2008 OMIG, Abstract 1

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Decreased Childhood Mortality With Mass Azithromycin Distributions For Trachoma.
Keenan J, Porco T, House J, Hong K, Zhou Z, Stoller N, Whitcher J, Gaynor B, Lietman T.
F.I. Proctor Foundation, University of California San Francisco

Purpose: Trachoma, caused by ocular chlamydia infection, is the leading infectious cause of blindness. Repeated mass azithromycin treatments are highly effective for ocular chlamydia, and are currently recommended by the WHO for trachoma control. An additional benefit of azithromycin is its efficacy for respiratory infections, diarrheal infections, and even malaria, which are the top three causes of childhood mortality in trachoma-endemic areas.  Here, we study whether repeated mass azithromycin treatments will reduce childhood mortality.
Methods: We conducted a cluster-randomized clinical trial in Ethiopia in which 36 communities were treated with azithromycin, and 12 control communities received no treatment. Treated communities were treated for one year with one of three schedules of mass oral azithromycin: annual treatment for all community members over 1 year of age, biannual treatment for all community members over 1 year of age, or treatment every 3 months for 1-10 year old children only.  A census was performed at baseline, and a re-census was performed at 12 months. Verbal autopsies were performed for all identified deaths. Age-specific mortality rates were estimated by dividing the number of deaths by the number of person-years at risk.
Results: Of 9754 children ages 1-5 present at baseline, 62 deaths were recorded at 1 year. The mortality rate for children ages 1-5 was 12.2 per 1000 person years (95% CI 7.8-19.0) in the control group, and 5.7 per 1000 person years (95% CI 4.0-8.3) in the treated group. Therefore, mass oral azithromycin reduced the mortality rate in 1-5 year-old children by 53% (relative rate 0.47 for treated group compared to control, 95% CI 0.26-0.84, P=0.01, negative binomial regression). In children less than 1 year old, none of whom received oral azithromycin, the mortality rate of the control group (42.0 per 1000 person-years, 95% CI 27.3-64.6) and the treated group (35.5 per 1000 person-years, 95% CI 27.3 to 46.0) did not differ significantly (16% risk reduction in treated group, relative rate 0.84, 95% CI 0.51 to 1.40, P=0.51).  There was also no significant reduction in mortality in individuals ages 6 and older (12% lower mortality rate in treated group, relative rate 0.88, 95% CI 0.63 to 1.24, P=0.47).
Conclusions:  In a trachoma-endemic area, mass distribution of oral azithromycin may reduce mortality in pre-school children.