To the Editor: Dr Atik and colleagues1 studied the prevalence of active trachoma and ocular Chlamydia trachomatis infection in 3 Vietnamese communes. Two communes (Surgery for trachomatous trichiasis; Antibiotics for Chlamydia trachomatis infection; [SA], and Surgery for trachomatous trichiasis; Antibiotics for Chlamydia trachomatis infection; Facial cleanliness; Environmental improvement [SAFE])were selected to receive azithromycin using a targeted approach in which schoolchildren aged 5 to 15 years with signs of active trachoma and their household contacts were treated. A third commune that did not receive oral antibiotics served as a control. Because no association was found between clinical signs and the presence of ocular C trachomatis infection, only a small proportion of infected individuals was treated with azithromycin: 4% and 11% of the 2 SA and SAFE communes, respectively, at baseline; and 0% and 10% at 1 year.
The prevalence of active trachoma declined in all 3 communes from greater than 5% at baseline to less than 5% at 36 months. The prevalence of infection was lower in all 3 communes at 36 months than at baseline. Because a small increase in the prevalence of C trachomatis infection was seen between 24 and 36 months in the 2 communes treated with azithromycin, but not in the control commune, the authors conclude that “treatment appears to result in increased rates of re-infection that may adversely affect the prevalence of disease over time.”
We do not believe that this conclusion is supported by the data presented. Important inter-community variance existed at baseline, which was not addressed in the analysis. There were only 2 communes in the intervention group and 1 in the control group. Either selection bias or chance may explain the findings.
The authors state, “the data are consistent with the hypothesis that systemic azithromycin treatment may interrupt the duration of infection, interfering with host responses and, thereby, increase the number of individuals who are susceptible to Ctrachomatis re-infection.” Because the study did not measure immune responses, this is speculative. It is unlikely that treatment of at most 11% of infected individuals could have such an effect on herd immunity. The article cited to support their statement that the immune response to C trachomatis is usually sustained for only 1 to 4 months2 included some of us as authors; we note that this was not a finding of the cited study, and are not aware of other evidence to support their statement.
Mass treatment with azithromycin has been shown to lead to sustained reductions in the prevalence of ocular C trachomatis infection, and can be expected to prevent the development of blinding sequelae.3 - 5
Financial Disclosures: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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