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-
1.
Mabey DC, Solomon AW, Foster A, 2003. Trachoma. Lancet 362: 223–229.
-
2.
Taylor HR, Burton MJ, Haddad D, West F, Wright H, 2014. Trachoma. Lancet 384: 2142–2152.
-
3.
World Health Organization, 2006. Trachoma Control: A Guide from Prgoramme Managers. Geneva, Switzerland: World Health Organization, 1–53.
-
4.
Harding-Esch EM et al. Partnership for Rapid Elimination of Trachoma (PRET) study group, 2013. Mass treatment with azithromycin for trachoma: when is one round enough? Results from the PRET trial in the Gambia. PLoS Negl Trop Dis 7: e2115.
-
5.
Lietman T, Porco T, Dawson C, Blower S, 1999. Global elimination of trachoma: how frequently should we administer mass chemotherapy? Nat Med 5: 572–576.
-
6.
Last AR, Burr SE, Weiss HA, Harding-Esch EM, Cassama E, Nabicassa M, Mabey DC, Holland MJ, Bailey RL, 2014. Risk factors for active trachoma and ocular Chlamydia trachomatis infection in treatment-naïve trachoma-hyperendemic communities of the Bijagós Archipelago, Guinea Bissau. PLoS Negl Trop Dis 8: e2900.
-
7.
Schemann JF, Sacko D, Malvy D, Momo G, Traore L, Bore O, Coulibaly S, Banou A, 2002. Risk factors for trachoma in Mali. Int J Epidemiol 31: 194–201.
-
8.
Amza A et al. PRET Partnership, 2012. Community risk factors for ocular Chlamydia infection in Niger: pre-treatment results from a cluster-randomized trachoma trial. PLoS Negl Trop Dis 6: e1586.
-
9.
Grassly NC, Ward ME, Ferris S, Mabey DC, Bailey RL, 2008. The natural history of trachoma infection and disease in a Gambian cohort with frequent follow-up. PLoS Negl Trop Dis 2: e341.
-
10.
Solomon AW et al. 2004. Mass treatment with single-dose azithromycin for trachoma. N Engl J Med 351: 1962–1971.
-
11.
House JI et al. 2009. Assessment of herd protection against trachoma due to repeated mass antibiotic distributions: a cluster-randomisedtrial. Lancet 373: 1111–1118.
-
12.
Amza A et al. 2017. A cluster-randomized trial to assess the efficacy of targeting trachoma treatment to children. Clin Infect Dis 64: 743–750.
-
13.
Yohannan J, Munoz B, Mkocha H, Gaydos CA, Bailey R, Lietman TA, Quinn T, West SK, 2013. Can we stop mass drug administration prior to 3 annual rounds in communities with low prevalence of trachoma?: PRET Ziada trail results. JAMA Ophthalmol 131: 431–436.
-
14.
Stare D, Harding-Esch E, Munoz B, Bailey R, Mabey D, Holland M, Gaydos C, West S, 2011. Design and baseline data of a randomized trial to evaluate coverage and frequency of mass treatment with azithromycin: the partnership for rapid elimination of trachoma (PRET) in Tanzania and the Gambia. Ophthalmic Epidemiol 18: 20–29.
-
15.
Thylefors B, Dawson CR, Jones BR, West SK, Taylor HR, 1987. A simple system for the assessment of trachoma and its complications. Bull World Health Organ 65: 477–483.
-
16.
Ray KJ, Zhou Z, Cevallos V, Chin S, Enanoria W, Lui F, Lietman TM, Porco TC, 2014. Estimating community prevalence of ocular Chlamydia trachomatis infection using pooled polymerase chain reaction testing. Ophthalmic Epidemiol 21: 86–91.
-
17.
Holm SO et al. 2001. Comparison of two azithromycin distribution strategies for controlling trachoma in Nepal. Bull World Health Organ 79: 194–200.
-
18.
Frick KD, Lietman TM, Osaki-Holm S, Jha H, Chaudary J, Bhatta RC, 2001. Cost-effectiveness of trachoma control measures: comparing targeted household treatment and mass treatment of children. Bull World Health Organ 79: 201–207.
-
19.
Chidambaram JD et al. 2004. Mass antibiotic treatment and community protection in trachoma control programs. Clin Infect Dis 39: e95–e97.
-
20.
Skalet AH et al. 2010. Antibiotic selection pressure and macrolide resistance in nasopharyngeal Streptococcus pneumoniae: a cluster-randomized clinical trial. PLoS Med 7: e1000377.
-
21.
Haug S et al. 2010. The decline of pneumococcal resistance after cessation of mass antibiotic distributions for trachoma. Clin Infect Dis 51: 571–574.
| Past two years | Past Year | Past 30 Days | |
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| Abstract Views | 47 | 47 | 9 |
| Full Text Views | 607 | 114 | 0 |
| PDF Downloads | 177 | 48 | 0 |
Comparison of Mass Azithromycin Coverage Targets of Children in Niger: A Cluster-Randomized Trachoma Trial
Catherine E. Oldenburg
Catherine E. Oldenburg
F.I. Proctor Foundation, University of California San Francisco, San Francisco, California;
Department of Ophthalmology, University of California San Francisco, San Francisco, California;
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Department of Ophthalmology, University of California San Francisco, San Francisco, California;
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Abdou Amza
Abdou Amza
Programme FSS/Université Abdou Moumouni de Niamey, Programme National de Santé Oculaire, Niamey, Niger;
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Boubacar Kadri
Boubacar Kadri
Programme FSS/Université Abdou Moumouni de Niamey, Programme National de Santé Oculaire, Niamey, Niger;
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Beido Nassirou
Beido Nassirou
Programme FSS/Université Abdou Moumouni de Niamey, Programme National de Santé Oculaire, Niamey, Niger;
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Sun Y. Cotter
Sun Y. Cotter
F.I. Proctor Foundation, University of California San Francisco, San Francisco, California;
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Nicole E. Stoller
Nicole E. Stoller
F.I. Proctor Foundation, University of California San Francisco, San Francisco, California;
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Sheila K. West
Sheila K. West
Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland;
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Robin L. Bailey
Robin L. Bailey
Clinical Research Unit, Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom;
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Travis C. Porco
Travis C. Porco
F.I. Proctor Foundation, University of California San Francisco, San Francisco, California;
Department of Ophthalmology, University of California San Francisco, San Francisco, California;
Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California
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Department of Ophthalmology, University of California San Francisco, San Francisco, California;
Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California
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Bruce D. Gaynor
Bruce D. Gaynor
F.I. Proctor Foundation, University of California San Francisco, San Francisco, California;
Department of Ophthalmology, University of California San Francisco, San Francisco, California;
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Department of Ophthalmology, University of California San Francisco, San Francisco, California;
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Jeremy D. Keenan
Jeremy D. Keenan
F.I. Proctor Foundation, University of California San Francisco, San Francisco, California;
Department of Ophthalmology, University of California San Francisco, San Francisco, California;
Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California
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Department of Ophthalmology, University of California San Francisco, San Francisco, California;
Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California
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Thomas M. Lietman
Thomas M. Lietman
F.I. Proctor Foundation, University of California San Francisco, San Francisco, California;
Department of Ophthalmology, University of California San Francisco, San Francisco, California;
Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California
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Department of Ophthalmology, University of California San Francisco, San Francisco, California;
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Repeated oral azithromycin distribution targeted only to children has proven effective in reducing the ocular Chlamydia that causes trachoma. Here, we assess whether an enhanced coverage target of at least 90% of children is superior to the World Health Organization recommendation of at least 80%. Twenty-four trachoma-endemic communities in Matamèye, Niger, were randomized to a single day of azithromycin distribution aiming for at least 80% coverage or up to 4 days of treatment and > 90% coverage of children under age 12. All distributions were biannual. Children < 5 years of age and adults > 15 years were monitored for ocular Chlamydia infection by polymerase chain reaction every 6 months for 36 months in children and at baseline and 36 months in adults. Ocular Chlamydia prevalence in children decreased from 24.9% (95% confidence interval [CI] 15.9–33.8%) to 4.4% (95% CI 0.6–8.2%, P < 0.001) at 36 months in the standard coverage arm and from 15.6% (95% CI 10.0–21.2%) to 3.3% (95% CI 1.0–5.5%; P < 0.001) in the enhanced coverage arm. Enhanced coverage reduced ocular Chlamydia prevalence in children more quickly over time compared with standard (P = 0.04). There was no difference between arms at 36 months in children (2.4% lower with enhanced coverage, 95% CI 7.7–12.5%; P = 0.60). No infection was detected in adults at 36 months. Increasing antibiotic coverage among children from 80% to 90% may yield only short term improvements for trachoma control programs. Targeting treatment to children alone may be sufficient for trachoma control in this setting.
Author Notes
Financial support: This trial was funded by the Bill and Melinda Gates Foundation (PI S. K. W.).
Trial Registration: ClinicalTrials.gov NCT00792922.
Authors’ addresses: Catherine E. Oldenburg, Travis C. Porco, Jeremy D. Keenan, and Thomas M. Lietman, F.I. Proctor Foundation and Departments of Ophthalmology and Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, E-mails: catherine.oldenburg@ucsf.edu, travis.porco@ucsf.edu, jeremy.keenan@ucsf.edu, tom.lietman@ucsf.edu. Abdou Amza, Boubacar Kadri, and Beido Nassirou, Programme FSS/Université Abdou Moumouni de Niamey, Programme National de Santé Oculaire, Niamey, Niger, E-mails: dr.amzaabdou@gmail.com, kadriboubacar@gmail.com, and nasbeido@yahoo.fr. Sun Y. Cotter and Nicole E. Stoller, F.I. Proctor Foundation, University of California, San Francisco, San Francisco, CA, E-mails: sun.cotter@ucsf.edu and nicolestoller@gmail.com. Sheila K. West, Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins Wilmer Eye Institute, Baltimore, MD, E-mail: shwest@jhmi.edu. Robin L. Bailey, Clinical Research Unit, Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Bloomsbury, London, United Kingdom, E-mail: robin.bailey@lshtm.ac.uk. Bruce D. Gaynor, F.I. Proctor Foundation and Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, E-mail: bdgaynor@gmail.com.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
Mabey DC, Solomon AW, Foster A, 2003. Trachoma. Lancet 362: 223–229.
-
2.
Taylor HR, Burton MJ, Haddad D, West F, Wright H, 2014. Trachoma. Lancet 384: 2142–2152.
-
3.
World Health Organization, 2006. Trachoma Control: A Guide from Prgoramme Managers. Geneva, Switzerland: World Health Organization, 1–53.
-
4.
Harding-Esch EM et al. Partnership for Rapid Elimination of Trachoma (PRET) study group, 2013. Mass treatment with azithromycin for trachoma: when is one round enough? Results from the PRET trial in the Gambia. PLoS Negl Trop Dis 7: e2115.
-
5.
Lietman T, Porco T, Dawson C, Blower S, 1999. Global elimination of trachoma: how frequently should we administer mass chemotherapy? Nat Med 5: 572–576.
-
6.
Last AR, Burr SE, Weiss HA, Harding-Esch EM, Cassama E, Nabicassa M, Mabey DC, Holland MJ, Bailey RL, 2014. Risk factors for active trachoma and ocular Chlamydia trachomatis infection in treatment-naïve trachoma-hyperendemic communities of the Bijagós Archipelago, Guinea Bissau. PLoS Negl Trop Dis 8: e2900.
-
7.
Schemann JF, Sacko D, Malvy D, Momo G, Traore L, Bore O, Coulibaly S, Banou A, 2002. Risk factors for trachoma in Mali. Int J Epidemiol 31: 194–201.
-
8.
Amza A et al. PRET Partnership, 2012. Community risk factors for ocular Chlamydia infection in Niger: pre-treatment results from a cluster-randomized trachoma trial. PLoS Negl Trop Dis 6: e1586.
-
9.
Grassly NC, Ward ME, Ferris S, Mabey DC, Bailey RL, 2008. The natural history of trachoma infection and disease in a Gambian cohort with frequent follow-up. PLoS Negl Trop Dis 2: e341.
-
10.
Solomon AW et al. 2004. Mass treatment with single-dose azithromycin for trachoma. N Engl J Med 351: 1962–1971.
-
11.
House JI et al. 2009. Assessment of herd protection against trachoma due to repeated mass antibiotic distributions: a cluster-randomisedtrial. Lancet 373: 1111–1118.
-
12.
Amza A et al. 2017. A cluster-randomized trial to assess the efficacy of targeting trachoma treatment to children. Clin Infect Dis 64: 743–750.
-
13.
Yohannan J, Munoz B, Mkocha H, Gaydos CA, Bailey R, Lietman TA, Quinn T, West SK, 2013. Can we stop mass drug administration prior to 3 annual rounds in communities with low prevalence of trachoma?: PRET Ziada trail results. JAMA Ophthalmol 131: 431–436.
-
14.
Stare D, Harding-Esch E, Munoz B, Bailey R, Mabey D, Holland M, Gaydos C, West S, 2011. Design and baseline data of a randomized trial to evaluate coverage and frequency of mass treatment with azithromycin: the partnership for rapid elimination of trachoma (PRET) in Tanzania and the Gambia. Ophthalmic Epidemiol 18: 20–29.
-
15.
Thylefors B, Dawson CR, Jones BR, West SK, Taylor HR, 1987. A simple system for the assessment of trachoma and its complications. Bull World Health Organ 65: 477–483.
-
16.
Ray KJ, Zhou Z, Cevallos V, Chin S, Enanoria W, Lui F, Lietman TM, Porco TC, 2014. Estimating community prevalence of ocular Chlamydia trachomatis infection using pooled polymerase chain reaction testing. Ophthalmic Epidemiol 21: 86–91.
-
17.
Holm SO et al. 2001. Comparison of two azithromycin distribution strategies for controlling trachoma in Nepal. Bull World Health Organ 79: 194–200.
-
18.
Frick KD, Lietman TM, Osaki-Holm S, Jha H, Chaudary J, Bhatta RC, 2001. Cost-effectiveness of trachoma control measures: comparing targeted household treatment and mass treatment of children. Bull World Health Organ 79: 201–207.
-
19.
Chidambaram JD et al. 2004. Mass antibiotic treatment and community protection in trachoma control programs. Clin Infect Dis 39: e95–e97.
-
20.
Skalet AH et al. 2010. Antibiotic selection pressure and macrolide resistance in nasopharyngeal Streptococcus pneumoniae: a cluster-randomized clinical trial. PLoS Med 7: e1000377.
-
21.
Haug S et al. 2010. The decline of pneumococcal resistance after cessation of mass antibiotic distributions for trachoma. Clin Infect Dis 51: 571–574.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 47 | 47 | 9 |
| Full Text Views | 607 | 114 | 0 |
| PDF Downloads | 177 | 48 | 0 |