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Ocular Chlamydia trachomatis infection and infectious load among pre-school aged children within trachoma hyperendemic districts receiving the SAFE strategy, Amhara region, Ethiopia.

  • Nash, Scott D
  • Chernet, Ambahun
  • Moncada, Jeanne
  • Stewart, Aisha EP
  • Astale, Tigist
  • Sata, Eshetu
  • Zerihun, Mulat
  • Gessese, Demelash
  • Melak, Berhanu
  • Ayenew, Gedefaw
  • Ayele, Zebene
  • Chanyalew, Melsew
  • Lietman, Thomas M
  • Callahan, E Kelly
  • Schachter, Julius
  • Tadesse, Zerihun
Publication Date
May 18, 2020
eScholarship - University of California
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BACKGROUND:After approximately 5 years of SAFE (surgery, antibiotics, facial cleanliness, environmental improvement) interventions for trachoma, hyperendemic (trachomatous inflammation-follicular (TF) ≥30%) districts remained in Amhara, Ethiopia. This study's aim was to characterize the epidemiology of Chlamydia trachomatis (Ct) infection and load among pre-school aged children living under the SAFE strategy. METHODS:Conjunctival swabs from a population-based sample of children aged 1-5 years collected between 2011 and 2015 were assayed to provide Ct infection data from 4 endemic zones (comprised of 58 districts). Ct load was determined using a calibration curve. Children were graded for TF and trachomatous inflammation-intense (TI). RESULTS:7,441 children were swabbed in 4 zones. TF and TI prevalence were 39.9% (95% confidence Interval [CI]: 37.5%, 42.4%), and 9.2% (95% CI: 8.1%, 10.3%) respectively. Ct infection prevalence was 6.0% (95% CI: 5.0%, 7.2%). Infection was highest among children aged 2 to 4 years (6.6%-7.0%). Approximately 10% of infection occurred among children aged 1 year. Ct load decreased with age (P = 0.002), with the highest loads observed in children aged 1 year (P = 0.01) vs. aged 5 years. Participants with TF (P = 0.20) and TI (P<0.01) had loads greater than individuals without active trachoma. CONCLUSIONS:In this hyperendemic setting, it appears that the youngest children may contribute in meaningful ways towards persistent active trachoma.

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