Mass Drug Administration for Trachoma: How Long Is Not Long Enough?

Abstract

BackgroundBlinding trachoma is targeted for elimination by 2020 using the SAFE strategy (Surgery, Antibiotics, Facial cleanliness, and Environmental improvements). Annual mass drug administration (MDA) with azithromycin is a cornerstone of this strategy. If baseline prevalence of clinical signs of trachomatous inflammation – follicular among 1-9 year-olds (TF1-9) is ≥10% but <30%, the World Health Organization guidelines are for at least 3 annual MDAs; if ≥30%, 5. We assessed the likelihood of achieving the global elimination target of TF1-9 <5% at 3 and 5 year evaluations using program reports.Methodology/Principal FindingsWe used the International Trachoma Initiative’s prevalence and treatment database. Of 283 cross-sectional survey pairs with baseline and follow-up data, MDA was conducted in 170 districts. Linear and logistic regression modeling was applied to these to investigate the effect of MDA on baseline prevalence. Reduction to <5% was less likely, though not impossible, at higher baseline TF1-9 prevalences. Increased number of annual MDAs, as well as no skipped MDAs, were significant predictors of reduced TF1-9 at follow-up. The probability of achieving the <5% target was <50% for areas with ≥30% TF1-9 prevalence at baseline, even with 7 or more continuous annual MDAs.ConclusionsNumber of annual MDAs alone appears insufficient to predict program progress; more information on the effects of baseline prevalence, coverage, and underlying environmental and hygienic conditions is needed. Programs should not skip MDAs, and at prevalences >30%, 7 or more annual MDAs may be required to achieve the target. There are five years left before the 2020 deadline to eliminate blinding trachoma. Low endemic settings are poised to succeed in their elimination goals. However, newly-identified high prevalence districts warrant immediate inclusion in the global program. Intensified application of the SAFE strategy is needed in order to guarantee blinding trachoma elimination by 2020.

Macrolide resistance mechanisms inEnterobacteriaceae: Focus on azithromycin

“…or Campylobacter spp. (Allos, 2001;Anonymous, 2013;Crameri & Heininger, 2008;Jimenez et al, 2015;Mitj a et al, 2015;Rolain et al, 2004;Ruiz et al, 2007;Stoner, 2007;Zuckerman, 2004), and have shown activity against some protozoa such as Plasmodium spp. or Toxoplasma gondii (Lee et al, 2011;Pereira et al, 2011).…”

“…Recently the use of azithromycin in mass treatment to eradicate either trachoma or yaws has been proposed and evaluated (Jimenez et al, 2015;Mitj a et al, 2015). Interestingly, in a clinical trial on the eradication of trachoma developed in Ethiopia it was observed that the survival rate of children in the azithromycin arm was better than that of children receiving a placebo (Keenan et al, 2011).…”

Implementer and recipient perspectives of community-wide mass drug administration for soil-transmitted helminths in Kwale County, Kenya

“…Community-wide MDA is a key intervention for the control and elimination of several NTDs, including lymphatic filariasis (LF), onchocerciasis, trachoma, and schistosomiasis. Multiple studies have focused on the effectiveness and acceptability of MDA for these diseases [5][6][7][8]; however, there is limited evidence supporting the use of community-wide MDA for STH. The TUMIKIA Project, conducted in Kenya, was the first cluster randomized control trial assessing the effectiveness, equity, and cost of school-based versus community-wide treatment strategies on the prevalence and intensity of STH infection [9,10].…”

Inverse relationship between microRNA-155 and -184 expression with increasing conjunctival inflammation during ocular Chlamydia trachomatis infection

“…Whilst MDA is generally effective, there are concerns regarding its efficacy in hyper-endemic settings such as Ethiopia, where trachoma prevalence remains high despite >5 years of biannual MDA in some districts [ 4 ]. High recurrence rates of trichiasis following lid margin rotation surgery [ 5 ] and the presence of follicular trachoma and incident scarring in populations where Ct infection prevalence has been controlled [ 1 , 6 ] are also of concern.…”