OPHTHALMOLOGY

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Complete Local Elimination of Infectious Trachoma from Severely Affected Communities after Six Biannual Mass Azithromycin Distributions

Trachoma is the result of infection of the eye with Chlamydia trachomatis. Infection spreads from person to person, and is frequently passed from child to child and from child to mother, especially where there are shortages of water, numerous flies, and crowded living conditions. Infection often begins during infancy or childhood and can become chronic. If left untreated, the infection eventually causes the eyelid to turn inwards, which in turn causes the eyelashes to rub on the eyeball, resulting in intense pain and scarring of the front of the eye. This ultimately leads to irreversible blindness, typically between 30 and 40 years of age. A study published in the journal Ophthalmology (2009; 116:2047-2050), was performed to determine whether infectious trachoma can be completely eliminated from severely affected villages by treatment with azithromycin. The study was a cross-sectional survey of 2 villages in Ethiopia previously enrolled and monitored over 42 months as part of a larger, group-randomized clinical trial. A total of 758 individuals were evaluated who resided in 2 villages with high baseline trachoma prevalence, of a total population of 768 (98.7%). For the study, all members of the 2 villages were offered 6 biannual mass treatments with oral azithromycin. At 42 months, each current village member was examined. The right upper tarsal conjunctiva was everted and swabbed. Samples were processed for evidence of Chlamydia trachomatis RNA. The main outcome measure was clinical activity by World Health Organization simplified grading scale for trachoma and laboratory evidence of chlamydial RNA. Results showed that average antibiotic coverage over the study period was 90% and 94% in the 2 villages. Clinical trachoma activity in children aged 1 to 5 years decreased from 78% and 83% in the 2 villages before treatment to 17% and 24% at 42 months. Polymerase chain reaction (PCR) evidence of infection in the same age group decreased from 48% to 0% in both villages at 42 months. When all age groups were examined, there were zero cases with evidence of chlamydial RNA among 758 total villagers tested. According to the authors, biannual mass distribution of azithromycin can locally eliminate ocular chlamydial infection from severely affected communities.

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