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Nash SD, Sata E, Chernet A, Gonzalez TA, Nute AW, Ontiveros VC, Gessese D, Zerihun M, Jensen KA, Yismaw G, Zeru T, Melak B, Ayele Z, Mihretu F, Seife F, Tadesse Z, Callahan EK. The Epidemiology of Ocular Chlamydia trachomatis Infection within Districts Persistently Endemic for Trachoma in Amhara, Ethiopia. Am J Trop Med Hyg 2024; 111:105-113. [PMID: 38955191 PMCID: PMC11376115 DOI: 10.4269/ajtmh.23-0876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/27/2024] [Indexed: 07/04/2024] Open
Abstract
Persistent trachoma is a growing concern to trachoma control programs globally and programs serving Ethiopia specifically. Persistent trachoma is defined as a district with two or more trachoma impact surveys (TISs) at which the prevalence of trachomatous inflammation-follicular (TF) among children ages 1-9 years is ≥5%, the elimination threshold. Because the global target for trachoma elimination as a public health problem is 2030, research is needed to better characterize persistent trachoma. This study described the epidemiology of ocular Chlamydia trachomatis infection, the causative bacteria of trachoma, in seven contiguous districts experiencing persistent trachoma. In 2019, multistage cluster random sampling TISs were conducted in the seven districts after 10 years of interventions. All individuals ages ≥1 year were examined for trachoma clinical signs by certified graders, and conjunctival swabs were collected from children ages 1-5 years to test for C. trachomatis infection. The district TF prevalence ranged from 11.8% (95% CI:7.6-16.0%) to 36.1% (95% CI:27.4-44.3%). The range of district-level C. trachomatis infection prevalence was between 2.7% and 34.4%. Statistically significant spatial clustering of high-infection communities was observed in the study districts, and children with infection were more likely than those without to be found in households with clinical signs of trachoma and those without latrines. These seven districts appear to constitute a persistent hotspot in Amhara, where an additional 3-5 years or more of interventions will be required. The global program will need to strengthen and enhance intervention strategies within persistent districts if elimination by 2030 is to be achieved.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Taye Zeru
- Amhara Public Health Institute, Bahir Dar, Ethiopia
| | | | | | | | - Fikre Seife
- Federal Ministry of Health, Addis Ababa, Ethiopia
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Pitt SJ, Gunn A. The One Health Concept. Br J Biomed Sci 2024; 81:12366. [PMID: 38434675 PMCID: PMC10902059 DOI: 10.3389/bjbs.2024.12366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/05/2024] [Indexed: 03/05/2024]
Abstract
The concept of One Health has been developed as the appreciation that human health is intricately connected to those of other animals and the environment that they inhabit. In recent years, the COVID-19 pandemic and noticeable effects of climate change have encouraged national and international cooperation to apply One Health strategies to address key issues of health and welfare. The United Nations (UN) Sustainable Development Goals have established targets for health and wellbeing, clean water and sanitation, climate action, as well as sustainability in marine and terrestrial ecosystems. The One Health Quadripartite comprises the World Health Organization (WHO), the World Organization for Animal Health (WOAH-formerly OIE), the United Nations Food and Agriculture Organization (FAO) and the United Nations Environment Programme (UNEP). There are six areas of focus which are Laboratory services, Control of zoonotic diseases, Neglected tropical diseases, Antimicrobial resistance, Food safety and Environmental health. This article discusses the concept of One Health by considering examples of infectious diseases and environmental issues under each of those six headings. Biomedical Scientists, Clinical Scientists and their colleagues working in diagnostic and research laboratories have a key role to play in applying the One Health approach to key areas of healthcare in the 21st Century.
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Affiliation(s)
- Sarah J. Pitt
- School of Applied Sciences, University of Brighton, Brighton, United Kingdom
| | - Alan Gunn
- School of Biological and Environmental Sciences, Liverpool John Moores University, Liverpool, United Kingdom
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Abstract
Trachoma is a neglected tropical disease caused by infection with conjunctival strains of Chlamydia trachomatis. It can result in blindness. Pathophysiologically, trachoma is a disease complex composed of two linked chronic processes: a recurrent, generally subclinical infectious-inflammatory disease that mostly affects children, and a non-communicable, cicatricial and, owing to trichiasis, eventually blinding disease that supervenes in some individuals later in life. At least 150 infection episodes over an individual's lifetime are needed to precipitate trichiasis; thus, opportunity exists for a just global health system to intervene to prevent trachomatous blindness. Trachoma is found at highest prevalence in the poorest communities of low-income countries, particularly in sub-Saharan Africa; in June 2021, 1.8 million people worldwide were going blind from the disease. Blindness attributable to trachoma can appear in communities many years after conjunctival C. trachomatis transmission has waned or ceased; therefore, the two linked disease processes require distinct clinical and public health responses. Surgery is offered to individuals with trichiasis and antibiotic mass drug administration and interventions to stimulate facial cleanliness and environmental improvement are designed to reduce infection prevalence and transmission. Together, these interventions comprise the SAFE strategy, which is achieving considerable success. Although much work remains, a continuing public health problem from trachoma in the year 2030 will be difficult for the world to excuse.
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Global progress toward the elimination of active trachoma: an analysis of 38 countries. Lancet Glob Health 2022; 10:e491-e500. [PMID: 35303459 DOI: 10.1016/s2214-109x(22)00050-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 01/27/2022] [Accepted: 02/03/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Global elimination of trachoma as a public health problem was targeted for 2020. We reviewed progress towards the elimination of active trachoma by country and geographical group. METHODS In this retrospective analysis of national survey and implementation data, all countries ever known to be endemic for trachoma that had either implemented at least one trachoma impact survey shown in the publicly available Trachoma Atlas, or are in Africa were invited to participate in this study. Scale-up was described according to the number of known endemic implementation units and mass drug administration implementation over time. The prevalence of active trachoma-follicular among children aged 1-9 years (TF1-9) from baseline, impact, and surveillance surveys was categorised and used to show programme progress towards reaching the elimination threshold (TF1-9 <5%) using dot maps, spaghetti plots, and boxplots. FINDINGS We included data until Nov 10, 2021, for 38 countries, representing 2097 ever-endemic implementation units. Of these, 1923 (91·7%) have had mass drug administration. Of 1731 implementation units with a trachoma impact survey, the prevalence of TF1-9 had reduced by at least 50% in 1465 (84·6%) implementation units and 1182 (56·4%) of 2097 ever-endemic implementation units had reached the elimination threshold. 2 years after reaching a TF1-9 prevalence below 5%, most implementation units sustained this target; however, 58 (56·3%) of 103 implementation units in Ethiopia showed recrudescence. INTERPRETATION Global elimination of trachoma as a public health problem by 2020 was not possible, but this finding masks the great progress achieved. Implementation units in high baseline categories and recrudescent TF1-9 might prolong the attainment of elimination of active trachoma. Elimination is delayed but, with an understanding of the patterns and timelines to reaching elimination targets and a commitment toward meeting future targets, global elimination can still be achieved by 2030. FUNDING None.
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Comparison of platforms for testing antibodies to Chlamydia trachomatis antigens in the Democratic Republic of the Congo and Togo. Sci Rep 2021; 11:7225. [PMID: 33790370 PMCID: PMC8012353 DOI: 10.1038/s41598-021-86639-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 03/08/2021] [Indexed: 11/27/2022] Open
Abstract
Trachoma, caused by repeated ocular infection with Chlamydia trachomatis (Ct), is targeted for elimination as a public health problem. Serological testing for antibodies is promising for surveillance; determining useful thresholds will require collection of serological data from settings with different prevalence of the indicator trachomatous inflammation—follicular (TF). Dried blood spots were collected during trachoma mapping in two districts each of Togo and Democratic Republic of the Congo. Anti-Ct antibodies were detected by multiplex bead assay (MBA) and three different lateral flow assays (LFA) and seroprevalence and seroconversion rate (SCR) were determined. By most tests, the district with > 5% TF (the elimination threshold) had five–sixfold higher seroprevalence and tenfold higher SCR than districts with < 5% TF. The agreement between LFA and MBA was improved using a black latex developing reagent. These data show optimization of antibody tests against Ct to better differentiate districts above or below trachoma elimination thresholds.
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Nash SD, Astale T, Nute AW, Bethea D, Chernet A, Sata E, Zerihun M, Gessese D, Ayenew G, Ayele Z, Melak B, Haile M, Zeru T, Tadesse Z, Arnold BF, Callahan EK, Martin DL. Population-Based Prevalence of Chlamydia trachomatis Infection and Antibodies in Four Districts with Varying Levels of Trachoma Endemicity in Amhara, Ethiopia. Am J Trop Med Hyg 2021; 104:207-215. [PMID: 33200728 PMCID: PMC7790060 DOI: 10.4269/ajtmh.20-0777] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
The Trachoma Control Program in Amhara region, Ethiopia, scaled up the surgery, antibiotics, facial cleanliness, and environmental improvement (SAFE) strategy in all districts starting in 2007. Despite these efforts, many districts still require additional years of SAFE. In 2017, four districts were selected for the assessment of antibody responses against Chlamydia trachomatis antigens and C. trachomatis infection to better understand transmission. Districts with differing endemicity were chosen, whereby one had a previous trachomatous inflammation-follicular (TF) prevalence of ≥ 30% (Andabet), one had a prevalence between 10% and 29.9% (Dera), one had a prevalence between 5% and 10% (Woreta town), and one had a previous TF prevalence of < 5% (Alefa) and had not received antibiotic intervention for 2 years. Survey teams assessed trachoma clinical signs and took conjunctival swabs and dried blood spots (DBS) to measure infection and antibody responses. Trachomatous inflammation-follicular prevalence among children aged 1–9 years was 37.0% (95% CI: 31.1–43.3) for Andabet, 14.7% (95% CI: 10.0–20.5) for Dera, and < 5% for Woreta town and Alefa. Chlamydia trachomatis infection was only detected in Andabet (11.3%). Within these districts, 2,195 children provided DBS. The prevalence of antibody responses to the antigen Pgp3 was 36.9% (95% CI: 29.0–45.6%) for Andabet, 11.3% (95% CI: 5.9–20.6%) for Dera, and < 5% for Woreta town and Alefa. Seroconversion rate for Pgp3 in Andabet was 0.094 (95% CI: 0.069–0.128) events per year. In Andabet district, where SAFE implementation has occurred for 11 years, the antibody data support the finding of persistently high levels of trachoma transmission.
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Affiliation(s)
- Scott D Nash
- 1Trachoma Control Program, The Carter Center, Atlanta, Georgia
| | - Tigist Astale
- 2Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Andrew W Nute
- 1Trachoma Control Program, The Carter Center, Atlanta, Georgia
| | - Danaya Bethea
- 3Centers for Disease Control and Prevention, DPD, Atlanta, Georgia
| | - Ambahun Chernet
- 2Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Eshetu Sata
- 2Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Mulat Zerihun
- 2Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Demelash Gessese
- 2Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Gedefaw Ayenew
- 2Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Zebene Ayele
- 2Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Berhanu Melak
- 2Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Mahteme Haile
- 4Amhara Public Health Institute, Research and Technology Transfer Directorate, Bahir Dar, Ethiopia
| | - Taye Zeru
- 4Amhara Public Health Institute, Research and Technology Transfer Directorate, Bahir Dar, Ethiopia
| | - Zerihun Tadesse
- 2Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Benjamin F Arnold
- 5Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California.,6Department of Ophthalmology, University of California San Francisco, San Francisco, California
| | | | - Diana L Martin
- 3Centers for Disease Control and Prevention, DPD, Atlanta, Georgia
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Sata E, Nute AW, Astale T, Gessese D, Ayele Z, Zerihun M, Chernet A, Melak B, Jensen KA, Haile M, Zeru T, Beyen M, Dawed AA, Seife F, Tadesse Z, Callahan EK, Ngondi J, Nash SD. Twelve-Year Longitudinal Trends in Trachoma Prevalence among Children Aged 1-9 years in Amhara, Ethiopia, 2007-2019. Am J Trop Med Hyg 2021; 104:1278-1289. [PMID: 33534757 PMCID: PMC8045658 DOI: 10.4269/ajtmh.20-1365] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 11/23/2020] [Indexed: 11/07/2022] Open
Abstract
Trachoma control in the Amhara region of Ethiopia, where all districts were once endemic, began in 2001 and attained full scale-up of the Surgery, Antibiotics, Facial cleanliness, and Environmental improvement (SAFE) strategy by 2010. Since scaling up, the program has distributed approximately 14 million doses of antibiotic per year, implemented village- and school-based health education, and promoted latrine construction. This report aims to provide an update on the prevalence of trachoma among children aged 1-9 years as of the most recent impact or surveillance survey in all 160 districts of Amhara. As of 2019, 45 (28%) districts had a trachomatous inflammation-follicular (TF) prevalence below the 5% elimination threshold. There was a statistically significant relationship between TF prevalence observed at the first impact survey (2010-2015) and eventual achievement of TF < 5% (2015-2019). Of the 26 districts with a first impact survey < 10% TF, 20 (76.9%) had < 5% TF at the most recent survey. Of the 75 districts with a first survey between 10% and 29.9% TF, 21 (28.0%) had < 5% TF at the most recent survey. Finally, among 59 districts ≥ 30% TF at the first survey, four (6.8%) had < 5% TF by 2019. As of 2019, 30 (18.8%) districts remained with TF ≥ 30%. Amhara has seen considerable reductions of trachoma since the start of the program. A strong commitment to the SAFE strategy coupled with data-driven enhancements to that strategy is necessary to facilitate timely elimination of trachoma as a public health problem regionally in Amhara and nationwide in Ethiopia.
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Affiliation(s)
- Eshetu Sata
- 1Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Andrew W Nute
- 2Trachoma Control Program, The Carter Center, Atlanta, Georgia
| | - Tigist Astale
- 1Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Demelash Gessese
- 1Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Zebene Ayele
- 1Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Mulat Zerihun
- 1Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Ambahun Chernet
- 1Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Berhanu Melak
- 1Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | | | - Mahteme Haile
- 3Amhara Public Health Institute, Research and Technology Transfer Directorate, Bahir Dar, Ethiopia
| | - Taye Zeru
- 3Amhara Public Health Institute, Research and Technology Transfer Directorate, Bahir Dar, Ethiopia
| | - Melkamu Beyen
- 4Amhara Regional Health Bureau, Health Promotion and Disease Prevention, Bahir Dar, Ethiopia
| | - Adisu Abebe Dawed
- 4Amhara Regional Health Bureau, Health Promotion and Disease Prevention, Bahir Dar, Ethiopia
| | - Fikre Seife
- 5Federal Ministry of Health, Disease Prevention and Control Directorate, Addis Ababa, Ethiopia
| | - Zerihun Tadesse
- 1Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | | | - Jeremiah Ngondi
- 6RTI International, International Development (Global Health), London, United Kingdom
| | - Scott D Nash
- 2Trachoma Control Program, The Carter Center, Atlanta, Georgia
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Amza A, Kadri B, Nassirou B, Arzika AM, Austin A, Nyatigo F, Lebas E, Arnold BF, Lietman TM, Oldenburg CE. Azithromycin Reduction to Reach Elimination of Trachoma (ARRET): study protocol for a cluster randomized trial of stopping mass azithromycin distribution for trachoma. BMC Ophthalmol 2021; 21:15. [PMID: 33407263 PMCID: PMC7789605 DOI: 10.1186/s12886-020-01776-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 12/17/2020] [Indexed: 12/23/2022] Open
Abstract
Background The World Health Organization (WHO) recommends annual mass azithromycin distribution until districts drop below 5% prevalence of trachomatous inflammation—follicular (TF). Districts with very low TF prevalence may have little or no transmission of the ocular strains of Chlamydia trachomatis that cause trachoma, and additional rounds of mass azithromycin distribution may not be useful. Here, we describe the protocol for a randomized controlled trial designed to evaluate whether mass azithromycin distribution can be stopped prior to the current WHO guidelines. Methods The Azithromycin Reduction to Reach Elimination of Trachoma (ARRET) study is a 1:1 community randomized non-inferiority trial designed to evaluate whether mass azithromycin distribution can be stopped in districts with baseline prevalence of TF under 20%. Communities in Maradi, Niger are randomized after baseline assessment either to continued annual mass azithromycin distribution or stopping annual azithromycin distribution over a 3-year period. We will compare the prevalence of ocular C. trachomatis (primary outcome), TF and other clinical signs of trachoma, and serologic markers of trachoma after 3 years. We hypothesize that stopping annual azithromycin distribution will be non-inferior to continued annual azithromycin distributions for all markers of trachoma prevalence and transmission. Discussion The results of this trial are anticipated to provide potentially guideline-changing evidence for when mass azithromycin distributions can be stopped in low TF prevalence areas. Trial registration number This study is registered at clinicaltrials.gov (NCT04185402). Registered December 4, 2019; prospectively registered pre-results.
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Affiliation(s)
- Abdou Amza
- Programme National de Santé Oculaire, Ministere de la Santé Publique, Niamey, Niger
| | - Boubacar Kadri
- Programme National de Santé Oculaire, Ministere de la Santé Publique, Niamey, Niger
| | - Beido Nassirou
- Programme National de Santé Oculaire, Ministere de la Santé Publique, Niamey, Niger
| | - Ahmed M Arzika
- Centre de Recherche et d'Intervention en Santé Publique, Niamey, Niger
| | - Ariana Austin
- Francis I Proctor Foundation, University of California, San Francisco, USA
| | - Fanice Nyatigo
- Francis I Proctor Foundation, University of California, San Francisco, USA
| | - Elodie Lebas
- Francis I Proctor Foundation, University of California, San Francisco, USA
| | - Benjamin F Arnold
- Francis I Proctor Foundation, University of California, San Francisco, USA.,Department of Ophthalmology, University of California, 490 Illinois St, Floor 2, San Francisco, CA, 94158, USA
| | - Thomas M Lietman
- Francis I Proctor Foundation, University of California, San Francisco, USA.,Department of Ophthalmology, University of California, 490 Illinois St, Floor 2, San Francisco, CA, 94158, 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, 490 Illinois St, Floor 2, San Francisco, CA, 94158, USA. .,Department of Epidemiology & Biostatistics, University of California, San Francisco, USA.
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