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Free Content Chlamydial infection during trachoma monitoring: are the most difficult‐to‐reach children more likely to be infected?

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Objectives  During mass antibiotic distributions for trachoma, certain individuals are difficult to locate and go untreated. These untreated individuals may serve as a source of community reinfection. The importance of this difficult‐to‐locate, untreated population is unclear. We sought to determine whether individuals who are difficult to locate were more likely to be infected with ocular chlamydia than those who were easier to locate.

Methods  We monitored 12 Ethiopian communities 1 year after a third annual mass azithromycin treatment for trachoma. Conjunctival swabbing for chlamydial RNA was performed in a random sample of children from each community. If insufficient numbers of children were enrolled on the first monitoring day, we returned on subsequent days.

Results  Of the 12 communities, 10 required more than one monitoring day. On average, 16.1% (95% CI 7.9–30.0) of children were enrolled after the initial day. Evidence of chlamydia was found in 7.1% (95% CI 2.7–17.4) of 0‐ to 9‐year‐old children. No ocular swabs collected after the initial day were positive for chlamydial RNA. Children examined after the initial monitoring day were significantly less likely to have ocular chlamydial infection than children seen on the initial day; Mantel–Haenszel common OR = 0 (95% CI 0–0.77).

Conclusions  In a setting of repeated annual mass azithromycin treatments, after approximately 80% of individuals have been located in a community, extra efforts to find absent individuals may not yield significantly more cases of ocular chlamydia.
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Language: English

Document Type: Research Article

Affiliations: 1:  Department of Laboratory Medicine, University of California, San Francisco, CA, USA 2:  The Carter Center, Addis Ababa, Ethiopia 3:  Francis I. Proctor Foundation, San Francisco, CA, USA 4:  The Carter Center, Atlanta, GA, USA 5:  Department of Epidemiology & Biostatistics, University of California, San Francisco, CA, USA

Publication date: 2012-03-01

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