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Beatriz E. Munoz, Harran Mkocha, Charlotte A. Gaydos, Thomas C. Quinn, Sheila K. West; Chlamydia Trachomatis Infection Among Incoming Families to Communities with Annual Mass Treatment Distribution of Anbiotics for Trachoma Control, PRET Study. Invest. Ophthalmol. Vis. Sci. 2012;53(14):66.
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The World Health Organization recommends annual Mass Drug Administration (MDA) with antibiotics in communities where the prevalence of active trachoma in children age 1-10 years is 10% or more, with the goal of reducing trachoma prevalence to <5%. Although annual MDA with high coverage has been successful in reducing the prevalence of C. trachomatis (CT) infection, re-emergent infection of unknown source has been observed. We assessed the contribution to the prevalence of C. infection of in-migration of families from untreated areas to communities that have been part of the control program.
The data from 4 Tanzanian communities with endemic trachoma that have already had two annual rounds of MDA with coverage above 80% was examined. Census/update of all households was conducted yearly prior to the MDA, and in addition all children aged 0-9 were examined for trachoma using the WHO grading scheme and tested for CT infection using Amplicor. Within each community, families were grouped in neighborhoods of 10 to 15 families each. We examined the relationship between the arrival of new families to the neighborhood and the presence of CT infection in the children residents of that neighborhood. Random effects models were used to account for the clustering effect of neighborhoods within communities.
One year after the second MDA, a total of 2596 children were examined. Of them, 4% belonged to families who were new to the community. The prevalence of CT infection in children from new families was 14% compared to 7% in children from families resident in the community for at least a year (fisher’s exact test p=0.016). Within the 4 communities there were 100 distinct neighborhoods with prevalence of CT infection in children ranging from 0% to 9%. Neighborhoods with new arrivals were more likely to have 2 or more children infected (Odds Ratio=4.1, 95% Confidence Interval (1.56, 10.74)).
Trachoma control programs should be aware that even with high annual MDA coverage, new families from untreated areas could be a significant source of re-infection. Surveillance and treatment of these families may be important for the interruption of re-emergent Chlamydia trachomatis infection in the community.
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