Evaluation of a Single Dose of Azithromycin for Trachoma in Low-Prevalence Communities
Evaluation of a Single Dose of Azithromycin for Trachoma in Low-Prevalence Communities
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DOI：
10.1080/09286586.2017.1293693
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发表时间：
2019-01-01
影响因子：
1.8
通讯作者：
Martin, Diana L.
中科院分区：
文献类型：
--
作者：
Wilson, Nana;Goodhew, Brook;Martin, Diana L.
目的：沙眼是由沙眼衣原体反复眼部感染引起的，是世界范围内致盲的主要传染性原因，是作为一个公共卫生问题被消灭的目标。我们试图确定在疾病患病率在5%至9.9%之间的社区中，一次性阿奇霉素大规模治疗是否会将沙眼炎症-滤泡（TF）水平降低到5%以下的消除阈值。方法：在坦桑尼亚Kongwa地区的96个村庄单位（balozis）进行研究，根据先前的流行调查预测，TF在5 - 9.9%之间。Balozis被随机分配到干预组和对照组。干预组接受阿奇霉素单次大剂量给药。在基线和随访12个月时，进行眼部沙眼检查、眼拭子检测衣原体DNA、手指刺血检测抗衣原体抗体。结果：基线和12个月随访比较显示，对照组和治疗组患者TF1-9总体患病率无显著差异。治疗组在治疗12个月后眼部感染显著减少（p = 0.004），而对照组无变化。在对照组或治疗组治疗后未观察到pgp3特异性抗体反应的变化。两个研究组的抗ct694反应均有所增加（对照组p = 0.009，治疗组p = 0.04）。结论：这些数据表明，当TF1-9基线值在5 - 9.9%之间时，单轮MDA可能不足以将TF水平降至5%以下。
Purpose: Trachoma, caused by repeated ocular infection with Chlamydia trachomatis, is the leading infectious cause of blindness worldwide and is targeted for elimination as a public health problem. We sought to determine whether a one-time azithromycin mass treatment would reduce trachomatous inflammation-follicular (TF) levels below the elimination threshold of 5% in communities with disease prevalence between 5 and 9.9%.Methods: The study was conducted in 96 sub-village units (balozis) in the Kongwa district of Tanzania which were predicted from prior prevalence surveys to have TF between 5 and 9.9%. Balozis were randomly assigned to the intervention and control arms. The intervention arm received a single mass drug administration of azithromycin. At baseline and 12-month followup, ocular exams for trachoma, ocular swabs for detection of chlamydial DNA, and finger prick blood for analysis of anti-chlamydial antibody were taken.Results: Comparison of baseline and 12-month follow-up showed no significant difference in the overall TF1-9 prevalence by balozi between control and treatment arms. In the treatment arm there was a significant reduction of ocular infection 12 months after treatment (p = 0.004) but no change in the control arm. No change in Pgp3-specific antibody responses were observed after treatment in the control or treatment arms. Anti-CT694 responses increased in both study arms (p = 0.009 for control arm and p = 0.04 for treatment arm).Conclusion: These data suggest that a single round of MDA may not be sufficient to decrease TF levels below 5% when TF1-9 is between 5 and 9.9% at baseline.