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Abstract
BackgroundBiannual mass azithromycin administration to preschool children reduces all-cause mortality, but the mechanism for the effect is not understood. Azithromycin has activity against malaria parasites, and malaria is a leading cause of child mortality in the Sahel. The effect of biannual versus annual azithromycin distribution for trachoma control on serological response to merozoite surface protein 1 (MSP-119), a surrogate for malaria incidence, was evaluated among children in Niger.MethodsMarkers of malaria exposure were measured in two arms of a factorial randomized controlled trial designed to evaluate targeted biannual azithromycin distribution to children under 12 years of age compared to annual azithromycin to the entire community for trachoma control (N = 12 communities per arm). Communities were treated for 36 months (6 versus 3 distributions). Dried blood spots were collected at 36 months among children ages 1–5 years, and MSP-119 antibody levels were assessed using a bead-based multiplex assay to measure malaria seroprevalence.ResultsAntibody results were available for 991 children. MSP-119 seropositivity was 62.7% in the biannual distribution arm compared to 68.7% in the annual arm (prevalence ratio 0.91, 95% CI 0.83 to 1.00). Mean semi-quantitative antibody levels were lower in the biannual distribution arm compared to the annual arm (mean difference − 0.39, 95% CI − 0.05 to − 0.72).ConclusionsTargeted biannual azithromycin distribution was associated with lower malaria seroprevalence compared to that in a population that received annual distribution.Trial Registration Clinicaltrials.gov NCT00792922
Highlights
Biannual mass azithromycin administration to preschool children reduces all-cause mortality, but the mechanism for the effect is not understood
In the Partnership for the Rapid Elimination of Trachoma (PRET)-Niger study, lower malaria parasitaemia prevalence was documented in communities that had received two biannual azithromycin Mass drug administration (MDA) compared to communities receiving one annual MDA [10]
The effect of a single dose of azithromycin for malaria would likely occur over a shorter time period, and a single measure of malaria infection many months after treatment may not be an ideal measure of the overall effect of azithromycin on malaria incidence
Summary
Biannual mass azithromycin administration to preschool children reduces all-cause mortality, but the mechanism for the effect is not understood. The effect of biannual versus annual azithromycin distribution for trachoma control on serological response to merozoite surface protein 1 (MSP-119), a surrogate for malaria incidence, was evaluated among children in Niger. In the Partnership for the Rapid Elimination of Trachoma (PRET)-Niger study, lower malaria parasitaemia prevalence was documented in communities that had received two biannual azithromycin MDAs compared to communities receiving one annual MDA [10]. There was no difference in parasitaemia after 36 months of biannual versus annual MDA [18, 19]. These studies measured malaria infection via thick smear, 6 to 12 months after the last antibiotic dose, when trachoma measurements are typically performed in trachoma trials. Alternative measures of malaria exposure and transmission may be useful in evaluating the effect of azithromycin for malaria as an off-target effect of azithromycin for trachoma control
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