Cohort and age effects of mass drug administration on prevalence of trachoma: a longitudinal study in rural Tanzania.
OBJECTIVE
Mass drug administration (MDA) is part of the SAFE strategy for trachoma elimination. This study examined the effect of three annual MDAs on prevalence of trachoma among 13 longitudinal cohorts of Tanzanian children.


METHODS
Children younger than 10 years were assigned to cohorts based on age at baseline and followed annually for 3 years, with newborns assigned to new cohorts over time. Annual MDA consisted of topical tetracycline for children younger than 6 months and oral azithromycin for those 6 months and older. Follicular trachoma (TF) and Chlamydia trachomatis infection status were assessed annually before the next MDA. Prevalence and risk factors for TF and infection at each age were compared across cohorts.


RESULTS
At each survey, most age groups and cohorts had MDA coverage of more than 80% and showed decreased TF prevalence after every MDA. One cohort had consistently lower coverage, higher-than-expected TF and infection at ages 6 and 7, and elevated risk of TF at age 7 relative to the preceding cohort in spite of receiving one additional MDA (odds ratio 2.3, 95% confidence interval 1.0-5.2). Cohorts aged 1 or older at baseline generally showed reductions in TF and infection after each MDA, whereas younger cohorts showed decreased infection but increased TF over time. Successive cohorts of never-treated children younger than 1 year showed sequential TF and infection reductions with each MDA (P < 0.001).


CONCLUSIONS
Multiple MDAs significantly reduce trachoma prevalence and appear to increasingly protect children born into these communities. The youngest children show declining/stable rates of infection but increasing rates of trachoma, which may reflect longer duration of clinical signs.
Dana Center for Preventive Ophthalmology, Johns Hopkins University, Baltimore, Maryland, United States.
Nakul
N
Shekhawat
Harran
H
Mkocha
Beatriz
B
Munoz
Charlotte
C
Gaydos
Laura
L
Dize
Thomas C
TC
Quinn
Sheila K
SK
West
D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D015995:Prevalence; D011379:Prognosis; D012424:Rural Population; D013636:Tanzania / Q000453:epidemiology; D014141:Trachoma / Q000188:drug therapy* / Q000453:epidemiology
D000900:Anti-Bacterial Agents
Tanzania; cohort study; mass drug administration (MDA); population-based study; trachoma