Reduction and Return of Infectious Trachoma in Severely Affected Communities in Ethiopia 英文参考文献.docVIP

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Reduction and Return of Infectious Trachoma in Severely Affected Communities in Ethiopia 英文参考文献.doc

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Reduction and Return of Infectious Trachoma in Severely Affected Communities in Ethiopia 英文参考文献

ReductionandReturnofInfectiousTrachomainSeverely AffectedCommunitiesinEthiopia TakeleLakew1,JenafirHouse2,KevinC.Hong2,ElizabethYi2,WonduAlemayehu1,MulukenMelese1, ZhaoxiaZhou2,KathrynRay2,StephanieChin2,EmmanuelRomero2,JeremyKeenan2,3,JohnP. Whitcher2,3,4,5,BruceD.Gaynor2,3,ThomasM.Lietman2,3,4,5 * 1OrbisInternational,AddisAbaba,Ethiopia,2F.I.ProctorFoundation,UniversityofCalifornia,SanFrancisco,UnitedStatesofAmerica,3DepartmentofOphthalmology, UniversityofCalifornia,SanFrancisco,UnitedStatesofAmerica,4DepartmentofEpidemiologyBiostatistics,UniversityofCalifornia,SanFrancisco,UnitedStatesof America,5InstituteforGlobalHealth,UniversityofCalifornia,SanFrancisco,UnitedStatesofAmerica Abstract Background:AntibioticsareamajortoolintheWHO’strachomacontrolprogram.Evenasinglemassdistributionreduces theprevalenceoftheocularchlamydiathatcausestrachoma.Unfortunately,infectionreturnsafterasingletreatment,at least in severely affected areas. Here, we test whether additional scheduled treatments further reduce infection, and whetherinfectionreturnsafterdistributionsarediscontinued. Methods:SixteencommunitiesinEthiopiawererandomlyselected.Ocularchlamydialinfectionin1-to5-year-oldchildren wasmonitoredoverfourbiannualazithromycindistributionsandfor24monthsafterthelasttreatment. Findings:Theaverageprevalenceofinfectionin1-to5-year-oldchildrenwasreducedfrom63.5%pre-treatmentto11.5% sixmonthsafterthefirstdistribution(P,0.0001).Itfurtherdecreasedto2.6%sixmonthsafterthefourthandfinaltreatment (P=0.0004). In the next 18months, infection returned to 25.2%, a significant increase from six months after the last treatment (P=0.008), but still far lower than baseline (P,0.0001). Although the prevalence of infection in any particular villagefluctuated,themeanprevalenceofthe16villagessteadilydecreasedwitheachtreatmentandsteadilyreturnedafter treatmentswerediscontinued. Conclusion: In some of the most severely affected communities ever studied, we demonstrate that repeated mass oral azithromyci