@article{28550,
  keywords = {Treatment Outcome, Trachoma, Pregnancy, Male, Infant, Humans, Female, Ethiopia, Drug Administration Schedule, Child, Preschool, Azithromycin, Anti-Bacterial Agents},
  author = {Lakew T and House J and Hong KC and Yi E and Alemayehu W and Melese M and Zhou Z and Ray K and Chin S and Romero E and Keenan JD and Whitcher J and Gaynor B and Lietman TM},
  title = {Reduction and return of infectious trachoma in severely affected communities in Ethiopia.},
  abstract = {<p><strong>BACKGROUND: </strong>Antibiotics are a major tool in the WHO's trachoma control program. Even a single mass distribution reduces the prevalence of the ocular chlamydia that causes trachoma. Unfortunately, infection returns after a single treatment, at least in severely affected areas. Here, we test whether additional scheduled treatments further reduce infection, and whether infection returns after distributions are discontinued.</p>

<p><strong>METHODS: </strong>Sixteen communities in Ethiopia were randomly selected. Ocular chlamydial infection in 1- to 5-year-old children was monitored over four biannual azithromycin distributions and for 24 months after the last treatment.</p>

<p><strong>FINDINGS: </strong>The average prevalence of infection in 1- to 5-year-old children was reduced from 63.5% pre-treatment to 11.5% six months after the first distribution (P&lt;0.0001). It further decreased to 2.6% six months after the fourth and final treatment (P = 0.0004). In the next 18 months, 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&lt;0.0001). Although the prevalence of infection in any particular village fluctuated, the mean prevalence of the 16 villages steadily decreased with each treatment and steadily returned after treatments were discontinued.</p>

<p><strong>CONCLUSION: </strong>In some of the most severely affected communities ever studied, we demonstrate that repeated mass oral azithromycin distributions progressively reduce ocular chlamydial infection in a community, as long as these distributions are given frequently enough and at a high enough coverage. However, infection returns into the communities after the last treatment. Sustainable changes or complete local elimination of infection will be necessary.</p>

<p><strong>TRIAL REGISTRATION: </strong>ClinicalTrials.gov NCT00221364.</p>
},
  year = {2009},
  journal = {PLoS neglected tropical diseases},
  volume = {3},
  pages = {e376},
  issn = {1935-2735},
  url = {http://journals.plos.org/plosntds/article/file?id=10.1371/journal.pntd.0000376&type=printable},
  doi = {10.1371/journal.pntd.0000376},
  language = {eng},
}