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Low Prevalence of Conjunctival Infection with Chlamydia trachomatis in a Treatment-Naive Trachoma-Endemic Region of the Solomon Islands

Butcher, RMR; Sokana, O; Jack, K; Macleod, CK; Marks, ME; Kalae, E; Sui, L; ... Roberts, CH; + view all (2016) Low Prevalence of Conjunctival Infection with Chlamydia trachomatis in a Treatment-Naive Trachoma-Endemic Region of the Solomon Islands. PLoS Neglected Tropical Diseases , 10 (9) , Article e0004863. 10.1371/journal.pntd.0004863. Green open access

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Abstract

Background Trachoma is endemic in several Pacific Island states. Recent surveys across the Solomon Islands indicated that whilst trachomatous inflammation—follicular (TF) was present at levels warranting intervention, the prevalence of trachomatous trichiasis (TT) was low. We set out to determine the relationship between chlamydial infection and trachoma in this population. Methods We conducted a population-based trachoma prevalence survey of 3674 individuals from two Solomon Islands provinces. Participants were examined for clinical signs of trachoma. Conjunctival swabs were collected from all children aged 1–9 years. We tested swabs for Chlamydia trachomatis (Ct) DNA using droplet digital PCR. Chlamydial DNA from positive swabs was enriched and sequenced for use in phylogenetic analysis. Results We observed a moderate prevalence of TF in children aged 1–9 years (n = 296/1135, 26.1%) but low prevalence of trachomatous inflammation—intense (TI) (n = 2/1135, 0.2%) and current Ct infection (n = 13/1002, 1.3%) in children aged 1–9 years, and TT in those aged 15+ years (n = 2/2061, 0.1%). Ten of 13 (76.9%) cases of infection were in persons with TF or TI (p = 0.0005). Sequence analysis of the Ct-positive samples yielded 5/13 (38%) complete (>95% coverage of reference) genome sequences, and 8/13 complete plasmid sequences. Complete sequences all aligned most closely to ocular serovar reference strains. Discussion The low prevalence of TT, TI and Ct infection that we observed are incongruent with the high proportion of children exhibiting signs of TF. TF is present at levels that apparently warrant intervention, but the scarcity of other signs of trachoma indicates the phenotype is mild and may not pose a significant public health threat. Our data suggest that, whilst conjunctival Ct infection appears to be present in the region, it is present at levels that are unlikely to be the dominant driving force for TF in the population. This could be one reason for the low prevalence of TT observed during the study.

Type: Article
Title: Low Prevalence of Conjunctival Infection with Chlamydia trachomatis in a Treatment-Naive Trachoma-Endemic Region of the Solomon Islands
Open access status: An open access version is available from UCL Discovery
DOI: 10.1371/journal.pntd.0004863
Publisher version: http://doi.org/10.1371/journal.pntd.0004863
Language: English
Additional information: This work is licensed under a Creative Commons Attribution 4.0 International License. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license, users will need to obtain permission from the license holder to reproduce the material. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/
Keywords: Science & Technology, Life Sciences & Biomedicine, Infectious Diseases, Parasitology, Tropical Medicine, MASS ANTIBIOTIC DISTRIBUTIONS, CLUSTER-RANDOMIZED TRIAL, LOCAL-GOVERNMENT AREAS, FAR NORTH REGION, MAPPING TRACHOMA, RISK-FACTORS, NORTHWESTERN NIGERIA, ACTIVE TRACHOMA, GENOME, AZITHROMYCIN
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health > Genetics and Genomic Medicine Dept
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health > Infection, Immunity and Inflammation Dept
URI: https://discovery.ucl.ac.uk/id/eprint/1514903
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