Trachoma Decline and Widespread Use of Antimicrobial Drugs

Chidambaram, Jaya D.; Bird, Mariko; Schiedler, Vivian; Fry, Alicia M.; Porco, Travis C.; Bhatta, Ramesh; Jha, Hem Chandra; Chaudary, J.S.P.; Gaynor, Bruce D.; Yi, Elizabeth; Whitcher, John P.; Osaki-Holm, Susie; Lietman, Thomas M.

doi:10.3201/eid1011.040476

Cited by 18 publications

(10 citation statements)

References 23 publications

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“…Antibiotic distributions could be continued indefinitely, although this raises issues of cost, resistance, and loss of immunity[18],[32],[33],[34],[35],[36],[37]. A secular trend outside of the trachoma program may assist in the elimination of trachoma, as has been described in several other settings[7],[8],[9],[12],[25]. Finally, if infection can be eliminated locally, then this offers a higher level of sustainability[12],[19],[22].…”

Section: Discussionmentioning

confidence: 99%

Reduction and Return of Infectious Trachoma in Severely Affected Communities in Ethiopia

et al. 2009

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BackgroundAntibiotics are a major tool in the WHO's trachoma control program. Even a single mass distribution reduces the prevalence of the ocular chlamydia that causes trachoma. Unfortunately, infection returns after a single treatment, at least in severely affected areas. Here, we test whether additional scheduled treatments further reduce infection, and whether infection returns after distributions are discontinued.MethodsSixteen communities in Ethiopia were randomly selected. Ocular chlamydial infection in 1- to 5-year-old children was monitored over four biannual azithromycin distributions and for 24 months after the last treatment.FindingsThe average prevalence of infection in 1- to 5-year-old children was reduced from 63.5% pre-treatment to 11.5% six months after the first distribution (P<0.0001). It further decreased to 2.6% six months after the fourth and final treatment (P = 0.0004). In the next 18 months, infection returned to 25.2%, a significant increase from six months after the last treatment (P = 0.008), but still far lower than baseline (P<0.0001). Although the prevalence of infection in any particular village fluctuated, the mean prevalence of the 16 villages steadily decreased with each treatment and steadily returned after treatments were discontinued.ConclusionIn some of the most severely affected communities ever studied, we demonstrate that repeated mass oral azithromycin distributions progressively reduce ocular chlamydial infection in a community, as long as these distributions are given frequently enough and at a high enough coverage. However, infection returns into the communities after the last treatment. Sustainable changes or complete local elimination of infection will be necessary.Trial RegistrationClinicalTrials.gov NCT00221364

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Section: Discussionmentioning

confidence: 99%

Reduction and Return of Infectious Trachoma in Severely Affected Communities in Ethiopia

et al. 2009

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“…21 There is evidence that clinically active trachoma may be disappearing in several countries in the absence of a trachoma program. [21][22][23][24] In a single Gambian village, the prevalence of active trachoma fell from 66% to 4% over a 28-year period starting in 1959. The only intervention during this time was the distribution of topical tetracycline from 1959 to 1961.…”

Section: Commentmentioning

confidence: 99%

Effect of a Single Mass Antibiotic Distribution on the Prevalence of Infectious Trachoma

Chidambaram

Alemayehu²,

Melese³

et al. 2006

JAMA

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127

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“…In particular, any difference in transmission conditions from baseline to 12–24 months, could be misinterpreted as evidence for positive feedback. In fact, the disappearance of trachoma in the absence of a trachoma program is a well recognized phenomenon (Dolin et al, 1997; Hoechsmann et al, 2001; Jha et al, 2002; Chidambaram et al, 2004). Control communities which did not initially receive treatment, but were randomized from the same pool as the communities studied in this report, had the same prevalence of infection at 12 months as these communities did at baseline, suggesting that transmission conditions did not change dramatically during the course of the monitoring (House et al, 2009).…”

Section: Discussionmentioning

confidence: 99%

The epidemiological dynamics of infectious trachoma may facilitate elimination

et al. 2011

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Introduction Trachoma programs use mass distributions of oral azithromycin to treat the ocular strains of Chlamydia trachomatis that cause the disease. There is debate whether infection can be eradicated or only controlled. Mass antibiotic administrations clearly reduce the prevalence of chlamydia in endemic communities. However, perfect coverage is unattainable, and the World Health Organization's goal is to control infection to a level where resulting blindness is not a public health concern. Here, we use mathematical models to assess whether more ambitious goals such as local elimination or even global eradication are possible. Methods We fit a class of non-linear, stochastic, susceptible–infectious–susceptible (SIS) models which allow positive or negative feedback, to data from a recent community-randomized trial in Ethiopia, and make predictions using model averaging. Results The models predict that reintroduced infection may not repopulate the community, or may do so sufficiently slowly that surveillance might be effective. The preferred model exhibits positive feedback, allowing a form of stochastic hysteresis in which infection returns slowly after mass treatment, if it returns at all. Results for regions of different endemicity suggest that elimination may be more feasible than earlier models had predicted. Discussion If trachoma can be eradicated with repeated mass antibiotic distributions, it would encourage similar strategies against other bacterial diseases whose only host is humans and for which effective vaccines are not available.

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Trachoma Decline and Widespread Use of Antimicrobial Drugs

Abstract: Widespread use of antimicrobial drugs may be contributing to trachoma decline.

Cited by 18 publications

References 23 publications

Reduction and Return of Infectious Trachoma in Severely Affected Communities in Ethiopia

Reduction and Return of Infectious Trachoma in Severely Affected Communities in Ethiopia

Effect of a Single Mass Antibiotic Distribution on the Prevalence of Infectious Trachoma

The epidemiological dynamics of infectious trachoma may facilitate elimination

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