Effect of a single mass antibiotic distribution on the prevalence of infectious trachoma
Effect of a single mass antibiotic distribution on the prevalence of infectious trachoma
复制标题
DOI：
10.1001/jama.295.10.1142
复制
发表时间：
2006-03-08
影响因子：
120.7
通讯作者：
Lietman, TM
中科院分区：
文献类型：
--
作者：
Chidambaram, JD;Alemayehu, W;Lietman, TM
背景世界卫生组织建议在其战略中大规模分发抗生素，以消除作为公共卫生问题的致盲沙眼。一些人假设单一分布足以控制导致沙眼的眼部衣原体菌株。其他人认为感染将不可避免地复发，定期治疗或其他措施是必要的。 目的 确定在埃塞俄比亚高流行地区进行一次大规模抗生素分发后 24 个月内，眼部衣原体感染是否会返回社区。 设计、设置和参与者 2003 年 3 月至 2005 年 3 月在埃塞俄比亚古拉奇地区进行的纵向队列研究。随机选择的八个村庄进行了眼部衣原体感染评估。在 12 个月时随机选择 15 个未经治疗的村庄，以评估长期趋势。 干预措施 为 8 个选定村庄的 1 岁或以上的所有居民提供单剂口服阿奇霉素。 主要结果指标 治疗前以及群体发生后 2、6、12、18 和 24 个月时，每个干预村庄的所有 1 至 5 岁儿童眼衣原体感染的患病率 结果 515 名儿童在基线时接受了眼部衣原体感染检查。后续检查的平均参与率为83%。治疗后，1至5岁儿童的平均感染率从43.5%（95%置信区间[CI]，35.0%-52.0%）下降至5.1%（95% CI，1.1%-9.2%）。平均而言，感染率在 24 个月内逐渐恢复至 11.3%（95% CI，4.5%-18.1%；P = .001）。在 8 个村庄中有 7 个，24 个月时的感染率高于 2 个月时的感染率。在剩下的村庄，经过治疗后任何一点都没有发现感染。 12 个月时入组的村庄感染人数明显少于 12 个月前入组的村庄，表明存在长期趋势 ( P < .001)。结论 在单次大规模阿奇霉素分发后，1 至 5 岁儿童的眼部衣原体感染并未消除；它在 24 个月内缓慢恢复，但并未恢复到基线水平。需要反复治疗或采取其他有效措施才能消除。
Context The World Health Organization recommends mass antibiotic distributions in its strategy to eliminate blinding trachoma as a public health concern. Some hypothesize that a single distribution is sufficient to control the ocular strains of chlamydia that cause trachoma. Others believe infection will inevitably return and periodic treatments or other measures are essential.Objective To determine whether ocular chlamydial infection returns to the community up to 24 months after a single mass antibiotic distribution in a hyperendemic region of Ethiopia.Design, Setting, and Participants Longitudinal cohort study conducted March 2003 to March 2005 in the Gurage Zone of Ethiopia. Eight randomly selected villages were assessed for ocular chlamydial infection. Fifteen untreated villages were randomly chosen at 12 months to allow assessment of a secular trend.Intervention A single dose of oral azithromycin was offered to all residents of the 8 selected villages who were aged 1 year or older.Main Outcome Measure Prevalence of ocular chlamydial infection in all children aged 1 to 5 years from each intervention village prior to treatment and 2, 6, 12, 18, and 24 months after mass antibiotic treatment, and also in untreated villages enrolled at 12 months.Results Five hundred fifteen children were examined for ocular chlamydial infection at baseline. For the follow-up examinations, the mean participation rate was 83%. The mean prevalence of infection in children aged 1 to 5 years decreased from 43.5% (95% confidence interval [CI], 35.0%-52.0%) to 5.1% ( 95% CI, 1.1%-9.2%) after treatment. On average, infection returned gradually over 24 months to 11.3% ( 95% CI, 4.5%-18.1%; P = .001). In 7 of 8 villages, infection was higher at 24 months than at 2 months. In the remaining village, no infection could be identified at any point after treatment. Villages enrolled at 12 months had significantly fewer infections than those enrolled 12 months earlier, suggesting a secular trend ( P < .001).Conclusions Ocular chlamydial infection was not eliminated in children aged 1 to 5 years after a single mass azithromycin distribution; it slowly returned over 24 months, although not to baseline levels. Repeated treatments or other effective measures will be necessary for elimination.