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Wolle MA, West SK. Ocular Chlamydia trachomatis infection: elimination with mass drug administration. Expert Rev Anti Infect Ther 2019; 17:189-200. [PMID: 30698042 DOI: 10.1080/14787210.2019.1577136] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Ocular Chlamydia trachomatis infection, the causative agent for trachoma, is responsible for 1.9 million cases of visual loss worldwide. Mass Drug Administration (MDA) with azithromycin to entire trachoma-endemic districts is part of the World Health Organization's public health strategy for trachoma elimination. Areas covered: Background on C. trachomatis and the epidemiology of trachoma are presented, followed by a review of the antibiotics for treatment and the need for a public health approach to trachoma elimination. The effectiveness of mass drug administration is presented, concluding with challenges to trachoma elimination in the future. Expert opinion: MDA using azithromycin is a key component of the public health strategy for trachoma elimination. With high coverage in children, there is good evidence that MDA drops the community pool of infection. There are challenges to trachoma elimination by the year 2020, and the drug donation program for country MDAs will be integral to ongoing efforts.
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Affiliation(s)
- Meraf A Wolle
- a Dana Center for Preventive Ophthalmology , Johns Hopkins Medical Institutions , Baltimore , MD , USA
| | - Sheila K West
- a Dana Center for Preventive Ophthalmology , Johns Hopkins Medical Institutions , Baltimore , MD , USA
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Marks M, Bottomley C, Tome H, Pitakaka R, Butcher R, Sokana O, Kako H, Solomon AW, Mabey DC. Mass drug administration of azithromycin for trachoma reduces the prevalence of genital Chlamydia trachomatis infection in the Solomon Islands. Sex Transm Infect 2016; 92:261-5. [PMID: 26888658 PMCID: PMC4893086 DOI: 10.1136/sextrans-2015-052439] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 01/23/2016] [Indexed: 11/30/2022] Open
Abstract
Objectives Chlamydia trachomatis is the most common bacterial sexually transmitted infection and is frequently asymptomatic; ocular C. trachomatis strains cause trachoma. Mass drug administration (MDA) of azithromycin for trachoma might also reduce the prevalence of genital C. trachomatis. In a survey conducted in the Solomon Islands in 2014, prior to MDA, the prevalence of genital C. trachomatis was 20.3% (95% CI 15.9% to 25.4%). We conducted a survey to establish the impact of MDA with azithromycin on genital C. trachomatis. Methods Women attending three community outpatient clinics, predominantly for antenatal care, 10 months after MDA with azithromycin given for trachoma elimination, were enrolled in this survey. Self-taken high vaginal swabs were for C. trachomatis and Neisseria gonorrhoeae using the BD Probetec strand displacement assay. Results 298 women were enrolled. C. trachomatis infection was diagnosed in 43 women (14.4%, 95% CI 10.6% to 18.9%) and N. gonorrhoeae in 9 (3%, 95% CI 1.4% to 5.7%). The age-adjusted OR for C. trachomatis infection was consistent with a significant decrease in the prevalence of C. trachomatis following MDA (OR 0.58, 95% CI 0.37 to 0.94, p=0.027). There was no change in the prevalence of N. gonorrhoeae between following MDA (OR 0.51, 95% CI 0.22 to 1.22, p=0.13). Conclusions This study demonstrated a 40% reduction in the age-adjusted prevalence of genital C. trachomatis infection following azithromycin MDA for trachoma elimination.
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Affiliation(s)
- M Marks
- Faculty of Infectious and Tropical Diseases, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK Hospital for Tropical Diseases, University College London Hospitals NHS Trust, London, UK
| | - C Bottomley
- Department of Infectious Diseases Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - H Tome
- Nursing Division, Honiara City Council, Honiara, Solomon Islands
| | - R Pitakaka
- National Referral Hospital, Honiara, Solomon Islands
| | - R Butcher
- Faculty of Infectious and Tropical Diseases, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - O Sokana
- Eye Health Department, Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - H Kako
- Department of STI and HIV Prevention, Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - A W Solomon
- Faculty of Infectious and Tropical Diseases, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK Hospital for Tropical Diseases, University College London Hospitals NHS Trust, London, UK
| | - D C Mabey
- Faculty of Infectious and Tropical Diseases, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK Hospital for Tropical Diseases, University College London Hospitals NHS Trust, London, UK
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Seidman JC, Coles CL, Silbergeld EK, Levens J, Mkocha H, Johnson LB, Muñoz B, West SK. Increased carriage of macrolide-resistant fecal E. coli following mass distribution of azithromycin for trachoma control. Int J Epidemiol 2014; 43:1105-13. [PMID: 24659584 DOI: 10.1093/ije/dyu062] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Mass drug treatment with azithromycin (MDA) is part of the WHO-endorsed 'SAFE' strategy for trachoma control in endemic communities. MDA has been associated with reduced trachoma prevalence and short-term reductions in other bacterial infections, but can also lead to increased circulation of macrolide-resistant bacteria. METHODS We prospectively monitored macrolide resistance in fecal E. coli collected from young children participating in the PRET+ Study in rural Tanzania. MDA was administered in four villages with >10% trachoma prevalence. Four nearby communities with lower trachoma prevalence served as controls. Rectal swabs were collected during cross-sectional surveys performed at baseline, 1, 3 and 6 months after MDA. Fecal E. coli isolates were screened for macrolide susceptibility using disc diffusion and minimum inhibitory concentration methods. Cross-sectional and longitudinal differences in resistance prevalence by MDA exposure were compared using t-tests and logistic regression. RESULTS There was no difference in the proportion of individuals carrying azithromycin-resistant E. coli at baseline (0.21 vs. 0.16, P > 0.05). Azithromycin resistance carriage prevalence remained stable over follow-up in non-MDA villages but increased sharply in MDA villages (0.61 at 1 month, 0.42 at 3 months and 0.31 at 6 months). MDA exposure was highly associated with azithromycin resistance carriage at 1 month post-MDA (OR 15.27, P < 0.001) and subsequent surveys. Younger age and recent diarrhoea were also associated with increased odds of resistance (P < 0.01). CONCLUSIONS MDA resulted in significantly increased prevalence of macrolide resistance in E. coli. Although MDA is effective for trachoma elimination, it has costs; it is essential to monitor antimicrobial resistance following MDA.
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Affiliation(s)
- Jessica C Seidman
- Department of International Health, Department of Environmental Health and Dana Center for Preventive Ophthalmology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Kongwa Trachoma Project, Kongwa, United Republic of Tanzania and Biology Department, Morgan State University, Baltimore, MD, USA
| | - Christian L Coles
- Department of International Health, Department of Environmental Health and Dana Center for Preventive Ophthalmology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Kongwa Trachoma Project, Kongwa, United Republic of Tanzania and Biology Department, Morgan State University, Baltimore, MD, USA
| | - Ellen K Silbergeld
- Department of International Health, Department of Environmental Health and Dana Center for Preventive Ophthalmology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Kongwa Trachoma Project, Kongwa, United Republic of Tanzania and Biology Department, Morgan State University, Baltimore, MD, USA
| | - Joshua Levens
- Department of International Health, Department of Environmental Health and Dana Center for Preventive Ophthalmology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Kongwa Trachoma Project, Kongwa, United Republic of Tanzania and Biology Department, Morgan State University, Baltimore, MD, USA
| | - Harran Mkocha
- Department of International Health, Department of Environmental Health and Dana Center for Preventive Ophthalmology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Kongwa Trachoma Project, Kongwa, United Republic of Tanzania and Biology Department, Morgan State University, Baltimore, MD, USA
| | - Lashaunda B Johnson
- Department of International Health, Department of Environmental Health and Dana Center for Preventive Ophthalmology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Kongwa Trachoma Project, Kongwa, United Republic of Tanzania and Biology Department, Morgan State University, Baltimore, MD, USA
| | - Beatriz Muñoz
- Department of International Health, Department of Environmental Health and Dana Center for Preventive Ophthalmology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Kongwa Trachoma Project, Kongwa, United Republic of Tanzania and Biology Department, Morgan State University, Baltimore, MD, USA
| | - Sheila K West
- Department of International Health, Department of Environmental Health and Dana Center for Preventive Ophthalmology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Kongwa Trachoma Project, Kongwa, United Republic of Tanzania and Biology Department, Morgan State University, Baltimore, MD, USA
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Goldschmidt P, Einterz E. The limits of medical interventions for the elimination of preventable blindness. Trop Med Health 2014; 42:43-52. [PMID: 24808746 PMCID: PMC3965845 DOI: 10.2149/tmh.2013-26] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 12/21/2013] [Indexed: 11/11/2022] Open
Abstract
Background: Health authorities are working toward the global elimination of trachoma by the year 2020 with actions focused on the World Health Organization SAFE strategy (surgery of trichiasis, antibiotics, face washing and environmental changes) with emphasis on hygienist approaches for education. Objectives: The present survey was performed to assess the sustainability of the SAFE strategy 3 years after trachoma was eliminated from 6 villages. Methods: In February 2013 a rapid trachoma assessment was conducted in 6 villages of Kolofata’s district, Extreme north Region, Cameroon, where trachoma was eliminated in 2010. A total of 300 children (1–10 years) from 6 villages were examined by trained staff. Results: The prevalence of active trachoma (children aged > 1 and < 10 years) in 2013 was 15% and in at least 25% was observed absence of face washing and flies in their eyes and nose. Income level, quality of roads, hygiene, and illiteracy were similar in all the villages; they did not change between 2010 and 2013 and could not be analyzed as independent risk factors. Discussion: The heterogeneity of methods described for clinical trials makes it inappropriate to conduct meta-analysis for the present and for other SAFE-related trials. The results obtained after implementation the SAFE strategy (recurrence) reveal that the causes (infectious agents and dirtiness) and effects (illness) were not connected by illiterate people living under conditions of extreme poverty. So far, antibiotics, surgery and hygiene education are insufficient for the sustainability of trachoma elimination and highlight that hypothetic-deductive processes seem not operational after implementing the awareness campaigns. Trachoma recurrence detected in 2013 in sedentary populations of Kolofata receiving efficacious treatments against Chlamydia sp. suggest that the elimination goals will be delayed if strategies are limited to medical actions. Restricting efforts to repeated pharmacological and surgical interventions for people infected with susceptible bacteria could be understood as the hidden side of a passive attitude toward basic education actions.
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Affiliation(s)
- Pablo Goldschmidt
- Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris France and Ophtalmo sans Frontières, Luçon, France
| | - Ellen Einterz
- Hôpital de District de Kolofata, Far North Region, Cameroon
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Bamani S, Toubali E, Diarra S, Goita S, Berté Z, Coulibaly F, Sangaré H, Tuinsma M, Zhang Y, Dembelé B, Melvin P, MacArthur C. Enhancing community knowledge and health behaviors to eliminate blinding trachoma in Mali using radio messaging as a strategy. HEALTH EDUCATION RESEARCH 2013; 28:360-370. [PMID: 23125253 DOI: 10.1093/her/cys105] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The National Blindness Prevention Program in Mali has broadcast messages on the radio about trachoma as part of the country's trachoma elimination strategy since 2008. In 2011, a radio impact survey using multi-stage cluster sampling was conducted in the regions of Kayes and Segou to assess radio listening habits, coverage of the broadcasts, community knowledge and behavior specific to trachoma and facial cleanliness of children. Radio access and listening were high, with 60% of respondents having heard a message on the radio about trachoma. The majority of respondents knew about trachoma, its root causes, its impact on health and prevention measures. Additionally, 66% reported washing their children's faces more than or equal to twice/day and 94% reported latrine disposal of feces. A high percentage of persons who gave a positive response to knowledge and behavior questions reported hearing the trachoma messages on the radio with 60% reporting that the radio is where they learned about trachoma. There was no significant difference in facial cleanliness when comparing children whose primary caregiver had/had not heard the trachoma messages. Next steps include revising the current messages to include more focused behavior change messaging and to engage in a more robust use of community radios.
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Affiliation(s)
- Sanoussi Bamani
- Programme National de Lutte Contre la Cécité, Ministère de la Santé, Bamako, Mali
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Abstract
PURPOSE OF REVIEW To review recent clinical and epidemiological studies regarding the prevention, diagnosis, and treatment of trachoma. RECENT FINDINGS Newer studies propose novel diagnostic tests that appear sensitive for the detection of ocular chlamydial infection. For example, recent studies with ribosomal RNA-based nucleic acid amplification tests (NAATs) have demonstrated improved sensitivities compared to DNA-based NAATs; and the progression of scarring has now been characterized with confocal microscopy. Immunologic studies have further explored the etiology of clinical sequelae, suggesting that chronic inflammation can lead to progressive scarring even in the absence of Chlamydia. Mass oral azithromycin distributions remain a mainstay of treatment; studies have assessed the appropriate frequency and duration of treatment programs. Current studies have also explored ancillary effects of azithromycin distribution on mortality and bacterial infections. SUMMARY Trachoma programs have had remarkable success at reducing chlamydial infection and clinical signs of trachoma. Recent work suggests improved methods to monitor infection and scarring, and better ways to distribute treatment. Whereas studies continue to demonstrate reduction in infection in hyperendemic areas, more work is necessary to achieve elimination of this blinding disease.
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