Clinical Activity and Polymerase Chain Reaction Evidence of Chlamydial Infection after Repeated Mass Antibiotic Treatments for Trachoma

Jeremy D. Keenan Department of Ophthalmology, F. I. Proctor Foundation, Department of Epidemiology and Biostatistics, and Institute for Global Health, University of California, San Francisco, California; Orbis International, Addis Ababa, Ethiopia

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Takele Lakew Department of Ophthalmology, F. I. Proctor Foundation, Department of Epidemiology and Biostatistics, and Institute for Global Health, University of California, San Francisco, California; Orbis International, Addis Ababa, Ethiopia

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Wondu Alemayehu Department of Ophthalmology, F. I. Proctor Foundation, Department of Epidemiology and Biostatistics, and Institute for Global Health, University of California, San Francisco, California; Orbis International, Addis Ababa, Ethiopia

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Muluken Melese Department of Ophthalmology, F. I. Proctor Foundation, Department of Epidemiology and Biostatistics, and Institute for Global Health, University of California, San Francisco, California; Orbis International, Addis Ababa, Ethiopia

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Travis C. Porco Department of Ophthalmology, F. I. Proctor Foundation, Department of Epidemiology and Biostatistics, and Institute for Global Health, University of California, San Francisco, California; Orbis International, Addis Ababa, Ethiopia

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Elizabeth Yi Department of Ophthalmology, F. I. Proctor Foundation, Department of Epidemiology and Biostatistics, and Institute for Global Health, University of California, San Francisco, California; Orbis International, Addis Ababa, Ethiopia

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Jenafir I. House Department of Ophthalmology, F. I. Proctor Foundation, Department of Epidemiology and Biostatistics, and Institute for Global Health, University of California, San Francisco, California; Orbis International, Addis Ababa, Ethiopia

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Zhaoxia Zhou Department of Ophthalmology, F. I. Proctor Foundation, Department of Epidemiology and Biostatistics, and Institute for Global Health, University of California, San Francisco, California; Orbis International, Addis Ababa, Ethiopia

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Kathryn J. Ray Department of Ophthalmology, F. I. Proctor Foundation, Department of Epidemiology and Biostatistics, and Institute for Global Health, University of California, San Francisco, California; Orbis International, Addis Ababa, Ethiopia

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Nisha R. Acharya Department of Ophthalmology, F. I. Proctor Foundation, Department of Epidemiology and Biostatistics, and Institute for Global Health, University of California, San Francisco, California; Orbis International, Addis Ababa, Ethiopia

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John P. Whitcher Department of Ophthalmology, F. I. Proctor Foundation, Department of Epidemiology and Biostatistics, and Institute for Global Health, University of California, San Francisco, California; Orbis International, Addis Ababa, Ethiopia

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Bruce D. Gaynor Department of Ophthalmology, F. I. Proctor Foundation, Department of Epidemiology and Biostatistics, and Institute for Global Health, University of California, San Francisco, California; Orbis International, Addis Ababa, Ethiopia

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Thomas M. Lietman Department of Ophthalmology, F. I. Proctor Foundation, Department of Epidemiology and Biostatistics, and Institute for Global Health, University of California, San Francisco, California; Orbis International, Addis Ababa, Ethiopia

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It is unclear how the prevalence of clinically active trachoma correlates with the prevalence of ocular chlamydial infection at the community level. In 24 villages from a cluster-randomized clinical trial of mass azithromycin distributions in Ethiopia, the correlation between the prevalence of clinical activity (on examination) and chlamydial infection (by polymerase chain reaction) was moderately strong before mass antibiotic treatments (Pearson's correlation coefficient r = 0.75, 95% confidence interval [CI] = 0.52–0.87), but decreased at each time point during four biannual treatments (at 24 months, r = 0.15, 95% CI = −0.14–0.41). One year after the final treatment, the correlation coefficient had increased, but not to the pre-treatment level (r = 0.55, 95% CI = 0.30–0.73). In a region with hyperendemic trachoma, conjunctival examination was a useful indicator of the prevalence of chlamydial infection before treatments, less useful during mass treatments, but regained utility by one year after treatments had stopped.

Author Notes

Address correspondence to Jeremy D. Keenan, Department of Ophthalmology, F. I. Proctor Foundation, 95 Kirkham Street, Room 307, University of California, San Francisco, CA 94143-0944. E-mail: jeremy.keenan@ucsf.edu

Financial support: This work was supported by the Heed Ophthalmic Foundation, International Trachoma Initiative, the Bernard Osher Foundation, That Man May See, the Peierls Foundation, the Bodri Foundation, the Harper Inglis Trust, the South Asia Research Fund, Research to Prevent Blindness, and grants K23 EY019071 and U10 EY016214 from the National Institutes of Health.

Authors' addresses: Jeremy D. Keenan, Travis C. Porco, Elizabeth Yi, Jenafir I. House, Kathryn J. Ray, Nisha R. Acharya, John P. Whitcher, Bruce D. Gaynor, Zhaoxia Zhou, and Thomas M. Lietman, F. I. Proctor Foundation, University of California, San Francisco, CA. Takele Lakew, Wondu Alemayehu, and Muluken Melese, ORBIS International, Addis Ababa, Ethiopia.

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