Association of Mass Treatment with Azithromycin in Trachoma-Endemic Communities with Short-Term Reduced Risk of Diarrhea in Young Children

Christian L. Coles Department of International Health, Bloomberg School of Public Health, and Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland; Kongwa Trachoma Project, Kongwa, Tanzania

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Jessica C. Seidman Department of International Health, Bloomberg School of Public Health, and Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland; Kongwa Trachoma Project, Kongwa, Tanzania

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Joshua Levens Department of International Health, Bloomberg School of Public Health, and Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland; Kongwa Trachoma Project, Kongwa, Tanzania

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Harran Mkocha Department of International Health, Bloomberg School of Public Health, and Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland; Kongwa Trachoma Project, Kongwa, Tanzania

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Beatriz Munoz Department of International Health, Bloomberg School of Public Health, and Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland; Kongwa Trachoma Project, Kongwa, Tanzania

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Sheila West Department of International Health, Bloomberg School of Public Health, and Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland; Kongwa Trachoma Project, Kongwa, Tanzania

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A cohort study was designed to assess the impact of mass distribution of azithromycin (MDA) for trachoma control on incidence over six months of pediatric diarrhea in eight communities in rural Tanzania. A single dose of azithromycin was offered to all residents in four communities, where trachoma prevalence was ≥ 10%. Four geographically matched communities had trachoma prevalences < 10% and did not receive MDA. All randomly selected children (n = 1036) were followed-up for six months post-MDA with bi-weekly surveillance at home. In the 0–1-month and 1–3-month periods, MDA exposure was associated with a 39% (rate ratio = 0.61, 95% confidence interval = 0.39–0.95) and 24% (rate ratio = 0.76, 95% confidence interval = 0.54–1.07) lower risk of diarrhea, respectively, compared with those unexposed, after adjustment for clustering and covariates. By the 3–6-month period, diarrhea incidence was comparable between groups. Thus, MDA was associated with a short-term reduction in diarrheal morbidity in children.

Author Notes

*Address correspondence to Christian L. Coles, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Room W5009, Baltimore, MD 21205. E-mail: ccoles@jhsph.edu

Financial support: This study was supported by a grant from the Bill and Melinda Gates Foundation (Seattle, WA) (#48027) and an unrestricted grant from Research to Prevent Blindness. Pfizer, Inc. donated the azithromycin for the study. Sheila West is supported by a Senior Scientific Award from Research to Prevent Blindness.

Disclosure: None of the authors have any conflicts of interest.

Authors' addresses: Christian L. Coles and Jessica C. Seidman, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, E-mails: ccoles@jhsph.edu and jseidman@jhsph.edu. Joshua Levens, Beatriz Munoz, and Sheila West, Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, E-mails: joshualevens@gmail.com, bmunoz@jhmi.edu, and shwest@jhmi.edu. Harran Mkoche, Trachoma Project Kongwa, Tanzania c/o Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, E-mail: harry_mkocha2@yahoo.com.

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