Abstract
Ocular infection with Chlamydia trachomatis can lead to trachoma, a leading infectious cause of blindness. Trachoma is targeted for elimination by 2020. Clinical grading for ocular disease is currently used for evaluating trachoma elimination programs, but serological surveillance can be a sensitive measure of disease transmission and provide a more objective testing strategy than clinical grading. We calculated the basic reproduction number from serological data in settings with high, medium, and low disease transmission based on clinical disease. The data showed a striking relationship between age seroprevalence and clinical data, demonstrating the proof-of-principle that age seroprevalence predicts transmission rates and therefore could be used as an indicator of decreased transmission of ocular trachoma.
Highlights
Trachoma is a neglected tropical disease caused by repeated ocular infection with the bacterium Chlamydia trachomatis (Ct)
We evaluated age seroprevalence in communities described as hyperendemic, mesoendemic, or hypoendemic for trachoma based on trachomatous inflammation–follicular (TF) and rates of ocular infection, and estimated the basic reproduction number (R0) for each scenario
TF was present in 2·9% and ocular infection in 1·8% of 680 1–9 year-olds evaluated (Table 1)
Summary
Trachoma is a neglected tropical disease caused by repeated ocular infection with the bacterium Chlamydia trachomatis (Ct). Program end-points are currently set at < 5% TF in 1–9 year-olds, operating under the assumption that low enough levels of ocular trachoma transmission will not result in downstream blindness. Since MDA will not uniformly result in zero transmission in districts, serosurveillance will only be useful to programs if there is a clear understanding of how seroprevalence relates to currently used indicators of trachoma. To this end, we evaluated age seroprevalence in communities described as hyperendemic, mesoendemic, or hypoendemic for trachoma based on TF and rates of ocular infection, and estimated the basic reproduction number (R0) for each scenario
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