High prevalence of trachomatous inflammation–follicular with no trachomatous trichiasis: can alternative indicators explain the epidemiology of trachoma in Côte d’Ivoire?

Author:

Atekem Kareen12,Harding-Esch Emma M3,Martin Diana L4,Downs Philip2,Palmer Stephanie L5,Kaboré Achille5,Kelly Michaela2,Bovary Anoma6,Sarr Astou2,Nguessan Konan2,James Fiona2,Gwyn Sarah4,Wickens Karana7,Bakhtiari Ana8,Boyd Sarah8,Aba Ange5,Senyonjo Laura2,Courtright Paul29,Meite Aboulaye6

Affiliation:

1. Department of Entomology, Center for Infectious Disease Dynamics, Pennsylvania State University , University Park, PA, USA

2. Sightsavers

3. London School of Hygiene and Tropical Medicine , London , UK

4. Centers for Disease Control and Prevention , Atlanta, GA, USA

5. FHI 360 , Washington, DC, USA

6. Ministry of Health, Abidjan, Côte d'Ivoire

7. Oak Ridge Institute for Science and Education , Atlanta, GA, USA

8. International Trachoma Initiative, Task Force for Global Health , Decatur, GA, USA

9. Kilimanajaro Centre for Community Ophthalmology, Division of Ophthalmology, University of Cape Town , Cape Town , South Africa

Abstract

Abstract Baseline trachoma surveys in Côte d'Ivoire (2019) identified seven evaluation units (EUs) with a trachomatous inflammation–follicular (TF) prevalence ≥10%, but a trachomatous trichiasis (TT) prevalence in individuals ≥15 y of age below the elimination threshold (0.2%). Two of these EUs, Bondoukou 1 and Bangolo 2, were selected for a follow-up survey to understand the epidemiology of trachoma using additional indicators of Chlamydia trachomatis infection (DNA from conjunctival swabs) and exposure (anti-Pgp3 and Ct694 antibodies from dried blood spots [DBSs]). A two-stage cluster sampling methodology was used to select villages and households. All individuals 1–9 y of age from each selected household were recruited, graded for trachoma and had a conjunctival swab and DBS collected. Conjunctival swabs and DBSs were tested using Cepheid GeneXpert and a multiplex bead assay, respectively. The age-adjusted TF and infection prevalence in 1- to 9-year-olds was <1% and <0.3% in both EUs. Age-adjusted seroprevalence was 5.3% (95% confidence interval [CI] 1.5 to 15.6) in Bondoukou 1 and 8.2% (95% CI 4.3 to 13.7) in Bangolo 2. The seroconversion rate for Pgp3 was low, at 1.23 seroconversions/100 children/year (95% CI 0.78 to 1.75) in Bondoukou 1 and 1.91 (95% CI 1.58 to 2.24) in Bangolo 2. Similar results were seen for CT694. These infection, antibody and clinical data provide strong evidence that trachoma is not a public health problem in either EU.

Funder

International Trachoma Initiative

Publisher

Oxford University Press (OUP)

Subject

Public Health, Environmental and Occupational Health,General Medicine,Health (social science)

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