Abstract
BackgroundIn the Solomon Islands and Vanuatu, the sign trachomatous inflammation—follicular (TF) is common, but ocular infection with Chlamydia trachomatis is not. It is therefore debatable whether azithromycin mass drug administration (MDA), the recommended antibiotic treatment strategy for trachoma’s elimination as a public health problem, is necessary in this setting. We set out to estimate what proportion of adolescents were at risk of progression of trachomatous scarring.MethodsA cross-sectional survey was undertaken of all children aged 10–14 years resident in communities identified as high-TF clusters during previous population-based mapping. Graders examined children for clinical evidence of trachomatous scarring, pannus, and Herbert’s pits (HPs) or limbal follicles in both eyes. A dried blood spot was collected from each child and tested for antibodies to C. trachomatis.ResultsA total of 492 children in 24 villages of the Solomon Islands and Vanuatu were examined. In total, 35/492 (7%) of children had limbal signs (pannus and/or HPs) plus any conjunctival scarring. And 9/492 (2%) had limbal signs and moderate or severe conjunctival scarring; 22% of children were anti-Pgp3 seropositive.ConclusionsFew adolescents here are at risk of future complications from trachoma, supporting the conclusion that further antibiotic MDA is not currently required for trachoma elimination purposes in these settings.
Highlights
Trachoma is the most common infectious cause of blindness [1] and a neglected tropical disease targeted for global elimination as a public health problem
Trachoma is considered eliminated as a public health problem when three criteria are satisfied in each formerly-endemic district: (a) prevalence of trachomatous inflammation—follicular (TF) in 1–9-year-olds
A further p 12/130 (9%) individuals with scarring had two scarred eyelids which differed in scarring severity. e Scarring was not associated with gender or age, but was less common in participants with TF Acc
Summary
The proportion of participants with a scarring grade of C≥1 in at least one eye was higher in the Solomon Islands d than in Vanuatu (112/323 [35%] versus 18/169 [11%]; Welch t-test p
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