House Jenafir I, Ayele Berhan, Porco Travis C, Zhou Zhaoxia, Hong Kevin C, Gebre Teshome, Ray Kathryn J, Keenan Jeremy D, Stoller Nicole E, Whitcher John P, Gaynor Bruce D, Emerson Paul M, Lietman Thomas M
FI Proctor Foundation, University of California, San Francisco, USA.
Lancet. 2009 Mar 28;373(9669):1111-8. doi: 10.1016/S0140-6736(09)60323-8.
Trachoma-control programmes distribute oral azithromycin to treat the ocular strains of chlamydia that cause the disease and to control infection. Theoretically, elimination of infection is feasible if untreated individuals receive an indirect protective effect from living in repeatedly treated communities, which is similar to herd protection in vaccine programmes. We assessed indirect protection against trachoma with mass azithromycin distributions.
In a cluster randomised trial, 24 subkebeles (government-defined units) in Amhara, Ethiopia, were randomised, with use of a simple random sample, to distribution four times per year of single-dose oral azithromycin to children aged 1-10 years (12 subkebeles, 4764 children), or to delayed treatment until after the study (control; 12 subkebeles, 6014 children). We compared the prevalence of ocular chlamydial infection in untreated individuals 11 years and older between baseline and 12 months in the treated subkebeles, and at 12 months between the treated and control subkebeles. Health-care and laboratory personnel were blinded to study group. Analysis was intention to treat. The study is registered with clinicaltrials.gov, number NCT00322972.
At 12 months, 637 children aged 1-10 years and 561 adults and children aged 11 years and older were analysed in the children-treated group, and 618 and 550, respectively, in the control group. The mean prevalence of infection in children decreased from 48.4% (95% CI 42.9-53.9) to 3.6% (0.8-6.4) after four mass treatments. At 12 months, the mean prevalence of infection in the untreated age group (>/=11 years) was 47% (95% CI 33-57) less than baseline (p=0.002), and 35% (95% CI 1-57) less than that in untreated communities (p=0.04).
Frequent treatment of children, who are a core group for transmission of trachoma, could eventually eliminate infection from the entire community. Herd protection is offered by repeated mass antibiotic treatments, providing a strategy for elimination of a bacterial disease when an effective vaccine is unavailable.
National Institutes of Health.
沙眼控制项目分发口服阿奇霉素，以治疗引起该疾病的衣原体眼部菌株并控制感染。从理论上讲，如果未接受治疗的个体因生活在反复接受治疗的社区而获得间接保护作用，类似于疫苗项目中的群体保护，那么消除感染是可行的。我们评估了大规模分发阿奇霉素对沙眼的间接保护作用。
在一项整群随机试验中，埃塞俄比亚阿姆哈拉州的24个次凯贝勒（政府定义的单位）通过简单随机抽样，被随机分为两组，一组为每年对1至10岁儿童进行4次单剂量口服阿奇霉素分发（12个次凯贝勒，4764名儿童），另一组为延迟治疗直至研究结束（对照组；12个次凯贝勒，6014名儿童）。我们比较了治疗组次凯贝勒中11岁及以上未治疗个体在基线和12个月时眼部衣原体感染的患病率，以及治疗组和对照组次凯贝勒在12个月时的患病率。医疗保健和实验室人员对研究组不知情。分析采用意向性治疗。该研究已在clinicaltrials.gov注册，编号为NCT00322972。
在12个月时，治疗儿童组分析了637名1至10岁儿童以及561名11岁及以上的成人和儿童，对照组分别为618名和550名。经过4次大规模治疗后，儿童感染的平均患病率从48.4%（95%CI 42.9 - 53.9）降至3.6%（0.8 - 6.4）。在12个月时，未治疗年龄组（≥11岁）的感染平均患病率比基线低47%（95%CI 33 - 57）（p = 0.002），比未治疗社区低35%（95%CI 1 - 57）（p = 0.04）。
频繁治疗作为沙眼传播核心群体的儿童，最终可能消除整个社区的感染。反复进行大规模抗生素治疗可提供群体保护，在没有有效疫苗的情况下，为消除细菌性疾病提供了一种策略。
美国国立卫生研究院。
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