title: Chlamydial infection during trachoma monitoring: are the most difficult-to-reach children more likely to be infected?
abstract: OBJECTIVE
  During mass antibiotic distributions for trachoma, certain individuals are difficult to locate and go untreated. These untreated individuals may serve as a source of community reinfection. The importance of this difficult-to-locate, untreated population is unclear. We sought to determine whether individuals who are difficult to locate were more likely to be infected with ocular chlamydia than those who were easier to locate.
  
  
  METHODS
  We monitored 12 Ethiopian communities 1 year after a third annual mass azithromycin treatment for trachoma. Conjunctival swabbing for chlamydial RNA was performed in a random sample of children from each community. If insufficient numbers of children were enrolled on the first monitoring day, we returned on subsequent days.
  
  
  RESULTS
  Of the 12 communities, 10 required more than one monitoring day. On average, 16.1% (95% CI 7.9-30.0) of children were enrolled after the initial day. Evidence of chlamydia was found in 7.1% (95% CI 2.7-17.4) of 0- to 9-year-old children. No ocular swabs collected after the initial day were positive for chlamydial RNA. Children examined after the initial monitoring day were significantly less likely to have ocular chlamydial infection than children seen on the initial day; Mantel-Haenszel common OR = 0 (95% CI 0-0.77).
  
  
  CONCLUSIONS
  In a setting of repeated annual mass azithromycin treatments, after approximately 80% of individuals have been located in a community, extra efforts to find absent individuals may not yield significantly more cases of ocular chlamydia.
authors: Francis I. Proctor Foundation, San Francisco, CA 94143-0412, USA. jeremy.keenan@ucsf.edu
authors: Jeremy D
authors: JD
authors: Keenan
authors: J
authors: J
authors: Moncada
authors: T
authors: T
authors: Gebre
authors: B
authors: B
authors: Ayele
authors: M C
authors: MC
authors: Chen
authors: S N
authors: SN
authors: Yu
authors: P M
authors: PM
authors: Emerson
authors: N E
authors: NE
authors: Stoller
authors: C E
authors: CE
authors: McCulloch
authors: B D
authors: BD
authors: Gaynor
authors: J
authors: J
authors: Schachter
mesh_terms: D017963:Azithromycin / Q000627:therapeutic use*; D002692:Chlamydia trachomatis / Q000235:genetics*; D003228:Conjunctiva / Q000382:microbiology*; D003695:Delivery of Health Care; D006297:Health Services Accessibility; D006801:Humans; D016017:Odds Ratio; D011159:Population Surveillance; D012111:Residence Characteristics; D014141:Trachoma / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology
chemical_list: D017963:Azithromycin