Abstract
BackgroundThe COVID-19 pandemic has disrupted planned annual antibiotic mass drug administration (MDA) activities that have formed the cornerstone of the largely successful global efforts to eliminate trachoma as a public health problem.MethodsUsing a mathematical model we investigate the impact of interruption to MDA in trachoma-endemic settings. We evaluate potential measures to mitigate this impact and consider alternative strategies for accelerating progress in those areas where the trachoma elimination targets may not be achievable otherwise.ResultsWe demonstrate that for districts that were hyperendemic at baseline, or where the trachoma elimination thresholds have not already been achieved after three rounds of MDA, the interruption to planned MDA could lead to a delay to reaching elimination targets greater than the duration of interruption. We also show that an additional round of MDA in the year following MDA resumption could effectively mitigate this delay. For districts where the probability of elimination under annual MDA was already very low, we demonstrate that more intensive MDA schedules are needed to achieve agreed targets.ConclusionThrough appropriate use of additional MDA, the impact of COVID-19 in terms of delay to reaching trachoma elimination targets can be effectively mitigated. Additionally, more frequent MDA may accelerate progress towards 2030 goals.
Highlights
IntroductionThe active trachoma threshold for elimination as a public health problem (EPHP) has been set by World Health Organization (WHO) as a prevalence of trachomatous inflammation–follicular (TF) in children aged 1–9 y of less than 5% (TF1–9
In response to the COVID-19 pandemic, on 1 April 2020 the World Health Organization (WHO) released interim guidance that community-based surveys, active case-finding and mass drug administration (MDA) programmes for neglected tropical diseases (NTDs), including trachoma, be postponed.[1]The active trachoma threshold for elimination as a public health problem (EPHP) has been set by WHO as a prevalence of trachomatous inflammation–follicular (TF) in children aged 1–9 y of less than 5% (TF1–9
The model incorporates current knowledge of the natural history and transmission of trachoma, including direct person-to-person transmission with infectivity proportional to an individual’s bacterial load, children acting as a core group for transmission, individuals being susceptible to repeated infections and the persistence of TF after clearance of ocular C. trachomatis infection.[18,19,20]
Summary
The active trachoma threshold for elimination as a public health problem (EPHP) has been set by WHO as a prevalence of trachomatous inflammation–follicular (TF) in children aged 1–9 y of less than 5% (TF1–9
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