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. 2009 Dec 22;3(12):e573.
doi: 10.1371/journal.pntd.0000573.

Active trachoma and ocular Chlamydia trachomatis infection in two Gambian regions: on course for elimination by 2020?

Emma M Harding-Esch  1 , Tansy Edwards, Ansumana Sillah, Isatou Sarr, Chrissy H Roberts, Paul Snell, Esther Aryee, Sandra Molina, Martin J Holland, David C W Mabey, Robin L Bailey
Affiliations

Active trachoma and ocular Chlamydia trachomatis infection in two Gambian regions: on course for elimination by 2020?

Emma M Harding-Esch et al. PLoS Negl Trop Dis. .

Abstract

Background: Trachoma has been endemic in The Gambia for decades. National trachoma control activities have been in place since the mid-1980's, but with no mass antibiotic treatment campaign. We aimed to assess the prevalence of active trachoma and of actual ocular Chlamydia trachomatis infection as measured by polymerase chain reaction (PCR) in the two Gambian regions that had had the highest prevalence of trachoma in the last national survey in 1996 prior to planned national mass antibiotic treatment distribution in 2006.

Methodology/principal findings: Two stage random sampling survey in 61 randomly selected Enumeration Areas (EAs) in North Bank Region (NBR) and Lower River Region (LRR). Fifty randomly selected children aged under 10 years were examined per EA for clinical signs of trachoma. In LRR, swabs were taken to test for ocular C. trachomatis infection. Unadjusted prevalences of active trachoma were calculated, as would be done in a trachoma control programme. The prevalence of trachomatous inflammation, follicular (TF) in the 2777 children aged 1-9 years was 12.3% (95% CI 8.8%-17.0%) in LRR and 10.0% (95% CI 7.7%-13.0%) in NBR, with significant variation within divisions (p<0.01), and a design effect of 3.474. Infection with C. trachomatis was found in only 0.3% (3/940) of children in LRR.

Conclusions/significance: This study shows a large discrepancy between the prevalence of trachoma clinical signs and ocular C. trachomatis infection in two Gambian regions. Assessment of trachoma based on clinical signs alone may lead to unnecessary treatment, since the prevalence of active trachoma remains high but C. trachomatis infection has all but disappeared. Assuming that repeated infection is required for progression to blinding sequelae, blinding trachoma is on course for elimination by 2020 in The Gambia.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Spatial distribution of TF prevalence in 1–9 year-olds in districts and sampled villages in North Bank and Lower River Regions.
See this image and copyright information in PMC

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