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1.
Washington, D.C.; OPS; 2022-09-21.
en Español | PAHO-IRIS | ID: phr-56432

RESUMEN

El tracoma, una enfermedad prevenible, es una de las principales causas de ceguera de origen infeccioso en el mundo. Además, afecta principalmente las poblaciones que viven en zonas rurales, pobres y remotas que tienen un acceso deficiente o inexistente a servicios básicos como agua, saneamiento, salud o educación, entre otros. En la Región de las Américas, el tracoma representa un problema de salud pública en Brasil, Colombia, Guatemala y Perú, y se estima que en el 2021 cerca de 5 millones de personas vivían en zonas en las que se necesitan intervenciones para eliminarlo. Esta caja de herramientas reúne las recomendaciones actualizadas de la Organización Panamericana de la Salud y de la Organización Mundial de la Salud para la puesta en marcha de actividades locales dirigidas a acelerar las iniciativas de eliminación del tracoma en las Américas. Contiene adaptaciones a la situación epidemiológica del tracoma en la Región y se estructura en cuatro módulos que cubren los temas siguientes: 1) evaluaciones rápidas del tracoma, 2) búsqueda activa dae casos de triquiasis tracomatosa, 3) monitoreo y seguimiento de casos de triquiasis tracomatosa y 4) planificación de jornadas quirúrgicas para la corrección de la triquiasis tracomatosa. Está publicación está dirigida a los equipos de gerencia y administración de los programas nacionales y subnacionales para la eliminación del tracoma como problema de salud pública, y se espera que contribuya a facilitar la planeación, ejecución y monitoreo de medidas operativas de eliminación de esta enfermedad.


Asunto(s)
Tracoma , Ceguera , Zonas Remotas , Áreas de Pobreza , Saneamiento Rural , Vigilancia en Salud Pública , Epidemiología , Américas
2.
Indian J Ophthalmol ; 70(9): 3260-3265, 2022 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-36018099

RESUMEN

Purpose: In the mid-twentieth century, trachoma was endemic in the northwestern states of India. We aimed to generate recent estimates of prevalence of trachomatous inflammation, follicular (TF) and trachomatous trichiasis (TT) in ten suspected-endemic districts across seven previously hyper-endemic states and union territories for trachoma in India including Delhi, Rajasthan, Haryana, Punjab, Gujarat, Uttarakhand and the Andaman and Nicobar Islands. Methods: Population-based prevalence surveys were undertaken in 10 districts. In each of those districts, two-stage cluster sampling was used to select a sample of 2000 children aged 1-9 years and all adults aged ≥15 years in the enumerated households from a total of 20 clusters per district. Consenting eligible participants were examined for trachoma by trained ophthalmologists using the World Health Organization's simplified grading system. Data were analyzed at the district level. Results: A total of 13,802 households were surveyed in which 19,662 children were examined for TF and 44,135 adults aged ≥15 years were examined for TT. District-level TF prevalence in 1-9-year-olds ranged from 0.1% in Bikaner (95% CI: 0.01-0.3) to 2.1% in Dholpur (95% CI: 1.6-2.8) and that of trichiasis ranged from 0.7 per 1000 in Pauri Garhwal (95% CI: 0.01-1.4) to 22.1 per 1000 (95% CI: 15.8-28.4) in Car Nicobar. In four districts (Car Nicobar, Dholpur, Hoshiarpur, Tonk), trichiasis prevalence in adults aged ≥15 years was ≥0.2%. Conclusion: TF was not a public health problem in any of the districts surveyed; thus, antibiotic mass drug administration is not needed. However, TT among adults was found to be above 0.2% in four districts; thus, further trichiasis surgery interventions at the public health level are warranted to achieve elimination. These findings will facilitate planning for elimination of trachoma as a public health problem in India.


Asunto(s)
Tracoma , Triquiasis , Adulto , Niño , Estudios Transversales , Humanos , India , Lactante , Prevalencia
4.
JAMA Netw Open ; 5(8): e2228244, 2022 08 01.
Artículo en Inglés | MEDLINE | ID: mdl-35997979

RESUMEN

Importance: Because transmission of ocular strains of Chlamydia trachomatis is greatest among preschool-aged children, limiting azithromycin distributions to this age group may conserve resources and result in less antimicrobial resistance, which is a potential advantage in areas with hypoendemic trachoma and limited resources. Objective: To determine the efficacy of mass azithromycin distributions to preschool-aged children as a strategy for trachoma elimination in areas with hypoendemic disease. Design, Setting, and Participants: In this cluster randomized clinical trial performed from November 23, 2014, until July 31, 2017, thirty rural communities in Niger were randomized at a 1:1 ratio to biannual mass distributions of either azithromycin or placebo to children aged 1 to 59 months. Participants and study personnel were masked to treatment allocation. Data analyses for trachoma outcomes were performed from October 19, 2021, through June 10, 2022. Interventions: Every 6 months, a single dose of either oral azithromycin (20 mg/kg using height-based approximation for children who could stand or weight calculation for small children) or oral placebo was provided to all children aged 1 to 59 months. Main Outcomes and Measures: Trachoma was a prespecified outcome of the trial, assessed as the community-level prevalence of trachomatous inflammation-follicular and trachomatous inflammation-intense through masked grading of conjunctival photographs from a random sample of 40 children per community each year during the 2-year study period. A secondary outcome was the seroprevalence of antibodies to C trachomatis antigens. Results: At baseline, 4726 children in 30 communities were included; 1695 children were enrolled in 15 azithromycin communities and 3031 children were enrolled in 15 placebo communities (mean [SD] proportions of boys, 51.8% [4.7%] vs 52.0% [4.2%]; mean [SD] age, 30.8 [2.8] vs 30.6 [2.6] months). The mean coverage of study drug for the 4 treatments was 79% (95% CI, 75%-83%) in the azithromycin group and 82% (95% CI, 79%-85%) in the placebo group. The mean prevalence of trachomatous inflammation-follicular at baseline was 1.9% (95% CI, 0.5%-3.5%) in the azithromycin group and 0.9% (95% CI, 0-1.9%) in the placebo group. At 24 months, trachomatous inflammation-follicular prevalence was 0.2% (95% CI, 0-0.5%) in the azithromycin group and 0.8% (95% CI, 0.2%-1.6%) in the placebo group (incidence rate ratio adjusted for baseline: 0.18 [95% CI, 0.01-1.20]; permutation P = .07). Conclusions and Relevance: The findings of this trial do not show that biannual mass azithromycin distributions to preschool-aged children were more effective than placebo, although the underlying prevalence of trachoma was low. The sustained absence of trachoma even in the placebo group suggests that trachoma may have been eliminated as a public health problem in this part of Niger. Trial Registration: ClinicalTrials.gov Identifier: NCT02048007.


Asunto(s)
Gonorrea , Enfermedades del Recién Nacido , Tracoma , Adulto , Antibacterianos , Azitromicina/uso terapéutico , Niño , Preescolar , Chlamydia trachomatis , Humanos , Recién Nacido , Inflamación/tratamiento farmacológico , Masculino , Niger/epidemiología , Prevalencia , Estudios Seroepidemiológicos , Tracoma/tratamiento farmacológico , Tracoma/epidemiología , Tracoma/prevención & control
5.
PLoS Negl Trop Dis ; 16(8): e0010660, 2022 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-36037211

RESUMEN

INTRODUCTION: Mexico was the first country in the Americas and the third in the world to eliminate trachoma as a public health problem, as validated by the WHO in 2017. OBJECTIVE: To describe the critical elements that favored the elimination of trachoma as a public health problem in Mexico and the public health impact of this success. METHODOLOGY: A revision and compilation of data and information contained in the dossier presented by the country to PAHO/WHO to obtain the validation of trachoma elimination as a public health problem was conducted by a group of delegates from the national and local trachoma prevention and control program. Data from the national and local surveillance systems and reports of actions conducted after achieving the elimination goal were also included. Critical elements that favored the achievement of the elimination goal from 1896 to 2019 were extracted. RESULTS: Mexico reached the elimination of trachoma in 2016 obtaining the validation in 2017. 264 communities were no longer endemic and 151,744 people were no longer at risk of visual impairment or possible blindness due to trachoma. The key to the success of this elimination process was primarily the local leadership of health authorities with sustained funding for brigades, increased access to potable water and sanitation, and key alliances with indigenous authorities, health authorities, and government institutions that contributed to the achievement of the goal. The SAFE strategy started implementation in Mexico in 2004 as a comprehensive package of interventions. SAFE stands for surgery, antibiotics, facial cleanliness, and improvement of the environmental conditions. These actions impacted drastically on the number of new cases trachmatous trichiasis (TT) and trachomatous inflammation-follicular (TF), which decreased from 1,794 in 2004 to zero in 2016. CONCLUSIONS: The elimination of trachoma as a public health problem in Mexico is a true success story that may serve as a model example for the elimination of other neglected infectious diseases in the Americas.


Asunto(s)
Enfermedades del Recién Nacido , Tracoma , Triquiasis , Prioridades en Salud , Humanos , Lactante , Recién Nacido , México/epidemiología , Prevalencia , Salud Pública , Tracoma/epidemiología , Tracoma/prevención & control , Triquiasis/epidemiología
7.
PLoS Negl Trop Dis ; 16(7): e0010532, 2022 07.
Artículo en Inglés | MEDLINE | ID: mdl-35877683

RESUMEN

BACKGROUND: There is evidence of the occurrence of trachoma in Peru, and studies have shown that soil-transmitted helminthiases (STH) are affecting rural communities in the Amazon basin in Loreto Department. This study was done to estimate trachoma prevalence, STH prevalence, and the associated factors for both diseases in children aged 1-9 years in rural communities of Peru. METHODOLOGY: A population-based cross-sectional survey was carried out in rural communities of Loreto. A standardized survey questionnaire with individual and household risk factors related to both diseases was used. Ocular examination was done for all participants aged one year and above, and eye swab samples were collected from children with follicular trachoma (TF). Anthropometric measurements, stool samples for STH, and blood samples for hemoglobin measurement were taken from children. PRINCIPAL FINDINGS: TF prevalence was 7.74% (95% CI 5.08-11.63%), STH prevalence was 49.49% (95% CI 25.00-52.43%), and prevalence of co-occurrence of both diseases was 5.06% (95% CI 2.80-8.98%) in children aged 1-9 years. Being at age 3-8 years old (AOR = 6.76; 95% CI 1.346-33.947), have an unclean face (AOR = 24.64; 95% CI 6.787-89.444), and having been dewormed in the last six months (AOR = 2.47; 95% CI 1.106-5.514), were risk factors of TF. Being a female (AOR = 0.22; 95% CI 0.103-0.457) was associated with decreased odds of TF. Having been dewormed in the last six months (AOR = 0.30; 95% CI 0.139-0.628) was a preventative factor for STH. Risk factors for children with both diseases mirrored the findings for risk factors for individual diseases. CONCLUSIONS: Neglected tropical diseases and associated risk factors overlap in communities living in vulnerable conditions in the Amazon basin of Peru. These findings support the need to implement integrated interventions, including mass drug administration, water, sanitation, and hygiene for both diseases in the study area.


Asunto(s)
Helmintiasis , Tracoma , Niño , Preescolar , Estudios Transversales , Femenino , Helmintiasis/epidemiología , Humanos , Lactante , Perú/epidemiología , Prevalencia , Factores de Riesgo , Población Rural , Suelo , Tracoma/epidemiología
8.
PLoS Negl Trop Dis ; 16(7): e0010563, 2022 07.
Artículo en Inglés | MEDLINE | ID: mdl-35816486

RESUMEN

BACKGROUND: Great progress has been made toward the elimination of trachoma as a public-health problem. Mathematical and statistical models have been used to forecast when the program will attain the goal of the elimination of active trachoma, defined as prevalence of trachomatous inflammation-follicular in 1-9 year olds (TF1-9) <5%. Here we use program data to create an empirical model predicting the year of attaining global elimination of TF1-9. METHODOLOGY/PRINCIPAL FINDINGS: We calculated the mean number of years (95% CI) observed for an implementation unit (IU) to move from a baseline TF1-9 prevalence ≥5% to the elimination threshold, based on the region (Ethiopia vs. non-Ethiopia) and baseline prevalence category. Ethiopia IUs had significantly different rates of reaching the TF1-9 elimination threshold after a trachoma impact survey (TIS) compared to non-Ethiopia IUs across all baseline categories. We used those estimates to predict when remaining active trachoma-endemic IUs (TF1-9 ≥5%) would have their last round of mass drug administration (MDA) based on the mean number of years required and number of MDA rounds already completed. Our model predicts that elimination of TF1-9 will be achieved in 2028 in Ethiopia (95% CI: 2026-2033) and 2029 outside of Ethiopia (95% CI: 2023-2034), with some IUs in East Africa predicted to be the last requiring MDA globally. CONCLUSIONS/SIGNIFICANCE: Our empirical estimate is similar to those resulting from previous susceptible-infectious-susceptible (SIS) and mathematical models, suggesting that the forecast achievement of TF1-9 elimination is realistic with the caveat that although disease elimination progress can be predicted for most IUs, there is an important minority of IUs that is not declining or has not yet started trachoma elimination activities. These IUs represent an important barrier to the timely global elimination of active trachoma.


Asunto(s)
Enfermedades del Recién Nacido , Tracoma , Estudios Transversales , Erradicación de la Enfermedad , Humanos , Lactante , Recién Nacido , Administración Masiva de Medicamentos , Prevalencia , Tracoma/tratamiento farmacológico , Tracoma/epidemiología , Tracoma/prevención & control
9.
PLoS Negl Trop Dis ; 16(7): e0010560, 2022 07.
Artículo en Inglés | MEDLINE | ID: mdl-35816549

RESUMEN

BACKGROUND: Neglected Tropical Diseases amenable to Preventive Chemotherapy (PC-NTDs) affect the poorest populations around the world, especially in Africa. Scientific information on the distribution and level of endemicity of these diseases in the Republic of the Congo (RoC) is scarce in the published literature. We sought to collect all available epidemiological data on PC-NTDs in the RoC to document the historical and current situation and identify challenges in reaching the elimination of NTDs. METHODS: We searched Medline and Horizon databases for studies published until to July 4th, 2019, on onchocerciasis, lymphatic filariasis, soil-transmitted helminth infections, schistosomiasis, and trachoma in the RoC. Unpublished reports were also reviewed. We included all epidemiological studies containing community data and excluded case reports. Location, prevalence data, and dates of the studies were extracted. PRINCIPAL FINDINGS: We identified 933 records, of which 56 met the inclusion criteria. The articles published before 1960 mainly concerned onchocerciasis and schistosomiasis. Despite a low number over the studied period, since 2005 there has been a steady increase in the number of publications. Most of the studies were cross-sectional and conducted in the general population. Trachoma is endemic in the Sangha and Likouala departments (prevalence of trachomatous inflammation-follicular > 5% in some villages), and further mapping is essential to properly assess the burden of this disease in the country. While the prevalence of soil-transmitted helminths is still high (over 20%) in a large part of Congo, cases of lymphatic filariasis (based on Wuchereria bancrofti antigenaemia and/or microfilaraemia) and onchocerciasis are becoming rare and very focused. To achieve the elimination of PC-NTDs, further intervention is required. CONCLUSIONS: Except for trachoma, whose epidemiological situation should be better evaluated, PC-NTDs are endemic in the RoC, and actions to control them have been taken by health authorities. To eliminate PC-NTDs, which are still present in some locations, new mapping surveys are needed, and increased investment in scientific research should be encouraged in the country.


Asunto(s)
Filariasis Linfática , Oncocercosis , Esquistosomiasis , Tracoma , Medicina Tropical , Congo/epidemiología , Filariasis Linfática/tratamiento farmacológico , Filariasis Linfática/epidemiología , Filariasis Linfática/prevención & control , Humanos , Enfermedades Desatendidas/tratamiento farmacológico , Enfermedades Desatendidas/epidemiología , Enfermedades Desatendidas/prevención & control , Esquistosomiasis/epidemiología , Suelo/parasitología , Tracoma/tratamiento farmacológico , Tracoma/epidemiología , Tracoma/prevención & control
10.
PLoS Negl Trop Dis ; 16(7): e0010629, 2022 07.
Artículo en Inglés | MEDLINE | ID: mdl-35830476

RESUMEN

BACKGROUND: Serologic testing for chlamydial antibodies is one potential tool for trachoma monitoring. Understanding the dynamics of seroconversion and seroreversion in low endemic districts is critical for determining the value of using serology. METHODOLOGY/PRINCIPAL FINDINGS: We surveyed a random sample of 2536 children aged 1-9 years in Kongwa, Tanzania, over three years; 1719 (67.8%) participants had all three follow-ups. Surveys assessed trachomatous inflammation-follicular (TF), Chlamydia trachomatis infection, and anti-pgp3 antibodies. Mass drug administration occurred immediately after the first and second follow-up surveys. The cohort was classified into trajectories of change in serostatus, and risk factors were evaluated for seroconversion and seroreversion. We found that 86.2% of seropositives remained seropositive throughout the study, whereas 12.1% seroreverted. Seroreverters were younger (Odds Ratio [OR] = 0.88 for every one-year increase in age, 95% CI = 0.79-0.99). 84.5% of seronegatives remained seronegative, and 13.0% seroconverted. Seroconverters were also younger (OR = 0.92, 95% CI = 0.87-0.98). Seroconversion and seroreversion were not explained by indeterminate values for the intensity of antibody response. Less than 1% of the cohort had unstable changes in serostatus, mostly explained by values in the indeterminate range. TF and infection in the cohort declined over time, while seropositivity increased from 31.5% to 36.4%. CONCLUSIONS/SIGNIFICANCE: Antibody status is relatively stable over time. Both seroconversion and seroreversion occurred over the three years in this low endemic district, especially in younger children. Modeling seroreversion is important for accurate determination of seroconversion. The use of serology as a monitoring tool should target the younger aged children as they will most likely capture recent changes in serostatus.


Asunto(s)
Tracoma , Antibacterianos/uso terapéutico , Niño , Chlamydia trachomatis , Humanos , Lactante , Prevalencia , Seroconversión , Tanzanía/epidemiología
11.
PLoS Negl Trop Dis ; 16(6): e0010169, 2022 06.
Artículo en Inglés | MEDLINE | ID: mdl-35759466

RESUMEN

BACKGROUND: Globally, although effective prevention strategies and treatment are available, trachoma remains the major cause of infectious loss of sight. Trachoma is a predominant neglected disease in Ethiopia, and there is a 40.4% prevalence of active trachoma in the Goro district, Southeast Ethiopia. World Health Organization (WHO) recommends azithromycin mass treatment of at least 80% coverage to eliminate trachoma, even though the coverage of azithromycin mass treatment has not been studied yet in depth. Thus, this study aimed to assess the coverage and factors influencing azithromycin mass treatment uptake among adults in Goro district, Southeast Ethiopia. METHODS: A community-based cross-sectional study was conducted from April 1st to April 30th, 2021 among all adults aged 15 years old and above. The multistage sampling technique was used to select 593 study respondents. A structured interviewer-administered questionnaire was used. Data were entered into Epi-Data version 3.1 and analyzed using SPSS version 23.0 software. Descriptive analysis and binary logistic regression analysis were used to analyze the data. Adjusted odds ratios (AOR) along with a 95% confidence interval (CI) and p-value < 0.05 were used to declare the strength and the significance of association, respectively. RESULTS/PRINCIPAL FINDINGS: Five hundred and seventy eight study participants with a 97% response rate were included. The proportion of azithromycin mass drug administration coverage was found to be 75.80%; 95% CI: (72%-79%) in this study. Having better knowledge about trachoma (AOR = 2.36; 95% CI: 1.19-4.70), having better knowledge about azithromycin mass treatment (AOR = 4.19; 95% CI: 2.19-7.98), being educated (AOR = 7.20; 95% CI: 1.02-51.09), a campaign conducted at the quiet time (off-harvesting/planting season) (AOR = 6.23; 95% CI: 3.23-11.98), heard about the serious adverse effect from others (AOR = 0.25; 95% CI: 0.10-0.59) and being a volunteer to take azithromycin in the next campaign (AOR = 5.46; 95% CI: 2.76-10.79) were significantly associated with azithromycin mass drug administration coverage. CONCLUSIONS/SIGNIFICANCE: The proportion of azithromycin mass treatment coverage of this study was lower than the WHO minimum target coverage. Thus, strengthening awareness, enhancing azithromycin mass trachoma treatment messages, and conducting campaigns off-season outside of harvesting and planting time should be prioritized in the future to meet the 2030 Sustainable Development Goal (SDG) target.


Asunto(s)
Enfermedades del Recién Nacido , Tracoma , Adolescente , Adulto , Azitromicina/uso terapéutico , Estudios Transversales , Etiopía/epidemiología , Humanos , Recién Nacido , Enfermedades del Recién Nacido/tratamiento farmacológico , Administración Masiva de Medicamentos , Tracoma/tratamiento farmacológico , Tracoma/epidemiología , Tracoma/prevención & control
12.
PLoS One ; 17(6): e0268441, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35704657

RESUMEN

BACKGROUND: Trachoma is the leading infectious disease that leads to blindness worldwide, especially in developing countries. Though Ethiopia had targeted a trachoma elimination program by 2020, the problem worsens, particularly in the Amhara Region. Even though sustained intervention measures are undertaken across the region, it is unclear why trachoma is still a significant public health problem. So, this study assessed the prevalence of active trachoma and associated factors among 1-9 years of age children from model and non-model kebeles in Dangila district Amhara Region, Northwest Ethiopia. METHODS: A community-based comparative cross-sectional study was conducted from 20th September 2019 to 29th October 2019. A multistage stratified random sampling technique was used to reach 704 children from model and non-model kebeles. Samples were allocated proportionally to model and non-model kebeles. A structured and pretested data collection tool and observational checklist was used to manage the necessary data. Data were coded and entered in Epidata version 4.6, and further analysis was done using SPSS version 20 software. Bivariable and multivariable logistic regression analysis was employed to identify factors associated with active trachoma. Adjusted Odds Ratios (AOR), p-value, and respected Confidence Interval (CI) were used to report the findings. RESULTS: Seven hundred four children were included in this study, with a response rate of 97.8%. The overall prevalence of active trachoma was 6% (95% CI: 4.5, 8.1). The prevalence of active trachoma among non-model and model Kebele was not significantly different. Still, the prevalence of active trachoma among children from model Kebele were [4.5%, (95% CI: 2.4%, 7.1%)] relatively lower compared with non-model kebeles, [7.6%, 95% CI: (4.9%, 10.9%)]. Moreover, not using latrine (AOR = 4.29, 95% CI: 1.96, 9.34), fly-eye contact (AOR = 2.59, 95% CI: 1.11, 6.03), presence of sleep in eyes (AOR = 2.46, 95% CI: 1.10, 5.47), presence of ocular discharge (AOR = 2.79, 95% CI: 1.30, 6.00), presence of nasal discharges (AOR = 2.67, 95% CI: 1.21, 5.90) and washing faces with soap (AOR = 0.22, 95% CI: 0.07, 0.69) were found significantly associated with the prevalence of active trachoma among children 1-9 years old. CONCLUSIONS: The prevalence of active trachoma in the model and non-model kebeles was high and did not show a statistical difference. Attention to be given to latrine utilization, washing face with soap, and other personal hygiene activities.


Asunto(s)
Gonorrea , Enfermedades del Recién Nacido , Tracoma , Estudios Transversales , Etiopía/epidemiología , Humanos , Recién Nacido , Prevalencia , Factores de Riesgo , Jabones , Tracoma/epidemiología , Tracoma/prevención & control
13.
Infect Dis Poverty ; 11(1): 77, 2022 Jun 30.
Artículo en Inglés | MEDLINE | ID: mdl-35773722

RESUMEN

BACKGROUND: Mass drug administration (MDA) is a strategy to improve health at the population level through widespread delivery of medicine in a community. We surveyed the literature to summarize the benefits and potential risks associated with MDA of antibacterials, focusing predominantly on azithromycin as it has the greatest evidence base. MAIN BODY: High-quality evidence from randomized controlled trials (RCTs) indicate that MDA-azithromycin is effective in reducing the prevalence of infection due to yaws and trachoma. In addition, RCTs suggest that MDA-azithromycin reduces under-five mortality in certain low-resource settings that have high childhood mortality rates at baseline. This reduction in mortality appears to be sustained over time with twice-yearly MDA-azithromycin, with the greatest effect observed in children < 1 year of age. In addition, observational data suggest that infections such as skin and soft tissue infections, rheumatic heart disease, acute respiratory illness, diarrheal illness, and malaria may all be treated by azithromycin and thus incidentally impacted by MDA-azithromycin. However, the mechanism by which MDA-azithromycin reduces childhood mortality remains unclear. Verbal autopsies performed in MDA-azithromycin childhood mortality studies have produced conflicting data and are underpowered to answer this question. In addition to benefits, there are several important risks associated with MDA-azithromycin. Direct adverse effects potentially resulting from MDA-azithromycin include gastrointestinal side effects, idiopathic hypertrophic pyloric stenosis, cardiovascular side effects, and increase in chronic diseases such as asthma and obesity. Antibacterial resistance is also a risk associated with MDA-azithromycin and has been reported for both gram-positive and enteric organisms. Further, there is the risk for cross-resistance with other antibacterial agents, especially clindamycin. CONCLUSIONS: Evidence shows that MDA-azithromycin programs may be beneficial for reducing trachoma, yaws, and mortality in children < 5 years of age in certain under-resourced settings. However, there are significant potential risks that need to be considered when deciding how, when, and where to implement these programs. Robust systems to monitor benefits as well as adverse effects and antibacterial resistance are warranted in communities where MDA-azithromycin programs are implemented.


Asunto(s)
Tracoma , Buba , Antibacterianos/efectos adversos , Azitromicina/efectos adversos , Niño , Humanos , Administración Masiva de Medicamentos , Medición de Riesgo , Tracoma/epidemiología
14.
Pediatrics ; 149(Suppl 5)2022 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-35503336

RESUMEN

BACKGROUND: Neglected tropical diseases (NTDs) are a group of communicable diseases affecting the poorest populations around the world. OBJECTIVE: To assess the effectiveness of interventions, including mass drug administration (MDA), water, sanitation, and hygiene (WASH), vector control, health education, and micronutrients supplementation, for NTDs among children and adolescents. METHODS: We conducted a literature search on the Cochrane Controlled Trials Register, Medline, and other databases until December 2020. We included randomized controlled trials and quasi-experimental studies conducted among children and adolescents. Two authors independently screened studies for relevance. Two authors independently extracted data, assessed the risk of bias, performed metaanalysis, and rated the quality of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation. RESULTS: We included 155 studies (231 articles) involving 262 299 participants. For soil-transmitted helminthiasis, MDA may reduce the prevalence of Ascaris, Trichuris, and hookworm by 58%, 36%, and 57%, respectively. We are uncertain of the effect of health education, WASH, and iron supplementation on soil-transmitted helminthiasis prevalence. For Schistosomiasis, health education probably reduces the intensity and prevalence of S. mansoni, whereas micronutrient supplementation may reduce anemia prevalence and the infection intensity of S. hematobium compared with no supplementation. We are uncertain of the effect of MDA and vector control on Schistosomiasis outcomes. For trachoma, health education probably reduces the prevalence of active Trachoma, whereas we are uncertain of the effect of MDA, WASH, and vector control on Trachoma outcomes. There is limited data on the effectiveness of interventions for NTDs targeting children and adolescents. CONCLUSION: Future studies are needed to evaluate the relative effectiveness and cost-effectiveness of various interventions specifically targeting children and adolescents.


Asunto(s)
Helmintiasis , Esquistosomiasis , Tracoma , Adolescente , Niño , Helmintiasis/epidemiología , Helmintiasis/prevención & control , Humanos , Enfermedades Desatendidas/epidemiología , Enfermedades Desatendidas/prevención & control , Saneamiento , Esquistosomiasis/epidemiología , Suelo , Tracoma/epidemiología
15.
Ital J Pediatr ; 48(1): 61, 2022 May 03.
Artículo en Inglés | MEDLINE | ID: mdl-35505439

RESUMEN

BACKGROUND: Trachoma is an infectious eye disease caused by Chlamydial trachomatis. It is a major health problem in poor nations, notably in Sub-Saharan Africa. Despite the severity of the problem, there was a scarcity of data on trachoma prevalence and associated factors among school-aged children in Debre Tabor town following SAFE and MDA. OBJECTIVES: The goal of this study was to determine the prevalence of active trachoma and its associated factors among school-aged children in Debre Tabor, Northwest Ethiopia, in 2019. METHODS: A community-based cross-sectional study was used among school-aged children. Structured interview questionnaires, an observational checklist, and a physical examination were used to collect data from study participants who were chosen using a systematic random sampling procedure. IBM SPSS 20 was used to enter data, which was then transferred to IBM SPSS 20 for bivariate and multivariable logistic regression analysis. RESULT: A total of 394 children aged 5-15 had been screened and took part in the study, with 9.9% (95% CI: 6.9, 12.7) testing positive for active trachoma. Having an unimproved larine type (AOR = 5.18; 95%CI: 1.96, 13.69), improper solid waste disposal (AOR = 3.026; 95%CI: 1.17, 7.8), family size greater than four (AOR = 3.4; 95%CI: 1.22, 9.49), not using soap for face washing (AOR = 4.48; 95%CI: 1.46, 13.72) and an unclean face of the child during examination (AOR = 23.93; 95%CI: 8.25, 69.38) were found to be significant predictors of active trachoma. CONCLUSION: Active trachoma among school-age children was high compared to the WHO's definition of trachoma as a public health problem. A family size of four, poor solid waste management, an unimproved type of latrine, an unclean child's face, and not using soap when washing one's face were all significant predictors of active trachoma. Promotion of behavioral determinants through health education programs like keeping facial cleanliness by washing their child's face with soap, managing solid waste properly, and installing improved latrines to reduce active trachoma needs to be in place.


Asunto(s)
Enfermedades del Recién Nacido , Tracoma , Niño , Estudios Transversales , Etiopía/epidemiología , Humanos , Recién Nacido , Prevalencia , Factores de Riesgo , Jabones , Tracoma/diagnóstico , Tracoma/epidemiología , Tracoma/prevención & control
16.
PLoS Negl Trop Dis ; 16(5): e0010424, 2022 05.
Artículo en Inglés | MEDLINE | ID: mdl-35560031

RESUMEN

If facial hygiene practices vary seasonally this could have important implications for the design of interventions for trachoma control. This observational study was conducted to explore seasonal variation in hygiene behaviours in 9 households with at least one child aged 1-9 years-of-age in the West Arsi zone in rural Oromia, Ethiopia. Sixty-one household members were observed intensively over two days in the dry season (January), the rainy season (July) and during the harvest period (October) in 2018. Structured record forms were used to document household water availability and use. Daily water use per capita was very low in all seasons (3.1-4.2 litres). Around one third of water consumed in households in all seasons was associated with body washing. Soap was used during 44 of 677 (6%) of these observed occasions and half of all body washes (n = 340; 50%) included face washing. Overall, 95% of 58 individuals washed their faces at least once between 06:30h and 21:30h in the dry season (21% with soap), compared with 79% in the rainy season (2% with soap) (p = 0.013). Sixty-five percent of householders washed their faces during the harvest observation period (06:30h to 17:30h), none of whom used soap. Twenty-eight percent of 204 children aged 11 and under still had ocular or nasal discharge on their faces after washing. Seventy-three percent of those who washed their faces did so more than once in the dry season, compared with 33% in the rainy season (p<0.001). Face washing occurred throughout the day during the dry season, with a clear peak in the early morning and extra washes in the early evening. Face washing mainly took place in the early morning in the other two seasons. Genuine water scarcity in this area is likely to limit the impact of face washing interventions for trachoma control in the absence of water supply interventions. However, face washing was most common at the time of year when water is the hardest to come by, and seasonal differences in behaviour should be considered in any resulting intervention design.


Asunto(s)
Enfermedades del Recién Nacido , Tracoma , Niño , Preescolar , Etiopía/epidemiología , Humanos , Higiene , Lactante , Recién Nacido , Factores de Riesgo , Estaciones del Año , Jabones , Tracoma/epidemiología , Tracoma/prevención & control , Agua
17.
Nat Rev Dis Primers ; 8(1): 33, 2022 05 26.
Artículo en Inglés | MEDLINE | ID: mdl-35618865
18.
Nat Rev Dis Primers ; 8(1): 32, 2022 05 26.
Artículo en Inglés | MEDLINE | ID: mdl-35618795

RESUMEN

Trachoma is a neglected tropical disease caused by infection with conjunctival strains of Chlamydia trachomatis. It can result in blindness. Pathophysiologically, trachoma is a disease complex composed of two linked chronic processes: a recurrent, generally subclinical infectious-inflammatory disease that mostly affects children, and a non-communicable, cicatricial and, owing to trichiasis, eventually blinding disease that supervenes in some individuals later in life. At least 150 infection episodes over an individual's lifetime are needed to precipitate trichiasis; thus, opportunity exists for a just global health system to intervene to prevent trachomatous blindness. Trachoma is found at highest prevalence in the poorest communities of low-income countries, particularly in sub-Saharan Africa; in June 2021, 1.8 million people worldwide were going blind from the disease. Blindness attributable to trachoma can appear in communities many years after conjunctival C. trachomatis transmission has waned or ceased; therefore, the two linked disease processes require distinct clinical and public health responses. Surgery is offered to individuals with trichiasis and antibiotic mass drug administration and interventions to stimulate facial cleanliness and environmental improvement are designed to reduce infection prevalence and transmission. Together, these interventions comprise the SAFE strategy, which is achieving considerable success. Although much work remains, a continuing public health problem from trachoma in the year 2030 will be difficult for the world to excuse.


Asunto(s)
Gonorrea , Tracoma , Triquiasis , Ceguera/etiología , Niño , Chlamydia trachomatis , Gonorrea/complicaciones , Humanos , Tracoma/complicaciones , Tracoma/epidemiología , Tracoma/prevención & control , Triquiasis/complicaciones , Triquiasis/etiología
20.
Expert Rev Vaccines ; 21(6): 771-781, 2022 06.
Artículo en Inglés | MEDLINE | ID: mdl-35470769

RESUMEN

INTRODUCTION: Chlamydia trachomatis, commonly referred to as chlamydia (a bacterium), is a common sexually transmitted infection, and if attended to early, it can be treatable. However, if left untreated it can lead to serious consequences. C. trachomatis infects both females and males although its occurrence in females is more common, and it can spread to the eyes causing disease and in some case blindness. AREA COVERED: With ongoing attempts in the most impoverished regions of the country, trachoma will be eradicated as a blinding disease by the year 2022. A prophylactic vaccine candidate with established safety and efficacy is a cogent tool to achieve this goal. This manuscript covers the vaccine development programs for chlamydial infection. EXPERT OPINION: Currently, the Surgery Antibiotics Facial Environmental (SAFE) program is being implemented in endemic countries in order to reduce transmission and control of the disease. Vaccines have been shown over the years to protect against infectious diseases. Charge variant-based adjuvant can also be used for the successful delivery of chlamydial specific antigen for efficient vaccine delivery through nano delivery platform. Thus, a vaccine against C. trachomatis would be of great public health benefit.


Asunto(s)
Infecciones por Chlamydia , Tracoma , Vacunas Bacterianas , Infecciones por Chlamydia/prevención & control , Chlamydia trachomatis , Femenino , Humanos , Masculino , Tracoma/epidemiología , Tracoma/microbiología , Tracoma/prevención & control
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