Atik Berna, Thanh Ton Ton Kim, Luong Vu Quoc, Lagree Stephane, Dean Deborah
Children's Hospital Oakland Research Institute, Oakland, Calif 94609, USA.
JAMA. 2006 Sep 27;296(12):1488-97. doi: 10.1001/jama.296.12.1488.
The World Health Organization developed the SAFE strategy (Surgery for trichiasis; Antibiotics for Chlamydia trachomatis infection; Facial cleanliness; and Environmental improvement) to eliminate blinding trachoma globally by the year 2020. Despite a number of studies using various intervals of treatment for different prevalence rates, there has been a lack of sufficient follow-up beyond the final treatment point to determine rates of recurrence of disease and infection and the risk factors that may contribute to each.
To evaluate the impact of 2 annual targeted azithromycin treatments on active trachoma and C trachomatis infection rates over 3 years in Vietnam.
DESIGN, SETTING, AND PARTICIPANTS: Three communes were randomly selected for a longitudinal study in Vietnam from November 2000 through November 2003. Individuals (n = 3186) were graded for trachoma followed by conjunctival sampling to detect chlamydiae by commercial polymerase chain reaction. Grading and chlamydial detection were repeated every 6 months for 3 years.
Azithromycin was given to children aged 5 through 15 years with active trachoma and their household members in SAFE and SA communes at baseline and 12 months; these communes were compared with the S-only control commune that did not receive azithromycin targeted treatment.
Prevalence and incidence of active trachoma and C trachomatis infection in all communes at baseline, 6, 12, 18, 24, and 36 months. Subgroup analysis evaluated new infection, continuing infection, and reinfection at 6, 12, 18, 24, and 36 months and risk factors for each.
Reinfection rates increased significantly between 12 and 36 months for SAFE (from 1.6 to 29.3 per 1000; P<.001) and SA (5.1 to 25.3 per 1000; P = .002) communes but not for the S-only commune (13.4 to 6.7 per 1000; P = .55) after 24 months. Compared with the S-only commune, mixed-effects and generalized estimating equations (GEE) logistic models showed that reinfection risk was significantly higher for SAFE (odds ratio [OR], 4.1; 95% confidence interval [CI], 1.5-9.8; P = .005) and SA (OR, 4.2; 95% CI, 1.1-17.3; P = .04) communes at 36 months.
Increasing reinfection rates suggest that treatment may interrupt the duration of infection required for developing immunity, increasing the number of individuals susceptible to reinfection and adversely affecting disease prevalence over time. Additional research is needed to determine optimal trachoma control strategies, including evaluation of the "F" and "E" components.
www.actr.org.au Identifier: 12606000360516.
世界卫生组织制定了SAFE战略（睑内翻倒睫手术；沙眼衣原体感染抗生素治疗；面部清洁；以及环境改善），目标是到2020年在全球消除致盲性沙眼。尽管有多项研究针对不同患病率采用了不同的治疗间隔，但在最终治疗点之后缺乏足够的随访，无法确定疾病和感染的复发率以及可能导致复发的危险因素。
评估在越南，每年进行2次阿奇霉素靶向治疗对3年内活动性沙眼和沙眼衣原体感染率的影响。
设计、地点和参与者：2000年11月至2003年11月，在越南随机选择3个公社进行纵向研究。对3186名个体进行沙眼分级，随后采集结膜样本，通过商业聚合酶链反应检测衣原体。在3年时间里，每6个月重复进行分级和衣原体检测。
在基线和12个月时，对SAFE公社和SA公社中患有活动性沙眼的5至15岁儿童及其家庭成员给予阿奇霉素；将这些公社与未接受阿奇霉素靶向治疗的仅设为S的对照公社进行比较。
在基线、6、12、18、24和36个月时，所有公社中活动性沙眼和沙眼衣原体感染的患病率和发病率。亚组分析评估了在6、12、18、24和36个月时的新感染、持续感染和再感染情况以及每种情况的危险因素。
在24个月后，SAFE公社（从每1000人1.6例增至29.3例；P<0.001）和SA公社（从每1000人5.1例增至25.3例；P = 0.002）的再感染率显著上升，但仅设为S的公社（从每1000人13.4例降至6.7例；P = 0.55）没有。与仅设为S的公社相比，混合效应和广义估计方程（GEE）逻辑模型显示，在36个月时，SAFE公社（优势比[OR]，4.1；95%置信区间[CI]，1.5 - 9.8；P = 0.005）和SA公社（OR，4.2；95%CI，1.1 - 17.3；P = 0.04）的再感染风险显著更高。
再感染率上升表明治疗可能会中断产生免疫力所需的感染持续时间，增加易受再感染的个体数量，并随着时间的推移对疾病患病率产生不利影响。需要进一步研究以确定最佳的沙眼控制策略，包括对“F”和“E”部分的评估。
www.actr.org.au 标识符：12606000360516
