Infection with Chlamydia trachomatis after mass treatment of a trachoma hyperendemic community in Tanzania:: a longitudinal study
Infection with Chlamydia trachomatis after mass treatment of a trachoma hyperendemic community in Tanzania:: a longitudinal study
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DOI：
10.1016/s0140-6736(05)67529-0
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发表时间：
2005-10-08
期刊：
影响因子：
168.9
通讯作者：
Mabey, DCW
中科院分区：
文献类型：
--
作者：
West, SK;Munoz, B;Mabey, DCW
背景 在沙眼流行的社区进行的研究数据表明，经过一次大规模抗生素治疗后，沙眼衣原体引起的眼部感染可以被消除。然而，沙眼高流行社区没有可比较的长期数据。因此，我们的目标有两个：首先，在大规模治疗后确定沙眼高流行社区中沙眼和沙眼衣原体眼部感染的疾病模式；其次，确定发生感染的危险因素。方法我们对坦桑尼亚的一个沙眼高流行社区（n=1017）进行了纵向研究。我们在基线、第 2、6、12 和 18 个月进行了调查，包括眼拭子，以确定对所有 6 个月或以上的所有个体接受 20 毫克/公斤阿奇霉素单次肿块治疗后沙眼衣原体的存在和数量；无临床疾病的孕妇接受局部四环素治疗。结果 大规模治疗（覆盖率 86%）在 2 个月时将感染率从 57%（871 人中的 495 人）显着降低至 12%（705 人中的 85 人）。感染在 12 个月内保持相当稳定，有证据表明治疗后 18 个月感染数量和负荷有所增加。如果 2 个月时另一位家庭成员的每个拭子检测到超过 19 个微生物，则 6 个月时发生感染的可能性会增加 3.5 倍。在 12 个月内，出村旅行和拜访家庭并不会增加家庭内感染的风险。 解释 在这个沙眼高流行社区，高抗生素覆盖率后的感染水平在 18 个月内持续保持在较低水平，有证据表明 1 年后重新出现。相当轻的感染量与家庭传播有关。几年内每年进行大规模治疗可能足以消除感染。
Background Data from studies done in communities where trachoma is mesoendemic suggest that ocular infection with Chlamydia trachomatis can be eliminated after one mass treatment with antibiotics. However, there are no comparable long-term data from trachoma hyperendemic communities. Our aim, therefore, was two-fold: first, to ascertain the disease pattern of trachoma and ocular infection with C trachomatis in a trachoma hyperendemic community after mass treatment; and, second, to ascertain the risk factors for incident infection.Methods We did a longitudinal study of a trachoma hyperendemic community (n=1017) in Tanzania. We did surveys, including ocular swabs, at baseline, 2, 6, 12, and 18 months to identify the presence, and quantity, of C trachomatis after single mass treatment of all individuals aged 6 months or older with azithromycin 20 mg per kg; pregnant women without clinical disease received topical tetracycline.Findings Mass treatment (coverage 86%) significantly reduced the prevalence of infection from 57% (495 of 871) to 12% (85 of 705) at 2 months. infection remained fairly constant to 12 months, with evidence of increasing numbers and load of infection by 18 months post-treatment. Incident infection at 6 months was 3.5-times more likely if another member of the household had more than 19 organisms per swab at 2 months. Travel outside the village, and visitors to the household, did not increase the risk of infection within households up to 12 months.Interpretation In this trachoma hyperendemic community, infection levels after high antibiotic coverage persisted at a low level to 18 months, with evidence for re-emergence after 1 year. Fairly light loads of infection were associated with household transmission. Yearly mass treatment over a few years could be sufficient to eliminate infection.