Complete local elimination of infectious trachoma from severely affected communities after six biannual mass azithromycin distributions.
OBJECTIVE
To determine whether infectious trachoma can be completely eliminated from severely affected villages.


METHODS
Cross-sectional survey of 2 villages previously enrolled and monitored over 42 months as part of a larger, group-randomized clinical trial.


METHODS
A total of 758 individuals residing in 2 villages with high baseline trachoma prevalence, of a total population of 768 (98.7%).


METHODS
All members of the 2 villages were offered 6 biannual mass treatments with oral azithromycin. At 42 months, each current village member was examined. The right upper tarsal conjunctiva was everted and swabbed. Samples were processed for evidence of Chlamydia trachomatis RNA.


METHODS
Clinical activity by World Health Organization simplified grading scale for trachoma and laboratory evidence of chlamydial RNA.


RESULTS
Average antibiotic coverage over the study period was 90% and 94% in the 2 villages. Clinical trachoma activity in children aged 1 to 5 years decreased from 78% and 83% in the 2 villages before treatment to 17% and 24% at 42 months. Polymerase chain reaction (PCR) evidence of infection in the same age group decreased from 48% to 0% in both villages at 42 months. When all age groups were examined, there were zero cases with evidence of chlamydial RNA among 758 total villagers tested.


CONCLUSIONS
Biannual mass distribution of azithromycin can locally eliminate ocular chlamydial infection from severely affected communities.
Biebesheimer
Jesse B
JB
FI Proctor Foundation, University of California, San Francisco, California 94143-0412, USA.
House
Jenafir
J
Hong
Kevin Cyrus
KC
Lakew
Takele
T
Alemayehu
Wondu
W
Zhou
Zhaoxia
Z
Moncada
Jeanne
J
Rogér
Andrew
A
Keenan
Jeremy
J
Gaynor
Bruce D
BD
Schachter
Julius
J
Lietman
Thomas M
TM
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D017963:Azithromycin / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D002692:Chlamydia trachomatis / Q000235:genetics / Q000302:isolation & purification; D003228:Conjunctiva / Q000382:microbiology; D003430:Cross-Sectional Studies; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D015995:Prevalence; D012329:RNA, Bacterial / Q000032:analysis; D012424:Rural Population; D014141:Trachoma / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D055815:Young Adult
D000900:Anti-Bacterial Agents; D012329:RNA, Bacterial; D017963:Azithromycin