Population-Based Prevalence of Ocular Chlamydia trachomatis Infection among Infants in the Trachoma Endemic Amhara Region, Ethiopia.

Scott D Nash,Mulat Zerihun,Ambahun Chernet,Zerihun Tadesse,Tigist Astale,Andrew W Nute,Zebene Ayele,Eshetu Sata,Berhanu Melak,E Kelly Callahan,Demelash Gessese,Kimberly A Jensen,Taye Zeru,Mahteme Haile

doi:10.4269/ajtmh.21-0873

Abstract

ABSTRACT.Infants ages < 6 months do not receive azithromycin as part of trachoma control and thus may serve as an infection reservoir in persistently endemic districts. The aim of this study was to determine the population-based Chlamydia trachomatis infection prevalence and infectious load among infants ages 1–12 months in persistently trachoma endemic districts in Amhara, Ethiopia. Across six districts, 475 infants were enumerated, and of these 464 (97.7%) were swabbed for infection testing. The C. trachomatis infection prevalence in the study area among infants was 0.2% (95% CI: 0.0–1.5). Among children ages 0–5 years positive for C. trachomatis, the median load was 31 elementary bodies (EB) (Inter quartile range: 7–244 EB), and the infection-positive infant had a load of 7,755 EB. While it is worth reconsidering azithromycin treatment recommendations for the potential mortality benefits, these results do not support lowering the treatment age for trachoma control.

Highlights

Some trachoma-endemic districts in Amhara region, Ethiopia, have received $ 10 annual rounds of antibiotic mass drug administration (MDA) with . 80% reported population coverage and still have a persistently high prevalence of trachoma and its causative agent, ocular Chlamydia trachomatis infection.[1,2] Trachoma MDA programs deliver azithromycin to individuals ages $ 6 months and tetracycline eye ointment (TEO), twice daily for 6 weeks, to individuals age, 6 months
The district-level trachomatous inflammation-follicular (TF) prevalence among children ages 1–9 years ranged from 4.1% to 23.4%, and the prevalence of C. trachomatis infection among children ages 1–5 years ranged from 0.0% to 4.0% (Supplemental Table 1)
The C. trachomatis infection prevalence in the enumeration unit (EU) among infants was 0.2%

Summary

Introduction

Some trachoma-endemic districts in Amhara region, Ethiopia, have received $ 10 annual rounds of antibiotic mass drug administration (MDA) with . 80% reported population coverage and still have a persistently high prevalence of trachoma and its causative agent, ocular Chlamydia trachomatis infection.[1,2] Trachoma MDA programs deliver azithromycin to individuals ages $ 6 months and tetracycline eye ointment (TEO), twice daily for 6 weeks, to individuals age , 6 months. 80% reported population coverage and still have a persistently high prevalence of trachoma and its causative agent, ocular Chlamydia trachomatis infection.[1,2] Trachoma MDA programs deliver azithromycin to individuals ages $ 6 months and tetracycline eye ointment (TEO), twice daily for 6 weeks, to individuals age , 6 months. TEO has been shown to be effective against C. trachomatis, it has been demonstrated that compliance is poor.[3,4,5] Infants could represent a potential infection reservoir within communities, as many do not receive azithromycin under current treatment guidelines. Infants may be missing a potential mortality benefit, as azithromycin MDA has shown to reduce childhood mortality.[6] The aim of this study was to determine the C. trachomatis infection prevalence and infectious load among a populationbased sample of infants ages 1–12 months in districts experiencing persistently endemic trachoma in Amhara

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Results

Conclusion