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2004 OMIG, Abstract 3

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Eliminating Trachoma: Fly Control or Antibiotics?
S Lee1, A Wondu2, M Muluken2, D Lee1, E Yi1, Z Zhou1, V Cevallos1, K Donnallan1, J Chidambaram1, B Gaynor1, J Whitcher1, T Lietman1. 1UCSF Department of Ophthalmology, Proctor Foundation and 2Orbis International, Ethiopia

Purpose: Trachoma is by far the leading cause of infectious blindness worldwide. There are two schools of thought in controlling trachoma: eliminate the Chlamydial infection that causes the disease, or decrease the spread of infection by flies (in particular Musca sorbens). In fact, enormous efforts are being taken to reduce Musca sorbens populations in trachoma endemic areas. Here, we determine how this proportion depends on the prevalence of infection in children, and how treating children with antibiotics affects carriage of chlamydia by flies.
Methods: 120 flies were collected from the faces of 120 children in three villages that had received mass oral azithromycin distributions 6 months previously. 120 flies were also collected from 120 children in three 'before treatment' villages, randomly selected from the same pool as the treated villages. Roche Amplicor PCR kits were performed in a masked fashion to detect chlamydial DNA on the flies from both treated and untreated villages as previously described. Conjunctival swabs were also taken to assay for chlamydial prevalence in the children.
Results: Chlamydia trachomatis was found on 23% of the flies in the untreated (control) villages, but only 0.3% of flies in the treated villages (P<0.001, Fisher's exact). Prevalence of trachoma in children proved to be an excellent predictor of the prevalence in flies in that village (correlation coefficient 0.3918).
Conclusion: The prevalence of chlamydia on flies is highly correlated with the prevalence of chlamydial infection in children. Great efforts are being made to reduce the prevalence of flies in trachoma endemic villages, however treating children with antibiotics drastically reduces the role of flies as a vector. Fly control may not be necessary for effective trachoma control.

Acknowledgements: Osher Foundation, IntI Trachoma Initiative, Research to Prevent Blindness

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