2003 OMIG, Abstract 6

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Elimination May Not Be Too High a Goal For Trachoma Programs
Bruce Gaynor, Hem Jha, Kevin Miller, Elizabeth Yi, Jaya Chidambaram, Susan Osaki-Holm, John Whitcher, Thomas Lietman. Ft Proctor Foundation & Department of Ophthalmology, University of California at San Francisco

Purpose: To describe the success of multiple mass azithromycin treatments in eliminating ocular Chlamydia.
Methods: We monitored trachoma prevalence in a village in Western Nepal for three years, using both clinical grading system and nucleic acid amplification tests. Three annual azithromycin (20mg/kg) treatments were distributed to all children in the village aged 1-10 years. All children were examined biannually, and the conjunctivae of a stratified random sample of children were swabbed and later tested for the presence of Chlamydia trachomatis DNA.
Results: At the final visit, 6 months after the last treatment, every child was examined and swabbed. Before the first treatment, 39% were clinically active by the clinical exam and an estimated 26% (95% CI 16-35%) were infected with chlamydia. At the final, May 2001 visit, 7 of 187 children (4%) were clinically active. Only a single child of the 187 (0.5%) had evidence of chlamydia by PCR.
Conclusions: Whether success in this village was due solely to our treatment program, or due in part to a secular trend in the area, the results are encouraging. These results from Nepal imply that the local elimination of ocular chlamydia in children may be an attainable goal, at least in areas with modest to moderate amounts of disease. Whether or not elimination is necessary is a separate question.

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