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Sata E, Seife F, Ayele Z, Murray SA, Wickens K, Le P, Zerihun M, Melak B, Chernet A, Jensen KA, Gessese D, Zeru T, Dawed AA, Debebe H, Tadesse Z, Callahan EK, Martin DL, Nash SD. Wait and watch: A trachoma surveillance strategy from Amhara region, Ethiopia. PLoS Negl Trop Dis 2024; 18:e0011986. [PMID: 38386689 PMCID: PMC10914254 DOI: 10.1371/journal.pntd.0011986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 03/05/2024] [Accepted: 02/09/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Trachoma recrudescence after elimination as a public health problem has been reached is a concern for control programs globally. Programs typically conduct district-level trachoma surveillance surveys (TSS) ≥ 2 years after the elimination threshold is achieved to determine whether the prevalence of trachomatous inflammation-follicular (TF) among children ages 1 to 9 years remains <5%. Many TSS are resulting in a TF prevalence ≥5%. Once a district returns to TF ≥5%, a program typically restarts costly mass drug administration (MDA) campaigns and surveys at least twice, for impact and another TSS. In Amhara, Ethiopia, most TSS which result in a TF ≥5% have a prevalence close to 5%, making it difficult to determine whether the result is due to true recrudescence or to statistical variability. This study's aim was to monitor recrudescence within Amhara by waiting to restart MDA within 2 districts with a TF prevalence ≥5% at TSS, Metema = 5.2% and Woreta Town = 5.1%. The districts were resurveyed 1 year later using traditional and alternative indicators, such as measures of infection and serology, a "wait and watch" approach. METHODS/PRINCIPAL FINDINGS These post-surveillance surveys, conducted in 2021, were multi-stage cluster surveys whereby certified graders assessed trachoma signs. Children ages 1 to 9 years provided a dried blood spot and children ages 1 to 5 years provided a conjunctival swab. TF prevalence in Metema and Woreta Town were 3.6% (95% Confidence Interval [CI]:1.4-6.4) and 2.5% (95% CI:0.8-4.5) respectively. Infection prevalence was 1.2% in Woreta Town and 0% in Metema. Seroconversion rates to Pgp3 in Metema and Woreta Town were 0.4 (95% CI:0.2-0.7) seroconversions per 100 child-years and 0.9 (95% CI:0.6-1.5) respectively. CONCLUSIONS/SIGNIFICANCE Both study districts had a TF prevalence <5% with low levels of Chlamydia trachomatis infection and transmission, and thus MDA interventions are no longer warranted. The wait and watch approach represents a surveillance strategy which could lead to fewer MDA campaigns and surveys and thus cost savings with reduced antibiotic usage.
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Affiliation(s)
- Eshetu Sata
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Fikre Seife
- Disease Prevention and Control Directorate, Ministry of Health, Addis Ababa, Ethiopia
| | - Zebene Ayele
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Sarah A. Murray
- Trachoma Control Program, The Carter Center, Atlanta, Georgia, United States of America
| | - Karana Wickens
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Internships and Fellowships, Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, United States of America
| | - Phong Le
- Trachoma Control Program, The Carter Center, Atlanta, Georgia, United States of America
| | - Mulat Zerihun
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Berhanu Melak
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Ambahun Chernet
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Kimberly A. Jensen
- Trachoma Control Program, The Carter Center, Atlanta, Georgia, United States of America
| | - Demelash Gessese
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Taye Zeru
- Research and Technology Transfer Directorate, Amhara Public Health Institute, Bahir Dar, Ethiopia
| | - Adisu Abebe Dawed
- Department of Health Promotion and Disease Prevention, Amhara Regional Health Bureau, Bahir Dar, Ethiopia
| | - Hiwot Debebe
- Department of Health Promotion and Disease Prevention, Amhara Regional Health Bureau, Bahir Dar, Ethiopia
| | - Zerihun Tadesse
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - E. Kelly Callahan
- Trachoma Control Program, The Carter Center, Atlanta, Georgia, United States of America
| | - Diana L. Martin
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Scott D. Nash
- Trachoma Control Program, The Carter Center, Atlanta, Georgia, United States of America
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Tedijanto C, Aragie S, Gwyn S, Wittberg DM, Zeru T, Tadesse Z, Chernet A, Thompson IJ, Nash SD, Lietman TM, Martin DL, Keenan JD, Arnold BF. Seroreversion to Chlamydia trachomatis Pgp3 antigen among children in a hyperendemic region of Amhara, Ethiopia. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.02.04.23285360. [PMID: 36798251 PMCID: PMC9934712 DOI: 10.1101/2023.02.04.23285360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Monitoring trachoma transmission with antibody data requires characterization of decay in IgG to Chlamydia trachomatis antigens. In a three-year longitudinal cohort in a high transmission setting, we estimated a median IgG half-life of 3 years and a seroreversion rate of 2.5 (95% CI: 1.6, 3.5) per 100 person-years.
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Affiliation(s)
- Christine Tedijanto
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA
| | | | - Sarah Gwyn
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Dionna M. Wittberg
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA
| | - Taye Zeru
- Amhara Public Health Institute, Bahir Dar, Ethiopia
| | | | | | - Isabel J.B. Thompson
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA
| | | | - Thomas M. Lietman
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Diana L. Martin
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jeremy D. Keenan
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - Benjamin F. Arnold
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
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3
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Asmare ZA, Seifu BL, Mare KU, Asgedom YS, Kase BF, Shibeshi AH, Tebeje TM, Lombebo AA, Sabo KG, Fente BM, Teshale AB, Asebe HA. Prevalence and associated factors of active trachoma among 1-9 years of age children in Andabet district, northwest Ethiopia, 2023: A multi-level mixed-effect analysis. PLoS Negl Trop Dis 2023; 17:e0011573. [PMID: 37590321 PMCID: PMC10464999 DOI: 10.1371/journal.pntd.0011573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/29/2023] [Accepted: 08/05/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Trachoma is the chief cause of preventable blindness worldwide and has been earmarked for elimination as a public health problem by 2030. Despite the five-year Surgery, Antibiotics, Facial cleanliness, and Environmental improvement (SAFE)-based interventions in the Andabet district, the prevalence of trachomatous follicular (TF) was 37%. With such a high prevalence of TF, the determinant factors were not revealed. Besides, there were no reports on the overall prevalence of active trachoma (i.e.TF and or trachomatous intense (TI)). OBJECTIVE To determine the prevalence and associated factors of active trachoma among 1-9 years of age children in the Andabet district. METHOD A community-based cross-sectional study was conducted among children aged under nine years from March 1-30, 2023 in Andabet district, Northwest Ethiopia. Multi-stage systematic random sampling was employed to reach 540 children. A multilevel mixed-effect logistic regression analysis was employed to assess factors associated with active trachoma. We fitted both random effect and fixed effect analysis. Finally, variables with p<0.05 in the multivariable multilevel analysis were claimed to be significantly associated with active trachoma. RESULT In this study, the overall prevalence of active trachoma was 35.37% (95% CI: 31.32%, 39.41%). The prevalence of TF and TI was 31.3% and 4.07% respectively. In the multilevel logistic regression analysis ocular discharge, fly-eye contact, latrine utilization, and source of water were significantly associated with the prevalence of active trachoma. CONCLUSION In this study, the prevalence of active trachoma was much higher than the World Health Organization (WHO) threshold prevalence. Ocular discharge, fly-eye contact, latrine utilization, and source of water were independent determinants of active trachoma among children (1-9 years). Therefore, paying special attention to these high-risk groups could decrease the prevalence of a neglected hyperendemic disease, active trachoma.
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Affiliation(s)
- Zufan Alamrie Asmare
- Department of Ophthalmology, School of Medicine and Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Beminate Lemma Seifu
- Department of Public Health, Collage of Medicine and Health Science, Samara University, Afar, Ethiopia
| | - Kusse Urmale Mare
- Department of Nursing, College of Medicine and Health Sciences, Samara University, Afar, Ethiopia
| | - Yordanos Sisay Asgedom
- Department of Epidemiology and Biostatics, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Bizunesh Fantahun Kase
- Department of Public Health, Collage of Medicine and Health Science, Samara University, Afar, Ethiopia
| | - Abdu Hailu Shibeshi
- Department of Statistics, College of Natural and Computational Science, Samara University, Afar, Ethiopia
| | - Tsion Mulat Tebeje
- School of Public Health, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
| | - Afework Alemu Lombebo
- School of Medicine, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Kebede Gemeda Sabo
- Department of Nursing, College of Medicine and Health Sciences, Samara University, Afar, Ethiopia
| | - Bezawit Melak Fente
- Department of General Midwifery, School of Midwifery, College of Medicine & Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Achamyeleh Birhanu Teshale
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Hiwot Altaye Asebe
- Department of Public Health, Collage of Medicine and Health Science, Samara University, Afar, Ethiopia
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4
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Goodhew EB, Taoaba R, Harding-Esch EM, Gwyn SE, Bakhtiari A, Butcher R, Cama A, Guagliardo SAJ, Jimenez C, Mpyet CD, Tun K, Wickens K, Solomon AW, Martin DL, Tekeraoi R. Changes in trachoma indicators in Kiribati with two rounds of azithromycin mass drug administration, measured in serial population-based surveys. PLoS Negl Trop Dis 2023; 17:e0011441. [PMID: 37418501 PMCID: PMC10355439 DOI: 10.1371/journal.pntd.0011441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 07/19/2023] [Accepted: 06/06/2023] [Indexed: 07/09/2023] Open
Abstract
Baseline mapping in the two major population centers of Kiribati showed that trachoma was a public health problem in need of programmatic interventions. After conducting two annual rounds of antibiotic mass drug administration (MDA), Kiribati undertook trachoma impact surveys in 2019, using standardized two-stage cluster surveys in the evaluation units of Kiritimati Island and Tarawa. In Kiritimati, 516 households were visited and in Tarawa, 772 households were visited. Nearly all households had a drinking water source and access to an improved latrine. The prevalence of trachomatous trichiasis remained above the elimination threshold (0.2% in ≥15-year-olds) and was virtually unchanged from baseline. The prevalence of trachomatous inflammation-follicular (TF) in 1-9-year-olds decreased by approximately 40% from baseline in both evaluation units but remained above the 5% TF prevalence threshold for stopping MDA. TF prevalence at impact survey was 11.5% in Kiritimati and 17.9% in Tarawa. Infection prevalence in 1-9-year-olds by PCR was 0.96% in Kiritimati and 3.3% in Tarawa. Using a multiplex bead assay to measure antibodies to the C. trachomatis antigen Pgp3, seroprevalence in 1-9-year-olds was 30.2% in Kiritimati and 31.4% in Tarawa. The seroconversion rate, in seroconversion events/100 children/year, was 9.0 in Kiritimati and 9.2 in Tarawa. Seroprevalence and seroconversion rates were both assessed by four different assays, with strong agreement between tests. These results show that, despite decreases in indicators associated with infection at impact survey, trachoma remains a public health problem in Kiribati, and provide additional information about changes in serological indicators after MDA.
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Affiliation(s)
| | | | - Emma M. Harding-Esch
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sarah E. Gwyn
- Centers for Disease Control and Prevention, Atlanta Georgia
| | - Ana Bakhtiari
- International Trachoma Initiative, Task Force for Global Health, Atlanta, Georgia
| | - Robert Butcher
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | | | | | - Caleb D. Mpyet
- Department of Ophthalmology, College of Health Sciences, University of Jos; Jos, Nigeria, and Sightsavers, Nigeria Country Office, Kaduna, Nigeria
| | - Kab Tun
- Ministry of Health and Medical Services, South Tarawa, Kiribati
| | - Karana Wickens
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Anthony W. Solomon
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | | | - Rabebe Tekeraoi
- Ministry of Health and Medical Services, South Tarawa, Kiribati
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5
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Tedijanto C, Solomon AW, Martin DL, Nash SD, Keenan JD, Lietman TM, Lammie PJ, Aiemjoy K, Amza A, Aragie S, Arzika AM, Callahan EK, Carolan S, Dawed AA, Goodhew EB, Gwyn S, Hammou J, Kadri B, Kalua K, Maliki R, Nassirou B, Seife F, Tadesse Z, West SK, Wittberg DM, Zeru Tadege T, Arnold BF. Monitoring transmission intensity of trachoma with serology. Nat Commun 2023; 14:3269. [PMID: 37277341 PMCID: PMC10241377 DOI: 10.1038/s41467-023-38940-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/22/2023] [Indexed: 06/07/2023] Open
Abstract
Trachoma, caused by ocular Chlamydia trachomatis infection, is targeted for global elimination as a public health problem by 2030. To provide evidence for use of antibodies to monitor C. trachomatis transmission, we collated IgG responses to Pgp3 antigen, PCR positivity, and clinical observations from 19,811 children aged 1-9 years in 14 populations. We demonstrate that age-seroprevalence curves consistently shift along a gradient of transmission intensity: rising steeply in populations with high levels of infection and active trachoma and becoming flat in populations near elimination. Seroprevalence (range: 0-54%) and seroconversion rates (range: 0-15 per 100 person-years) correlate with PCR prevalence (r: 0.87, 95% CI: 0.57, 0.97). A seroprevalence threshold of 13.5% (seroconversion rate 2.75 per 100 person-years) identifies clusters with any PCR-identified infection at high sensitivity ( >90%) and moderate specificity (69-75%). Antibody responses in young children provide a robust, generalizable approach to monitor population progress toward and beyond trachoma elimination.
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Affiliation(s)
- Christine Tedijanto
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, 94158, USA
| | - Anthony W Solomon
- Global Neglected Tropical Diseases Programme, World Health Organization, Geneva, Switzerland
| | - Diana L Martin
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | | | - Jeremy D Keenan
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, 94158, USA
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, 94158, USA
| | - Thomas M Lietman
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, 94158, USA
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, 94158, USA
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, 94143, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, 94143, USA
| | - Patrick J Lammie
- Neglected Tropical Diseases Support Center, Task Force for Global Health, Atlanta, GA, 30030, USA
| | - Kristen Aiemjoy
- Division of Epidemiology, Department of Public Health Sciences, University of California Davis School of Medicine, Davis, CA, USA
| | - Abdou Amza
- Programme National de Santé Oculaire, Niamey, Niger
- Programme National de Lutte Contre la Cecité, Niamey, Niger
| | - Solomon Aragie
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, 94158, USA
- The Carter Center Ethiopia, Addis Ababa, Ethiopia
- Infection Biology, Addis Ababa University, Addis Ababa, Ethiopia
| | | | | | - Sydney Carolan
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, 94158, USA
| | | | - E Brook Goodhew
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Sarah Gwyn
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Jaouad Hammou
- Service of Ocular and Otological Diseases, Epidemiology and Disease Control Directorate, Ministry of Health, Rabat, Morocco
| | - Boubacar Kadri
- Programme National de Santé Oculaire, Niamey, Niger
- Programme National de Lutte Contre la Cecité, Niamey, Niger
| | - Khumbo Kalua
- Blantyre Institute for Community Outreach, Blantyre, Malawi
| | | | - Beido Nassirou
- Programme National de Santé Oculaire, Niamey, Niger
- Programme National de Lutte Contre la Cecité, Niamey, Niger
| | - Fikre Seife
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | | | - Sheila K West
- Johns Hopkins School of Medicine, Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Baltimore, MD, USA
| | - Dionna M Wittberg
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, 94158, USA
| | | | - Benjamin F Arnold
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, 94158, USA.
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, 94158, USA.
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6
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Asmare ZA, Assefa NL, Abebe D, Nigatu SG, Alimaw YA. Trachoma prevention practice and associated factors among mothers having children aged under nine years in Andabet district, northwest Ethiopia, 2022: A multi-level analysis. PLoS Negl Trop Dis 2023; 17:e0011433. [PMID: 37390045 DOI: 10.1371/journal.pntd.0011433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 06/02/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND The world health organization (WHO) adopted the Surgery, Antibiotic, facial cleanliness, and environmental improvement (SAFE) strategy for the prevention of trachoma, and different prevention strategies have been employed in Andabet district. Trachoma still has a high prevalence despite these efforts. So, it is imperative to assess ground trachoma prevention practice (TPP) since there are insufficient studies in the study area. OBJECTIVE To determine the magnitude and factors associated with TPP among mothers having children aged under nine years in Andabet district, Northwest Ethiopia. METHOD A community-based cross-sectional study involving 624 participants was conducted June 1-30, 2022. Systematic random sampling was carried out to select study participants. Multi-level binary logistic regression analysis was used to identify factors associated with poor TPP. Descriptive and summary statistics were performed and variables with p-value < 0.05 in the best-fitted model were declared to be significantly associated with poor TPP. RESULTS In this study, the proportion of poor TPP was found to be 50.16% (95%CI = 46.23, 54.08). In the multi-variable multi-level logistic regression; having no formal education (AOR = 2.95; 95%CI: 1.41,6.15) and primary education (AOR = 2.33; 95%CI:1.04, 5.24), being a farmer (AOR = 3.02; 95%CI:1.73,5.28), and merchant (AOR = 2.63; 95%CI:1.20, 5.75), time taken to water point >30 minutes (AOR = 4.60,95CI:1.30,16.26) and didn't receive health education about trachoma (AOR = 2.36;95CI:1.16,4.79) were significantly associated with poor TPP. CONCLUSION The proportion of poor TPP was high relative to other studies. Level of education, occupation, time taken to the water point, and health education were significantly associated with poor TPP. Therefore, taking special attention to these high-risk groups could decrease the poor TPP.
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Affiliation(s)
- Zufan Alamrie Asmare
- Department of Ophthalmology, School of Medicine and Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Natnael Lakachew Assefa
- Department of Optometry, School of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Dagmawi Abebe
- Department of Ophthalmology, School of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Solomon Gedlu Nigatu
- Department of Epidemiology & Biostatistics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Yezinash Addis Alimaw
- Department of Optometry, School of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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7
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Tedijanto C, Solomon AW, Martin DL, Nash SD, Keenan JD, Lietman TM, Lammie PJ, Aiemjoy K, Amza A, Aragie S, Arzika AM, Callahan EK, Carolan S, Dawed AA, Goodhew EB, Gwyn S, Hammou J, Kadri B, Kalua K, Maliki R, Nassirou B, Seife F, Tadesse Z, West SK, Wittberg DM, Zeru T, Arnold BF. Monitoring transmission intensity of trachoma with serology. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.02.13.23285881. [PMID: 36824972 PMCID: PMC9949201 DOI: 10.1101/2023.02.13.23285881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Trachoma, caused by ocular Chlamydia trachomatis infection, is targeted for global elimination as a public health problem by 2030. To provide evidence for use of antibodies to monitor C. trachomatis transmission, we collated IgG responses to Pgp3 antigen, PCR positivity, and clinical observations from 19,811 children aged 1- 9 years in 14 populations. We demonstrate that age-seroprevalence curves consistently shift along a gradient of transmission intensity: rising steeply in populations with high levels of infection and active trachoma and becoming flat in populations near elimination. Seroprevalence (range: 0-54%) and seroconversion rates (range: 0-15 per 100 person-years) correlate with PCR prevalence (r: 0.87, 95% CI: 0.57, 0.97). A seroprevalence threshold of 13.5% (seroconversion rate 2.75 per 100 person-years) identifies clusters with any PCR-identified infection at high sensitivity (>90%) and moderate specificity (69-75%). Antibody responses in young children provide a robust, generalizable approach to monitor population progress toward and beyond trachoma elimination.
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Affiliation(s)
- Christine Tedijanto
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA, 94158
| | - Anthony W. Solomon
- Global Neglected Tropical Diseases Programme, World Health Organization, Geneva, Switzerland
| | - Diana L. Martin
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, USA 30329
| | | | - Jeremy D. Keenan
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA, 94158
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA, 94158
| | - Thomas M. Lietman
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA, 94158
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA, 94158
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA 94143
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94143
| | - Patrick J. Lammie
- Neglected Tropical Diseases Support Center, Task Force for Global Health, Atlanta, GA, USA, 30030
| | - Kristen Aiemjoy
- Division of Epidemiology, Department of Public Health Sciences, University of California Davis School of Medicine, Davis, CA, USA
| | - Abdou Amza
- Programme National de Santé Oculaire, Niamey, Niger
- Programme National de Lutte Contre la Cecité, Niamey, Niger
| | - Solomon Aragie
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA, 94158
- The Carter Center Ethiopia, Addis Ababa, Ethiopia
- Infection Biology, Addis Ababa University, Addis Ababa, Ethiopia
| | | | | | - Sydney Carolan
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA, 94158
| | | | - E. Brook Goodhew
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, USA 30329
| | - Sarah Gwyn
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, USA 30329
| | - Jaouad Hammou
- Service of Ocular and Otological Diseases, Epidemiology and Disease Control Directorate, Ministry of Health, Morocco
| | - Boubacar Kadri
- Programme National de Santé Oculaire, Niamey, Niger
- Programme National de Lutte Contre la Cecité, Niamey, Niger
| | - Khumbo Kalua
- Blantyre Institute for Community Outreach, Malawi
| | | | - Beido Nassirou
- Programme National de Santé Oculaire, Niamey, Niger
- Programme National de Lutte Contre la Cecité, Niamey, Niger
| | - Fikre Seife
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | | | - Sheila K. West
- Johns Hopkins School of Medicine, Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Baltimore MD USA
| | - Dionna M. Wittberg
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA, 94158
| | - Taye Zeru
- Amhara Public Health Institute, Bahir-Dar, Ethiopia
| | - Benjamin F. Arnold
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA, 94158
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA, 94158
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8
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Goodhew B, Tang X, Goldstein J, Lee J, Martin D, Gwyn S. Validation of immunoassays for the Chlamydia trachomatis antigen Pgp3 using a chimeric monoclonal antibody. Sci Rep 2023; 13:7281. [PMID: 37142607 PMCID: PMC10160048 DOI: 10.1038/s41598-023-33834-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 04/19/2023] [Indexed: 05/06/2023] Open
Abstract
Seroepidemiology, or measuring antibodies to pathogens to estimate population-level exposure, can provide useful public health data. The tests used, however, often lack sufficient validation data due to absence of a gold standard. For many pathogens, serum antibodies can be detected long after resolution of infection, but infection status is often used as a gold standard for antibody positivity. To ensure that recently developed antibody tests for seroepidemiology of Chlamydia trachomatis (Ct), the causative agent of urogenital chlamydia and the blinding eye disease trachoma, have high performance, we generated a chimeric antibody to the immunodominant Ct antigen Pgp3. Two clones were selected to evaluate the test performance of three assays to measure antibodies to Pgp3: multiplex bead assay (MBA), enzyme-linked immunosorbent assay (ELISA), and lateral flow assay (LFA). Overall, each assay demonstrated high accuracy and precision when tested using either clone, and the clones were stable when stored at - 20 °C and 4 °C for almost 2 years. The limit of detection was similar for MBA and LFA, but almost a log-fold higher (i.e. less sensitive) using ELISA. Overall, the chimeric antibodies represent stable control reagents for tests with robust performance and will facilitate deployment of these tests to other laboratories.
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Affiliation(s)
- Brook Goodhew
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Xiaoling Tang
- Division of Scientific Resources, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jason Goldstein
- Division of Scientific Resources, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Joo Lee
- Division of Scientific Resources, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Diana Martin
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sarah Gwyn
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia.
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Sanders AM, Makoy S, Deathe AR, Ohidor S, Jesudason TC, Nute AW, Odongi P, Boniface L, Abuba S, Delahaut AS, Sebit W, Niquette J, Callahan EK, Walker DG, Nash SD. Cost and community acceptability of enhanced antibiotic distribution approaches for trachoma in the Republic of South Sudan: enhancing the A in SAFE (ETAS) study protocol. BMC Ophthalmol 2023; 23:51. [PMID: 36747194 PMCID: PMC9900535 DOI: 10.1186/s12886-023-02783-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 01/13/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The World Health Organization targeted trachoma for global elimination as a public health problem by 2030. Reaching elimination thresholds by the year 2030 in the Republic of South Sudan will be a considerable challenge, as the country currently has many counties considered hyper-endemic (> 30% trachomatous inflammation-follicular [TF]) that have yet to receive interventions. Evidence from randomized trials, modeling, and population-based surveys suggests that enhancements may be needed to the standard-of-care annual mass drug administration (MDA) to reach elimination thresholds in a timely manner within highly endemic areas. We describe a protocol for a study to determine the cost and community acceptability of enhanced antibiotic strategies for trachoma in South Sudan. METHODS The Enhancing the A in SAFE (ETAS) study is a community randomized intervention costing and community acceptability study. Following a population-based trachoma prevalence survey in 1 county, 30 communities will be randomized 1:1 to receive 1 of 2 enhanced MDA interventions, with the remaining communities receiving standard-of-care annual MDA. The first intervention strategy will consist of a community-wide MDA followed by 2 rounds of targeted treatment to children ages 6 months to 9 years, 2 weeks and 4 weeks after the community MDA. The second strategy will consist of a community-wide biannual MDA approximately 6 to 8 months apart. The costing analysis will use a payer perspective and identify the total cost of the enhanced interventions and annual MDA. Community acceptability will be assessed through MDA coverage monitoring and mixed-methods research involving community stakeholders. A second trachoma-specific survey will be conducted 12 months following the original survey. DISCUSSION ETAS has received ethical clearance and is expected to be conducted between 2022 and 2023. Results will be shared through subsequent manuscripts. The study's results will provide information to trachoma programs on whether enhanced interventions are affordable and acceptable to communities. These results will further help in the design of future trachoma-specific antibiotic efficacy trials. Enhanced MDA approaches could help countries recover from delays caused by conflict or humanitarian emergencies and could also assist countries such as South Sudan in reaching trachoma elimination as a public health problem by 2030. TRIAL REGISTRATION This trial was registered on December 1st, 2022 (clinicaltrails.org: NCT05634759).
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Affiliation(s)
| | - Samuel Makoy
- Ministry of Health, Juba, Republic of South Sudan
| | - Andrew R. Deathe
- grid.418694.60000 0001 2291 4696The Carter Center, Atlanta, GA USA
| | | | | | - Andrew W. Nute
- grid.418694.60000 0001 2291 4696The Carter Center, Atlanta, GA USA
| | | | | | - Stella Abuba
- The Carter Center, Juba, Republic of South Sudan
| | | | - Wilson Sebit
- Ministry of Health, Juba, Republic of South Sudan
| | | | | | | | - Scott D. Nash
- grid.418694.60000 0001 2291 4696The Carter Center, Atlanta, GA USA
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10
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D. Nash S, Chernet A, Weiss P, W. Nute A, Zerihun M, Sata E, Gessese D, A. Jensen K, Ayele Z, Melak B, Zeru T, Mengistu A, Abebe A, Seife F, Tadesse Z, Callahan EK. Prevalence of Ocular Chlamydia trachomatis Infection in Amhara Region, Ethiopia, after 8 Years of Trachoma Control Interventions. Am J Trop Med Hyg 2023; 108:261-267. [PMID: 36623484 PMCID: PMC9896333 DOI: 10.4269/ajtmh.22-0535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/14/2022] [Indexed: 01/11/2023] Open
Abstract
Although trachoma mass drug administration (MDA) programs target ocular Chlamydia trachomatis, the global trachoma control program does not monitor infection as a measure of impact but instead relies on monitoring clinical indicators. This study aimed to monitor the prevalence of ocular C. trachomatis among a population-based sample of children ages 1-5 years throughout Amhara, Ethiopia, a region that has received approximately 8 years of annual MDA as part of trachoma control. Between 2014 and 2021, trachoma impact surveys and surveillance surveys were conducted in all 156 districts of Amhara using a multistage cluster randomized methodology. Certified graders assessed individuals ages ≥ 1 year for trachomatous inflammation-follicular (TF), and a random subset of children ages 1-5 years also provided a conjunctival swab. Polymerase chain reaction was used to test for C. trachomatis. A total of 28,410 conjunctival swabs were collected from children ages 1-5 years across Amhara. The regional C. trachomatis infection prevalence was 4.7% (95% uncertainty interval: 4.3-5.1%). Infection was detected in all 10 zones of the region and ranged from 0.2% in Awi Zone to 11.9% in Waghemra Zone. Infection was detected in 17 (26%) districts with a TF prevalence < 10% and in 7 (21%) districts with a TF prevalence < 5%. Through programmatic monitoring of C. trachomatis infection, this study demonstrated that considerable infection remained throughout Amhara despite approximately 8 years of trachoma interventions and that enhanced interventions such as more frequent than annual MDA will be needed if elimination thresholds are to be reached.
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Affiliation(s)
- Scott D. Nash
- Trachoma Control Program, The Carter Center, Atlanta, Georgia;,Address correspondence to Scott Nash, The Carter Center, 453 John Lewis Freedom Pkwy. NE, Atlanta, GA 30307. E-mail:
| | - Ambahun Chernet
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Paul Weiss
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia
| | - Andrew W. Nute
- Trachoma Control Program, The Carter Center, Atlanta, Georgia
| | - Mulat Zerihun
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Eshetu Sata
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Demelash Gessese
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | | | - Zebene Ayele
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Berhanu Melak
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Taye Zeru
- Amhara Public Health Institute, Bahir, Dar, Ethiopia
| | | | - Adisu Abebe
- Amhara Regional Health Bureau, Bahir Dar, Ethiopia
| | | | - Zerihun Tadesse
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
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11
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Risk of seroconversion and seroreversion of antibodies to Chlamydia trachomatis pgp3 in a longitudinal cohort of children in a low trachoma prevalence district in Tanzania. PLoS Negl Trop Dis 2022; 16:e0010629. [PMID: 35830476 PMCID: PMC9312410 DOI: 10.1371/journal.pntd.0010629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 07/25/2022] [Accepted: 07/01/2022] [Indexed: 11/19/2022] Open
Abstract
Background Serologic testing for chlamydial antibodies is one potential tool for trachoma monitoring. Understanding the dynamics of seroconversion and seroreversion in low endemic districts is critical for determining the value of using serology. Methodology/Principal findings We surveyed a random sample of 2536 children aged 1–9 years in Kongwa, Tanzania, over three years; 1719 (67.8%) participants had all three follow-ups. Surveys assessed trachomatous inflammation—follicular (TF), Chlamydia trachomatis infection, and anti-pgp3 antibodies. Mass drug administration occurred immediately after the first and second follow-up surveys. The cohort was classified into trajectories of change in serostatus, and risk factors were evaluated for seroconversion and seroreversion. We found that 86.2% of seropositives remained seropositive throughout the study, whereas 12.1% seroreverted. Seroreverters were younger (Odds Ratio [OR] = 0.88 for every one-year increase in age, 95% CI = 0.79–0.99). 84.5% of seronegatives remained seronegative, and 13.0% seroconverted. Seroconverters were also younger (OR = 0.92, 95% CI = 0.87–0.98). Seroconversion and seroreversion were not explained by indeterminate values for the intensity of antibody response. Less than 1% of the cohort had unstable changes in serostatus, mostly explained by values in the indeterminate range. TF and infection in the cohort declined over time, while seropositivity increased from 31.5% to 36.4%. Conclusions/Significance Antibody status is relatively stable over time. Both seroconversion and seroreversion occurred over the three years in this low endemic district, especially in younger children. Modeling seroreversion is important for accurate determination of seroconversion. The use of serology as a monitoring tool should target the younger aged children as they will most likely capture recent changes in serostatus. Trachoma, the leading infectious cause of blindness worldwide, is a chronic conjunctivitis caused by repeated infection with Chlamydia trachomatis. As more endemic regions approach the trachoma elimination goal, it becomes critical to identify tools that can be used for monitoring the potential resurgence or re-emergence of trachoma. Serologic testing for chlamydial antibodies is one potential tool. Understanding the risk of seroconversion and seroreversion in children in low endemic districts is critical for determining the value of serology as a monitoring tool. We followed a cohort of children in the formerly trachoma endemic Kongwa district in Tanzania over three years. We demonstrated the relative stability of antibody status with 85–86% of the children retaining their baseline serostatus. We also documented an overall seroconversion rate of 13% and a seroreversion rate of 12%. We found younger ages to be a risk factor for both seroconversion and seroreversion. Our study provides necessary new evidence for the slow rate of overall change in seroprevalence over three years and highlights the potential use of the younger aged children for sero-monitoring of trachoma as they are more likely to reflect the dynamic interplay of true seroconversion and seroreversion. Furthermore, using only cross-sectional serostatus to estimate seroconversion may result in an underestimate if seroreversion rates are not included in the estimation.
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12
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Hammou J, Guagliardo SAJ, Obtel M, Razine R, Haroun AE, Youbi M, Bellefquih AM, White M, Gwyn S, Martin DL. Post-Validation Survey in Two Districts of Morocco after the Elimination of Trachoma as a Public Health Problem. Am J Trop Med Hyg 2022; 106:tpmd211140. [PMID: 35344929 PMCID: PMC9128706 DOI: 10.4269/ajtmh.21-1140] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 01/16/2022] [Indexed: 11/07/2022] Open
Abstract
Trachoma is the leading infectious cause of blindness. In 2016, Morocco was validated by WHO as having eliminated trachoma as a public health problem. We evaluated two previously endemic districts in Morocco for trachomatous inflammation-follicular (TF), trachomatous trichiasis (TT), and antibodies against Chlamydia trachomatis, the causative agent of trachoma. Community-based cross-sectional surveys in the districts of Boumalene Dades and Agdez included 4,445 participants for whom both questionnaire and serology data were available; 58% were aged 1-9 years. Participants had eyes examined for TF and blood collected for analysis of antibodies to the C. trachomatis antigen Pgp3 by both a multiplex bead assay (MBA) and lateral flow assay (LFA). Seroconversion rates (SCR) per 100 people per year were used to estimate changes in the force of infection using Bayesian serocatalytic models. In Agdez, TF prevalence in 1-9-year-olds was 0.3%, seroprevalence ranged from 9.4% to 11.4%, and SCR estimates ranged from 2.4 to 3.0. In Boumalene Dades, TF prevalence in 1-9-year-olds was 0.07%, and modeling data from the different assays indicated a decrease in transmission between 20 and 24 years ago. The TF data support an absence of active trachoma in the two districts examined. However, seroprevalence and SCR in younger people were higher in Agdez than Boumalene Dades, showing that there can be differences in serology metrics in areas with similar TF prevalence. Data will be included in multicountry analyses to better understand potential thresholds for serological surveillance in trachoma.
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Affiliation(s)
- Jaouad Hammou
- Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco
| | - Sarah Anne J. Guagliardo
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Majdouline Obtel
- Laboratory of Biostatistics, Clinical Research and Epidemiology, Department of Public Health, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco
- Laboratory of Community Heath (Public Health, Preventive Medicine and Hygiene), Department of Public Health, Faculty of Medicine and Pharmacy, University Mohammed V, Rabat, Morocco
| | - Rachid Razine
- Laboratory of Biostatistics, Clinical Research and Epidemiology, Department of Public Health, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco
- Laboratory of Community Heath (Public Health, Preventive Medicine and Hygiene), Department of Public Health, Faculty of Medicine and Pharmacy, University Mohammed V, Rabat, Morocco
| | - Abbas Ermilo Haroun
- Laboratory of Biostatistics, Clinical Research and Epidemiology, Department of Public Health, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco
- Laboratory of Community Heath (Public Health, Preventive Medicine and Hygiene), Department of Public Health, Faculty of Medicine and Pharmacy, University Mohammed V, Rabat, Morocco
| | - Mohamed Youbi
- Directorate of Epidemiology and Disease Control, Ministry of Health, Rabat, Morocco
| | | | - Michael White
- Infectious Disease Epidemiology and Analytics Unit, Department of Global Health, Institute Pasteur, Paris, France
| | - Sarah Gwyn
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Diana L. Martin
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
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13
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Xiong T, Yue Y, Li WX, Choonara I, Qazi S, Chen HJ, Tang J, Shi J, Wang H, Zeng LN, Xia B, Qiao LN, Qu Y, Mu DZ. Effectiveness of azithromycin mass drug administration on trachoma: a systematic review. Chin Med J (Engl) 2021; 134:2944-2953. [PMID: 34665571 PMCID: PMC8710348 DOI: 10.1097/cm9.0000000000001717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUNDS Azithromycin mass drug administration (MDA) is a key part of the strategy for controlling trachoma. This systematic review aimed to comprehensively summarize the present studies of azithromycin MDA on trachoma; provide an overview of the impact of azithromycin MDA on trachoma in different districts; and explore the possible methods to enhance the effectiveness of azithromycin MDA in hyperendemic districts. METHODS PubMed, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, and ClinicalTrials.gov were searched up to February 2021 with no language restriction. Studies reporting the effect of azithromycin MDA on trachoma were included. Mathematical modeling studies, animal studies, case reports, and reviews were excluded. The trachomatous inflammation-follicular (TF) <5.0% was used to judge the effect of azithromycin MDA on eliminating trachoma as a public health problem. Two researchers independently conducted the selection process and risk of bias assessment. RESULTS A total of 1543 studies were screened, of which 67 studies including 13 cluster-randomized controlled trials and 54 non-randomized studies were included. The effect of azithromycin MDA on trachoma was closely related to the baseline prevalence in districts. For the districts with baseline prevalence between 5.0% and 9.9%, a single round of MDA achieved a TF <5.0%. For the districts with baseline between 10.0% and 29.9%, annual MDA for 3 to 5 years reduced TF <5.0%. However, for the districts with high level of baseline prevalence (TF >30.0%), especially with baseline TF >50.0%, annual MDA was unable to achieve the TF <5.0% even after 5 to 7 years of treatment. Quarterly MDA is more effective in controlling trachoma in these hyperendemic districts. CONCLUSIONS Azithromycin MDA for controlling trachoma depends on the baseline prevalence. The recommendation by the World Health Organization that annual MDA for 3 to 5 years in the districts with TF baseline >10.0% is not appropriate for all eligible districts.
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Affiliation(s)
- Tao Xiong
- Department of Pediatrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Yan Yue
- Key Laboratory of Obstetrics & Gynecologic and Pediatric Diseases and Birth Defects of the Ministry of Education, Sichuan University, Chengdu, Sichuan 610041, China
| | - Wen-Xing Li
- Department of Pediatrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Imti Choonara
- Academic Division of Child Health, University of Nottingham, Derbyshire Children's Hospital, Derby, UK
| | - Shamim Qazi
- Department of Maternal Newborn Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Hong-Ju Chen
- Department of Pediatrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Jun Tang
- Department of Pediatrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Jing Shi
- Department of Pediatrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Hua Wang
- Department of Pediatrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Li-Nan Zeng
- Department of Pharmacy, Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, Chengdu, Sichuan 610041, China
| | - Bin Xia
- Department of Pediatrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Li-Na Qiao
- Department of Pediatrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Yi Qu
- Department of Pediatrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - De-Zhi Mu
- Key Laboratory of Obstetrics & Gynecologic and Pediatric Diseases and Birth Defects of the Ministry of Education, Sichuan University, Chengdu, Sichuan 610041, China
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14
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Danavall DC, Gwyn S, Anyalechi GE, Bowden KE, Hong J, Kirkcaldy RD, Bernstein KT, Kersh EN, Martin D, Raphael BH. Assessment and utility of 2 Chlamydia trachomatis Pgp3 serological assays for seroprevalence studies among women in the United States. Diagn Microbiol Infect Dis 2021; 101:115480. [PMID: 34325205 DOI: 10.1016/j.diagmicrobio.2021.115480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/29/2021] [Accepted: 07/01/2021] [Indexed: 11/27/2022]
Abstract
Two plasmid gene protein (Pgp3)-based serological assays, the Pgp3-ELISA and multiplex bead assay (Pgp3-MBA), were compared and used to estimate seropositivity of Chlamydia trachomatis (CT) among females 14 to 39 years old participating in the National Health and Nutrition Examination Survey between 2013-2016. Of the 2,201 specimens tested, 502 (29.5%, 95% CI 27.6-31.5) were positive using Pgp3-ELISA and 624 (28.4%, 95% CI 26.5-30.3) were positive using Pgp3-MBA. The overall agreement between the assays was 87.7%. Corresponding nucleic acid amplification test (NAAT) results were available for 1,725 specimens (from women 18-39 years old); of these, 42 (2.4%, 95% CI 1.8-3.3) were CT NAAT-positive. Most of the CT NAAT-positive specimens had corresponding positive serological assay results; 33 (78.6%, 95% CI 62.8-89.2) were Pgp3-ELISA-positive and 36 (85.7%, 95% CI 70.8-94.1) were Pgp3-MBA-positive. Although Pgp3-ELISA and Pgp3-MBA demonstrated equivalent performance in this study, an advantage of the Pgp3-MBA over Pgp3-ELISA is that it is well suited for high sample throughput applications.
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Affiliation(s)
- Damien C Danavall
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Sarah Gwyn
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Gloria E Anyalechi
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Katherine E Bowden
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jaeyoung Hong
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Robert D Kirkcaldy
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kyle T Bernstein
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ellen N Kersh
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Diana Martin
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Brian H Raphael
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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15
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Odonkor M, Naufal F, Munoz B, Mkocha H, Kasubi M, Wolle M, West S. Serology, infection, and clinical trachoma as tools in prevalence surveys for re-emergence of trachoma in a formerly hyperendemic district. PLoS Negl Trop Dis 2021; 15:e0009343. [PMID: 33861754 PMCID: PMC8081338 DOI: 10.1371/journal.pntd.0009343] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 04/28/2021] [Accepted: 03/30/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND To eliminate trachoma as a public health problem, countries must achieve a district-level prevalence of trachomatous inflammation-follicular (TF) <5% in children ages 1-9 years. Re-emergence of TF could trigger additional rounds of mass drug/antibiotic administration (MDA), so accurate tools for use in surveys assessing trachoma prevalence are essential. METHODOLOGY & PRINCIPAL FINDINGS We surveyed 2401 children ages 1-9 years from 50 villages in Kongwa, Tanzania, 2 years post-MDA and 1.5 years after an impact survey found TF <5% in the same villages. Our survey included multiple tools: clinical determination of TF, Cepheid testing for Chlamydia trachomatis infection, and testing for anti-pgp3 antibodies via multiplex bead array. Photographs of the upper tarsal conjunctiva were taken in a subset of children to corroborate the field grades. Overall TF prevalence in 1-9 year olds was 7.1% (95% CI: 5.6%-8.9%), which decreased with age (p = <0.0001). TF prevalence by village was heterogeneous, with 19 villages having TF <5% and 16 villages having TF >10%. There was a strong correlation between field and photo grading of TF (kappa = 0.69; 95% CI: 0.60-0.78) and between TF and infection, with 21.5% of TF-positive children also testing positive for infection, as compared to only 1.6% of TF-negative children (p = 0.0010). Overall seroprevalence was 18.2% (95% CI: 14.8%-22.1%), which increased with age (p = <0.0001). Notably, 1-2 year olds, who were born after the cessation of MDA and theoretically should not have had exposure to C. trachomatis in the absence of transmission, had an average seroprevalence of 6.7%. CONCLUSIONS & SIGNIFICANCE Field TF prevalence, supported by photographic review and infection data, suggested re-emergence of trachoma in Kongwa. Moreover, seropositivity in the children born after cessation of MDA indicated exposure to C. trachomatis despite a previous survey finding of TF <5%. Examining seropositivity in specific age groups expected to have limited exposure to C. trachomatis can be used to detect re-emergence.
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Affiliation(s)
- Michelle Odonkor
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, United States of America
- * E-mail: (MO); (SW)
| | - Fahd Naufal
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Beatriz Munoz
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, United States of America
| | | | - Mabula Kasubi
- Department of Microbiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Meraf Wolle
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Sheila West
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, United States of America
- * E-mail: (MO); (SW)
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