Profound and Sustained Reduction in Chlamydia trachomatis in The Gambia: A Five-Year Longitudinal Study of Trachoma Endemic Communities
Profound and Sustained Reduction in Chlamydia trachomatis in The Gambia: A Five-Year Longitudinal Study of Trachoma Endemic Communities
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DOI：
10.1371/journal.pntd.0000835
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发表时间：
2010-10-01
影响因子：
3.8
通讯作者：
Bailey, Robin L.
中科院分区：
文献类型：
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作者：
Burton, Matthew J.;Holland, Martin J.;Bailey, Robin L.
背景：消除致盲性沙眼的重点是通过大规模抗生素治疗和限制传播措施来控制沙眼衣原体感染。随着疾病患病率的下降，最有效的治疗策略的不确定性增加。关于治疗对感染的影响，特别是在低流行率环境中，几乎没有长期数据作为指南的基础。方法/主要发现：在五年内（基线、2、6、12、17、30 和 60 个月）对冈比亚 14 个沙眼流行村庄的人口进行了 7 次检查。仅在基线时进行大规模抗生素治疗。所有家庭全年都能获得清洁用水。 17 个月后，每户家庭都安装了新厕所。收集结膜拭子样本并通过 PCR 检测沙眼衣原体。治疗前村级1～9岁滤泡性沙眼患病率(TF(%1-9))为15.4%，沙眼衣原体患病率为9.7%。抗生素治疗覆盖率为 83% 的人口。在接下来的五年里，12个村庄的所有基线感染均被清除，并且很少发现散发病例。在另外两个村庄，治疗后两个月感染率增加，这与与其他未接受治疗的社区的广泛接触有关。在没有任何进一步的抗生素治疗的情况下，到研究结束时，这两个村庄的感染率随后降至 0%，全体人口的感染率降至 0.6%。然而，一些村庄的 TF(%1-9) >10%，在没有任何可检测到的沙眼衣原体的情况下，这是开始或继续大规模抗生素治疗的阈值。结论/意义：在低流行地区，当与抑制传播的环境条件（如良好的供水和卫生设施）相结合时，单轮大规模抗生素治疗可能足以控制沙眼衣原体感染。
Background: The elimination of blinding trachoma focuses on controlling Chlamydia trachomatis infection through mass antibiotic treatment and measures to limit transmission. As the prevalence of disease declines, uncertainty increases over the most effective strategy for treatment. There are little long-term data on the effect of treatment on infection, especially in low prevalence settings, on which to base guidelines.Methodology/Principal Findings: The population of a cluster of 14 Gambian villages with endemic trachoma was examined on seven occasions over five years (baseline, 2, 6, 12, 17, 30 and 60 months). Mass antibiotic treatment was given at baseline only. All families had accessible clean water all year round. New latrines were installed in each household after 17 months. Conjunctival swab samples were collected and tested for C. trachomatis by PCR. Before treatment the village-level prevalence of follicular trachoma in 1 to 9 year olds (TF(%1-9)) was 15.4% and C. trachomatis was 9.7%. Antibiotic treatment coverage was 83% of the population. In 12 villages all baseline infection cleared and few sporadic cases were detected during the following five years. In the other two villages treatment was followed by increased infection at two months, which was associated with extensive contact with other untreated communities. The prevalence of infection subsequently dropped to 0% in these 2 villages and 0.6% for the whole population by the end of the study in the absence of any further antibiotic treatment. However, several villages had a TF(%1-9) of >10%, the threshold for initiating or continuing mass antibiotic treatment, in the absence of any detectable C. trachomatis.Conclusions/Significance: A single round of mass antibiotic treatment may be sufficient in low prevalence settings to control C. trachomatis infection when combined with environmental conditions, which suppress transmission, such as a good water supply and sanitation.