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Bhutta ZA. Unravelling the Potential Mortality Benefits of Mass Drug Administration With Azithromycin in Niger. JAMA Netw Open 2023; 6:e2346811. [PMID: 38100114 DOI: 10.1001/jamanetworkopen.2023.46811] [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] [Indexed: 12/18/2023] Open
Affiliation(s)
- Zulfiqar A Bhutta
- SickKids Centre for Global Child Health, Research Institute, The Hospital for Sick Children, SickKids Peter Gilgan Centre for Research and Learning, Toronto, Canada
- Center of Excellence in Women and Child Health & Institute for Global Health & Development, The Aga Khan University South-Central Asia, East Africa & United Kingdom, Karachi, Pakistan
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2
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Mahmud H, Haile BA, Tadesse Z, Gebresillasie S, Shiferaw A, Zerihun M, Liu Z, Callahan EK, Cotter SY, Varnado NE, Oldenburg CE, Porco TC, Lietman TM, Keenan JD. Targeted Mass Azithromycin Distribution for Trachoma: A Community-Randomized Trial (TANA II). Clin Infect Dis 2023; 77:388-395. [PMID: 37021692 PMCID: PMC10681647 DOI: 10.1093/cid/ciad211] [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: 12/11/2022] [Revised: 03/23/2023] [Accepted: 04/04/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND Current guidelines recommend annual community-wide mass administration of azithromycin for trachoma. Targeting treatments to those most likely to be infected could reduce the amount of unnecessary antibiotics distributed. METHODS In a cluster-randomized trial conducted from 1 November 2010 through 8 November 2013, 48 Ethiopian communities previously treated with annual mass azithromycin distributions for trachoma were randomized in equal numbers to (1) annual azithromycin distributions targeted to children aged 0-5 years, (2) annual azithromycin distributions targeted to households with a child aged 0-5 years found to have clinically active trachoma, (3) continued annual mass azithromycin distributions to the entire community, or (4) cessation of treatment. The primary outcome was the community prevalence of ocular chlamydia infection among children aged 0-9 years at month 36. Laboratory personnel were masked to treatment allocation. RESULTS The prevalence of ocular chlamydia infection among children aged 0-9 years increased from 4.3% (95% confidence interval [CI], .9%-8.6%) at baseline to 8.7% (95% CI, 4.2%-13.9%) at month 36 in the age-targeted arm, and from 2.8% (95% CI, .8%-5.3%) at baseline to 6.3% (95% CI, 2.9%-10.6%) at month 36 in the household-targeted arm. After adjusting for baseline chlamydia prevalence, the 36-month prevalence of ocular chlamydia was 2.4 percentage points greater in the age-targeted group (95% CI, -4.8% to 9.6%; P = .50; prespecified primary analysis). No adverse events were reported. CONCLUSIONS Targeting azithromycin treatment to preschool children was no different than targeting azithromycin to households with a child with clinically active trachoma. Neither approach reduced ocular chlamydia over the 3-year study. CLINICAL TRIALS REGISTRATION NCT01202331.
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Affiliation(s)
- Hamidah Mahmud
- School of Medicine, University of California, San Francisco, California, USA
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
| | | | | | | | | | | | - Zijun Liu
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
| | | | - Sun Y Cotter
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
| | - Nicole E Varnado
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
| | - Catherine E Oldenburg
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
- Department of Ophthalmology, University of California, San Francisco, California, USA
- Department of Epidemiology & Biostatistics, University of California, San Francisco, California, USA
| | - Travis C Porco
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
- Department of Ophthalmology, University of California, San Francisco, California, USA
- Department of Epidemiology & Biostatistics, University of California, San Francisco, California, USA
| | - Thomas M Lietman
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
- Department of Ophthalmology, University of California, San Francisco, California, USA
- Department of Epidemiology & Biostatistics, University of California, San Francisco, California, USA
| | - Jeremy D Keenan
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
- Department of Ophthalmology, University of California, San Francisco, California, USA
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3
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Tedijanto C, Solomon AW, Martin DL, Nash SD, Keenan JD, Lietman TM, Lammie PJ, Aiemjoy K, Amza A, Aragie S, Arzika AM, Callahan EK, Carolan S, Dawed AA, Goodhew EB, Gwyn S, Hammou J, Kadri B, Kalua K, Maliki R, Nassirou B, Seife F, Tadesse Z, West SK, Wittberg DM, Zeru Tadege T, Arnold BF. Monitoring transmission intensity of trachoma with serology. Nat Commun 2023; 14:3269. [PMID: 37277341 PMCID: PMC10241377 DOI: 10.1038/s41467-023-38940-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/22/2023] [Indexed: 06/07/2023] Open
Abstract
Trachoma, caused by ocular Chlamydia trachomatis infection, is targeted for global elimination as a public health problem by 2030. To provide evidence for use of antibodies to monitor C. trachomatis transmission, we collated IgG responses to Pgp3 antigen, PCR positivity, and clinical observations from 19,811 children aged 1-9 years in 14 populations. We demonstrate that age-seroprevalence curves consistently shift along a gradient of transmission intensity: rising steeply in populations with high levels of infection and active trachoma and becoming flat in populations near elimination. Seroprevalence (range: 0-54%) and seroconversion rates (range: 0-15 per 100 person-years) correlate with PCR prevalence (r: 0.87, 95% CI: 0.57, 0.97). A seroprevalence threshold of 13.5% (seroconversion rate 2.75 per 100 person-years) identifies clusters with any PCR-identified infection at high sensitivity ( >90%) and moderate specificity (69-75%). Antibody responses in young children provide a robust, generalizable approach to monitor population progress toward and beyond trachoma elimination.
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Affiliation(s)
- Christine Tedijanto
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, 94158, USA
| | - Anthony W Solomon
- Global Neglected Tropical Diseases Programme, World Health Organization, Geneva, Switzerland
| | - Diana L Martin
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | | | - Jeremy D Keenan
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, 94158, USA
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, 94158, USA
| | - Thomas M Lietman
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, 94158, USA
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, 94158, USA
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, 94143, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, 94143, USA
| | - Patrick J Lammie
- Neglected Tropical Diseases Support Center, Task Force for Global Health, Atlanta, GA, 30030, USA
| | - Kristen Aiemjoy
- Division of Epidemiology, Department of Public Health Sciences, University of California Davis School of Medicine, Davis, CA, USA
| | - Abdou Amza
- Programme National de Santé Oculaire, Niamey, Niger
- Programme National de Lutte Contre la Cecité, Niamey, Niger
| | - Solomon Aragie
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, 94158, USA
- The Carter Center Ethiopia, Addis Ababa, Ethiopia
- Infection Biology, Addis Ababa University, Addis Ababa, Ethiopia
| | | | | | - Sydney Carolan
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, 94158, USA
| | | | - E Brook Goodhew
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Sarah Gwyn
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Jaouad Hammou
- Service of Ocular and Otological Diseases, Epidemiology and Disease Control Directorate, Ministry of Health, Rabat, Morocco
| | - Boubacar Kadri
- Programme National de Santé Oculaire, Niamey, Niger
- Programme National de Lutte Contre la Cecité, Niamey, Niger
| | - Khumbo Kalua
- Blantyre Institute for Community Outreach, Blantyre, Malawi
| | | | - Beido Nassirou
- Programme National de Santé Oculaire, Niamey, Niger
- Programme National de Lutte Contre la Cecité, Niamey, Niger
| | - Fikre Seife
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | | | - Sheila K West
- Johns Hopkins School of Medicine, Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Baltimore, MD, USA
| | - Dionna M Wittberg
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, 94158, USA
| | | | - Benjamin F Arnold
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, 94158, USA.
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, 94158, USA.
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Tedijanto C, Solomon AW, Martin DL, Nash SD, Keenan JD, Lietman TM, Lammie PJ, Aiemjoy K, Amza A, Aragie S, Arzika AM, Callahan EK, Carolan S, Dawed AA, Goodhew EB, Gwyn S, Hammou J, Kadri B, Kalua K, Maliki R, Nassirou B, Seife F, Tadesse Z, West SK, Wittberg DM, Zeru T, Arnold BF. Monitoring transmission intensity of trachoma with serology. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.02.13.23285881. [PMID: 36824972 PMCID: PMC9949201 DOI: 10.1101/2023.02.13.23285881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Trachoma, caused by ocular Chlamydia trachomatis infection, is targeted for global elimination as a public health problem by 2030. To provide evidence for use of antibodies to monitor C. trachomatis transmission, we collated IgG responses to Pgp3 antigen, PCR positivity, and clinical observations from 19,811 children aged 1- 9 years in 14 populations. We demonstrate that age-seroprevalence curves consistently shift along a gradient of transmission intensity: rising steeply in populations with high levels of infection and active trachoma and becoming flat in populations near elimination. Seroprevalence (range: 0-54%) and seroconversion rates (range: 0-15 per 100 person-years) correlate with PCR prevalence (r: 0.87, 95% CI: 0.57, 0.97). A seroprevalence threshold of 13.5% (seroconversion rate 2.75 per 100 person-years) identifies clusters with any PCR-identified infection at high sensitivity (>90%) and moderate specificity (69-75%). Antibody responses in young children provide a robust, generalizable approach to monitor population progress toward and beyond trachoma elimination.
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Affiliation(s)
- Christine Tedijanto
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA, 94158
| | - Anthony W. Solomon
- Global Neglected Tropical Diseases Programme, World Health Organization, Geneva, Switzerland
| | - Diana L. Martin
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, USA 30329
| | | | - Jeremy D. Keenan
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA, 94158
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA, 94158
| | - Thomas M. Lietman
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA, 94158
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA, 94158
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA 94143
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94143
| | - Patrick J. Lammie
- Neglected Tropical Diseases Support Center, Task Force for Global Health, Atlanta, GA, USA, 30030
| | - Kristen Aiemjoy
- Division of Epidemiology, Department of Public Health Sciences, University of California Davis School of Medicine, Davis, CA, USA
| | - Abdou Amza
- Programme National de Santé Oculaire, Niamey, Niger
- Programme National de Lutte Contre la Cecité, Niamey, Niger
| | - Solomon Aragie
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA, 94158
- The Carter Center Ethiopia, Addis Ababa, Ethiopia
- Infection Biology, Addis Ababa University, Addis Ababa, Ethiopia
| | | | | | - Sydney Carolan
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA, 94158
| | | | - E. Brook Goodhew
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, USA 30329
| | - Sarah Gwyn
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, USA 30329
| | - Jaouad Hammou
- Service of Ocular and Otological Diseases, Epidemiology and Disease Control Directorate, Ministry of Health, Morocco
| | - Boubacar Kadri
- Programme National de Santé Oculaire, Niamey, Niger
- Programme National de Lutte Contre la Cecité, Niamey, Niger
| | - Khumbo Kalua
- Blantyre Institute for Community Outreach, Malawi
| | | | - Beido Nassirou
- Programme National de Santé Oculaire, Niamey, Niger
- Programme National de Lutte Contre la Cecité, Niamey, Niger
| | - Fikre Seife
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | | | - Sheila K. West
- Johns Hopkins School of Medicine, Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Baltimore MD USA
| | - Dionna M. Wittberg
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA, 94158
| | - Taye Zeru
- Amhara Public Health Institute, Bahir-Dar, Ethiopia
| | - Benjamin F. Arnold
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA, 94158
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA, 94158
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Naufal F, Brady CJ, Muñoz B, Mkocha H, West SK. Comparison of Five Camera Systems for Capturing and Grading Trachoma Images. Ophthalmic Epidemiol 2023:1-6. [PMID: 36775887 DOI: 10.1080/09286586.2023.2174559] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/16/2023] [Accepted: 01/25/2023] [Indexed: 02/14/2023]
Abstract
PURPOSE As training of trachoma graders using live participants grows increasingly difficult and expensive, alternative ways are needed possibly through replacement of field grading with photography. However, minimum specifications for a camera system capable of capturing high quality images have not been defined. This study compared images captured using four smartphones with those from a Nikon SLR camera for image quality and assessment of trachomatous inflammation - follicular (TF). METHODS The smartphones - Samsung Galaxy S8 (S8), Techno Camon 17 pro (TC), Infinix Note 10 pro (IN), Huawei p30 pro (HP) - were chosen for their availability and likelihood of good performance based on specifications without external attachments. All smartphones were used in random order for each participant. RESULTS 129 children in Kongwa, Tanzania were enrolled (32.8% TF prevalence). The SLR camera had the least percent of ungradable images (3.1%), followed by the S8 (14%), HP (23.4%), IN (65.9%), and TC (71.2%). The S8 and the HP were significantly more likely to take ungradable images if they were used toward the end of the camera rotation. Agreement between the SLR and field grade was kappa = 0.73. Agreement between the field grade and gradable images from the S8 (0.68) and HP (0.8) was measured. CONCLUSIONS Published specifications did not predict the success of using different smartphones for everted eyelid photographs; proprietary post-processing software likely influenced gradeability. Smartphones, though we cannot recommend those tested in this study, may be viable for capturing images for trachoma provided the quality of images from the field are adequate.
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Affiliation(s)
- Fahd Naufal
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Beatriz Muñoz
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Sheila K West
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA
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