zithromax and Blindness

The World Health Organisation (WHO) estimated that in 2002, 1.3 million people were blind due to trachoma, an eye infection caused by Chlamydia trachomatis. This review examines the evidence behind current strategies to reduce the global burden of trachoma. Trachoma disappeared from most western nations before the advent of antibiotics, probably due to improvements in water, sanitation and hygiene. The current effort to target trachoma, headed by the WHO and the Alliance for the Global Elimination of Trachoma by 2020, is called the SAFE (Surgery, Antibiotics, Facial cleanliness and Environmental improvement) strategy. Surgery for trachoma is more cost effective than extra-capsular cataract surgery and can reverse trichiasis (in-growing eyelashes), but needs to be repeated every few years. A single oral dose of azithromycin can eliminate trachoma infection, but cannot be used in infants under 6 months old, and needs to be given every few years in communities with a high prevalence of disease. Improved health education and facial hygiene has been linked to a lower incidence of trachoma, but the evidence is less clear than for surgery and antibiotics. Pit latrines and spraying with permethrin insecticide may reduce the spread of trachoma via eye-seeking flies.

Topics: Anti-Bacterial Agents; Azithromycin; Blindness; Chlamydia trachomatis; Communicable Disease Control; Face; Health Education; Humans; Hygiene; Sanitation; Trachoma; Water Supply; World Health Organization

Trachoma is a major cause of blindness in the developing world and 63 million people are currently infected. Large-scale control programmes are being implemented to clear ocular Chlamydia trachomatis infection--the causative agent of trachoma--and improve environmental conditions to reduce transmission. Chemotherapeutic intervention involves antibiotic administration and the effectiveness of this treatment is currently under investigation. A mathematical model has been developed to allow the impact of control programmes on infection and blinding disease sequelae to be predicted. The model has a structure that allows an important aspect of trachoma pathogenesis to be taken into account, namely the effect of repeated cycles of infection and recovery leading to scarring and the damaging disease sequelae. This novel model structure reproduces many age- and time-dependent epidemiological patterns observed in endemic settings and allows the dynamic effect of treatment on infection and disease sequelae to be gauged.

Topics: Age Factors; Anti-Bacterial Agents; Azithromycin; Blindness; Humans; Models, Biological; Trachoma

Global elimination of blinding trachoma, the world's leading preventable cause of blindness, now seems possible. The disease, which persists most severely in the poorest parts of Africa and Asia, is already eliminated in North America and Europe. On a scientific basis, the case for elimination was outlined at a WHO global scientific meeting in 1996. To facilitate action, WHO founded the Alliance for Global Elimination of Trachoma by 2020 (GET 2020) in 1997. In 1998 a World Health Assembly resolution called for member states to take steps to eliminate blinding trachoma by 2020 using the WHO recommended SAFE strategy (surgery of late stage disease, antibiotics for acute infection, and improved facial hygiene and environmental change-ie, improved access to water and sanitation). These developments contributed to the decision by Pfizer Inc to donate azithromycin in support of national programmes implementing SAFE and, with the Edna McConnell Clark Foundation, to found the International Trachoma Initiative as a charity dedicated to the elimination of blinding trachoma by 2020. Reports of the early programme scope and impact are encouraging. In ten national programmes currently underway (constituting about 50% of the global burden) more than 55,000 lid surgeries have halted further corneal damage and prevented blindness, and more than 6 million treatments with azithromycin have been given with reductions in acute infections of around 50% in children. Morocco, one of the first countries to implement SAFE with azithromycin, has achieved remarkable results and expects to eliminate blinding trachoma by 2005. If political will and public-health support can be mobilised, the goal of eliminating this cause of blindness can become a reality by 2020.

Topics: Africa; Azithromycin; Blindness; Child; Global Health; Humans; Hygiene; Prevalence; Trachoma

Trachoma is the world's leading cause of preventable blindness. It affects approximately 150 million people living in the world's poorest, rural communities and causes an estimated loss of $2.9 billion in productivity annually. In 1985, the Edna McConnell Clark Foundation joined with the World Health Organization to support studies on trachoma epidemiology and control, resulting in the elaboration of the surgery, antibiotics, facial cleanliness and environmental improvement (SAFE) strategy as the basis for the elimination of this blinding disease. Founded in 1998 by the Clark Foundation and Pfizer, Inc., the International Trachoma Initiative (ITI) is the only organization dedicated to eliminating blinding trachoma through support to national control programs. The availability of donated Zithromax (azithromycin) by Pfizer, Inc. has been paramount to the support of the ITI for implementation of SAFE in 10 country programs. The program has made considerable progress in four years. More than seven million individuals have received treatment, resulting in a cumulative reduction of 50% in active disease rates in children. More than 60,000 have also benefited from lid surgery that has halted progression to blindness. Morocco is expecting to attain the elimination of blinding trachoma by 2005. However, the challenges facing the goal of global elimination by 2020 involve a vital program expansion, increased financial and technical support, environmental improvement, and continued advocacy efforts.

Topics: Anti-Bacterial Agents; Azithromycin; Blindness; Global Health; Healthy People Programs; Humans; Poverty; Rural Population; Trachoma

Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Azithromycin; Blindness; Doxycycline; Global Health; Humans; Trachoma

Trachoma, a recurrent follicular conjunctivitis caused by Chlamydia trachomatis, is the leading cause of preventable blindness worldwide. Efforts to control this disease have met with limited success. This failure is due in part to the limitations of conventional antibiotic treatment, a prolonged course of topical tetracycline. Azithromycin, an azalide antibiotic, is effective against chlamydial infections when given as a single oral dose. Recent research from Africa has shown azithromycin to be as effective as tetracycline in the treatment of trachoma. Under operational conditions azithromycin proved to be more effective. This success is attributed to a much-improved compliance with treatment. Community-wide mass treatment with azithromycin is advocated as a means of controlling trachoma in endemic countries. Questions still remain over the use of azithromycin for this purpose. The frequency and target population of mass distribution campaigns need to be defined. A few countries are beneficiaries of a philanthropic donation by the manufacturer of azithromycin, Pfizer Inc. However, in the absence of a drug donation programme the cost-effectiveness of this measure is unclear.

Topics: Anti-Bacterial Agents; Azithromycin; Blindness; Chlamydia trachomatis; Community-Acquired Infections; Drug Resistance, Bacterial; Humans; Trachoma

Topics: Anti-Bacterial Agents; Azithromycin; Blindness; Humans; Trachoma; World Health Organization

Mass administration of azithromycin to eliminate blindness due to trachoma has raised concerns regarding the emergence of antimicrobial resistance. During 2000, we compared the antimicrobial resistance of nasopharyngeal pneumococcal isolates recovered from and the prevalence of impetigo, respiratory symptoms, and diarrhea among 458 children in Nepal before and after mass administration of azithromycin. No azithromycin-resistant pneumococci were isolated except from 4.3% of children who had received azithromycin during 2 previous mass treatments (P<.001). There were decreases in the prevalence of impetigo (from 14% to 6% of subjects; adjusted odds ratio [OR], 0.41; 95% confidence interval [CI], 0.21-0.80) and diarrhea (from 32% to 11%; adjusted OR, 0.26; 95% CI, 0.14-0.43) 10 days after azithromycin treatment. The absence of macrolide-resistant isolates after 1 mass treatment with azithromycin is encouraging, although the recovery of azithromycin-resistant isolates after 2 mass treatments suggests the need for resistance monitoring when multiple rounds of antimicrobial treatment are given.

Topics: Anti-Bacterial Agents; Azithromycin; Blindness; Child; Child, Preschool; Chlamydia trachomatis; Drug Resistance, Bacterial; Female; Gastrointestinal Diseases; Humans; Infant; Male; Nepal; Respiratory Tract Infections; Streptococcus pneumoniae; Trachoma

Mass drug administration (MDA) programs are a critical component of efforts to treat and eliminate trachoma, a leading cause of blindness worldwide. Despite the importance of these programs for individual and community health, pregnant and breastfeeding women have historically been excluded from treatment in these programs. Countries with active MDA programs also tend to have high fertility rates, and thus women may be left untreated for years at a time. Not only do these women suffer from the symptoms of disease (pain and eventual blindness), but also failure to include the entire population in drug administration programs leaves pockets of infection in the community, risking outright failure of eradication efforts. The medication used most commonly, azithromycin, appears to be safe for use in pregnancy and breastfeeding. The time has come to include pregnant and breastfeeding women in MDA programs, not just for them, but also for their communities.

Topics: Anti-Bacterial Agents; Azithromycin; Blindness; Breast Feeding; Female; Humans; Mass Drug Administration; Pregnancy

Topics: Africa; Asia; Azithromycin; Blindness; Chlamydia trachomatis; Disease Eradication; Global Health; Goals; Humans; Trachoma

Trachoma, caused by Chlamydia trachomatis, remains the leading infectious cause of blindness worldwide. Persistence and progression of the resulting clinical disease appears to be an immunologically mediated process. Azithromycin, which is distributed at the community level for trachoma control, has immunomodulatory properties. We investigated the impact of one round of oral azithromycin on conjunctival immune responses, C. trachomatis infection and clinical signs three- and six- months post treatment relative to three pre-treatment time-points.. A cohort of children aged 6 to 10 years were recruited from a trachoma endemic region of northern Tanzania and were visited five times in a 12-month period. They were examined for clinical signs of trachoma and conjunctival swabs were collected for laboratory analysis. C. trachomatis infection was detected and the expression of 46 host genes was quantified using quantitative PCR. All community members were offered azithromycin treatment immediately after the six-month timepoint according to international guidelines.. The prevalence of C. trachomatis infection and inflammatory disease signs were significantly reduced three- and six- months post-mass drug administration (MDA). C. trachomatis infection was strongly associated with clinical signs at all five time-points. A profound anti-inflammatory effect on conjunctival gene expression was observed 3 months post-MDA, however, gene expression had largely returned to pre-treatment levels of variation by 6 months. This effect was less marked, but still observed, after adjusting for C. trachomatis infection and when the analysis was restricted to individuals who were free from both infection and clinical disease at all five time-points. Interestingly, a modest effect was also observed in individuals who did not receive treatment.. Conjunctival inflammation is the major clinical risk factor for progressive scarring trachoma, therefore, the reduction in inflammation associated with azithromycin treatment may be beneficial in limiting the development of potentially blinding disease sequelae. Future work should seek to determine whether this effect is mediated directly through inhibition of pro-inflammatory intracellular signalling molecules, through reductions in concurrent, sub-clinical infections, and/or through reduction of infection exposure.

Topics: Anti-Bacterial Agents; Azithromycin; Blindness; Child; Chlamydia Infections; Chlamydia trachomatis; Cicatrix; Cohort Studies; Conjunctiva; Female; Gene Expression; Humans; Inflammation; Linear Models; Logistic Models; Male; Mass Drug Administration; Prevalence; Tanzania; Trachoma

Trachoma, caused by Chlamydia trachomatis (Ct), is the leading infectious cause of blindness worldwide. Yearly azithromycin mass drug administration (MDA) plays a central role in efforts to eliminate blinding trachoma as a public health problem. Programmatic decision-making is currently based on the prevalence of the clinical sign "trachomatous inflammation-follicular" (TF) in children. We sought to test alternative tools for trachoma surveillance based on serology in the 12-year cohort of Kahe Mpya, Rombo District, Tanzania, where ocular chlamydial infection was eliminated with azithromycin MDA by 2005.. The present study was a community-based cross-sectional survey in Kahe Mpya. Of 989 residents, 571 people aged 6 months to 87 years were enrolled: 58% of the total population and 73% of 1-9 year olds, the key WHO indicator age group. Participants were examined for TF, had conjunctival swabs collected for nucleic acid amplification test (NAAT)-based detection of Ct, and blood collected for analysis of antibodies to the Ct antigens pgp3 and CT694 by multiplex bead-based immunoassay. Seroconversion rate was used to estimate changes in the force of infection in a reversible catalytic model. No conjunctival swabs tested positive for Ct infection by NAAT. Among 1-9 year olds, TF prevalence was 6.5%, whereas only 3.5% were seropositive. Force of infection modelling indicated a 10-fold decrease in seroconversion rate at a time corresponding to MDA commencement. Without baseline serological data, the inferences we can make about antibody status before MDA and the longevity of the antibody response are limited, though our use of catalytic modelling overcomes some of these limitations.. Serologic tests support NAAT findings of very low to zero prevalence of ocular Ct in this community and have potential to provide objective measures of transmission and useful surveillance tools for trachoma elimination programs.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Antibodies, Bacterial; Antibody Formation; Antigens, Bacterial; Azithromycin; Blindness; Child; Child, Preschool; Chlamydia trachomatis; Cross-Sectional Studies; Epidemiological Monitoring; Female; Humans; Infant; Male; Middle Aged; Prevalence; Seroepidemiologic Studies; Tanzania; Trachoma; Withholding Treatment; Young Adult

To determine whether 2-day dosing of azithromycin may improve the efficacy of azithromycin dosing in children with severe trachoma.. Fifty children with severe trachoma (defined as either trachoma intense or follicular trachoma with ten or more follicles) were enrolled from five villages in Kongwa, Tanzania. Enrollment occurred within 1 month and within the same district as the historical control population of 99 children with severe trachoma, all of whom received 1-day dosing. Baseline data on age, sex, and trachoma status were obtained, and swabs for determination of Chlamydia trachomatis were taken. All 50 children received 20 mg/kg azithromycin daily for 2 days, which was directly observed. Children were followed up at 6 weeks for trachoma and infection. The laboratory was masked to treatment assignment.. Baseline characteristics were similar between the treatment group and the control group. A total of 1/46 (2.2%) of children in the treatment group were polymerase chain reaction (PCR)-positive at 6 weeks, a 96.3% reduction from baseline, compared to 13/96 (13.5%) in the historical control group, an 89.4% reduction. This difference was statistically significant. However when modeled using logistic regression and accounting for age, gender, weight, and baseline percent PCR positivity, the difference was not significant. Prevalence of clinical trachoma did not differ between the groups at 6 weeks.. For children with severe trachoma, a randomized controlled trial of 2-day versus 1-day treatment may be warranted.

Topics: Anti-Bacterial Agents; Azithromycin; Bacterial Load; Blindness; Child; Child, Preschool; Chlamydia trachomatis; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Follow-Up Studies; Humans; Infant; Male; Prevalence; Severity of Illness Index; Tanzania; Trachoma

An epidemiological study carried out in 2006 indicated a high prevalence of blinding trachoma in the Kolofata Health District, Far North Region, Republic of Cameroon. As a result, the national blindness control programme of Cameroon instituted a trachoma elimination programme using the SAFE strategy.. A campaign to treat the entire district population with azithromycin 1.5% eye drops was undertaken in February 2008. To measure the effectiveness of treatment on the prevalence of active trachoma, two epidemiological studies were conducted on a representative sample of children aged between 1 and 10 years. The first study was performed just prior to the treatment campaign and the second study was performed 1 year later.. The prevalence of active forms of trachoma (trachomatous inflammation--follicular (TF) + TF/trachomatous inflammation--intense (TI)) dropped from 31.5 (95% CI 26.4 to 37.5)% before treatment to 6.3 (95% CI 4.1 to 9.6)% 1 year after treatment-a reduction of nearly 80%. There were no reports of serious or systemic side effects. Tolerance was excellent and no treatment was interrupted.. Mass treatment with azithromycin 1.5% eye drops is feasible, well tolerated and effective.

Topics: Age Distribution; Anti-Bacterial Agents; Azithromycin; Blindness; Cameroon; Child; Child, Preschool; Epidemiologic Methods; Female; Humans; Infant; Male; National Health Programs; Ophthalmic Solutions; Program Evaluation; Sex Distribution; Trachoma; Treatment Outcome

Topics: Anti-Bacterial Agents; Azithromycin; Blindness; Chlamydia trachomatis; Humans; Tetracycline; Trachoma; Treatment Outcome

Trachoma, a major cause of blindness in some of the world's poorest countries, results from repeated or chronic eye infections with Chlamydia trachomatis.

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Blindness; Child; Child, Preschool; Chronic Disease; Corneal Opacity; Developing Countries; Eye Infections, Bacterial; Global Health; Humans; Infant; Ophthalmic Solutions; Randomized Controlled Trials as Topic; Tetracycline; Trachoma; World Health Organization

Topics: Anti-Bacterial Agents; Azithromycin; Blindness; Chlamydia trachomatis; Humans; Tanzania; Trachoma

Trachoma, caused by repeated ocular infections with Chlamydia trachomatis is an important cause of blindness. Mass azithromycin distribution is part of current recommended strategies for controlling trachoma. In order to ascertain an efficient strategy model at an acceptable cost, an intervention study was conducted in Mali between May 2000 and February 2002.. Three azithromycin administration strategies were evaluated: mass community-based treatment of all residents (strategy I), treatment of all children under 11 years of age and of women between 15 and 50 (strategy II), and treatment targeted to inhabitants of households where at least one child had clinically active trachoma diagnosed (strategy III). In a particular Malian area in which trachoma was known to be mesoendemic, three villages were selected for each of the three strategies. According to the strategy allocation, adults were eventually given a single dose of 1g azithromycin, and children a unique dose of 20 mg/kg. Moreover, cleanliness and washing of children's faces were assessed, and additional questions were addressed about education, environmental and socio-economic conditions for each household at baseline. Ophthalmic examination was performed at baseline and 1, 6 and 12 months after inclusion. The outcome variable was clinically active trachoma frequency 12 months after intervention among children under 11 years of age. A descriptive analysis was performed, and then logistic regression models were built to test the efficiency of the three strategies.. Among children under 11 years of age, the active trachoma prevalence fell dramatically in each strategy, from 23.7% to 6.4% in strategy I, from 20.8% to 6.8% in strategy II, and from 20.2% to 8.5% in strategy III. After adjustment on age (adjusted odds ratio [AOR] = 0.81; 95% confidence interval [95% CI]: 0.75-0.87) and on active trachoma occurrence at baseline (AOR = 3.81; [95% CI]: 2.70-5.39), the multiple logistic regression model showed that both strategies I and II gave similar results, while strategy III appeared significantly less effective (AOR = 1.56; [95% CI]: 1.00-2.43).. In mesoendemic trachoma areas, targeted treatment to all children under 11 years of age and women between 15 and 50 (strategy II) was as effective as indiscriminate mass distribution (strategy I) and more effective than treatment targeted to inhabitants of households where at least one child had active trachoma diagnosed (strategy III). Strategy II could therefore reduce the prevalence and intensity of trachoma infection at a lower cost than mass community-based treatment of all residents (strategy I).

Topics: Adolescent; Adult; Animals; Anti-Bacterial Agents; Azithromycin; Blindness; Child; Chlamydia trachomatis; Female; Humans; Longitudinal Studies; Male; Mali; Middle Aged; Rural Population; Trachoma; Treatment Outcome

Topics: Anti-Bacterial Agents; Azithromycin; Blindness; Child, Preschool; Chronic Disease; Diagnosis, Differential; Female; Humans; Inflammation; Population Surveillance; Prevalence; Public Health; Trachoma; World Health Organization

Trachoma causes blindness; the prevention strategy includes mass antibiotic treatment. In a community in Northern Tanzania offered mass treatment with azithromycin for the control of trachoma, we used focus group discussions, individual interviews, questionnaires and direct observation to quantify, explore and contextualize reasons for acceptance or refusal of the drug. In the village studied, 76% of the population eligible to receive azithromycin were treated. Uptake was significantly higher among women (79% treated) than men (72%). Factors affecting acceptability included: local prevention norms (such as the belief that injections, rather than oral medicine, should be used for prevention); perceptions of drugs in general and azithromycin in particular; perceptions of the distribution team's expertise; witnessing adverse effects in others; and the timing, quality and quantity of information about azithromycin and its availability. Familiarity with trachoma as a blinding disease was significantly associated with uptake. Individuals who refused treatment seemed to be less altruistic than other respondents. Neither socio-economic status nor use of traditional healers was related to uptake. Pre-distribution community assessment and community education, advance notice of the distribution, standardized distribution guidelines and improved distributor training are recommended to maximize acceptance of azithromycin in future campaigns.

Topics: Adult; Anti-Bacterial Agents; Attitude to Health; Azithromycin; Blindness; Female; Humans; Male; Middle Aged; Patient Acceptance of Health Care; Surveys and Questionnaires; Tanzania; Trachoma

The fight against blinding trachoma is being addressed with an integrated strategy of surgery, antibiotics, hygiene promotion, and environmental improvement-the SAFE strategy, but its cost-effectiveness is largely unknown. This paper estimates the cost effectiveness of surgery and antibiotics in trachoma-endemic areas in seven world regions.. A population model was applied to follow the lifelong impact on individuals receiving trachoma control. Intervention costs and effectiveness estimates were based on a combination of primary data collection and literature review.. Providing trichiasis surgery to 80% of those who need it would avert over 11 million DALYs per year globally, with cost effectiveness ranging from I$13 to I$78 per DALY averted across regions. Mass antibiotic treatment of all children using azythromycin at prevailing market prices would avert more than 4 million DALYs per year globally with cost-effectiveness ranging between I$9,000 and I$65,000 per DALY averted. The intervention is only cost-effective if azythromycin is donated or becomes available at reduced prices. Mass treatment of all children with tetracycline and targeted treatment with azythromycin are not cost-effective.. As individual components of the SAFE strategy, trichiasis surgery for trachoma is a cost-effective way of restoring sight in all epidemiological sub-regions considered, as is the use of azythromycin, if donated or at reduced prices. Large study uncertainties do not change study conclusions. The results should be interpreted in the context of the overall SAFE strategy to address issues of sustainability.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Azithromycin; Blindness; Combined Modality Therapy; Cost-Benefit Analysis; Eyelid Diseases; Female; Geography; Global Health; Hair Diseases; Humans; Male; Middle Aged; Ophthalmologic Surgical Procedures; Tetracycline; Trachoma

Topics: Anti-Bacterial Agents; Azithromycin; Blindness; Endemic Diseases; Global Health; Humans; Hygiene; Prevalence; Socioeconomic Factors; Trachoma

Topics: Anti-Bacterial Agents; Azithromycin; Blindness; Child; Humans; Malawi; Public Health; Trachoma

Topics: Azithromycin; Blindness; Computer Simulation; Eyelashes; Global Health; Humans; International Cooperation; Trachoma; World Health Organization

The World Health Organization has recommended repeat mass drug administration as part of their global initiative to eliminate blinding trachoma by the year 2020. The efficacy of repeat treatment will be tested empirically, but the results will not be available for many years, and recommendations for the necessary frequency of treatment are needed immediately. We have developed a mathematical model that uses available epidemiological data from a variety of countries. We recommend, based on our analysis, that in areas where trachoma is moderately prevalent (<35% in children), it should be treated annually, but hyperendemic areas (>50% in children), it should be treated biannually.

Topics: Anti-Bacterial Agents; Azithromycin; Blindness; Child; Child, Preschool; Computer Simulation; Global Health; Humans; Infant; Models, Theoretical; Prevalence; Trachoma