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Previous Volume 351:1962-1971 November 4, 2004 Number 19 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Mariotti, S. P. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background Trachoma, caused by repeated ocular infection with Chlamydia trachomatis, is an important cause of blindness. Current recommended dosing intervals for mass azithromycin treatment for trachoma are based on a mathematical model.

Methods We collected conjunctival swabs for quantitative polymerase-chain-reaction assay of C. trachomatis before and 2, 6, 12, 18, and 24 months after mass treatment with azithromycin in a Tanzanian community in which trachoma was endemic. For ethical reasons, at 6, 12, and 18 months, we gave tetracycline eye ointment to residents who had clinically active trachoma.

Results At baseline, 956 of 978 residents (97.8 percent) received either one oral dose of azithromycin or (if azithromycin was contraindicated) a course of tetracycline eye ointment. The prevalence of infection fell from 9.5 percent before mass treatment to 2.1 percent at 2 months and 0.1 percent at 24 months. The quantitative burden of ocular C. trachomatis infection in the community was 13.9 percent of the pretreatment level at 2 months and 0.8 percent at 24 months. At each time point after baseline, over 90 percent of the total community burden of C. trachomatis infection was found among subjects who had been positive the previous time they were tested.

Conclusions The prevalence and intensity of infection fell dramatically and remained low for two years after treatment. One round of very-high-coverage mass treatment with azithromycin, perhaps aided by subsequent periodic use of tetracycline eye ointment for persons with active disease, can interrupt the transmission of ocular C. trachomatis infection.

Source Information

From the London School of Hygiene and Tropical Medicine, London (A.W.S., M.J.H., N.D.E.A., A.A., A.N.-S., S.M., R.L.B., A.F., D.C.W.M.); Kilimanjaro Christian Medical College, Tumaini University, Moshi, Tanzania (A.W.S., J.F.S., P.C.); Huruma Hospital, Mkuu, Rombo, Tanzania (A.W.S., P.A.M., S.S.); the Medical Research Council Laboratories, Fajara, the Gambia (M.J.H., R.L.B.); Special Programme for Research and Training in Tropical Diseases, World Health Organization, Geneva (R.W.P.); the National Microbiology Laboratory, Health Canada, Winnipeg, Man. (R.W.P.); and the Dana Center for Preventive Ophthalmology, Johns Hopkins University, Baltimore (S.K.W.).

Address reprint requests to Dr. Solomon at the Clinical Research Unit, London School of Hygiene and Tropical Medicine, Keppel St., London WC1E 7HT, United Kingdom, or at anthony.solomon{at}lshtm.ac.uk.

Full Text of this Article

Related Letters:

Single-Dose Azithromycin for Trachoma
Lietman T. M., Gaynor B., Porco T., Solomon A. W., Foster A., Mabey D. C.W.
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N Engl J Med 2005; 352:414-415, Jan 27, 2005. Correspondence

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