There are many questions that remain in trachoma control. Some of the most important center around the long term use of mass oral antibiotics. In this proposal, we assess whether we can completely eliminate infection with repeated mass treatments, what happens when treatments are discontinued, and whether targeting treatment to high risk groups can prevent the return of infection. Mass antimicrobial administrations have been remarkably successful in reducing the prevalence of the ocular strains of chlamydia that cause trachoma. Repeated distributions progressively lower the prevalence of infection, and in some cases may even result in local elimination. Mass treatments cannot be continued forever, due to concerns about cost and antibiotic resistance. The hope has been that other measures such as latrine construction and hygiene programs would prevent infection from returning. Unfortunately, no non-antibiotic measure has yet demonstrated an effect on infection. Here, we evaluate how infection returns when antibiotics are discontinued, whether infection can be predictably eliminated, and whether infection can be prevented from returning with targeted treatment strategies. This proposal monitors communities from TANA I (U10 EY016214), an NEI-supported collection of cluster-randomized trachoma trials in Ethiopia. In one of the trials, a total of 111 communities will have received repeated mass oral azithromycin distributions over 42 months (final study visit in Fall 2009). These treatments have lowered, and in some cases may have eliminated, infection. Now, we have an unprecedented opportunity to continue to follow these communities, assessing what measures are necessary, if any, to keep infection from returning. It would take years and a great deal of resources to ever again set up these conditions in such a controlled setting. Continued monitoring of these communities will help us to determine the feasibility of control, local elimination, or even eradication.

Public Health Relevance

Trachoma is the leading cause of infectious blindness worldwide. The WHO has initiated a program designed to control infection to a low enough level that resulting blindness will not be a public health concern. Here, we assess whether loftier goals, such as elimination from large areas or even eradication may be feasible, by monitoring treatment in some of the most severely affected communities in the world.

Agency
National Institute of Health (NIH)
Institute
National Eye Institute (NEI)
Type
Cooperative Clinical Research--Cooperative Agreements (U10)
Project #
3U10EY016214-08S1
Application #
8531528
Study Section
Special Emphasis Panel (ZEY1-VSN (01))
Program Officer
Everett, Donald F
Project Start
2004-09-30
Project End
2014-08-31
Budget Start
2012-09-01
Budget End
2013-08-31
Support Year
8
Fiscal Year
2012
Total Cost
$257,691
Indirect Cost
$69,031
Name
University of California San Francisco
Department
Ophthalmology
Type
Schools of Medicine
DUNS #
094878337
City
San Francisco
State
CA
Country
United States
Zip Code
94143
Morberg, Daniel P; Alemayehu, Wondu; Melese, Muluken et al. (2018) A Longitudinal Analysis of Chlamydial Infection and Trachomatous Inflammation Following Mass Azithromycin Distribution. Ophthalmic Epidemiol :1-8
Altan, Eda; Aiemjoy, Kristen; Phan, Tung G et al. (2018) Enteric virome of Ethiopian children participating in a clean water intervention trial. PLoS One 13:e0202054
Chin, Stephanie A; Alemayehu, Wondu; Melese, Muluken et al. (2018) Association of Chlamydia trachomatis ompA genovar with trachoma phenotypes. Eye (Lond) 32:1411-1420
Chin, Stephanie A; Morberg, Daniel P; Alemayehu, Wondu et al. (2018) Diversity of Chlamydia trachomatis in Trachoma-Hyperendemic Communities Treated With Azithromycin. Am J Epidemiol 187:1840-1845
Aiemjoy, Kristen; Gebresillasie, Sintayehu; Stoller, Nicole E et al. (2017) Epidemiology of Soil-Transmitted Helminth and Intestinal Protozoan Infections in Preschool-Aged Children in the Amhara Region of Ethiopia. Am J Trop Med Hyg 96:866-872
Gao, Daozhou; Lietman, Thomas M; Dong, Chao-Ping et al. (2017) Mass drug administration: the importance of synchrony. Math Med Biol 34:241-260
Aiemjoy, Kristen; Stoller, Nicole E; Gebresillasie, Sintayehu et al. (2017) Is Using a Latrine ""A Strange Thing To Do""? A Mixed-Methods Study of Sanitation Preference and Behaviors in Rural Ethiopia. Am J Trop Med Hyg 96:65-73
Keenan, Jeremy D; Sahlu, Ida; McGee, Lesley et al. (2016) Nasopharyngeal Pneumococcal Serotypes Before and After Mass Azithromycin Distributions for Trachoma. J Pediatric Infect Dis Soc 5:222-6
Gebresillasie, Sintayehu; Tadesse, Zerihun; Shiferaw, Ayalew et al. (2015) Inter-Rater Agreement between Trachoma Graders: Comparison of Grades Given in Field Conditions versus Grades from Photographic Review. Ophthalmic Epidemiol 22:162-9
See, Craig W; O'Brien, Kieran S; Keenan, Jeremy D et al. (2015) The Effect of Mass Azithromycin Distribution on Childhood Mortality: Beliefs and Estimates of Efficacy. Am J Trop Med Hyg 93:1106-9

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