Surveillance Surveys for Reemergent Trachoma in Formerly Endemic Districts in Nepal From 2 to 10 Years After Mass Drug Administration Cessation
| Autor: | Charlotte A. Gaydos, Andrea I. Zambrano, Kathryn Crowley, Lisa Rotondo, Sailesh Mishra, Beatriz Munoz, Shekhar Sharma, Sheila K. West, Laura Dize |
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| Rok vydání: | 2017 |
| Předmět: |
Male
0301 basic medicine medicine.medical_specialty Adolescent Endemic Diseases Cross-sectional study 030231 tropical medicine Population Chlamydia trachomatis medicine.disease_cause Eye Infections Bacterial 03 medical and health sciences 0302 clinical medicine Anti-Infective Agents Nepal medicine Humans Child education Mass drug administration Trichiasis Retrospective Studies Original Investigation Trachoma education.field_of_study business.industry Infant Retrospective cohort study Eye infection medicine.disease Antibodies Bacterial eye diseases Surgery Ophthalmology Cross-Sectional Studies 030104 developmental biology Withholding Treatment Child Preschool Population Surveillance Female business Follow-Up Studies Forecasting Demography |
| Zdroj: | JAMA Ophthalmology. 135:1141 |
| ISSN: | 2168-6165 |
| DOI: | 10.1001/jamaophthalmol.2017.3062 |
| Popis: | Importance To verify districts for elimination of blinding trachoma, the World Health Organization requires a population-based surveillance survey for follicular trachoma (TF) and trachomatous trichiasis (TT) 2 years after mass drug administration (MDA) activities have ceased. However, it is unknown if 2 years provides enough time to discover reemergence. Objective To determine the prevalence of trachoma from surveys among 4 districts in Nepal (Dailekh, Dang, Surkhet, and Kanchanpur) that had surveillance intervals of 2, 4, 8, and 10 years, respectively, after cessation of MDA. Design, Setting, and Participants Cross-sectional surveys were carried out in 2015 and 2016. Data analyses were done from March to September 2016. Among 20 clusters randomly selected from each district, 15 were randomly selected for infection and antibody testing: TF and TT were assessed, conjunctival swabs were tested for chlamydial infection, and blood spots were collected on filter paper to test for antibodies to Chlamydia trachomatis pgp3 using a multiplex bead assay. The study setting was 4 districts previously endemic for trachoma in Nepal. Participants were randomly selected and included 50 children aged 1 to 9 years and 100 adolescents and adults 15 years and older from each of the 20 clusters; this investigation reports on the children. Main Outcomes and Measures Length of time since the last round of MDA and the prevalence of TF among children aged 1 to 9 years and the prevalence of TT among adolescents and adults 15 years and older. Results Of 3024 children surveyed in the clusters, 48.0% (n = 1452) were female. The mean (SD) age of the children was 5.4 (2.6) years. Eleven cases of TF were found, with a TF prevalence less than 1% in all 4 districts. Three cases of infection were found. Seropositivity for pgp3 antibody varied from 1.4% (95% CI, 0.7-2.6) in the district with a 10-year surveillance interval to 2.5% (95% CI, 1.3-4.5) in the district with a 4-year surveillance interval. Seropositivity increased slightly with age in only one district. The TT prevalence was less than 1 case per 1000 among the total population in all 4 districts after accounting for cases known to the health system and cases with no scarred conjunctiva. Conclusions and Relevance This study found no evidence of reemergence of trachoma up to 10 years after cessation of MDA in 4 districts in children in Nepal. The recommendation for a surveillance survey at 2 years, as proposed by the World Health Organization, is supported by these data. Determining if individuals with TT had scarring or are known to the health system was critical for meeting elimination criteria of blinding trachoma. |
| Databáze: | OpenAIRE |
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