Impact of annual targeted treatment on infectious trachoma and susceptibility to reinfection
Impact of annual targeted treatment on infectious trachoma and susceptibility to reinfection
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DOI：
10.1001/jama.296.12.1488
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发表时间：
2006-09-27
影响因子：
120.7
通讯作者：
Dean, Deborah
中科院分区：
文献类型：
--
作者：
Atik, Berna;Thanh, Ton Ton Kim;Dean, Deborah
世界卫生组织制定了SAFE战略（倒睫手术;沙眼衣原体感染抗生素;面部清洁;环境改善），以在2020年前在全球消除致盲性沙眼。尽管许多研究使用不同的治疗间隔不同的患病率，有一直缺乏足够的后续行动超出最终治疗点，以确定复发率的疾病和感染的危险因素，可能有助于each.Objective评价的影响，每年有针对性的阿奇霉素治疗活动性沙眼和沙眼衣原体感染率超过3年在越南。设置，和参与者三个公社被随机选择在越南的纵向研究，从2000年11月至2003年11月。个体（n = 3186）进行沙眼分级，然后结膜采样，通过商业聚合酶链反应检测衣原体。每6个月重复一次分级和衣原体检测，连续3年。在基线和12个月时，对SAFE和SA社区5 ~ 15岁活动性沙眼儿童及其家庭成员给予阿奇霉素干预;这些公社与S-主要指标活动性沙眼和沙眼衣原体的患病率和发病率基线、6、12、18、24和36个月时所有社区的感染情况。亚组分析评估了新的感染，持续感染，并在6，12，18，24，36个月和危险因素each.Results再感染率显着增加12和36个月之间的安全（从1.6至29.3每1000; P <0.001）和SA（5.1至25.3每1000; P = 0.001）。002)24个月后，仅含S的社区（13.4至6.7/1000; P = .55）。混合效应和广义估计方程（GEE）logistic模型显示，SAFE的再感染风险显著高于仅使用S的公社（比值比[OR]，4.1; 95%置信区间[CI]，1.5- 9.8; P = .005）和SA（OR，4.2; 95% CI，1.1-17.3; P = .04）36个月时的社区。结论再感染率的增加表明，治疗可能会中断产生免疫力所需的感染持续时间，随着时间的推移，易受再感染的人数增加，并对疾病流行产生不利影响。需要进一步的研究来确定最佳的沙眼控制策略，包括对“F”和“E”成分的评估。
Context The World Health Organization developed the SAFE strategy ( Surgery for trichiasis; Antibiotics for Chlamydia trachomatis infection; Facial cleanliness; and Environmental improvement) to eliminate blinding trachoma globally by the year 2020. Despite a number of studies using various intervals of treatment for different prevalence rates, there has been a lack of sufficient follow-up beyond the final treatment point to determine rates of recurrence of disease and infection and the risk factors that may contribute to each.Objective To evaluate the impact of 2 annual targeted azithromycin treatments on active trachoma and C trachomatis infection rates over 3 years in Vietnam.Design, Setting, and Participants Three communes were randomly selected for a longitudinal study in Vietnam from November 2000 through November 2003. Individuals (n = 3186) were graded for trachoma followed by conjunctival sampling to detect chlamydiae by commercial polymerase chain reaction. Grading and chlamydial detection were repeated every 6 months for 3 years.Intervention Azithromycin was given to children aged 5 through 15 years with active trachoma and their household members in SAFE and SA communes at baseline and 12 months; these communes were compared with the S-only control commune that did not receive azithromycin targeted treatment.Main Outcome Measures Prevalence and incidence of active trachoma and C trachomatis infection in all communes at baseline, 6, 12, 18, 24, and 36 months. Subgroup analysis evaluated new infection, continuing infection, and reinfection at 6, 12, 18, 24, and 36 months and risk factors for each.Results Reinfection rates increased significantly between 12 and 36 months for SAFE ( from 1.6 to 29.3 per 1000; P < .001) and SA (5.1 to 25.3 per 1000; P = . 002) communes but not for the S-only commune (13.4 to 6.7 per 1000; P = .55) after 24 months. Compared with the S-only commune, mixed-effects and generalized estimating equations ( GEE) logistic models showed that reinfection risk was significantly higher for SAFE ( odds ratio [OR], 4.1; 95% confidence interval [CI], 1.5- 9.8; P = .005) and SA ( OR, 4.2; 95% CI, 1.1-17.3; P = .04) communes at 36 months.Conclusions Increasing reinfection rates suggest that treatment may interrupt the duration of infection required for developing immunity, increasing the number of individuals susceptible to reinfection and adversely affecting disease prevalence over time. Additional research is needed to determine optimal trachoma control strategies, including evaluation of the "F" and "E" components.