Community-level chlamydial serology for assessing trachoma elimination in trachoma-endemic Niger
Community-level chlamydial serology for assessing trachoma elimination in trachoma-endemic Niger
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DOI：
10.1371/journal.pntd.0007127
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发表时间：
2019-01-01
影响因子：
3.8
通讯作者：
Martin, Diana L.
中科院分区：
文献类型：
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作者：
Kim, Jessica S.;Oldenburg, Catherine E.;Martin, Diana L.
背景：目前，沙眼消除的计划决策依赖于结膜临床体征。抗体检测可以提供更多的信息，沙眼的流行病学，特别是在地区，它正在消失或消除目标已经mention.Methods一个群集随机试验的大规模阿奇霉素分布战略沙眼消除进行了三年以上的中流行地区的尼日尔。在干预开始后36个月，从24个研究社区的1-5岁儿童随机样本中收集干血斑。多重珠测定用于测试针对两种沙眼衣原体抗原Pgp 3和CT 694的抗体。我们比较了两种抗原的血清阳性与活动性沙眼的临床体征（沙眼炎症滤泡[TF]和沙眼炎症强烈[TI]）在个体和群体水平，以及眼部衣原体患病率在社区水平。TF患病率为7.8%（95% CI 6.1 - 9.5），TI患病率为1.6%（95% CI 0.9 - 2.6）。Pgp 3抗体阳性的总体患病率为27.2%（95% CI 24.5至30），CT 694抗体阳性的总体患病率为23.7%（95% CI 21至26.2）。眼部衣原体感染患病率为5.2%（95%CI 2.8 - 7.6）。Pgp 3和/或CT694的血清阳性与TF在个人和社区水平上显著相关，与眼部衣原体感染和TI在社区水平上显著相关。结论在尼日尔中度流行区，沙眼衣原体感染与Pgp 3和CT 694血清阳性相关。试验注册ClinicalTrials.gov NCT 00792922。指导社区治疗决策，评估阿奇霉素大规模给药的反应。这些项目依赖于临床分级，在低流行地区，临床分级与沙眼病原体沙眼衣原体（Ct）感染相关性很差。Ct的血清学测量可以提供有关暴露和传播模式的额外信息。在这里，我们评估了Ct，感染，TF在个人和社区水平的血清学标志物之间的关系，以评估在尼日尔的中度流行区的沙眼测量血清学的效用。我们发现，血清学标志物与感染和TF相关，表明血清学标志物的列入可能有助于指导沙眼决策。
Background Program decision-making for trachoma elimination currently relies on conjunctival clinical signs. Antibody tests may provide additional information on the epidemiology of trachoma, particularly in regions where it is disappearing or elimination targets have been met.Methods A cluster-randomized trial of mass azithromycin distribution strategies for trachoma elimination was conducted over three years in a mesoendemic region of Niger. Dried blood spots were collected from a random sample of children aged 1-5 years in each of 24 study communities at 36 months after initiation of the intervention. A multiplex bead assay was used to test for antibodies to two Chlamydia trachomatis antigens, Pgp3 and CT694. We compared seropositivity to either antigen to clinical signs of active trachoma (trachomatous inflammationfollicular [TF] and trachomatous inflammationintense [TI]) at the individual and cluster level, and to ocular chlamydia prevalence at the community level.Results Of 988 children with antibody data, TF prevalence was 7.8% (95% CI 6.1 to 9.5) and TI prevalence was 1.6% (95% CI 0.9 to 2.6). The overall prevalence of antibody positivity to Pgp3 was 27.2% (95% CI 24.5 to 30), and to CT694 was 23.7% (95% CI 21 to 26.2). Ocular chlamydia infection prevalence was 5.2% (95% CI 2.8 to 7.6). Seropositivity to Pgp3 and/or CT694 was significantly associated with TF at the individual and community level and with ocular chlamydia infection and TI at the community level. Older children were more likely to be seropositive than younger children.Conclusion Seropositivity to Pgp3 and CT694 correlates with clinical signs and ocular chlamydia infection in a mesoendemic region of Niger.Trial registration ClinicalTrials.gov NCT00792922.Author summary Trachoma programs currently use the clinical sign of trachomatous inflammation-follicular (TF) to guide community treatment decisions and evaluate response to mass drug administration with azithromycin. These programs rely on clinical grading that poorly correlates with infection with the causative agent of trachoma, Chlamydia trachomatis (Ct), in low prevalence areas. Serologic measures of Ct may provide additional information about exposure and transmission patterns. Here, we evaluated the relationship between serologic markers of Ct, infection, and TF at the individual and community levels to evaluate the utility of serology for measuring trachoma in a mesoendemic region of Niger. We found that serologic markers correlated with both infection and TF, indicating that inclusion of serologic markers may be useful to guide trachoma decision making.