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Sheila K. West, Beatriz Munoz, Dianne Stare, Harran Mkocha, Charlotte Gaydos, Thomas Quinn; Do Infants Increase The Risk Of Re-emergent Infection With C. Trachomatis Post Mass Drug Administration For Trachoma?. Invest. Ophthalmol. Vis. Sci. 2011;52(14):5913.
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Mass drug administration (MDA) with azithromycin in areas with endemic trachoma is part of the World Health Organization (WHO) SAFE strategy. However, infants less than 6 months, who may have heavy loads of infection with C. trachomatis, are not approved to receive oral azithromycin, and parents are provided with topical tetracycline to apply twice a day for six weeks. We hypothesized that children in households with infants under 6 months at baseline would have higher rates of infection with C. trachomatis 6 months post mass treatment compared to children in households with no infant.
A longitudinal cohort of children ages under ten years at baseline was followed over 6 months post MDA, where coverage was over 90% in children older than 6 months. At baseline and 6 months, a trained grader used the WHO simplified grading system to determine the presence of active trachoma. Ocular swabs were collected and shipped to the International Chlamydia Research Laboratory at Johns Hopkins University for determination of infection using Amplicor polymerase chain reaction. Rates of infection in infants at baseline and 6 months were calculated, and the risk of infection for older children residing in a home with an infant was determined using a multiple regression model.
At baseline, 6% of 91 infants ages less than 6 months were infected and 1% had follicular trachoma. The prevalence of infection at 6 months in children living in a household with an infant was 6%, compared to 11% in children who did not live with an infant (p=.18). Adjusting for age, gender, baseline infection status and treatment, residing in a house with an infant was not associated with an increased risk of infection at 6 months post MDA (OR=0.5, 95% CI=0.2-1.2).
This prospective study did not find evidence that living in a household with an infant increased the risk of infection 6 months post MDA Topical tetracycline provision may be adequate as part of MDA.
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