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      Implications of the COVID-19 pandemic on eliminating trachoma as a public health problem

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          Abstract

          Background:

          Progress towards elimination of trachoma as a public health problem has been substantial, but the COVID-19 pandemic has disrupted community-based control efforts.

          Methods:

          We use a susceptible-infected model to estimate the impact of delayed distribution of azithromycin treatment on the prevalence of active trachoma.

          Results:

          We identify three distinct scenarios for geographic districts depending on whether the basic reproduction number and the treatment-associated reproduction number are above or below a value of one. We find that when the basic reproduction number is below one, no significant delays in disease control will be caused. However, when the basic reproduction number is above one, significant delays can occur. In most districts a year of COVID-related delay can be mitigated by a single extra round of mass drug administration. However, supercritical districts require a new paradigm of infection control because the current strategies will not eliminate disease.

          Conclusion:

          If the pandemic can motivate judicious, community-specific implementation of control strategies, global elimination of trachoma as a public health problem could be accelerated.

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          Most cited references34

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          A simple system for the assessment of trachoma and its complications.

          B Thylefors, C R Dawson, B Jones … (1987)
          A simple grading system for trachoma, based on the presence or absence of five selected "key" signs, has been developed. The method was tested in the field and showed good observer agreement, the most critical point being the identification of severe cases of the disease. It is expected that the system will facilitate the assessment of trachoma and its complications by non-specialist health personnel working at the community level.
          Article 0 comments Cited 271 times – based on 0 reviews     Review now
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            Azithromycin in control of trachoma.

            Julius Schachter, Shila K West, David Mabey … (1999)
            Trachoma is the leading cause of preventable blindness. Programmes to prevent blindness due to trachoma are based on community-wide treatment with topical tetracycline. We assessed the potential of community-wide azithromycin treatment for trachoma control. Pairs of villages in trachoma endemic areas of Egypt, The Gambia, and Tanzania were matched on trachoma rates in 1-10-year-old children. Villages were randomly assigned community-wide oral azithromycin treatment (three doses with intervals of 1 week) or treatment with 1% topical tetracycline (once daily for 6 weeks). Clinical examinations were done at baseline, 2-4.5 months, and 12-14 months after treatment. Chlamydia trachomatitis was identified by ligase chain reaction (LCR). Analyses were by intention to treat. Univariate comparisons and multivariate analyses were used to compare outcomes. LCR positivity was correlated with clinical severity, but about 30% of Egyptian and Gambian villagers with no active disease were LCR positive. Village-wide LCR positivity ranged from 16.5% (Tanzania) to 43.6% (Egypt). Treatment compliance was over 90% except in the tetracycline treatment village in Egypt. Of the participants initially LCR positive, 866 (95%) of 924 who received at least one azithromycin dose and 482 (82%) of 587 who received 28 days or more topical tetracycline, were negative at follow-up. At 1 year, village-wide LCR positivity rates were substantially lower than at baseline with both treatments; the decreases were greater with azithromycin than with tetracycline (93% vs 77% in Egypt, 78 vs 66% in The Gambia, 64 vs 55% in Tanzania). Similarly, greater reduction in clinical activity occurred after azithromycin. In multivariate analyses, factors associated with being LCR positive at 1 year were: not receiving azithromycin; age under 10 years; and LCR positivity at baseline. Community-wide treatment with oral azithromycin markedly reduces C. trachomatis infection and clinical trachoma in endemic areas and may be an important approach to control of trachoma.
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              Strategies for control of trachoma: observational study with quantitative PCR.

              P Massae, Matthew J Burton, Liam Johnson … (2003)
              Antibiotics are an important part of WHO's strategy to eliminate trachoma as a blinding disease by 2020. At present, who needs to be treated is unclear. We aimed to establish the burden of ocular Chlamydia trachomatis in three trachoma-endemic communities in Tanzania and The Gambia with real-time quantitative PCR. Conjunctival swabs were obtained at examination from 3146 individuals. Swabs were first tested by the qualitative Amplicor PCR, which is known to be highly sensitive. In positive samples, the number of copies of omp1 (a single-copy C trachomatis gene) was measured by quantitative PCR. Children had the highest ocular loads of C trachomatis, although the amount of pooling in young age groups was less striking at the site with the lowest trachoma frequency. Individuals with intense inflammatory trachoma had higher loads than did those with other conjunctival signs. At the site with the highest prevalence of trachoma, 48 of 93 (52%) individuals with conjunctival scarring but no sign of active disease were positive for ocular chlamydiae. Children younger than 10 years old, and those with intense inflammatory trachoma, probably represent the major source of ocular C trachomatis infection in endemic communities. Success of antibiotic distribution programmes could depend on these groups receiving effective treatment.
              Article 0 comments Cited 80 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): medRxiv
                Journal ID (publisher-id): MEDRXIV
                Title: medRxiv
                Publisher: Cold Spring Harbor Laboratory
                Publication date (Electronic): 27 October 2020
                Electronic Location Identifier: 2020.10.26.20219691
                Affiliations
                [a ]Francis I Proctor Foundation, UCSF, USA
                [b ]University of Oxford, Oxford, UK
                [c ]Faculty of Health and Medical Sciences, University of Surrey, UK
                [d ]Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
                [e ]International Trachoma Initiative, The Task Force for Global Health, USA
                [f ]Lancaster Medical School, Lancaster University, Bailrigg, Lancaster, UK
                [g ]Department of Epidemiology and Biostatistics, UCSF, USA
                [h ]Institute for Global Health Sciences, UCSF, USA
                [i ]Department of Ophthalmology, UCSF, USA
                Author notes

                Authors’ contributions

                This manuscript arose from a virtual meeting of the NTD Modeling Consortium for which all authors contributed analyses and discussions. SB, TML, and TCP wrote the first draft. All authors edited the manuscript and approved the final draft.6 The authors alone are responsible for the views expressed in this article and they do not necessarily represent the views, decisions or policies of the institutions with which they are affiliated.

                [* ] Corresponding author: Thomas M Lietman, 513 Parnassus Ave., San Francisco, CA 94143, Tom.Lietman@ 123456ucsf.edu , Phone: 415-502-2662
                Article
                DOI: 10.1101/2020.10.26.20219691
                PMC ID: 7605574
                PubMed ID: 33140063
                SO-VID: 1dd5e933-a2f3-49d5-bac1-399775d0d9a7
                License:

                It is made available under a CC-BY-NC-ND 4.0 International license.

                History
                Categories
                Subject: Article

                Keywords: control,covid-19,elimination,mass drug administration,mathematical modeling,trachoma
                Data availability:
                Keywords: control, covid-19, elimination, mass drug administration, mathematical modeling, trachoma

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