03639nas a2200457   4500000000100000008004100001653002200042653001300064653001500077653002500092653001100117653001100128653001300139653003300152653002100185653001700206653002700223653002600250100001800276700001600294700001300310700001200323700000900335700001200344700001500356700001100371700001200382700001100394700001500405700001700420700001200437700001500449700001300464700001500477245009400492856006200586300001100648490000800659520250000667022001403167       2006                            d10aTreatment Outcome10aTrachoma10aPrevalence10aLongitudinal studies10aInfant10aHumans10aEthiopia10aCommunicable Disease Control10aChild, Preschool10aAzithromycin10aAntibiotic Prophylaxis10aAnti-Bacterial Agents1 aChidambaram J1 aAlemayehu W1 aMelese M1 aLakew T1 aYi E1 aHouse J1 aCevallos V1 aZhou Z1 aMaxey K1 aLee DC1 aShapiro BL1 aSrinivasan M1 aPorco T1 aWhitcher J1 aGaynor B1 aLietman TM00aEffect of a single mass antibiotic distribution on the prevalence of infectious trachoma.  uhttp://jama.jamanetwork.com/article.aspx?articleid=202501  a1142-60 v2953 a<p><strong>CONTEXT: </strong>The World Health Organization recommends mass antibiotic distributions in its strategy to eliminate blinding trachoma as a public health concern. Some hypothesize that a single distribution is sufficient to control the ocular strains of chlamydia that cause trachoma. Others believe infection will inevitably return and periodic treatments or other measures are essential.</p>

<p><strong>OBJECTIVE: </strong>To determine whether ocular chlamydial infection returns to the community up to 24 months after a single mass antibiotic distribution in a hyperendemic region of Ethiopia.</p>

<p><strong>DESIGN, SETTING, AND PARTICIPANTS: </strong>Longitudinal cohort study conducted March 2003 to March 2005 in the Gurage Zone of Ethiopia. Eight randomly selected villages were assessed for ocular chlamydial infection. Fifteen untreated villages were randomly chosen at 12 months to allow assessment of a secular trend.</p>

<p><strong>INTERVENTION: </strong>A single dose of oral azithromycin was offered to all residents of the 8 selected villages who were aged 1 year or older.</p>

<p><strong>MAIN OUTCOME MEASURE: </strong>Prevalence of ocular chlamydial infection in all children aged 1 to 5 years from each intervention village prior to treatment and 2, 6, 12, 18, and 24 months after mass antibiotic treatment, and also in untreated villages enrolled at 12 months.</p>

<p><strong>RESULTS: </strong>Five hundred fifteen children were examined for ocular chlamydial infection at baseline. For the follow-up examinations, the mean participation rate was 83%. The mean prevalence of infection in children aged 1 to 5 years decreased from 43.5% (95% confidence interval [CI], 35.0%-52.0%) to 5.1% (95% CI, 1.1%-9.2%) after treatment. On average, infection returned gradually over 24 months to 11.3% (95% CI, 4.5%-18.1%; P = .001). In 7 of 8 villages, infection was higher at 24 months than at 2 months. In the remaining village, no infection could be identified at any point after treatment. Villages enrolled at 12 months had significantly fewer infections than those enrolled 12 months earlier, suggesting a secular trend (P&lt;.001).</p>

<p><strong>CONCLUSIONS: </strong>Ocular chlamydial infection was not eliminated in children aged 1 to 5 years after a single mass azithromycin distribution; it slowly returned over 24 months, although not to baseline levels. Repeated treatments or other effective measures will be necessary for elimination.</p>
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