SUMMARYThe ability of two live trachoma vaccines to protect against naturally acquired infection was tested in young Gambian children. With a mineral oil adjuvant vaccine prepared from a Gambian strain of trachoma (MRC–187) a barely significant measure of protection was demonstrable 6 months after the first dose, but not at 1 year, despite a reinforcing dose given 6 months after the first. In a later trial an aqueous vaccine prepared from the ‘fast-killing’ variants of strains ‘SA–2’ and ‘ASGH’ failed to induce immunity. Two years after vaccination, the proportion of vaccinated children progressing to cicatricial trachoma was less than in the controls, and the average severity of the disease in terms of clinical score was greater; vaccine-induced hypersensitivity may have contributed to this result.Irrespective of whether they had received trachoma vaccine, children with completely normal eyes at the outset were less likely to acquire trachoma than those with slight conjunctival folliculosis or papillary hyperplasia. In children acquiring trachoma, there was a highly significant positive correlation between severity of the disease and the presence of conjunctival inclusions. The pattern of trachoma differed significantly in the two villages used in both trials; the prev alence, severity and proportion of inclusion-positive subjects were all higher in the village with the greater population density.An efficient follow-up organization, use of a slit-lamp for clinical observations, and a scoring system for recording physical signs are all desirable for trachoma vaccine field trials.We are highly indebted to Dr G. Turner (Lister Institute, Elstree, Herts) for his assistance in making the vaccine used for Trial II; to Dr N. M. Lam (Pfizer Ltd.) and Dr C. H. Smith (Evans Medical Ltd.) for making the Trial III vaccine; to Dr I. A. Sutherland (M.R.C. Statistical Unit) for his advice and help with the statistical aspects; to the Pennsylvania Refinery Co. Inc. for a generous gift of Drakeol 6 VR; and to Mr M. Race for his invaluable technical assistance in The Gambia. We are also grateful to the Director and staff of the M.R.C. Laboratories, The Gambia, for various facilities; and to The Gambian Government for per mission to undertake these trials.

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SUMMARYIn terms of the rate of positive diagnoses the indirect fluorescent antibody (FA) test was rather more effective than iodine for demonstrating trachoma (TRIC) inclusions in conjunctival scrapings, but the degree of advantage was not statistically significant. In duplicate scrapings stained at random by one or the other method, FA staining yielded the higher inclusion count significantly more often than did iodine. Some inclusions that failed to stain with FA were found on subsequent staining with Giemsa. A method is described for improving the post-FA Giemsa staining of conjunctival smears stored at subzero temperatures. Given adequate facilities, the FA stain is preferable to iodine for demonstrating TRIC inclusions in the conjunctiva; but the iodine method, properly used, holds advantages for field use.

SUMMARYNinety-nine young Gambian children were studied for 61 weeks. About half of them had trachoma at the outset, and 80 % of the remainder acquired the disease while under observation. IgG trachoma antibody in the serum and IgG and IgA antibodies in the conjunctival secretions (CS) were titrated by an indirect immunofluorescence method. In serum samples obtained in capillary tubes the mean titre was slightly higher than in samples collected on filter paper. Serum antibody at titres > 1/10 was invariably associated with a clinical diagnosis of trachoma; it increased both in frequency and titre as the disease progressed, and was present in about half of those with Tr II. In CS, IgG antibody was present less often and at lower titres than in serum, and IgA antibody was detected even less frequently. There was some evidence of correlation between the titres of IgG and IgA antibodies in CS, but none for a relationship between the titres of the antibodies in serum and those in CS. Antibodies were almost never present in the absence of conjunctival follicles, but their titres were unrelated to the degree of follicular hyperplasia; there was no obvious relationship between the serological findings and corneal lesions. In children diagnosed clinically as trachoma, serum antibody was present in almost all those with conjunctival inclusions, and in a proportion of inclusion-negative subjects; the mean titre was much higher in the inclusionpositive group.These findings do not settle whether CS antibodies are made locally, or are derived partly or wholly from the blood. They suggest that the indirect immunofluorescence test may be a useful diagnostic aid in trachoma, particularly in view of the rarity of false positive reactions; but there is at present little to choose between it and complement-fixation tests in terms of sensitivity.

Very little of the original primary forest remains in Sierra Leone and the savanna is mainly woodland or a forest-savanna mosaic. The prevalence of microfilariae of Onchocerca volvulus, nodules and moderate or severe skin lesions was higher in forest than savanna villages. In forest villages the prevalence of microfilariae was 71.8% at the iliac crest, 36.6% (outer canthus), 12.8% (cornea) and 34.1% in the anterior chamber of the eye. Corresponding figures for the savanna villages were 51.9%, 20.5%, 5.6% and 21.8%. The overall prevalence of nodules in the forest and savanna was 70.5% and 53.2% respectively, while the prevalence of head and upper body nodules was 14.8% (forest) and 11.0% (savanna). The prevalence of moderate or severe skin lesions was 17.7% in forest and 13.0% in savanna villages. Lesions of the groin and scrotum were few in both zones. In persons aged 30 years or more the prevalence rates of severe eye lesions--sclerosing keratitis, iritis, optic atrophy and choroidoretinitis--were 4.3%, 16.1%, 13.9% and 14.8% respectively in forest villages. Corresponding figures for the savanna villages were 3.7%, 8.7%, 14.2% and 11.3%. Males were more commonly affected than females. At least one of these lesions was found in 32% persons in forest and 24% in savanna villages.