Background Following an epidemiological study carried out in 2006 showing a high prevalence of blinding trachoma in the Far North Region of Cameroon, a trachoma elimination programme using the SAFE strategy was initiated: three yearly trachoma mass treatments were to be performed. Methodology/Principal Findings The entire district population (120,000 persons) was treated with azithromycin 1.5% eye drops in February 2008 and January 2009. To assess the effect of treatment on the prevalence of active trachoma, three epidemiological studies were conducted on a representative sample of children aged between 1 and 10 years. The first study was performed just prior to the first treatment, the second just prior to the 2nd treatment and the third one, one year later. The prevalence of active forms of trachoma (TF + TI) dropped from 31.5% (95%CI 26.4–37.5) before treatment to 6.3% (95%CI 4.1–9.6) one year after first treatment; a reduction of nearly 80%. One year after the second treatment, the prevalence decreased to 3.1% (95%CI 2.0–4.9), a total reduction of 90%. Furthermore, there were no more TI cases (only TF). There was no report of serious or systemic side effects. Tolerance was excellent. Conclusions/Significance Active trachoma mass treatment with azithromycin 1.5% eye drops is feasible, well tolerated, and effective.
References
[1]
Solomon AW, Zondervan M, Kuper H, Buchan J, Mabey D, et al. (2006) Trachoma control. A guide for programme managers 1–53.
[2]
Hu VH, Harding-Esch EM, Burton MJ, Bailey RL, Kadimpeul J, et al. (2010) Epidemiology and control of trachoma: systematic review. Trop Med Int Health 15: 673–691. doi: 10.1111/j.1365-3156.2010.02521.x
[3]
Cromwell EA, Courtright P, King JD, Rotondo LA, Ngondi J, et al. (2009) The excess burden of trachomatous trichiasis in women: a systematic review and meta-analysis. Trans R Soc Trop Med Hyg 103: 985–992. doi: 10.1016/j.trstmh.2009.03.012
[4]
World Health Organization (WHO) (2003) Report of the 2nd Global Scientific Meeting on Trachoma. Geneva, Switzerland, 25-27 August, 2003. WHO/PBD/GET 03 1: 1–28.
[5]
Bensaid S, Huguet P, Goldschmidt P, Einterz E (2007) Le trachome au Cameroun: résultats d'une enquête épidémiologique dans le district de Kolofata dans la province de l'Extrême-Nord. Rev Int Trach Pathol Ocul Trop Subtrop Santé Publique 84: 79–103.
[6]
Mariotti SP, Prüss A, World Health Organization (2001) The Safe Strategy. Preventing trachoma. A guide for environmental sanitation and improved hygiene. WHO/PBD/GET/00.7/ Rev 1: 1–36.
[7]
Huguet P, Bella L, Einterz EM, Goldschmidt P, Bensaid P (2010) Mass treatment of trachoma with azithromycin 1.5% eye drops in the Republic of Cameroon: feasibility, tolerance and effectiveness. Br J Ophthalmol 94: 157–160. doi: 10.1136/bjo.2009.161513
[8]
World Health Organization, Programme for the Prevention of Blindness and Deafness (2004) Report of the eighth Meeting of the WHO Alliance for the Global Elimination of Blinding Trachoma. Geneva, Switzerland, 29 & 30 March 2004. WHO/PBL/GET/04.2 1–47.
[9]
National Institute of Statistics (2005) Third General Census of the population and households of Cameroon. Yaounde 1-.
[10]
Taylor HR, West SK, Katala S, Foster A (1987) Trachoma: evaluation of a new grading scheme in the United Republic of Tanzania. Bull World Health Organ 65: 485–488.
[11]
Thylefors B, Dawson CR, Jones BR, West SK, Taylor HR (1987) A simple system for the assessment of trachoma and its complications. Bull World Health Organ 65: 477–483.
[12]
World Health Organization, Programme for the Prevention of Blindness (1993) Primary health care level management of trachoma. WHO/PBL/93 33: 1–42.
[13]
Katz J, Zeger SL, Tielsch JM (1988) Village and household clustering of xerophthalmia and trachoma. Int J Epidemiol 17: 865–869. doi: 10.1093/ije/17.4.865
[14]
Bamani S, King JD, Dembele M, Coulibaly F, Sankara D, et al. (2010) Where do we go from here? Prevalence of trachoma three years after stopping mass distribution of antibiotics in the regions of Kayes and Koulikoro, Mali. PLoS Negl Trop Dis 4: e734. doi: 10.1371/journal.pntd.0000734
[15]
Burton MJ, Holland MJ, Faal N, Aryee EA, Alexander ND, et al. (2003) Which members of a community need antibiotics to control trachoma? Conjunctival Chlamydia trachomatis infection load in Gambian villages. Invest Ophthalmol Vis Sci 44: 4215–4222. doi: 10.1167/iovs.03-0107
[16]
Centers for Disease Control and Prevention (2003) Pneumococcal conjunctivitis at an elementary school—Maine, September 20-December 6, 2002. JAMA 289: 1097–1098. doi: 10.1001/jama.289.9.1097
[17]
Burton MJ, Bowman RJ, Faal H, Aryee EA, Ikumapayi UN, et al. (2006) The long-term natural history of trachomatous trichiasis in the Gambia. Invest Ophthalmol Vis Sci 47: 847–852. doi: 10.1167/iovs.05-0714
[18]
Dawson CR, Marx R, Daghfous T, Juster R, Schachter J (1990) What clinical signs are critical in evaluating the impact of intervention in trachoma? In: Bowie WR, Caldwell HD, Jones RP, Mardh PA, Ridgway GL, Schachter J, Stamm WE, Ward ME, editors. Chlamydial infections: proceedings of the Seventh International Symposium on human Chlamydial infections, Harrison Hot Springs, British Columbia, Canada, 24-19 June 1990. Cambridge, United Kingdom: Cambridge University Press. pp. 271–278.
[19]
Munoz B, Bobo L, Mkocha H, Lynch M, Hsieh YH, et al. (1999) Incidence of trichiasis in a cohort of women with and without scarring. Int J Epidemiol 28: 1167–1171. doi: 10.1093/ije/28.6.1167
[20]
West SK, Munoz B, Mkocha H, Hsieh YH, Lynch MC (2001) Progression of active trachoma to scarring in a cohort of Tanzanian children. Ophthalmic Epidemiol 8: 137–144. doi: 10.1076/opep.8.2.137.4158
[21]
Amza A (2006) Résultats après trois années de mise en oeuvre de la stratégie CHANCE dans la région de Zinder au Niger. Rev Int Trach Pathol Ocul Trop Subtrop Santé Publique 83: 103–114.
[22]
Bamani S (2006) La lutte contre le trachome au Mali: forces et faiblesses. Rev Int Trach Pathol Ocul Trop Subtrop Santé Publique 83: 115–127.
[23]
Gaynor BD, Miao Y, Cevallos V, Jha H, Chaudary JS, et al. (2003) Eliminating trachoma in areas with limited disease. Emerg Infect Dis 9: 596–598. doi: 10.3201/eid0905.020577
[24]
West SK, Munoz B, Mkocha H, Gaydos C, Quinn T (2007) Trachoma and ocular Chlamydia trachomatis were not eliminated three years after two rounds of mass treatment in a trachoma hyperendemic village. Invest Ophthalmol Vis Sci 48: 1492–1497. doi: 10.1167/iovs.06-0625
[25]
Cochereau I, Goldschmidt P, Goepogui A, Afghani T, Delval L, et al. (2007) Efficacy and safety of short duration azithromycin eye drops versus azithromycin single oral dose for the treatment of trachoma in children - a randomised, controlled, double-masked clinical trial. Br J Ophthalmol 91: 667–672. doi: 10.1136/bjo.2006.099275
[26]
Emerson P, Frost L, Bailey R, Mabey D (2006) Implementing the SAFE strategy for trachoma control. A toolbox of interventions for promoting facial cleanliness and environmental improvement. pp. 1–56.
[27]
Wright HR, Turner A, Taylor HR (2008) Trachoma. Lancet 371: 1945–1954. doi: 10.1016/S0140-6736(08)60836-3
