Evaluation of a Single Dose of Azithromycin for Trachoma in Low-Prevalence Communities

• Published in: Ophthalmic epidemiology 2019-01, Vol.26 (1), p.1-6
• Main Authors: Wilson, Nana, Goodhew, Brook, Mkocha, Harran, Joseph, Kahaliah, Bandea, Claudiu, Black, Carolyn, Igietseme, Joseph, Munoz, Beatriz, West, Sheila K., Lammie, Patrick, Kasubi, Mabula, Martin, Diana L.
• Format: Article
• Language: English
• Subjects: Anti-Bacterial Agents - administration & dosage; Antibody; Azithromycin - administration & dosage; Child; Child, Preschool; chlamydia; Chlamydia trachomatis - genetics; DNA, Bacterial - analysis; Dose-Response Relationship, Drug; Eye Infections, Bacterial - drug therapy; Eye Infections, Bacterial - epidemiology; Eye Infections, Bacterial - microbiology; Female; Follow-Up Studies; Humans; Infant; Male; mass drug administration; Original; Prevalence; Tanzania - epidemiology; Time Factors; trachoma; Trachoma - drug therapy; Trachoma - epidemiology; Trachoma - microbiology; trachomatis; Treatment Outcome
• ISSN: 0928-6586; 1744-5086
• DOI: 10.1080/09286586.2017.1293693

Purpose: Trachoma, caused by repeated ocular infection with Chlamydia trachomatis, is the leading infectious cause of blindness worldwide and is targeted for elimination as a public health problem. We sought to determine whether a one-time azithromycin mass treatment would reduce trachomatous inflammation-follicular (TF) levels below the elimination threshold of 5% in communities with disease prevalence between 5 and 9.9%. Methods: The study was conducted in 96 sub-village units (balozis) in the Kongwa district of Tanzania which were predicted from prior prevalence surveys to have TF between 5 and 9.9%. Balozis were randomly assigned to the intervention and control arms. The intervention arm received a single mass drug administration of azithromycin. At baseline and 12-month follow-up, ocular exams for trachoma, ocular swabs for detection of chlamydial DNA, and finger prick blood for analysis of anti-chlamydial antibody were taken. Results: Comparison of baseline and 12-month follow-up showed no significant difference in the overall TF 1-9 prevalence by balozi between control and treatment arms. In the treatment arm there was a significant reduction of ocular infection 12 months after treatment (p = 0.004) but no change in the control arm. No change in Pgp3-specific antibody responses were observed after treatment in the control or treatment arms. Anti-CT694 responses increased in both study arms (p = 0.009 for control arm and p = 0.04 for treatment arm). Conclusion: These data suggest that a single round of MDA may not be sufficient to decrease TF levels below 5% when TF 1-9 is between 5 and 9.9% at baseline.