. Current targets to achieve elimination were set to 2020 but are being extended to 2030. Mathematical and statistical models suggest that 2030 is a realistic timeline for elimination as a public health problem in most trachoma endemic areas. Although the goal can be achieved, it is important to develop appropriate monitoring tools for surveillance after having achieved the elimination target to check for the possibility of resurgence. For this purpose, a standardized serological approach or the use of multiple diagnostics in complement would likely be required.
Collapse
|
22
|
Insights from mathematical modelling and quantitative analysis on the proposed 2030 goals for trachoma. Gates Open Res 2021; 3:1721. [PMID: 34027309 DOI: 10.12688/gatesopenres.13086.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2019] [Indexed: 11/20/2022] Open
Abstract
Trachoma is a neglected tropical disease and the leading infectious cause of blindness worldwide. The current World Health Organization goal for trachoma is elimination as a public health problem, defined as reaching a prevalence of trachomatous inflammation-follicular below 5% in children (1-9 years) and a prevalence of trachomatous trichiasis in adults below 0.2%. Current targets to achieve elimination were set to 2020 but are being extended to 2030. Mathematical and statistical models suggest that 2030 is a realistic timeline for elimination as a public health problem in most trachoma endemic areas. Although the goal can be achieved, it is important to develop appropriate monitoring tools for surveillance after having achieved the elimination target to check for the possibility of resurgence. For this purpose, a standardized serological approach or the use of multiple diagnostics in complement would likely be required.
Collapse
|
23
|
Designing multi-epitope subunit vaccine for ocular trachoma infection using Chlamydia trachomatis polymorphic membrane proteins G. INFORMATICS IN MEDICINE UNLOCKED 2021. [DOI: 10.1016/j.imu.2021.100764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
|
24
|
Li DK, Feng HH, Mu YT, Yu JQ, Yang F. Extraction and bioinformatics analysis of Chlamydia trachomatis LpxA. Int Ophthalmol 2020; 41:667-673. [PMID: 33078228 DOI: 10.1007/s10792-020-01623-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 10/07/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The aim of this study is to clone the LpxA gene of Chlamydia trachomatis and analyze its biological characteristics. METHODS Specific primers were designed according to the sequence of Ct LpxA gene. LpxA gene was amplified by PCR and connected to pMD18-T vectors. Positive clones were selected for PCR and DNA sequencing. Finally, bioinformatics software was used to analyze the biological properties of LpxA protein. RESULTS The total length of LpxA gene was 840 bp, encoding 280 amino acids. LpxA protein has no signal peptide and was located in bacterial cytoplasm. The prediction of secondary structure showed that the α-helix, extended strand, β-turn and random coil accounted for 19.6%, 32.8%, 11.4% and 36%, respectively. According to the prediction of tertiary structure, three identical LpxA molecules constituted homologous trimers. It was predicted that there were 11 B cell epitopes in LpxA. CONCLUSION Ct Lpxa gene was cloned, and LpxA protein structure and function were predicted.
Collapse
Affiliation(s)
- De-Kun Li
- Department of Ophthalmology, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Huan-Huan Feng
- Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei, China
| | - Ying-Tao Mu
- Department of TCM, Renmin Hospital, Hubei University of Medicine, No. 39 Middle Chaoyang Road, Shiyan, 442000, Hubei, China.
| | - Jin-Qiang Yu
- Department of Ophthalmology, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Fang Yang
- Department of Ophthalmology, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| |
Collapse
|
25
|
Li DK, Mu YT, Feng HH. The expression and purification of LpxA of Chlamydia trachomatis and preparation of its polyclonal antibody. Z NATURFORSCH C 2020; 75:313-317. [PMID: 32374296 DOI: 10.1515/znc-2020-0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 04/09/2020] [Indexed: 11/15/2022]
Abstract
The purpose of this study is to purify the LpxA protein of Chlamydia trachomatis (Ct) and prepare the polyclonal antibody against LpxA protein, so as to lay a foundation for studying the function of LpxA protein. The LpxA gene was amplified by PCR. The expression plasmid pET28a-LpxA was constructed by using pET28a as the vector. The fusion protein containing 6 histidine tag was induced by IPTG and purified by Ni2+ chromatography gel. The purified His-LpxA protein was used as an immunogen to immunize New Zealand rabbits subcutaneously through the back to prepare polyclonal antibody. Immunoblotting was used to detect the reaction between the antibody and His-LpxA. The determination of polyclonal antibody titer was detected by ELISA. The relative molecular weight of His-LpxA was 32.8 kDa, and it could be expressed in Escherichia coli. The purity of the purified protein was about 95%. After immunizing New Zealand rabbits, the antiserum was able to recognize the recombinant His-LpxA protein with a titer greater than 1:10240. In this study, LpxA protein was successfully purified and antiserum was prepared, which provided an experimental basis for studying the function of LpxA protein.
Collapse
Affiliation(s)
- De-Kun Li
- Department of Ophthalmology, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Ying-Tao Mu
- Department of TCM, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, PR China
| | - Huan-Huan Feng
- Xiangyang No.1 People's Hospital, Hubei University of Medicine, No. 15 Jiefang Road, Xiangyang, Hubei, 441000, PR China
| |
Collapse
|
26
|
Kassaw MW, Abebe AM, Tegegne KD, Getu MA, Bihonegn WT. Prevalence and associations of active trachoma among rural preschool children in Wadla district, northern Ethiopia. BMC Ophthalmol 2020; 20:346. [PMID: 32842993 PMCID: PMC7449018 DOI: 10.1186/s12886-020-01585-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 07/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Trachoma is a neglected eye disease and an important cause of preventable corneal blindness. In endemic areas, initial infection can occur in early childhood and following a recurrent episodes, it progresses to scarring and visual impairment. Trachoma disappeared from high income countries through enhancements of hygiene and sanitation but the disease is still a challenge in developing countries. In Ethiopia, data indicate that Amhara is the region with the highest prevalence of active trachoma. The aim of this study was to assess the prevalence and associations of active trachoma among rural preschool children in Wadla district, Amhara region, Ethiopia. METHODS In this study, 596 children were screened for signs of active trachoma by using cluster-sampling technique. Following pre-testing of the survey instrument in a different district, questions about socio-demographic status were delivered for heads of households. Integrated eye care workers, previously trained to undertake trachoma screening for one month, performed eye examination. The logistic regression model was used to look for associations of active trachoma. RESULTS The prevalence of active trachoma among rural preschool children in Wadla district was 22%. Low economic status (adjusted odds ratio [AOR]3.8 (95%CI 1.3-11.4), being 37-48 months old (4.2;1.5-12.0), living in a house with thatched roof (4.4;1.4-13.6), presence of flies in a home (4.6;2.1-9.9), once-weekly face-washing frequency (8.6;2.5-29.3), having a face that had not been washed for longer than a week (10.6;2.9-37.7), and not using soap (4.5;1.8-11.3) had association to active trachoma. CONCLUSION The prevalence of active trachoma among rural pre-school children in Wadla district was high. This indicates that Trachoma is still a public health problem in the district. This high prevalence calls for further interventions to prevent future trachomatis blindness.
Collapse
Affiliation(s)
| | - Ayele Mamo Abebe
- Department of nursing, Debre Berhan University, Debre Berhan, Ethiopia
| | | | | | | |
Collapse
|
27
|
Lietman TM, Ayele B, Gebre T, Zerihun M, Tadesse Z, Emerson PM, Nash SD, Porco TC, Keenan JD, Oldenburg CE. Frequency of Mass Azithromycin Distribution for Ocular Chlamydia in a Trachoma Endemic Region of Ethiopia: A Cluster Randomized Trial. Am J Ophthalmol 2020; 214:143-150. [PMID: 32171768 PMCID: PMC9982657 DOI: 10.1016/j.ajo.2020.02.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Annual mass azithromycin distribution significantly reduces the prevalence of ocular Chlamydia trachomatis, the causative organism of trachoma. However, in some areas a decade or more of treatment has not controlled infection. Here, we compared multiple treatment arms from a community-randomized trial to evaluate whether increasing frequency of azithromycin distribution decreases prevalence in the short term. METHODS Seventy-two communities in Goncha Siso Enesie woreda in the Amhara region of Northern Ethiopia were randomized to 1 of 6 azithromycin distribution strategies: (1) delayed, (2) annual, (3) biannual, (4) quarterly to children only, (5) biennial, or (6) biennial plus latrine promotion. We analyzed data from the 60 communities in the delayed, annual, biannual, quarterly, and biennial distribution arms at the 12-month study visit. Communities in the annual and biennial distribution arm were combined, as they each had a single distribution before any 12-month retreatment. We assessed the effect of increased frequency of azithromycin distribution on ocular chlamydia prevalence. RESULTS Ocular chlamydia prevalence was significantly different across azithromycin distribution frequency in children (P < .0001) and adults (P < .0001), with lower prevalence associated with higher frequency. Among children, quarterly azithromycin distribution led to a significantly greater reduction in ocular chlamydia prevalence than the World Health Organization-recommended annual treatment prevalence (mean difference -11.4%, 95% confidence interval -19.5 to -3.3%, P = .007). CONCLUSIONS Increased frequency of azithromycin distribution leads to decreased ocular chlamydia prevalence over a short-term period. In some regions with high levels of ocular chlamydia prevalence, additional azithromycin distributions may help achieve local elimination of infection.
Collapse
Affiliation(s)
- Thomas M. Lietman
- Francis I Proctor Foundation, University of California, San Francisco,Department of Ophthalmology, University of California, San Francisco,Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Berhan Ayele
- The Carter Center Ethiopia, Addis Ababa, Ethiopia
| | - Teshome Gebre
- International Trachoma Initiative, Addis Ababa, Ethiopia
| | | | | | | | | | - Travis C. Porco
- Francis I Proctor Foundation, University of California, San Francisco,Department of Ophthalmology, University of California, San Francisco,Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Jeremy D. Keenan
- Francis I Proctor Foundation, University of California, San Francisco,Department of Ophthalmology, University of California, San Francisco,Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Catherine E. Oldenburg
- Francis I Proctor Foundation, University of California, San Francisco,Department of Ophthalmology, University of California, San Francisco,Department of Epidemiology and Biostatistics, University of California, San Francisco
| |
Collapse
|
28
|
Ndisabiye D, Gahungu A, Kayugi D, Waters EK. Association of environmental risk factors and trachoma in Gashoho Health District, Burundi. Afr Health Sci 2020; 20:182-189. [PMID: 33402906 PMCID: PMC7750037 DOI: 10.4314/ahs.v20i1.23] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Burundi is currently not meeting targets for elimination of trachoma and trichiasis by 2020 (GET2020). The recommended SAFE strategy (Surgery, antibiotics, face washing and environmental improvement) is currently not fully implemented in many areas of Burundi. The existence of associations between face-washing, sanitation and trachoma prevalence remain undocumented. Methods A convenience sample of 468 individuals from 117 households was drawn from attendees at trachoma clinics set up in four villages. Trachoma status, sex and age were recorded for all household members. Adult household members were surveyed about access to clean water and toilets, and knowledge of trachoma risk factors. Associations between cases of active trachoma per household and environmental risk factors were evaluated using generalised estimating equations. Results The overall prevalence of active trachoma was 7.1% (95% CI 5.0–9.6%), but 19.5% (95% CI13.7–26.4%) in children under nine years old. 0.9% (95% CI 0.3–2.0) of participants had trichiasis. Access to a sanitary toilet more than halved the odds of active trachoma (OR 0.43, 95% CI 0.25–0.74%), however, participants did not appreciate this association. Conclusion Access to sanitation was associated with the occurrence of active trachoma. Future research should focus on whether improving knowledge of and access to sanitation might reduce trachoma prevalence.
Collapse
Affiliation(s)
- Desire Ndisabiye
- School of Medicine, University of Notre Dame Australia, 160 Oxford St Darlinghurst NSW 2010 Australia
| | - Athanase Gahungu
- National Integrated Program for Neglected Tropical Diseases, Ministry of Health, Rue Pierre Ngendandumwe, Bujumbura, Burundi
| | - Donatien Kayugi
- National Integrated Program for Neglected Tropical Diseases, Ministry of Health, Rue Pierre Ngendandumwe, Bujumbura, Burundi
| | - Edward K Waters
- School of Medicine, University of Notre Dame Australia, 160 Oxford St Darlinghurst NSW 2010 Australia
| |
Collapse
|
29
|
Mustafa O, Daoud YJ. Herbert Pits in Trachoma Infection. Mayo Clin Proc 2020; 95:134-135. [PMID: 31902408 DOI: 10.1016/j.mayocp.2019.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 10/25/2019] [Indexed: 11/24/2022]
Affiliation(s)
- Osama Mustafa
- Cornea, Cataract, and Refractive Surgery Division, The Wilmer Eye Institute, The Johns Hopkins University Institutions, Baltimore, MD
| | - Yassine J Daoud
- Cornea, Cataract, and Refractive Surgery Division, The Wilmer Eye Institute, The Johns Hopkins University Institutions, Baltimore, MD.
| |
Collapse
|
30
|
Flueckiger RM, Courtright P, Abdala M, Abdou A, Abdulnafea Z, Al-Khatib TK, Amer K, Amiel ON, Awoussi S, Bakhtiari A, Batcho W, Bella AL, Bennawi KH, Brooker SJ, Chu BK, Dejene M, Dezoumbe D, Elshafie BE, Elvis AA, Fabrice DN, Omar FJ, François M, François D, Garap J, Gichangi M, Goepogui A, Hammou J, Kadri B, Kabona G, Kabore M, Kalua K, Kamugisha M, Kebede B, Keita K, Khan AA, Kiflu G, Yibi M, Mackline G, Macleod C, Manangazira P, Masika MP, Massangaie M, Mduluza T, Meno N, Midzi N, Minnih AO, Mishra S, Mpyet C, Muraguri N, Mwingira U, Nassirou B, Ndjemba J, Nieba C, Ngondi J, Olobio N, Pavluck A, Phiri I, Pullan R, Qureshi B, Sarr B, Seiha D, Chávez GMS, Sharma S, Sisaleumsak S, Southisombath K, Stevens G, Woldendrias AT, Traoré L, Turyaguma P, Willis R, Yaya G, Yeo S, Zambroni F, Zhao J, Solomon AW. The global burden of trichiasis in 2016. PLoS Negl Trop Dis 2019; 13:e0007835. [PMID: 31765415 PMCID: PMC6901231 DOI: 10.1371/journal.pntd.0007835] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 12/09/2019] [Accepted: 10/08/2019] [Indexed: 11/19/2022] Open
Abstract
Background Trichiasis is present when one or more eyelashes touches the eye. Uncorrected, it can cause blindness. Accurate estimates of numbers affected, and their geographical distribution, help guide resource allocation. Methods We obtained district-level trichiasis prevalence estimates in adults for 44 endemic and previously-endemic countries. We used (1) the most recent data for a district, if more than one estimate was available; (2) age- and sex-standardized corrections of historic estimates, where raw data were available; (3) historic estimates adjusted using a mean adjustment factor for districts where raw data were unavailable; and (4) expert assessment of available data for districts for which no prevalence estimates were available. Findings Internally age- and sex-standardized data represented 1,355 districts and contributed 662 thousand cases (95% confidence interval [CI] 324 thousand–1.1 million) to the global total. Age- and sex-standardized district-level prevalence estimates differed from raw estimates by a mean factor of 0.45 (range 0.03–2.28). Previously non- stratified estimates for 398 districts, adjusted by ×0.45, contributed a further 411 thousand cases (95% CI 283–557 thousand). Eight countries retained previous estimates, contributing 848 thousand cases (95% CI 225 thousand-1.7 million). New expert assessments in 14 countries contributed 862 thousand cases (95% CI 228 thousand–1.7 million). The global trichiasis burden in 2016 was 2.8 million cases (95% CI 1.1–5.2 million). Interpretation The 2016 estimate is lower than previous estimates, probably due to more and better data; scale-up of trichiasis management services; and reductions in incidence due to lower active trachoma prevalence. As an individual with trichiasis blinks, the eyelashes abrade the cornea, which can lead to corneal opacity and blindness. Through high quality surgery, which involves altering the position of the eyelid margin, it is possible to reduce the number of people with trichiasis. Accurate estimates of the number of persons with trichiasis and their geographical distribution are needed in order to effectively align resources for surgery and other necessary services. We obtained district-level trichiasis prevalence estimates for 44 endemic and previously-endemic countries. We used the most recently available data and expert assessments to estimate the global burden of trichiasis. We estimated that in 2016 the global burden was 2.8 million cases (95% CI 1.1–5.2 million). The 2016 estimate is lower than previous estimates, probably due to more and better data; scale-up of trichiasis management services; and reductions in incidence due to lower active trachoma prevalence.
Collapse
Affiliation(s)
- Rebecca M. Flueckiger
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Paul Courtright
- Kilimanjaro Centre for Community Ophthalmology, Division of Ophthalmology, University of Cape Town, Cape Town, South Africa
| | - Mariamo Abdala
- Ministerio da Saude, National Ophthalmology Program, Maputo, Mozambique
| | - Amza Abdou
- Ministère de la Santé et de la population, Niamey, Niger
| | | | - Tawfik K. Al-Khatib
- National Eye Health Programme, Ministry of Public Health and Population, Sana’a, Yemen
| | | | | | | | | | | | | | | | - Simon J. Brooker
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Global Health, Neglected Tropical Diseases, Bill & Melinda Gates Foundation, Seattle, USA
| | - Brian K. Chu
- The Task Force for Global Health, Atlanta, GA, USA
| | - Michael Dejene
- Michael Dejene Public Health Consultancy Services, Addis Ababa, Ethiopia
| | | | | | - Aba Ange Elvis
- Programme National de la Santé Oculaire et de la lutte contre l'Onchocercose, Abidjan, Côte d'Ivoire
| | | | | | - Missamou François
- Bureau des Maladies Oculaires, Ministère de la Santé, Kinshasa, Democratic Republic of the Congo
| | - Drabo François
- Programme national de lutte contre les maladies tropicales négligées (PNMTN), Ouagadougou, Burkina Faso
| | - Jambi Garap
- National Department of Health, Port Moresby, Papua New Guinea
| | | | - André Goepogui
- Programme National de Lutte Contre l’Onchocercose et la Cécité et les Maladies Tropicales Négligées, Conakry, Guinea
| | | | - Boubacar Kadri
- Ministère de la Santé et de la population, Niamey, Niger
| | - George Kabona
- Ministry of Health, Dar es Salaam, United Republic of Tanzania
| | - Martin Kabore
- l'unité d'élimination du trachome, PNMTN, Ouagadougou, Burkina Faso
| | - Khumbo Kalua
- Department of Ophthalmology, University of Malawi, College of Medicine, Blantyre, Malawi
| | - Mathias Kamugisha
- National Institute for Medical Research, Dar es Salaam, United Republic of Tanzania
| | | | - Kaba Keita
- Programme National de Lutte Contre l’Onchocercose et la Cécité et les Maladies Tropicales Négligées, Conakry, Guinea
| | | | - Genet Kiflu
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | | | | | - Colin Macleod
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Portia Manangazira
- Department of Epidemiology and Disease Control, Ministry of Health & Child Welfare, Harare, Zimbabwe
| | | | - Marilia Massangaie
- Ministerio da Saude, Department of Neglected Tropical Diseases, Maputo, Mozambique
| | - Takafira Mduluza
- Department of Biochemistry, University of Zimbabwe, Harare, Zimbabwe
| | | | - Nicholas Midzi
- Department of Medical Microbiology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | | | | | - Caleb Mpyet
- Sightsavers Nigeria, Kaduna, Nigeria & Department of Ophthalmology, Jos University, Jos, Nigeria
| | | | - Upendo Mwingira
- Ministry of Health, Dar es Salaam, United Republic of Tanzania
| | - Beido Nassirou
- Ministère de la Santé et de la population, Niamey, Niger
| | - Jean Ndjemba
- Bureau des Maladies Oculaires, Ministère de la Santé, Kinshasa, Democratic Republic of the Congo
| | - Cece Nieba
- Programme National de Lutte Contre l’Onchocercose et la Cécité et les Maladies Tropicales Négligées, Conakry, Guinea
| | - Jeremiah Ngondi
- RTI International, Dar es Salaam, United Republic of Tanzania
| | | | | | - Isaac Phiri
- Department of Epidemiology and Disease Control, Ministry of Health & Child Welfare, Harare, Zimbabwe
| | - Rachel Pullan
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Boubacar Sarr
- Ministère de la santé et de l’Action Sociale, Dakar, Senegal
| | - Do Seiha
- Prevention of Blindness Programme, Ministry of Health, Phnom Penh, Cambodia
| | | | | | | | - Khamphoua Southisombath
- National Program for the Prevention of Blindness, Ministry of Health, Vientiane, Lao People’s Democratic Republic
| | - Gretchen Stevens
- Department of Information, Evidence and Research, World Health Organization, Geneva, Switzerland
| | | | | | | | | | - Georges Yaya
- Ministère de la Santé Publique, Bangui, Central African Republic
| | - Souleymane Yeo
- Programme National de la Santé Oculaire et de la lutte contre l'Onchocercose, Abidjan, Côte d'Ivoire
| | | | - Jialiang Zhao
- Department of Ophthalmology, Peking Union Medical Colllege Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Anthony W. Solomon
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| |
Collapse
|
31
|
Macleod CK, Binnawi KH, Elshafie BE, Sadig HE, Hassan A, Cocks N, Willis R, Chu B, Solomon AW. Unimproved water sources and open defecation are associated with active trachoma in children in internally displaced persons camps in the Darfur States of Sudan. Trans R Soc Trop Med Hyg 2019; 113:599-609. [PMID: 31612959 PMCID: PMC6792159 DOI: 10.1093/trstmh/trz042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 04/01/2019] [Accepted: 05/30/2019] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To estimate the proportion of children with trachomatous inflammation-follicular (TF) and adults with trachomatous trichiasis (TT) in internally displaced persons (IDP) camps in the Darfur States of Sudan and to evaluate associated risk factors. METHODS IDP camps were identified from government census data. We conducted a subanalysis of data collected in these camps during 2014-2015 as part of surveys covering 37 districts of the Darfur States within the Global Trachoma Mapping Project. A random-effects hierarchical model was used to evaluate factors associated with TF in children or TT in adults. RESULTS Thirty-six IDP camps were represented in the survey data, in which 1926 children aged 1-9 y were examined, of whom 38 (8%) had TF. Poor sanitation, younger age and living in a household that purchased water from a vendor were associated with TF in children aged 1-9 y. Of 2139 individuals examined aged ≥15 y, 16 (0.7%) had TT. TT was strongly independently associated with being older and living alone. CONCLUSION Trachoma is found at low levels in these camps, but still at levels where intervention is needed. Disease elimination in conflict-related settings presents a unique challenge for the trachoma community, and may require an innovative approach. Understanding how best to undertake trachoma elimination interventions in these areas should be prioritized.
Collapse
Affiliation(s)
- Colin K Macleod
- Clinical Research Department, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
| | - Kamal Hashim Binnawi
- National Program for Prevention of Blindness, Federal Ministry of Health, PO Box 303 Khartoum, Sudan
- Department of Ophthalmology, Al Neelain University, Khartoum, Sudan
| | - Balgesa Elkheir Elshafie
- National Program for Prevention of Blindness, Federal Ministry of Health, PO Box 303 Khartoum, Sudan
| | - Husam Eldin Sadig
- Faculty of Mathematical Sciences and Statistics, Al-Neelain University, Sudan
| | | | - Naomi Cocks
- Clinical Research Department, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
| | - Rebecca Willis
- Task Force for Global Health, 330 W Ponce de Leon Ave, Decatur, GA, USA
| | - Brian Chu
- Task Force for Global Health, 330 W Ponce de Leon Ave, Decatur, GA, USA
| | - Anthony W Solomon
- Clinical Research Department, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | | |
Collapse
|
32
|
Amza A, Kadri B, Nassirou B, Cotter SY, Stoller NE, West SK, Bailey RL, Porco TC, Keenan JD, Lietman TM, Oldenburg CE. Community-level Association between Clinical Trachoma and Ocular Chlamydia Infection after MASS Azithromycin Distribution in a Mesoendemic Region of Niger. Ophthalmic Epidemiol 2019; 26:231-237. [PMID: 30957594 PMCID: PMC9982651 DOI: 10.1080/09286586.2019.1597129] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Purpose: The clinical sign trachomatous inflammation - follicular (TF) is used to monitor indication for and response to mass azithromycin distribution in trachoma-endemic communities. Here, we assess the relationship between TF, trachomatous inflammation - intense (TI), and infection with ocular Chlamydia trachomatis over time during annual mass azithromycin distribution. Methods: We used data from a cluster-randomized trial of mass azithromycin distribution for trachoma control in a mesoendemic region of Niger. This study includes 24 communities that received 3 years of annual mass azithromycin distribution. TF, TI, and ocular chlamydia infection were monitored among children aged 0-5 years. We assessed the correlation between the prevalence of ocular chlamydia infection and 1) TF and 2) TI prevalence over time. Results: At baseline, ocular chlamydia prevalence was 21.2% (95% CI 14.3-28.1%), TF prevalence was 27.7% (95% CI 21.2-34.2%), and TI prevalence was 8.3% (95% CI 5.2-11.5%). The prevalence of all three measures decreased significantly over time (P < 0.001). At baseline, ocular chlamydia infection prevalence was strongly correlated with both TF (rho = 0.78, P < 0.0001) and TI (rho = 0.76, P < 0.0001). The correlation between ocular chlamydia infection and both TF and TI was weak at months 12 and 24. At 36 months, when TF prevalence had dropped below 10%, ocular chlamydia infection and TF were moderately correlated (rho = 0.70, P= 0.0002). Conclusions: Both TF and TI are good indicators of infection prevalence prior to mass azithromycin distribution. However, this relationship may be affected by repeated rounds of mass azithromycin distribution.
Collapse
Affiliation(s)
- Abdou Amza
- Programme FSS/Université Abdou Moumouni de Niamey, Programme Nationale des Soins Oculaire, Niamey, Niger
| | - Boubacar Kadri
- Programme FSS/Université Abdou Moumouni de Niamey, Programme Nationale des Soins Oculaire, Niamey, Niger
| | - Beido Nassirou
- Programme FSS/Université Abdou Moumouni de Niamey, Programme Nationale des Soins Oculaire, Niamey, Niger
| | - Sun Y Cotter
- Francis I. Proctor Foundation, University of California, San Francisco, USA
| | - Nicole E. Stoller
- Francis I. Proctor Foundation, University of California, San Francisco, USA
| | - Sheila K West
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA
| | - Robin L. Bailey
- Clinical Research Unit, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Travis C. Porco
- Francis I. Proctor Foundation, University of California, San Francisco, USA,Department of Ophthalmology, University of California, San Francisco, USA,Department of Epidemiology & Biostatistics, University of California, San Francisco, USA
| | - Jeremy D. Keenan
- Francis I. Proctor Foundation, University of California, San Francisco, USA,Department of Ophthalmology, University of California, San Francisco, USA,Department of Epidemiology & Biostatistics, University of California, San Francisco, USA
| | - Thomas M. Lietman
- Francis I. Proctor Foundation, University of California, San Francisco, USA,Department of Ophthalmology, University of California, San Francisco, USA,Department of Epidemiology & Biostatistics, University of California, San Francisco, USA
| | - Catherine E. Oldenburg
- Francis I. Proctor Foundation, University of California, San Francisco, USA,Department of Ophthalmology, University of California, San Francisco, USA
| |
Collapse
|
33
|
Hiep NX, Ngondi JM, Anh VT, Dat TM, An TV, Dung NC, Thang ND, Chu BK, Willis R, Bakhtiari A, Pavluck AL, Johnson J, Sidwell J, Brady M, Henry R, Mosher A, Porco TC, Lietman TM, Rotondo LA, Lewallen S, Courtright P, Solomon AW. Trachoma in Viet Nam: results of 11 surveillance surveys conducted with the Global Trachoma Mapping Project. Ophthalmic Epidemiol 2019; 25:93-102. [PMID: 30806534 PMCID: PMC6444206 DOI: 10.1080/09286586.2018.1477964] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Purpose: Following interventions against trachoma in Viet Nam, impact surveys conducted in 2003–2011 suggested that trachoma was no longer a public health problem. In 2014, we undertook surveillance surveys to estimate prevalence of trachomatous inflammation—follicular (TF) and trichiasis. Methods: A population-based prevalence survey was undertaken in 11 evaluation units (EUs) encompassing 24 districts, using Global Trachoma Mapping Project methods. A two-stage cluster sampling design was used in each EU, whereby 20 clusters and 60 children per cluster were sampled. Consenting eligible participants (children aged 1–9 years and adults aged ≥50 years) were examined for trachoma. Results: A total of 9391 households were surveyed, and 20,185 participants (98.8% of those enumerated) were examined for trachoma. EU-level TF prevalence in 1–9-year-olds ranged from 0% to 1.6%. In one cluster (in Hà Giang Province), the percentage of children with TF was 10.3%. The overall pattern of cluster-level percentages of children with TF, however, was consistent with an exponential distribution, which would be consistent with trachoma disappearing. Among people aged ≥50 years, prevalence of trichiasis by EU ranged from 0% to 0.75%; these estimates are equivalent to 0–0.13% in all ages. The prevalence of trichiasis unknown to the health system among people aged ≥50 years, by EU, ranged from 0% to 0.17%, which is equivalent to 0–0.03% in all ages. Conclusion: Findings suggest that trachoma is no longer a public health problem in any of the 11 EUs surveyed. However, given the high proportion of children with TF in one cluster in Hà Giang Province, further investigations will be undertaken.
Collapse
Affiliation(s)
- Nguyen Xuan Hiep
- a Viet Nam Institute of Ophthalmology, Ministry of Health , Hanoi , Viet Nam
| | | | - Vu Tuan Anh
- a Viet Nam Institute of Ophthalmology, Ministry of Health , Hanoi , Viet Nam
| | - Tran Minh Dat
- a Viet Nam Institute of Ophthalmology, Ministry of Health , Hanoi , Viet Nam
| | - Tran Van An
- a Viet Nam Institute of Ophthalmology, Ministry of Health , Hanoi , Viet Nam
| | - Nguyen Chi Dung
- a Viet Nam Institute of Ophthalmology, Ministry of Health , Hanoi , Viet Nam
| | - Nguyen Duy Thang
- a Viet Nam Institute of Ophthalmology, Ministry of Health , Hanoi , Viet Nam
| | - Brian K Chu
- c Task Force for Global Health , Decatur , GA , USA
| | | | | | | | | | | | | | - Rob Henry
- f United States Agency for International Development , Washington , DC , USA
| | - Aryc Mosher
- f United States Agency for International Development , Washington , DC , USA
| | - Travis C Porco
- g F.I. Proctor Foundation , San Francisco , CA , USA.,h Department of Ophthalmology , San Francisco , CA , USA.,i Department of Epidemiology & Biostatistics , University of California , San Francisco , CA , USA
| | - Thomas M Lietman
- g F.I. Proctor Foundation , San Francisco , CA , USA.,h Department of Ophthalmology , San Francisco , CA , USA.,i Department of Epidemiology & Biostatistics , University of California , San Francisco , CA , USA
| | | | - Susan Lewallen
- j Kilimanjaro Center for Community Ophthalmology, Division of Ophthalmology , University of Cape Town , Cape Town , South Africa
| | - Paul Courtright
- j Kilimanjaro Center for Community Ophthalmology, Division of Ophthalmology , University of Cape Town , Cape Town , South Africa
| | - Anthony W Solomon
- k Clinical Research Department , London School of Hygiene & Tropical Medicine , London , UK.,l London Centre for Neglected Tropical Disease Research , London , UK
| | | |
Collapse
|
34
|
Mwale C, Mumbi W, Funjika M, Sokesi T, Silumesii A, Mulenga M, Mutati G, Kwendakwema D, Chelu C, Adamu Y, Alemayehu W, Al-Khatib T, Bakhtiari A, Dejene M, Massae PA, Mpyet C, Nwosu C, Willis R, Courtright P, Solomon AW. Prevalence of Trachoma in 47 Administrative Districts of Zambia: Results of 32 Population-Based Prevalence Surveys. Ophthalmic Epidemiol 2019; 25:171-180. [PMID: 30806543 PMCID: PMC6444202 DOI: 10.1080/09286586.2018.1546880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Purpose: A number of previous administrative-district-level baseline trachoma prevalence estimates in Zambia required verification. We used methodologies and systems for trachoma surveys considered to represent international best practice in order to generate reliable estimates of the prevalence of trachoma. Methods: Between March 2016 and July 2017, we undertook 32 population-based prevalence surveys covering 47 administrative districts. In each of the 32 evaluation units (EUs), we selected 31 households in each of 24 clusters. In selected households, trained, certified graders examined all residents aged 1 year and above for evidence of trachomatous inflammation—follicular (TF) and trichiasis. In eyes that had trichiasis, the presence or absence of trachomatous scarring (TS) was recorded, and the subject was asked about previous trichiasis management recommendations from health workers. Results: Five EUs (encompassing seven administrative districts) had prevalence estimates of trichiasis+TS unknown to the health system in ≥15-year-olds of ≥0.2%, and require public-health-level implementation of trichiasis surgery services. Eleven EUs (encompassing 16 administrative districts) had TF prevalence estimates in 1–9-year-olds of ≥5%. Intervention with the A, F and E components of the SAFE strategy for trachoma elimination is required for nearly 1.5 million people. Conclusion: Trachoma is a public health problem in some parts of Zambia. The Ministry of Health will continue to partner with other stakeholders to implement the multi-sectoral SAFE strategy. Consideration should be given to re-surveying other suspected-endemic administrative districts in which surveys using older methodologies returned TF prevalence estimates ≥5%.
Collapse
Affiliation(s)
- Consity Mwale
- a Lusaka Provincial Health Office , Lusaka , Zambia.,b University Teaching Eye Hospital , Lusaka , Zambia
| | - Willard Mumbi
- c Ophthalmology Unit , Kabwe General Hospital , Kabwe , Zambia
| | - Misa Funjika
- d Ophthalmology Unit , Ndola Teaching Hospital , Ndola , Zambia
| | - Teddy Sokesi
- d Ophthalmology Unit , Ndola Teaching Hospital , Ndola , Zambia
| | | | - Muma Mulenga
- b University Teaching Eye Hospital , Lusaka , Zambia
| | - Grace Mutati
- b University Teaching Eye Hospital , Lusaka , Zambia
| | | | | | - Yilikal Adamu
- g Department of Ophthalmology, Faculty of Medicine , Addis Ababa University , Addis Ababa , Ethiopia
| | - Wondu Alemayehu
- h The Fred Hollows Foundation , Addis Ababa , Ethiopia.,i Berhan Public Health and Eye Care Consultancy , Addis Ababa , Ethiopia
| | - Tawfik Al-Khatib
- j Prevention of Blindness Program , Ministry of Public Health & Population , Sana'a , Yemen.,k Department of Ophthalmology, College of Medicine , University of Sana'a , Sana'a , Yemen.,l Eye Unit , Al-Thawra Hospital , Sana'a , Yemen
| | | | - Michael Dejene
- n Michael Dejene Public Health Consultancy Services , Addis Ababa , Ethiopia
| | | | - Caleb Mpyet
- p Department of Ophthalmology , University of Jos , Jos , Nigeria.,q Sightsavers , Kaduna , Nigeria.,r Kilimanjaro Centre for Community Ophthalmology International, Division of Ophthalmology , University of Cape Town , Cape Town , South Africa
| | | | | | - Paul Courtright
- r Kilimanjaro Centre for Community Ophthalmology International, Division of Ophthalmology , University of Cape Town , Cape Town , South Africa
| | - Anthony W Solomon
- s Clinical Research Department , London School of Hygiene & Tropical Medicine , London , UK.,t Department of Control of Neglected Tropical Diseases , World Health Organization , Geneva , Switzerland
| |
Collapse
|
35
|
Chlamydiaceae: Diseases in Primary Hosts and Zoonosis. Microorganisms 2019; 7:microorganisms7050146. [PMID: 31137741 PMCID: PMC6560403 DOI: 10.3390/microorganisms7050146] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 05/19/2019] [Accepted: 05/20/2019] [Indexed: 12/23/2022] Open
Abstract
Bacteria of the Chlamydiaceae family are a type of Gram-negative microorganism typified by their obligate intracellular lifestyle. The majority of the members in the Chlamydiaceae family are known pathogenic organisms that primarily infect the host mucosal surfaces in both humans and animals. For instance, Chlamydia trachomatis is a well-known etiological agent for ocular and genital sexually transmitted diseases, while C. pneumoniae has been implicated in community-acquired pneumonia in humans. Other chlamydial species such as C. abortus, C. caviae, C. felis, C. muridarum, C. pecorum, and C. psittaci are important pathogens that are associated with high morbidities in animals. Importantly, some of these animal pathogens have been recognized as zoonotic agents that pose a significant infectious threat to human health through cross-over transmission. The current review provides a succinct recapitulation of the characteristics as well as transmission for the previously established members of the Chlamydiaceae family and a number of other recently described chlamydial organisms.
Collapse
|
36
|
Flueckiger RM, Giorgi E, Cano J, Abdala M, Amiel ON, Baayenda G, Bakhtiari A, Batcho W, Bennawi KH, Dejene M, Elshafie BE, Elvis AA, François M, Goepogui A, Kalua K, Kebede B, Kiflu G, Masika MP, Massangaie M, Mpyet C, Ndjemba J, Ngondi JM, Olobio N, Turyaguma P, Willis R, Yeo S, Solomon AW, Pullan RL. Understanding the spatial distribution of trichiasis and its association with trachomatous inflammation-follicular. BMC Infect Dis 2019; 19:364. [PMID: 31039737 PMCID: PMC6492377 DOI: 10.1186/s12879-019-3935-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 03/24/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Whilst previous work has identified clustering of the active trachoma sign "trachomatous inflammation-follicular" (TF), there is limited understanding of the spatial structure of trachomatous trichiasis (TT), the rarer, end-stage, blinding form of disease. Here we use community-level TF prevalence, information on access to water and sanitation, and large-scale environmental and socio-economic indicators to model the spatial variation in community-level TT prevalence in Benin, Cote d'Ivoire, DRC, Guinea, Ethiopia, Malawi, Mozambique, Nigeria, Sudan and Uganda. METHODS We fit binomial mixed models, with community-level random effects, separately for each country. In countries where spatial correlation was detected through a semi-variogram diagnostic check we then fitted a geostatistical model to the TT prevalence data including TF prevalence as an explanatory variable. RESULTS The estimated regression relationship between community-level TF and TT was significant in eight countries. We estimate that a 10% increase in community-level TF prevalence leads to an increase in the odds for TT ranging from 20 to 86% when accounting for additional covariates. CONCLUSION We find evidence of an association between TF and TT in some parts of Africa. However, our results also suggest the presence of additional, country-specific, spatial risk factors which modulate the variation in TT risk.
Collapse
Affiliation(s)
| | - Emanuele Giorgi
- Lancaster Medical School, Lancaster University, Lancaster, Lancashire, UK
| | - Jorge Cano
- London School of Hygiene and Tropical Medicine, London, UK
| | - Mariamo Abdala
- Ophthalmology Department, Ministry of Health, Maputo, Mozambique
| | | | | | | | - Wilfrid Batcho
- Programme National de Lutte contre les Maladies Transmissibles, Ministère de la Santé, Cotonou, Benin
| | | | - Michael Dejene
- Michael Dejene Public Health Consultancy Services, Addis Ababa, Ethiopia
| | | | - Aba Ange Elvis
- Programme National de la Santé Oculaire et de la lutte contre l'Onchocercose, Abidjan, Côte d'Ivoire
| | - Missamou François
- Direction de Lutte contre la Maladie, Kinshasa, Ministere de la Santé Publique, Kinshasa, Democratic Republic of Congo
| | - André Goepogui
- Programmes National de Lutte contre l'Onchocercoses et les autres Maladies Tropicales Négligées, Ministère de la Sante, Conakry, Guinea
| | - Khumbo Kalua
- Blantyre Institute for Community Outreach, Blantyre, Malawi
| | | | - Genet Kiflu
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | | | | | - Caleb Mpyet
- Sightsavers Nigeria, Kaduna, Nigeria.,Department of Ophthalmology, Jos University, Jos, Nigeria
| | - Jean Ndjemba
- Direction de Lutte contre la Maladie, Kinshasa, Ministere de la Santé Publique, Kinshasa, Democratic Republic of Congo
| | | | - Nicholas Olobio
- Nigeria Trachoma Elimination Program, Federal Ministry of Health, Abuja, Nigeria
| | | | | | - Souleymane Yeo
- Programme National de la Santé Oculaire et de la lutte contre l'Onchocercose, Abidjan, Côte d'Ivoire
| | | | | |
Collapse
|
37
|
Correia M, Brunner D, Sharma M, Andrade V, Magno J, Müller A, Pereira BM, Thumann G, Verma N, Bangert M, Kreis AJ, Solomon AW. A search for trachoma in Timor-Leste: no evidence to justify undertaking population-based prevalence surveys. Ophthalmic Epidemiol 2019; 25:131-137. [PMID: 30806540 PMCID: PMC6858277 DOI: 10.1080/09286586.2018.1545037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose We sought evidence to justify undertaking population-based trachoma surveys in Timor-Leste, believing that in the absence of such evidence, the country could be categorized as not needing interventions to eliminate trachoma. Methods We undertook a systematic review of published literature on trachoma in Timor-Leste, with results updated to 28 April 2018. We also undertook a series of clinic- and field-based screening exercises, consisting of: (1) in October 2015, conjunctival examination of all children attending a school in Vila, Atauro Island; (2) from 1 November 2016 to 30 April 2017, examination for trichiasis, by specifically-trained frontline eye workers, of all individuals presenting to the ophthalmic clinics of six referral hospitals and five district eye clinics; and (3) house-to-house case searches in a total of 110 households, drawn from three communities that were reported by investigators from the 2016 Rapid Assessment of Avoidable Blindness (RAAB) to include residents with trachoma. Results Three RAABs (2005, 2009–2010, 2016) and two relevant published papers were identified. The 2016 RAAB reported one female subject to have been diagnosed with trachomatous corneal opacity. Re-examination of that individual revealed that she had ankyloblepharon, without evidence of trichiasis or entropion. No children on Atauro Island, no clinic attendees, and no individuals examined in the targeted house-to-house searches had any sign of trachoma. Conclusion Trachoma is very unlikely to be a public health problem in Timor-Leste. It would not be appropriate to incur the costs of conducting formal population-based trachoma prevalence surveys here.
Collapse
Affiliation(s)
- Marcelino Correia
- a National Eye Center , Guido Valadares National Hospital , Dili , Timor-Leste
| | - David Brunner
- b Oxford Eye Hospital , Oxford University Hospitals , Oxford , UK
| | - Manoj Sharma
- a National Eye Center , Guido Valadares National Hospital , Dili , Timor-Leste.,c East Timor Eye Program , Royal Australasian College of Surgeons , Dili , Timor-Leste.,d Faculty of Medicine , National University of East Timor , Dili , Timor-Leste
| | - Valerio Andrade
- a National Eye Center , Guido Valadares National Hospital , Dili , Timor-Leste
| | - Julia Magno
- e Lumbini Eye Institute , Siddharthanagar , Nepal
| | - Andreas Müller
- f Centre for Eye Research Australia , University of Melbourne , Melbourne , Australia
| | | | - Gabriele Thumann
- g Ophthalmology Department , Hôpital Universitaire de Genève , Geneva , Switzerland
| | - Nitin Verma
- b Oxford Eye Hospital , Oxford University Hospitals , Oxford , UK.,h Faculty of Medicine , University of Tasmania , Hobart , Australia.,i Department of Ophthalmology , Royal Hobart Hospital , Hobart , Australia
| | - Mathieu Bangert
- j Department of Control of Neglected Tropical Diseases , World Health Organization , Geneva , Switzerland
| | - Andréas J Kreis
- b Oxford Eye Hospital , Oxford University Hospitals , Oxford , UK.,g Ophthalmology Department , Hôpital Universitaire de Genève , Geneva , Switzerland
| | - Anthony W Solomon
- j Department of Control of Neglected Tropical Diseases , World Health Organization , Geneva , Switzerland
| |
Collapse
|
38
|
Ali Thabit A, Al-Khatib T, Hail WHM, Al-Soofi A, Abdullah Thabit NA, Boather J, Abdullah A, Flueckiger RM, Pavluck AL, Willis R, Courtright P, Macleod CK, Solomon AW. Prevalence of trachoma in Yemen: results of population-based prevalence surveys of 42 evaluation units in nine governorates. Ophthalmic Epidemiol 2019; 25:62-69. [PMID: 30806535 PMCID: PMC6444195 DOI: 10.1080/09286586.2018.1441426] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Purpose: In suspected trachoma-endemic areas of Yemen, we sought to determine the prevalence of the sign trachomatous inflammation—follicular (TF) in children aged 1–9 years, and the potential individual and household risk factors for TF in that age group. We also sought to determine the prevalence of trichiasis in adults aged ≥15 years. Methods: We conducted a cluster-sampled survey in each of 42 evaluation units (EUs) comprising 166 rural districts of nine Governorates (Adh Dhale’a, Al Hodeihah, Al Jawf, Hadramoot, Hajjah, Ibb, Lahj, Ma’rib, Taiz) using the Global Trachoma Mapping Project systems and methodologies. Fieldwork was undertaken from September 2013 to March 2015. Risk factors for TF in children aged 1–9 years were evaluated using multilevel random effects logistic regression. Results: The TF prevalence in children aged 1–9 years was ≥10% in two EUs (7 districts) and 5–9.9% in six EUs (24 districts). In adults aged ≥15 years, trichiasis prevalence was ≥0.2% in five EUs (19 districts). Being older (within the 1–9-year age bracket), being male, living in a household with higher numbers of children, and living in a household that reported the use of open defecation, were each independently associated with higher odds of TF. Conclusions: These surveys provided baseline data to enable planning for trachoma elimination. The World Health Organization Alliance for the Global Elimination of Trachoma by 2020 stands ready to assist Yemen once security considerations permit further surveys and implementation of control activities.
Collapse
Affiliation(s)
- Adnan Ali Thabit
- a Prevention of Blindness Program , Ministry of Public Health & Population , Sana'a , Yemen.,b Department of Ophthalmology, College of Medicine , University of Sana'a , Sana'a , Yemen.,c Eye Unit , Kuwait University Teaching Hospital , Sana'a , Yemen
| | - Tawfik Al-Khatib
- a Prevention of Blindness Program , Ministry of Public Health & Population , Sana'a , Yemen.,b Department of Ophthalmology, College of Medicine , University of Sana'a , Sana'a , Yemen.,d Eye Unit , Al-Thawra Hospital , Sana'a , Yemen
| | | | - Ahmed Al-Soofi
- e World Health Organization Country Office , Sana'a , Yemen
| | | | - Jamal Boather
- f Ministry of Public Health & Population , Sana'a , Yemen
| | | | | | | | | | - Paul Courtright
- h Kilimanjaro Centre for Community Ophthalmology, Division of Ophthalmology , University of Cape Town , Cape Town , South Africa
| | - Colin K Macleod
- i Clinical Research Department , London School of Hygiene & Tropical Medicine , London , UK
| | - Anthony W Solomon
- i Clinical Research Department , London School of Hygiene & Tropical Medicine , London , UK.,j London Centre for Neglected Tropical Diseases Research , London , UK.,k Department of Control of Neglected Tropical Diseases , World Health Organization , Geneva , Switzerland
| | | |
Collapse
|
39
|
Macleod CK, Porco TC, Dejene M, Shafi O, Kebede B, Negussu N, Bero B, Taju S, Adamu Y, Negash K, Haileselassie T, Riang J, Badei A, Bakhtiari A, Willis R, Bailey RL, Solomon AW. Optimising age adjustment of trichiasis prevalence estimates using data from 162 standardised surveys from seven regions of Ethiopia. Ophthalmic Epidemiol 2018; 26:161-168. [PMID: 30592237 PMCID: PMC6532728 DOI: 10.1080/09286586.2018.1555262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
PURPOSE The prevalence of trichiasis is higher in females and increases markedly with age. Surveys carried out in the daytime, particularly in developing countries, are prone to find older individuals and females at home at the time of the survey. Population-level trichiasis estimates should adjust sample proportions to reflect the demographic breakdown of the population, although the most accurate method of doing this is unclear. METHODS Having obtained data from 162 surveys carried out in Ethiopia as part of the Global Trachoma Mapping Project from 2012 to 2015, we used internal validation with both Brier and Logarithmic forecast scoring to test stratification models to identify those models with the highest predictive accuracy. Selection of partitions was undertaken by both simple random sampling (SRS) and cluster sampling (CS) over 8192 selections. RESULTS A total of 4529 (1.9%) cases of trichiasis were identified from 241,139 individuals aged ≥15 years from a total of 4210 kebeles and 122,090 households visited. Overall, the binning method using 5-year bands from age 15 to 69 years, with coarser binning in 20-year age-bands above this age, provided the best predictive accuracy, in both SRS and CS methodologies and for both the Brier and Logarithmic scoring rules. CONCLUSION The greatest predictive accuracy for trichiasis estimates was found by adjusting for sex and in 5-year age-bands from the age of 15 to 69 years and in 20-year age-bands in those aged 70 years and greater. Trichiasis surveys attempting to make population-level inferences should use this method to optimise surgery backlog estimates.
Collapse
Affiliation(s)
- Colin K Macleod
- a Clinical Research Department , London School of Hygiene & Tropical Medicine , London , UK
| | - Travis C Porco
- b Francis I. Proctor Foundation, Department of Ophthalmology , University of California, San Francisco , San Francisco , USA.,c Department of Epidemiology and Biostatistics , University of California, San Francisco , San Francisco , USA
| | - Michael Dejene
- d Michael Dejene Public Health Consultancy Services , Addis Ababa , Ethiopia
| | - Oumer Shafi
- e Federal Ministry of Health , Addis Ababa , Ethiopia
| | - Biruck Kebede
- e Federal Ministry of Health , Addis Ababa , Ethiopia
| | | | - Berhanu Bero
- f The Fred Hollows Foundation Ethiopia , Addis Ababa , Ethiopia
| | - Sadik Taju
- g Department of Ophthalmology , Addis Ababa University , Addis Ababa , Ethiopia
| | - Yilikal Adamu
- g Department of Ophthalmology , Addis Ababa University , Addis Ababa , Ethiopia
| | | | | | - John Riang
- j Gambella Regional Health Bureau , Gambella , Ethiopia
| | - Ahmed Badei
- k Department of Disease Prevention , Somali Regional State Health Bureau , Jigjiga , Ethiopia
| | - Ana Bakhtiari
- l Task Force for Global Health , Decatur , Georgia , USA
| | - Rebecca Willis
- l Task Force for Global Health , Decatur , Georgia , USA
| | - Robin L Bailey
- a Clinical Research Department , London School of Hygiene & Tropical Medicine , London , UK
| | - Anthony W Solomon
- a Clinical Research Department , London School of Hygiene & Tropical Medicine , London , UK.,m Department of Control of Neglected Tropical Diseases , World Health Organization , Geneva , Switzerland
| |
Collapse
|
40
|
Achieving the endgame: Integrated NTD case searches. PLoS Negl Trop Dis 2018; 12:e0006623. [PMID: 30571758 PMCID: PMC6319769 DOI: 10.1371/journal.pntd.0006623] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 01/04/2019] [Accepted: 11/17/2018] [Indexed: 12/02/2022] Open
Abstract
Trachoma and Guinea Worm Disease (GWD) are neglected tropical diseases (NTD) slated for elimination as a public health problem and eradication respectively by the World Health Organization. As these programs wind down, uncovering the last cases becomes an urgent priority. In 2010, Ghana Health Services, along with The Carter Center, Sightsavers, and other partners, conducted integrated case searches for both GWD and the last stage of trachoma disease, trachomatous trichiasis (TT), as well as providing surgical treatment for TT to meet elimination (and eradication targets). House to house case searches for both diseases were conducted and two case management strategies were explored: a centralized referral to services method and a Point of Care (POC) delivery method. 835 suspected TT cases were discovered in the centralized method, of which 554 accepted surgery. 482 suspected TT cases were discovered in the POC method and all TT cases accepted surgery. The cost per TT case examined was lower in the POC searches compared to the centralized searches ($19.97 in the POC searches and $20.85 in the centralized searches). Both strategies resulted in high surgical uptake for TT surgery, with average uptakes of 72.4% and 83.9% for the centralized and POC searches respectively. We present here that house to house case searches offering services at POC are feasible and a potential tool for elimination and eradication programs nearing their end. Trachoma and Guinea Worm Disease (GWD) are neglected tropical diseases slated for elimination as a public health problem and eradication respectively by the World Health Organization. As these programs wind down, uncovering the last cases becomes an urgent priority in order to confirm that eradiation and elimination targets have been reached. Active case searches are one method of finding these last vestiges of disease. Searches that look for multiple diseases are referred to as integrated searches. We piloted here integrated house-to-house case searches for GWD and Trachoma with two case management strategies; a referral approach to a central location and a point of care approach (POC)–offering services at the household or ‘point of care’ location. POC approaches can be difficult to implement in low resource settings because they require extensive personnel, financial commitment, and logistical support. However, POC approaches remove one of the biggest barriers to treatment, time spent traveling to a health center, and thus can improve treatment acceptance. We found here that integrated active case searches with a POC case management approach can be implemented in a low resource setting; and improve acceptance and uptake of trachoma examination and trichiasis surgery respectively, without costing much more than a referral-based case management approach.
Collapse
|
41
|
Tesfazion A, Zecarias A, Zewengiel S, Willis R, Mebrahtu G, Capa E, Mpyet C, Al-Khatib T, Courtright P, Solomon AW. Progress Towards Elimination of Trachoma as a Public Health Problem in Eritrea: Results of a Systematic Review and Nine Population-based Prevalence Surveys Conducted in 2014. Ophthalmic Epidemiol 2018; 25:121-130. [PMID: 30806541 PMCID: PMC6444204 DOI: 10.1080/09286586.2018.1545036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 09/21/2018] [Accepted: 11/01/2018] [Indexed: 11/16/2022]
Abstract
PURPOSE To assess Eritrea's progress towards elimination of trachoma as a public health problem, we reviewed and compiled current knowledge on the distribution and burden of trachoma in Eritrea, then undertook further population-based surveys where indicated, with support from the Global Trachoma Mapping Project (GTMP). METHODS For the systematic review, undertaken in March 2014, we searched (1) PubMed, using the terms ((blind* or trachoma or trichiasis) AND Eritrea); (2) the online database of rapid assessments of avoidable blindness; (3) our own grey literature collections; and (4) the Global Atlas of Trachoma database. In June and July 2014, we conducted nine population-based prevalence surveys, for each of which 30 villages were systematically selected with probability proportional to population size; in each village, 30 households were systematically selected. All consenting residents of selected households aged ≥1 year were examined by GTMP-certified graders for signs of trachoma. Data on household-level access to water and sanitation were also collected. RESULTS One previous rapid assessment of avoidable blindness, three peer-reviewed publications, and two grey literature reports detailing sets of trachoma prevalence surveys conducted in 2006 and 2011, respectively, were located. Post-intervention impact surveys were needed in seven evaluation units (EUs, framed at sub-Zoba-level: population range 40,000-120,000) of Debub and Northern Red Sea, while baseline surveys were needed in two EUs of Anseba. Four of the seven impact survey EUs and both baseline survey EUs returned trachomatous inflammation-follicular prevalences in 1-9-year-olds of ≥5%; six of the seven impact survey EUs and one of the two baseline survey EUs returned trichiasis prevalences in ≥15-year-olds of ≥0.2%. The prevalence of access to water and sanitation varied widely between EUs. CONCLUSION Interventions are still required in Eritrea to eliminate trachoma as a public health problem. Data from these surveys will guide the Ministry of Health to undertake programme planning using a sound evidence base.
Collapse
Affiliation(s)
- Andeberhan Tesfazion
- National Program for the Prevention of Blindness, Ministry of Health, Asmara, Eritrea
| | - Alem Zecarias
- National Program for the Prevention of Blindness, Ministry of Health, Asmara, Eritrea
| | - Solomon Zewengiel
- National Program for the Prevention of Blindness, Ministry of Health, Asmara, Eritrea
| | | | | | - Eva Capa
- The Fred Hollows Foundation, Sydney, Australia
| | - Caleb Mpyet
- Department of Ophthalmology, University of Jos, Jos, Nigeria
- Sightsavers, Kaduna, Nigeria
- Kilimanjaro Centre for Community Ophthalmology, Division of Ophthalmology, University of Cape Town, Cape Town, South Africa
| | - Tawfik Al-Khatib
- Department of Ophthalmology, College of Medicine, University of Sana’a, Sana’a, Yemen
- Prevention of Blindness Program, Ministry of Public Health & Population, Sana’a, Yemen
- Eye Unit, Al-Thawra Hospital, Sana’a, Yemen
| | - Paul Courtright
- Kilimanjaro Centre for Community Ophthalmology, Division of Ophthalmology, University of Cape Town, Cape Town, South Africa
| | - Anthony W. Solomon
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
- London Centre for Neglected Tropical Diseases Research, London, UK
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| |
Collapse
|
42
|
Dézoumbé D, Djada DA, Harba TT, Biao JE, Kali B, Bernasconi J, Hiron D, Bengraïne K, D’Souza S, Willis R, Bakhtiari A, Resnikoff S, Courtright P, Solomon AW. Prevalence of trachoma in the Republic of Chad: results of 41 population-based surveys. Ophthalmic Epidemiol 2018; 25:143-154. [PMID: 30806544 PMCID: PMC6444194 DOI: 10.1080/09286586.2018.1546877] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 10/12/2018] [Accepted: 11/06/2018] [Indexed: 11/04/2022]
Abstract
PURPOSE To estimate the prevalence of trachoma in suspected-endemic areas of Chad, and thereby determine whether trachoma is a public health problem requiring intervention. METHODS We divided the suspected-endemic population living in secure districts into 46 evaluation units (EUs), and used the standardized methodologies of the Global Trachoma Mapping Project. A two-stage cluster-sampling procedure was adopted. In each EU, the goal was to examine at least 1019 children aged 1-9 years by recruiting 649 households; all consenting residents aged ≥ 1 year living in those households were examined. Each participant was examined for trachomatous inflammation-follicular (TF), trachomatous inflammation-intense (TI), and trichiasis. RESULTS Two EUs had data that could not be validated, and were excluded from the analysis. GPS data for three other pairs of EUs suggested that EU divisions were inaccurate; data for each pair were combined within the pair. In the 41 resulting EUs, 29,924 households in 967 clusters were visited, and 104,584 people were examined. The age-adjusted EU-level prevalence of TF in 1-9-year-olds ranged from 0.0% to 23.3%, and the age- and gender-adjusted EU-level prevalence of trichiasis in ≥ 15-year-olds ranged from 0.02% to 1.3%. TF was above the WHO elimination threshold in 16 EUs (39%) and trichiasis was above the WHO elimination threshold in 29 EUs (71%). Women had a higher prevalence of trichiasis than did men in 31 EUs (76%). A higher ratio of trichiasis prevalence in women to trichiasis prevalence in men was associated (p = 0.03) with a higher prevalence of trichiasis at EU level. CONCLUSION Public health-level interventions against trachoma are needed in Chad. Over 10,000 people need management of their trichiasis; women account for about two-thirds of this total. The association between a higher ratio of trichiasis prevalence in women to that in men with higher overall trichiasis prevalence needs further investigation.
Collapse
Affiliation(s)
- Djoré Dézoumbé
- Programme national de lutte contre la cécité, Ministère de la Santé Publique, N’Djamena, Tchad
| | | | | | - Jean-Eudes Biao
- Organisation pour la Prévention de la Cécité, N’Djamena, Tchad
| | - Barka Kali
- Organisation pour la Prévention de la Cécité, N’Djamena, Tchad
| | | | - Doniphan Hiron
- Organisation pour la Prévention de la Cécité, Paris, France
| | | | | | | | | | | | - Paul Courtright
- Kilimanjaro Centre for Community Ophthalmology, Division of Ophthalmology, University of Cape Town, Cape Town, South Africa
| | - Anthony W. Solomon
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| |
Collapse
|
43
|
Courtright P, Rotondo LA, MacArthur C, Jones I, Weaver A, Negash BK, Olobio N, Binnawi K, Bush S, Abdala M, Haddad D, Bonfield A, Emerson P, Sarah V, Solomon AW. Strengthening the links between mapping, planning and global engagement for disease elimination: lessons learnt from trachoma. Br J Ophthalmol 2018; 102:1324-1327. [PMID: 29907634 PMCID: PMC6173819 DOI: 10.1136/bjophthalmol-2018-312476] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 05/20/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Trachoma is the leading infectious cause of blindness. Until recently, reliable data on the global extent of the disease, detailed plans for elimination, and government, donor and partner engagement were all inadequate. METHODS The trachoma community undertook a systematic, three-pronged strategy to map trachoma district by district, develop national-level trachoma elimination plans, and create a framework for governments, donors and partners to convene and coordinate in support of trachoma elimination. RESULT: There has been a frame-shift in internal and external perceptions of the global trachoma programme, from being an effort working towards disease control in focussed geographical areas, to one in the process of achieving worldwide disease elimination. Multiple factors contributed to the successful implementation of mapping, planning, and cross-sectional engagement of governments, partners and donors. CONCLUSIONS Elimination of trachoma is possible if the right combination of factors is in place. Planning for success is a critical first step. Some remaining challenges must still be addressed if the elimination targets are to be successfully attained.
Collapse
Affiliation(s)
- Paul Courtright
- Kilimanjaro Centre for Community Ophthalmology, Division of Ophthalmology, University of Cape Town, Cape Town, South Africa
| | | | - Chad MacArthur
- Kilimanjaro Centre for Community Ophthalmology, Division of Ophthalmology, University of Cape Town, Cape Town, South Africa
| | - Iain Jones
- Department for International Development, London, UK
| | - Angela Weaver
- United States Agency for International Development, Washington, DC, USA
| | | | | | - Kamal Binnawi
- Ministry of Health and Alneelain University, Khartoum, Sudan
| | | | - Mariamo Abdala
- Nacional Eye Care Program, Ministério da Saude de Mozambique, Maputo, Mozambique
| | | | | | - Paul Emerson
- International Trachoma Initiative, Atlanta, Georgia, USA
| | - Virginia Sarah
- International Coalition for Trachoma Control and The Fred Hollows Foundation, London, UK
| | - Anthony W Solomon
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| |
Collapse
|
44
|
Keenan JD, Tadesse Z, Gebresillasie S, Shiferaw A, Zerihun M, Emerson PM, Callahan K, Cotter SY, Stoller NE, Porco TC, Oldenburg CE, Lietman TM. Mass azithromycin distribution for hyperendemic trachoma following a cluster-randomized trial: A continuation study of randomly reassigned subclusters (TANA II). PLoS Med 2018; 15:e1002633. [PMID: 30106956 PMCID: PMC6091918 DOI: 10.1371/journal.pmed.1002633] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 07/05/2018] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The World Health Organization recommends annual mass azithromycin administration in communities with at least 10% prevalence of trachomatous inflammation-follicular (TF) in children, with further treatment depending on reassessment after 3-5 years. However, the effect of stopping mass azithromycin distribution after multiple rounds of treatment is not well understood. Here, we report the results of a cluster-randomized trial where communities that had received 4 years of treatments were then randomized to continuation or discontinuation of treatment. METHODS AND FINDINGS In all, 48 communities with 3,938 children aged 0-9 years at baseline in northern Ethiopia had received 4 years of annual or twice yearly mass azithromycin distribution as part of the TANA I trial. We randomized these communities to either continuation or discontinuation of treatment. Individuals in the communities in the continuation arm were offered either annual or twice yearly distribution of a single directly observed dose of oral azithromycin. The primary outcome was community prevalence of ocular chlamydial infection in a random sample of children aged 0-9 years, 36 months after baseline. We also assessed the change from baseline to 36 months in ocular chlamydia prevalence within each arm. We compared 36-month ocular chlamydia prevalence in communities randomized to continuation versus discontinuation in a model adjusting for baseline ocular chlamydia prevalence. A secondary prespecified analysis assessed the rate of change over time in ocular chlamydia prevalence between arms. In the continuation arm, mean antibiotic coverage was greater than 90% at all time points. In the discontinuation arm, the mean prevalence of infection in children aged 0-9 years increased from 8.3% (95% CI 4.2% to 12.4%) at 0 months to 14.7% (95% CI 8.7% to 20.8%, P = 0.04) at 36 months. Ocular chlamydia prevalence in communities where mass azithromycin distribution was continued was 7.2% (95% CI 3.3% to 11.0%) at baseline and 6.6% (95% CI 1.1% to 12.0%, P = 0.64) at 36 months. The 36-month prevalence of ocular chlamydia was significantly lower in communities continuing treatment compared with those discontinuing treatment (P = 0.03). Limitations of the study include uncertain generalizability outside of trachoma hyperendemic regions. CONCLUSIONS In this study, ocular chlamydia infection rebounded after 4 years of periodic mass azithromycin distribution. Continued distributions did not completely eliminate infection in all communities or meet WHO control goals, although they did prevent resurgence. TRIAL REGISTRATION This study was prospectively registered at clinicaltrials.gov (clinicaltrials.gov NCT01202331).
Collapse
Affiliation(s)
- Jeremy D. Keenan
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California, United States of America
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, United States of America
- * E-mail:
| | | | | | | | | | - Paul M. Emerson
- The Carter Center, Atlanta, Georgia, United States of America
| | - Kelly Callahan
- The Carter Center, Atlanta, Georgia, United States of America
| | - Sun Y. Cotter
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California, United States of America
| | - Nicole E. Stoller
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California, United States of America
| | - Travis C. Porco
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California, United States of America
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, United States of America
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, United States of America
| | - Catherine E. Oldenburg
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California, United States of America
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, United States of America
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, United States of America
| | - Thomas M. Lietman
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California, United States of America
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, United States of America
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, United States of America
| |
Collapse
|
45
|
Characterization of Chlamydial Rho and the Role of Rho-Mediated Transcriptional Polarity during Interferon Gamma-Mediated Tryptophan Limitation. Infect Immun 2018; 86:IAI.00240-18. [PMID: 29712731 DOI: 10.1128/iai.00240-18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 04/27/2018] [Indexed: 01/15/2023] Open
Abstract
As an obligate intracellular, developmentally regulated bacterium, Chlamydia is sensitive to amino acid fluctuations within its host cell. When human epithelial cells are treated with the cytokine interferon gamma (IFN-γ), the tryptophan (Trp)-degrading enzyme, indoleamine-2,3-dioxygenase, is induced. Chlamydiae within such cells are starved for Trp and enter a state of so-called persistence. Chlamydia lacks the stringent response used by many eubacteria to respond to this stress. Unusually, chlamydial transcription is globally elevated during Trp starvation with transcripts for Trp codon-containing genes disproportionately increased. Yet, the presence of Trp codons destabilized 3' ends of transcripts in operons or large genes. We initially hypothesized that ribosome stalling on Trp codons rendered the 3' ends sensitive to RNase activity. The half-life of chlamydial transcripts containing different numbers of Trp codons was thus measured in untreated and IFN-γ-treated infected cells to determine whether Trp codons influenced the stability of transcripts. However, no effect of Trp codon content was detected. Therefore, we investigated whether Rho-dependent transcription termination could play a role in mediating transcript instability. Rho is expressed as a midcycle gene product, interacts with itself as predicted, and is present in all chlamydial species. Inhibition of Rho via the Rho-specific antibiotic, bicyclomycin, and overexpression of Rho are detrimental to chlamydiae. Finally, when we measured transcript abundance 3' to Trp codons in the presence of bicyclomycin, we observed that transcript abundance increased. These data are the first to demonstrate the importance of Rho in Chlamydia and the role of Rho-dependent transcription polarity during persistence.
Collapse
|
46
|
Oldenburg CE, Amza A, Kadri B, Nassirou B, Cotter SY, Stoller NE, West SK, Bailey RL, Porco TC, Gaynor BD, Keenan JD, Lietman TM. Comparison of Mass Azithromycin Coverage Targets of Children in Niger: A Cluster-Randomized Trachoma Trial. Am J Trop Med Hyg 2017; 98:389-395. [PMID: 29260659 DOI: 10.4269/ajtmh.17-0501] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Repeated oral azithromycin distribution targeted only to children has proven effective in reducing the ocular Chlamydia that causes trachoma. Here, we assess whether an enhanced coverage target of at least 90% of children is superior to the World Health Organization recommendation of at least 80%. Twenty-four trachoma-endemic communities in Matamèye, Niger, were randomized to a single day of azithromycin distribution aiming for at least 80% coverage or up to 4 days of treatment and > 90% coverage of children under age 12. All distributions were biannual. Children < 5 years of age and adults > 15 years were monitored for ocular Chlamydia infection by polymerase chain reaction every 6 months for 36 months in children and at baseline and 36 months in adults. Ocular Chlamydia prevalence in children decreased from 24.9% (95% confidence interval [CI] 15.9-33.8%) to 4.4% (95% CI 0.6-8.2%, P < 0.001) at 36 months in the standard coverage arm and from 15.6% (95% CI 10.0-21.2%) to 3.3% (95% CI 1.0-5.5%; P < 0.001) in the enhanced coverage arm. Enhanced coverage reduced ocular Chlamydia prevalence in children more quickly over time compared with standard (P = 0.04). There was no difference between arms at 36 months in children (2.4% lower with enhanced coverage, 95% CI 7.7-12.5%; P = 0.60). No infection was detected in adults at 36 months. Increasing antibiotic coverage among children from 80% to 90% may yield only short term improvements for trachoma control programs. Targeting treatment to children alone may be sufficient for trachoma control in this setting.
Collapse
Affiliation(s)
- Catherine E Oldenburg
- Department of Ophthalmology, University of California San Francisco, San Francisco, California.,F.I. Proctor Foundation, University of California San Francisco, San Francisco, California
| | - Abdou Amza
- Programme FSS/Université Abdou Moumouni de Niamey, Programme National de Santé Oculaire, Niamey, Niger
| | - Boubacar Kadri
- Programme FSS/Université Abdou Moumouni de Niamey, Programme National de Santé Oculaire, Niamey, Niger
| | - Beido Nassirou
- Programme FSS/Université Abdou Moumouni de Niamey, Programme National de Santé Oculaire, Niamey, Niger
| | - Sun Y Cotter
- F.I. Proctor Foundation, University of California San Francisco, San Francisco, California
| | - Nicole E Stoller
- F.I. Proctor Foundation, University of California San Francisco, San Francisco, California
| | - Sheila K West
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
| | - Robin L Bailey
- Clinical Research Unit, Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Travis C Porco
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California.,Department of Ophthalmology, University of California San Francisco, San Francisco, California.,F.I. Proctor Foundation, University of California San Francisco, San Francisco, California
| | - Bruce D Gaynor
- Department of Ophthalmology, University of California San Francisco, San Francisco, California.,F.I. Proctor Foundation, University of California San Francisco, San Francisco, California
| | - Jeremy D Keenan
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California.,Department of Ophthalmology, University of California San Francisco, San Francisco, California.,F.I. Proctor Foundation, University of California San Francisco, San Francisco, California
| | - Thomas M Lietman
- Department of Ophthalmology, University of California San Francisco, San Francisco, California.,F.I. Proctor Foundation, University of California San Francisco, San Francisco, California.,Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California
| |
Collapse
|
47
|
|
48
|
Effect of water, sanitation and hygiene interventions on active trachoma in North and South Wollo zones of Amhara Region, Ethiopia: A Quasi-experimental study. PLoS Negl Trop Dis 2017; 11:e0006080. [PMID: 29125849 PMCID: PMC5699846 DOI: 10.1371/journal.pntd.0006080] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 11/22/2017] [Accepted: 10/30/2017] [Indexed: 11/25/2022] Open
Abstract
Background Trachoma is chronic kerato conjunctivitis, which is caused by repeated infection with Chlamydia trachomatis bacterium. It is hyper endemic in many rural areas of Ethiopia. The objective of this study was to measure the effect of water, sanitation and hygiene interventions on active trachoma in selected woredas of North and South Wollo zones of Amhara Region, Ethiopia. Methodology A community based quasi-experimental study was conducted from October 2014 to December 2015 among children aged 1–8 years at baseline and among one year older same children after intervention. A four-stage random cluster-sampling technique was employed to select study participants. From each selected household, one child was clinically assessed for active trachoma. Structured questionnaire was used to collect socio demographic and behavioral data. MacNemar test was applied to compare the prevalence of active trachoma between baseline and after the intervention period at both intervention and non-intervention study areas. Results The prevalence of active trachoma was reduced from baseline prevalence of 26% to 18% after one-year intervention period in the intervention woredas (P≤0.001). MacNemar test result showed significant reduction of active trachoma prevalence after the intervention period in the intervention woredas compared to the non-intervention woredas (P≤0.001). Water, sanitation and hygiene related activities were significantly improved after the intervention period in the intervention woredas (P<0.05). Conclusions There was a significant reduction of active trachoma prevalence between the baseline and after the intervention period in the intervention woredas, but not in the non-intervention ones. Improved water, sanitation and hygiene interventions contributed to the reduction of active trachoma. However, the magnitude of active trachoma prevalence observed after the intervention is still very high in the studied areas of North and South Wollo Zones communities. To achieve the global trachoma elimination target by the year 2020 as set by the WHO, continued WaSH interventions and periodic monitoring, evaluation and reporting of the impact of WaSH on active trachoma is warranted. Trachoma is an infectious disease of the eye, which is caused by repeated infection with Chlamydia trachomatis bacterium. The disease is the leading cause of preventable blindness. Ethiopia is the most trachoma affected country in the world. The World Health Organization (WHO) recommends Water, Sanitation and Hygiene (WaSH) interventions to control and eliminate blinding trachoma. With the aim of assessing the effect of WaSH intervention on active trachoma in selected woredas/districts of North and South Wollo zones of Amhara Region, Ethiopia, we selected intervention and control woredas, and WaSH program was implemented in the intervention woredas for one year. Baseline trachoma prevalence was conducted in both intervention and control areas before WaSH program was implemented. Prevalence was determined in both study areas after one-year intervention period and was compared with the baseline. The finding showed that the prevalence of active trachoma was reduced from baseline prevalence of 26% to 18% after one-year WaSH program implementation in the intervention woredas compared to the non-intervention woredas. However, as the magnitude of active trachoma prevalence observed after the intervention is still very high. Continued WaSH interventions and periodic monitoring, evaluation and reporting of the impact of WaSH on active trachoma is warranted in the studied areas of Ethiopia.
Collapse
|
49
|
Abdala M, Singano CC, Willis R, Macleod CK, Backers S, Flueckiger RM, Vilanculos A, Terefe D, Houane M, Bikele F, Kello AB, Downs P, Bay Z, Senyonjo L, Solomon AW. The Epidemiology of Trachoma in Mozambique: Results of 96 Population-Based Prevalence Surveys. Ophthalmic Epidemiol 2017; 25:201-210. [PMID: 28910562 PMCID: PMC6444277 DOI: 10.1080/09286586.2017.1351996] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: Surveys are needed to guide trachoma control efforts in Mozambique, with WHO guidelines for intervention based on the prevalence of trachomatous inflammation–follicular (TF) in children aged 1–9 years and the prevalence of trichiasis in adults aged 15 years and above. We conducted surveys to complete the map of trachoma prevalence in Mozambique. Methods: Between July 2012 and May 2015, we carried out cross-sectional surveys in 96 evaluation units (EUs) covering 137 districts. Results: A total of 269,217 individuals were enumerated and 249,318 people were examined using the WHO simplified trachoma grading system. Overall, 102,641 children aged 1–9 years, and 122,689 individuals aged 15 years and above were examined. The prevalence of TF in children aged 1–9 years was ≥10% in 12 EUs, composed of 20 districts, covering an estimated total population of 2,455,852. These districts require mass distribution of azithromycin for at least 3 years before re-survey. The TF prevalence in children was 5.0–9.9% in 17 EUs (28 districts, total population 3,753,039). 22 EUs (34 districts) had trichiasis prevalences ≥0.2% in adults 15 years and above, and will require public health action to provide surgical services addressing the backlog of trichiasis. Younger age, more children resident in the household, and living in a household that had an unimproved latrine or no latrine facility, were independently associated with an increased odds of TF in children aged 1–9 years. Conclusions: Trachoma represents a significant public health problem in many areas of Mozambique.
Collapse
Affiliation(s)
- Mariamo Abdala
- a Ophthalmology Department , Ministry of Health , Maputo , Mozambique
| | | | | | - Colin K Macleod
- d Clinical Research Department , London School of Hygiene & Tropical Medicine , London , UK
| | | | | | | | | | | | | | | | | | | | | | - Anthony W Solomon
- l Clinical Research Department , London School of Hygiene & Tropical Medicine , London , UK
| |
Collapse
|
50
|
Harding-Esch EM, Kadimpeul J, Sarr B, Sane A, Badji S, Laye M, Sillah A, Burr SE, MacLeod D, Last AR, Holland MJ, Mabey DC, Bailey RL. Population-based prevalence survey of follicular trachoma and trachomatous trichiasis in the Casamance region of Senegal. BMC Public Health 2017; 18:62. [PMID: 28747198 PMCID: PMC5530574 DOI: 10.1186/s12889-017-4605-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 07/18/2017] [Indexed: 11/10/2022] Open
Abstract
Background Trachoma, caused by ocular infection with Chlamydia trachomatis, is the leading infectious cause of blindness worldwide. We conducted the first population-based trachoma prevalence survey in the Casamance region of Senegal to enable the Senegalese National Eye Care Programme (NECP) to plan its trachoma control activities. The World Health Organization (WHO) guidelines state that any individual with trachomatous trichiasis (TT) should be offered surgery, but that surgery should be prioritised where the prevalence is >0.1%, and that districts and communities with a trachomatous inflammation, follicular (TF) prevalence of ≥10% in 1–9 year-olds should receive mass antibiotic treatment annually for a minimum of three years, along with hygiene promotion and environmental improvement, before re-assessing the prevalence to determine whether treatment can be discontinued (when TF prevalence in 1–9 year-olds falls <5%). Methods Local healthcare workers conducted a population-based household survey in four districts of the Bignona Department of Casamance region to estimate the prevalence of TF in 1–9 year-olds, and TT in ≥15 year-olds. Children’s facial cleanliness (ocular and/or nasal discharge, dirt on the face, flies on the face) was measured at time of examination. Risk factor questionnaires were completed at the household level. Results Sixty communities participated with a total censused population of 5580 individuals. The cluster-, age- and sex-adjusted estimated prevalence of TF in 1–9 year-olds was 2.5% (95% Confidence Interval (CI) 1.8–3.6) (38/1425) at the regional level and <5% in all districts, although the upper 95%CI exceeded 5% in all but one district. The prevalence of TT in those aged ≥15 years was estimated to be 1.4% (95%CI 1.0–1.9) (40/2744) at the regional level and >1% in all districts. Conclusion With a prevalence <5%, TF does not appear to be a significant public health problem in this region. However, TF monitoring and surveillance at sub-district level will be required to ensure that elimination targets are sustained and that TF does not re-emerge as a public health problem. TT surgery remains the priority for trachoma elimination efforts in the region, with an estimated 1819 TT surgeries to conduct.
Collapse
Affiliation(s)
- Emma M Harding-Esch
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK.
| | - Julbert Kadimpeul
- Programme National de Lutte Contre la Cécité, Ministère de la Sante, Dakar, Sénégal
| | - Boubacar Sarr
- Programme National de Lutte Contre la Cécité, Ministère de la Sante, Dakar, Sénégal
| | - Awa Sane
- Programme National de Lutte Contre la Cécité, Ministère de la Sante, Dakar, Sénégal
| | - Souleymane Badji
- Programme National de Lutte Contre la Cécité, Ministère de la Sante, Dakar, Sénégal
| | - Mass Laye
- National Eye Health Programme, Ministry of Health and Social Welfare, Kanifing, Gambia
| | - Ansumana Sillah
- National Eye Health Programme, Ministry of Health and Social Welfare, Kanifing, Gambia
| | - Sarah E Burr
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK.,Disease Control and Elimination Theme, Medical Research Council Unit, The Gambia, Fajara, Banjul, Gambia
| | - David MacLeod
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Anna R Last
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Martin J Holland
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - David C Mabey
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Robin L Bailey
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|