Stopping azithromycin mass drug administration for trachoma: A systematic review.

The World Health Organization (WHO) recommends continuing azithromycin mass drug administration (MDA) for trachoma until endemic regions drop below 5% prevalence of active trachoma in children aged 1-9 years. Azithromycin targets the ocular strains of Chlamydia trachomatis that cause trachoma. Regio...

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Main Authors: Hamidah Mahmud, Emma Landskroner, Abdou Amza, Solomon Aragie, William W Godwin, Anna de Hostos Barth, Kieran S O'Brien, Thomas M Lietman, Catherine E Oldenburg
Format: Article
Language:English
Published: Public Library of Science (PLoS) 2021-07-01
Series:PLoS Neglected Tropical Diseases
Online Access:https://journals.plos.org/plosntds/article/file?id=10.1371/journal.pntd.0009491&type=printable
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author Hamidah Mahmud
Emma Landskroner
Abdou Amza
Solomon Aragie
William W Godwin
Anna de Hostos Barth
Kieran S O'Brien
Thomas M Lietman
Catherine E Oldenburg
author_facet Hamidah Mahmud
Emma Landskroner
Abdou Amza
Solomon Aragie
William W Godwin
Anna de Hostos Barth
Kieran S O'Brien
Thomas M Lietman
Catherine E Oldenburg
author_sort Hamidah Mahmud
collection DOAJ
description The World Health Organization (WHO) recommends continuing azithromycin mass drug administration (MDA) for trachoma until endemic regions drop below 5% prevalence of active trachoma in children aged 1-9 years. Azithromycin targets the ocular strains of Chlamydia trachomatis that cause trachoma. Regions with low prevalence of active trachoma may have little if any ocular chlamydia, and, thus, may not benefit from azithromycin treatment. Understanding what happens to active trachoma and ocular chlamydia prevalence after stopping azithromycin MDA may improve future treatment decisions. We systematically reviewed published evidence for community prevalence of both active trachoma and ocular chlamydia after cessation of azithromycin distribution. We searched electronic databases for all peer-reviewed studies published before May 2020 that included at least 2 post-MDA surveillance surveys of ocular chlamydia and/or the active trachoma marker, trachomatous inflammation-follicular (TF) prevalence. We assessed trends in the prevalence of both indicators over time after stopping azithromycin MDA. Of 140 identified studies, 21 met inclusion criteria and were used for qualitative synthesis. Post-MDA, we found a gradual increase in ocular chlamydia infection prevalence over time, while TF prevalence generally gradually declined. Ocular chlamydia infection may be a better measurement tool compared to TF for detecting trachoma recrudescence in communities after stopping azithromycin MDA. These findings may guide future trachoma treatment and surveillance efforts.
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spelling doaj-art-00a67f0c27c84c1b908259ee1f956be22025-08-20T02:17:57ZengPublic Library of Science (PLoS)PLoS Neglected Tropical Diseases1935-27271935-27352021-07-01157e000949110.1371/journal.pntd.0009491Stopping azithromycin mass drug administration for trachoma: A systematic review.Hamidah MahmudEmma LandskronerAbdou AmzaSolomon AragieWilliam W GodwinAnna de Hostos BarthKieran S O'BrienThomas M LietmanCatherine E OldenburgThe World Health Organization (WHO) recommends continuing azithromycin mass drug administration (MDA) for trachoma until endemic regions drop below 5% prevalence of active trachoma in children aged 1-9 years. Azithromycin targets the ocular strains of Chlamydia trachomatis that cause trachoma. Regions with low prevalence of active trachoma may have little if any ocular chlamydia, and, thus, may not benefit from azithromycin treatment. Understanding what happens to active trachoma and ocular chlamydia prevalence after stopping azithromycin MDA may improve future treatment decisions. We systematically reviewed published evidence for community prevalence of both active trachoma and ocular chlamydia after cessation of azithromycin distribution. We searched electronic databases for all peer-reviewed studies published before May 2020 that included at least 2 post-MDA surveillance surveys of ocular chlamydia and/or the active trachoma marker, trachomatous inflammation-follicular (TF) prevalence. We assessed trends in the prevalence of both indicators over time after stopping azithromycin MDA. Of 140 identified studies, 21 met inclusion criteria and were used for qualitative synthesis. Post-MDA, we found a gradual increase in ocular chlamydia infection prevalence over time, while TF prevalence generally gradually declined. Ocular chlamydia infection may be a better measurement tool compared to TF for detecting trachoma recrudescence in communities after stopping azithromycin MDA. These findings may guide future trachoma treatment and surveillance efforts.https://journals.plos.org/plosntds/article/file?id=10.1371/journal.pntd.0009491&type=printable
spellingShingle Hamidah Mahmud
Emma Landskroner
Abdou Amza
Solomon Aragie
William W Godwin
Anna de Hostos Barth
Kieran S O'Brien
Thomas M Lietman
Catherine E Oldenburg
Stopping azithromycin mass drug administration for trachoma: A systematic review.
PLoS Neglected Tropical Diseases
title Stopping azithromycin mass drug administration for trachoma: A systematic review.
title_full Stopping azithromycin mass drug administration for trachoma: A systematic review.
title_fullStr Stopping azithromycin mass drug administration for trachoma: A systematic review.
title_full_unstemmed Stopping azithromycin mass drug administration for trachoma: A systematic review.
title_short Stopping azithromycin mass drug administration for trachoma: A systematic review.
title_sort stopping azithromycin mass drug administration for trachoma a systematic review
url https://journals.plos.org/plosntds/article/file?id=10.1371/journal.pntd.0009491&type=printable
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