Abstract
BackgroundThe elimination of blinding trachoma focuses on controlling Chlamydia trachomatis infection through mass antibiotic treatment and measures to limit transmission. As the prevalence of disease declines, uncertainty increases over the most effective strategy for treatment. There are little long-term data on the effect of treatment on infection, especially in low prevalence settings, on which to base guidelines.Methodology/Principal FindingsThe population of a cluster of 14 Gambian villages with endemic trachoma was examined on seven occasions over five years (baseline, 2, 6, 12, 17, 30 and 60 months). Mass antibiotic treatment was given at baseline only. All families had accessible clean water all year round. New latrines were installed in each household after 17 months. Conjunctival swab samples were collected and tested for C. trachomatis by PCR. Before treatment the village-level prevalence of follicular trachoma in 1 to 9 year olds (TF%1–9) was 15.4% and C. trachomatis was 9.7%. Antibiotic treatment coverage was 83% of the population. In 12 villages all baseline infection cleared and few sporadic cases were detected during the following five years. In the other two villages treatment was followed by increased infection at two months, which was associated with extensive contact with other untreated communities. The prevalence of infection subsequently dropped to 0% in these 2 villages and 0.6% for the whole population by the end of the study in the absence of any further antibiotic treatment. However, several villages had a TF%1–9 of >10%, the threshold for initiating or continuing mass antibiotic treatment, in the absence of any detectable C. trachomatis.Conclusions/SignificanceA single round of mass antibiotic treatment may be sufficient in low prevalence settings to control C. trachomatis infection when combined with environmental conditions, which suppress transmission, such as a good water supply and sanitation.
Highlights
Trachoma is the leading infectious cause of blindness worldwide [1]
This study examines the effect of a single round of treatment on clinical disease and infection in a cluster of trachoma endemic Gambian villages over a five-year period
Several villages had a prevalence of active trachoma in 1 to 9 year old children of greater than 10% during the follow-up period, mostly in the absence of detectable infection
Summary
Repeated infection of the ocular surface by Chlamydia trachomatis, provokes conjunctival inflammation (active trachoma) and scarring. This may progress in some people to entropion (inturned eyelid), trichiasis (TT, lashes scratching the cornea) and blinding corneal opacification. The World Health Organization’s (WHO) most recent estimates indicate approximately 40 million people have active trachoma, 8 million have un-operated trichiasis and 1.3 million are blind [1,2]. The burden of this disease falls disproportionately on poor rural communities, predominantly in Sub-Saharan Africa. There are little long-term data on the effect of treatment on infection, especially in low prevalence settings, on which to base guidelines
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