Strategies for control of trachoma: observational study with quantitative PCR.
BACKGROUND
Antibiotics are an important part of WHO's strategy to eliminate trachoma as a blinding disease by 2020. At present, who needs to be treated is unclear. We aimed to establish the burden of ocular Chlamydia trachomatis in three trachoma-endemic communities in Tanzania and The Gambia with real-time quantitative PCR.


METHODS
Conjunctival swabs were obtained at examination from 3146 individuals. Swabs were first tested by the qualitative Amplicor PCR, which is known to be highly sensitive. In positive samples, the number of copies of omp1 (a single-copy C trachomatis gene) was measured by quantitative PCR.


RESULTS
Children had the highest ocular loads of C trachomatis, although the amount of pooling in young age groups was less striking at the site with the lowest trachoma frequency. Individuals with intense inflammatory trachoma had higher loads than did those with other conjunctival signs. At the site with the highest prevalence of trachoma, 48 of 93 (52%) individuals with conjunctival scarring but no sign of active disease were positive for ocular chlamydiae.


CONCLUSIONS
Children younger than 10 years old, and those with intense inflammatory trachoma, probably represent the major source of ocular C trachomatis infection in endemic communities. Success of antibiotic distribution programmes could depend on these groups receiving effective treatment.
Solomon
Anthony W
AW
London School of Hygiene and Tropical Medicine, WC1E 7HT, London, UK.
Holland
Martin J
MJ
Burton
Matthew J
MJ
West
Sheila K
SK
Alexander
Neal D E
ND
Aguirre
Aura
A
Massae
Patrick A
PA
Mkocha
Harran
H
Muñoz
Beatriz
B
Johnson
Gordon J
GJ
Peeling
Rosanna W
RW
Bailey
Robin L
RL
Foster
Allen
A
Mabey
David C W
DC
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D002692:Chlamydia trachomatis / Q000235:genetics / Q000302:isolation & purification*; D015169:Colony Count, Microbial / Q000379:methods; D003228:Conjunctiva / Q000382:microbiology; D004269:DNA, Bacterial / Q000235:genetics / Q000302:isolation & purification; D019353:Endemic Diseases / Q000706:statistics & numerical data; D005260:Female; D005714:Gambia / Q000453:epidemiology; D005798:Genes, Bacterial / Q000235:genetics*; D006801:Humans; D007223:Infant; D008297:Male; D016133:Polymerase Chain Reaction / Q000379:methods*; D015995:Prevalence; D013048:Specimen Handling; D013636:Tanzania / Q000453:epidemiology; D014141:Trachoma / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology*
D004269:DNA, Bacterial