Abstract
BackgroundDespite some success in controlling trachoma with repeated mass drug administration (MDA), some hyperendemic regions are not responding as fast as anticipated. Available data suggests that individuals with higher bacterial infection loads are less likely to resolve infection following a single dose of treatment, and thus remain a source of re-emergent infection following treatment. We assessed the potential impact of a new double-dose antibiotic distribution strategy in addition to enhanced facial cleanliness (F) and environmental improvements (E).MethodsUsing a within-community mathematical model of trachoma transmission we assessed the impact of a new double-dose antibiotic distribution strategy given 2 weeks apart, with and without enhanced F&E. We compared the annual double-dose strategy to single-dose annual MDA treatment in hyper-, meso- and hypoendemic settings, and to biannual MDA at 6-monthly intervals in hyperendemic communities.ResultsThe findings from our mathematical model suggest that implementing the new double-dose strategy for 5 years or less was predicted to control infection more successfully than annual or 6-monthly treatment. Infection was controlled more readily if treatment was combined with enhanced F&E. The results appeared robust to variation in a number of key epidemiological parameters. To have long-term impact on transmission, enhanced F&E is essential for high transmission settings.ConclusionOur current findings are based on simualtion modelling only, due to lack of epidemilogical data, however they do suggest that the annual double-dose treatment strategy is encouraging for trachoma control. In high transmission settings, both MDA and enhanced F&E are needed for sustained control.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-016-0614-6) contains supplementary material, which is available to authorized users.
Highlights
Despite some success in controlling trachoma with repeated mass drug administration (MDA), some hyperendemic regions are not responding as fast as anticipated
MDA alone For a hyperendemic community with intervention scenario two, infection and disease prevalence were reduced to less than 10 % following the first year of treatment (Fig. 2c, d), while with scenario one, prevalence was only reduced to 20 % and rebounded within 1 year
We found that the GET 2020 goal of reducing prevalence of TF in children aged 1–9 years old to < 5 % may be achievable with the interventions explored for a number of transmission settings; monitoring will be needed to check that the prevalence remains below the elimination threshold, as our results suggest that in the absence of transmission reduction interventions, infection may re-emerge
Summary
Despite some success in controlling trachoma with repeated mass drug administration (MDA), some hyperendemic regions are not responding as fast as anticipated. Available data suggests that individuals with higher bacterial infection loads are less likely to resolve infection following a single dose of treatment, and remain a source of re-emergent infection following treatment. Trachoma remains the most common infectious cause of blindness worldwide. It is estimated that 84 million people, mostly young children, have active disease, and 1.2 million people are blind from trachoma [1]. Blindness occurs as a result of repeated infection of the ocular surface with the bacterium Chlamydia trachomatis. The. To prevent sight loss from trachoma, effective longterm control of C. trachomatis infection and transmission is required [2].
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