Risk factors for the progression of trachomatous scarring in a cohort of women in a trachoma low endemic district in Tanzania.
Risk factors for the progression of trachomatous scarring in a cohort of women in a trachoma low endemic district in Tanzania.
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DOI：
10.1371/journal.pntd.0009914
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发表时间：
2021-11
影响因子：
3.8
通讯作者：
West SK
中科院分区：
文献类型：
--
作者：
Wolle MA;Muñoz BE;Naufal F;Kashaf MS;Mkocha H;West SK
沙眼是一种由沙眼衣原体引起的慢性结膜炎，是世界范围内导致失明的主要传染性原因。沙眼作为一个公共卫生问题，已被列为消除的目标，包括减少儿童沙眼炎症-滤泡患病率和减少成人沙眼倒睫患病率。沙眼性倒睫是一种可能致盲的晚期沙眼后遗症，其发展速度取决于沙眼瘢痕的发展和进展速度。迄今为止，很少有研究评估了沙眼瘢痕形成的进展，在社区最近过渡到一个低沙眼炎症滤泡患病率。从坦桑尼亚Kongwa区48个社区的家庭中随机选择15岁及以上的妇女，并对这项纵向研究进行了3.5年的跟踪调查。在坦桑尼亚Kongwa的1-9岁儿童中，基线和随访时沙眼性炎症-滤泡患病率为5%。1018名年龄在15岁及以上的女性在基线时有沙眼瘢痕形成，并有沙眼瘢痕进展的风险; 691名（68%）完成了随访评估。在基线和随访时拍摄上睑板结膜的照片，并使用先前发表的四步严重程度量表对沙眼瘢痕进行分级。瘢痕形成的总体累积3.5年进展率为35.3%（95% CI 31.6-39.1）。在50岁以下的女性中，TS进展的几率随着年龄的增加而增加（OR 1.03，95% CI 1.01-1.05，p = 0.005），以及家庭贫困指数的增加（OR 1.29，95% CI 1.13-1.48，p = 0.0002）。尽管活动性沙眼患病率较低，但坦桑尼亚中部Kongwa以前是一个高流行区，现在变成了低流行区，该地区妇女瘢痕形成的3.5年进展率很高。这表明疤痕进展的驱动因素可能与该地区正在进行的沙眼传播无关。沙眼是一种由沙眼衣原体引起的慢性结膜炎，在儿童中表现为滤泡（沙眼性炎症-滤泡，TF），在年轻人中导致沙眼性结膜瘢痕（TS）。TS可进展为睫毛内翻、沙眼性倒睫（TT），其使个体处于不可逆视力丧失的高风险中。到目前为止，很少有研究评估TS在最近转变为低沙眼患病率的社区中的进展。我们研究了坦桑尼亚Kongwa地区妇女的TS进展，该地区最近转变为沙眼的低患病率。我们发现，3.5年内瘢痕形成的总体累积进展率为35.3%。观察到的瘢痕进展率与我们十年前在孔瓜观察到的非常相似，当时沙眼患病率非常高。我们的研究结果表明，一旦疤痕已经发展，它继续进展，无论目前的沙眼环境。这对消除沙眼的努力有潜在的影响。一个区域可以消除TF，但仍然必须处理瘢痕进展，这可能导致TT的发展。如果发生这种情况：1）TT的消除将被推迟，这将推迟沙眼作为一个公共卫生问题的全面消除，2）消除计划可用的有限资源可能需要重新分配。
Trachoma, a chronic conjunctivitis caused by Chlamydia trachomatis, is the leading infectious cause of blindness worldwide. Trachoma has been targeted for elimination as a public health problem which includes reducing trachomatous inflammation—follicular prevalence in children and reducing trachomatous trichiasis prevalence in adults. The rate of development of trachomatous trichiasis, the potentially blinding late-stage trachoma sequelae, depends on the rate of trachomatous scarring development and progression. Few studies to date have evaluated the progression of trachomatous scarring in communities that have recently transitioned to a low trachomatous inflammation—follicular prevalence. Women aged 15 and older were randomly selected from households in 48 communities within Kongwa district, Tanzania and followed over 3.5 years for this longitudinal study. Trachomatous inflammation—follicular prevalence was 5% at baseline and at follow-up in children aged 1–9 in Kongwa, Tanzania. 1018 women aged 15 and older had trachomatous scarring at baseline and were at risk for trachomatous scarring progression; 691 (68%) completed follow-up assessments. Photographs of the upper tarsal conjunctiva were obtained at baseline and follow-up and graded for trachomatous scarring using a previously published four-step severity scale. The overall cumulative 3.5-year progression rate of scarring was 35.3% (95% CI 31.6–39.1). The odds of TS progression increased with an increase in age in women younger than 50, (OR 1.03, 95% CI 1.01–1.05, p = 0.005) as well as an increase in the household poverty index (OR 1.29, 95% CI 1.13–1.48, p = 0.0002). The 3.5-year progression of scarring among women in Kongwa, a formerly hyperendemic now turned hypoendemic district in central Tanzania, was high despite a low active trachoma prevalence. This suggests that the drivers of scarring progression are likely not related to on-going trachoma transmission in this district. Trachoma, a chronic conjunctivitis caused by Chlamydia trachomatis, presents with follicles (trachomatous inflammation—follicular, TF) in children which leads to trachomatous conjunctival scarring (TS) in young adults. TS can progress to the in-turning of eyelashes, trachomatous trichiasis (TT) which places individuals at high risk of irreversible vision loss. Few studies to date have evaluated the progression of TS in communities that have recently transitioned to a low trachoma prevalence. We studied the progression of TS in women in Kongwa, Tanzania a district that recently transitioned to a low prevalence of trachoma. We found that the overall cumulative progression of scarring was 35.3% over 3.5 years. The scarring progression rate observed is very similar to what we observed a decade prior in Kongwa when the trachoma prevalence was very high. Our findings suggest that once scarring has developed it continues to progress irrespective of the current trachoma environment. This has potential ramifications for trachoma elimination efforts. An area could achieve the elimination of TF and still have to deal with scarring progression, which may lead to the development of TT. If this occurs: 1) elimination of TT will be delayed which will delay the overall elimination of trachoma as a public health problem, and 2) the limited resources available to elimination programs may need to be re-allocated.
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