Background The epidemiology of trachoma in several Pacific Islands differs from other endemic settings, in that there is a high prevalence of clinical signs of trachoma, particularly trachomatous ...inflammation—follicular (TF), but few cases of trichiasis and limited evidence of ocular chlamydial infection. This so-called “Pacific enigma” has led to uncertainty regarding the appropriate public health response. In 2019 alongside Nauru’s national trachoma population survey, we performed bacteriological and serological assessments of children to better understand the typology of trachoma and to determine whether there is a need for trachoma interventions. Methods We used two-stage cluster sampling, examining residents aged ≥1 year and collecting household-level water, sanitation, and hygiene (WASH) variables. Children aged 1–9 years provided conjunctival swabs and finger-prick dried blood spots to investigate the presence of Chlamydia trachomatis nucleic acid and anti-Pgp3 antibodies, respectively. Principal Findings In 818 participants aged 1–9 years, the age-adjusted TF prevalence was 21.8% (95% CI 15.2–26.2%); ocular C. trachomatis prevalence was 34.5% (95% CI 30.6–38.9), and anti-Pgp3 antibody prevalence was 32.1% (95% CI 28.4%–36.3%). The age- and gender-adjusted prevalence of trichiasis in ≥15-year-olds was 0.3% (95% CI 0.00–0.85), but no individual with trichiasis had trachomatous scarring (TS). Multivariable analysis showed an association between age and both TF (OR per year of age 1.3 95% CI 1.2–1.4) and anti-Pgp3 positivity (OR 1.2 95% CI 1.2–1.3). There were high rates of access to water and sanitation and no WASH variable was associated with the presence of TF. Conclusions TF, nucleic acid, and age-specific antibody prevalence collectively indicate that high levels of C. trachomatis transmission among children present a high risk of ocular damage due to trachoma. The absence of trichiasis with trachomatous scarring suggest a relatively recent increase in transmission intensity. Author summary In contrast to several neighbouring Pacific Island nations, Nauruan children are heavily affected by active trachoma and the cause is ocular infection with C. trachomatis. Comprehensive public health intervention to control trachoma in Nauru is required. The use of laboratory markers for current and previous C. trachomatis infection should be considered in baseline trachoma prevalence surveys as we approach global elimination of trachoma, and in settings with inconsistent findings during previous screening exercises.
Both yaws and trachoma are endemic in several countries in the Pacific. In co-endemic countries there may be potential synergies between both control programmes.
We undertook a cluster randomised ...trachoma and yaws seroprevalence survey of children in the Western Division of Fiji. Children were examined for skin lesions consistent with active yaws. A dried blood spot was collected which was tested using the Treponema pallidum particle agglutination (TPPA) test and an ELISA to detect antibodies against Pgp3.
A total of 607 children from 305 households across 23 villages were recruited into the survey. On skin examination, no child had clinical evidence of yaws, and the TPPA assay was negative in all children (0%, 95% CI 0.0-0.6). The seroprevalence of Pgp3 antibodies was 20.9% (95% CI 17.8-24.6%).
In this study there was neither clinical nor serological evidence that transmission of yaws was ongoing. The Pgp3 seroprevalence pattern was consistent with either low level transmission of ocular Chlamydia trachomatis or exposure to C. trachomatis in the birth canal which is consistent with a survey conducted in the same region in 2013. These data suggest neither yaws nor ocular chlamydia infection are a significant public health problem in the Western Division of Fiji.
To determine where interventions are needed to eliminate trachoma as a public health problem, prevalence data are needed. We aimed to generate baseline population-based data on trachoma prevalence in ...suspected-endemic areas of Afghanistan.
Cross-sectional population-based prevalence surveys designed according to World Health Organization (WHO) recommendations were conducted in 35 evaluation units (EUs) covering 72 districts. In selected households, all resident individuals aged ≥1 year were examined for trachomatous inflammation-follicular (TF) and trachomatous trichiasis (TT) according to the WHO simplified trachoma grading system. Water, sanitation and hygiene access was assessed in households of survey participants.
104,104 people aged ≥1 year were examined, including 43,774 children aged 1-9 years and 46,439 people aged ≥15 years. The age-adjusted prevalence of TF in 1-9-year-olds was ≥5% in 3 EUs, with the highest EU TF prevalence being 7.8%. The age- and gender-adjusted prevalence of TT unknown to the health system in ≥15-year-olds was <0.2% in all EUs. The majority of households had access to an improved water source within 30 minutes of the house. However, only a minority of households had an improved latrine and/or a handwash station.
Trachoma is not a public health problem in the majority of EUs surveyed. However, antibiotic mass drug administration, promotion of facial cleanliness and environmental improvement (the A, F and E components of the SAFE strategy) are needed for trachoma elimination purposes in three of the EUs surveyed in Afghanistan.
Following baseline surveys in 2013 and 2014, trachoma elimination interventions, including three rounds of azithromycin mass drug administration (MDA), were implemented in 13 woredas (administrative ...districts) of Gambella Regional State, Ethiopia. We conducted impact surveys to determine if elimination thresholds have been met or if additional interventions are required.
Cross-sectional population-based surveys were conducted in 13 woredas of Gambella Regional State, combined into five evaluation units (EUs), 6─12 months after their last MDA round. A two-stage systematic (first stage) and random (second stage) sampling technique was used. WHO-recommended protocols were implemented with the support of Tropical Data. Household water, sanitation and hygiene (WASH) access was assessed.
The age-adjusted prevalence of trachomatous inflammation - follicular (TF) in 1-9-year-olds in the five EUs ranged from 0.3-19.2%, representing a general decline in TF prevalence compared to baseline estimates. The age- and gender-adjusted prevalence of trachomatous trichiasis (TT) unknown to the health system in those aged ≥ 15 years ranged from 0.47-3.08%. Of households surveyed, 44% had access to an improved drinking water source within a 30-minute return journey of the house, but only 3% had access to an improved latrine.
In two EUs, no further MDA should be delivered, and a surveillance survey should be conducted after two years without MDA. In one EU, one further round of MDA should be conducted followed by another impact survey. In two EUs, three further MDA rounds are required. Surgery, facial cleanliness and environmental improvement interventions are needed throughout the region.
Purpose
: To assess the contemporary prevalence of trachoma in Brazil's non-indigenous population, surveys of those thought to be at greatest risk of disease were conducted.
Methods
: Rural census ...tracts of non-indigenous population from nine mesoregions were selected to compose the survey evaluation units (EUs) by considering previously endemic municipalities at greatest risk of trachoma. In each of the nine EUs, we conducted a population-based prevalence survey. Every resident of selected households aged
1 year was examined for trachomatous inflammation - follicular (TF) and trachomatous trichiasis (TT). Additionally, data were collected on household-level access to water, sanitation, hygiene (WASH) and education.
Results
: A total of 27,962 individuals were examined across nine EUs. The age-adjusted TF prevalence in 1-9-year-olds was <5% in each EU. The age- and gender-adjusted prevalence of TT unknown to the health system in ≥15-year-olds was <0.2% in eight EUs; in one EU, it was 0.22%. The median number of households surveyed per EU with access to an improved drinking water source within a 30-minute roundtrip of the house was 66%. School attendance was >99% of surveyed children.
Conclusions
: The prevalence of TF was well below the target for elimination as a public health problem in all EUs. Because EUs surveyed were selected to represent the highest-risk non-indigenous areas of the country, TF prevalence is unlikely to be ≥5% in non-indigenous populations elsewhere. In one EU, the prevalence of TT was above the target threshold for elimination. Further investigation and possibly improvement in TT surgical provision are required in that EU.
Purpose: We sought to complete the baseline trachoma map of the Solomon Islands by establishing prevalences of active trachoma and trichiasis in the provinces of Choiseul, Western, Rennell-Bellona, ...and Temotu.
Methods: Using the standardized methodology developed for the Global Trachoma Mapping Project, we conducted cross-sectional community-based surveys from September to November 2013. Choiseul and Western provinces were each mapped as separate evaluation units (EUs); Rennell-Bellona and Temotu were combined to form a third EU.
Results: A total of 9819 individuals were sampled for inclusion, with 9224 (93.3%) consenting to examination, of whom 4587 (46.3%) were female. Survey teams visited 82 villages, and surveyed 2448 households. Two EUs had prevalences of trachomatous inflammation - follicular (TF) in 1-9-year-olds over the 10% threshold at which WHO recommends mass distribution of azithromycin for at least 3 years (Western 20.4%, 95% confidence interval, CI 15.6-26.3%; Rennell-Bellona/Temotu 22.0%, 95% CI 18.5-26.0%). Choiseul had a TF prevalence of 6.1% (95% CI 4.1-8.6%), and met the criterion for a single round of mass antibiotic distribution before re-survey. The adjusted prevalences of trichiasis in those aged 15+ years were 0.0% (95% CI 0.0-0.2%) in Choiseul, 0.16% (95% CI 0.0-0.5%) in Western, and 0.10% (95% CI 0-0.3%) in Rennell-Bellona/Temotu provinces. All three EUs require implementation of the facial cleanliness and environmental improvement components of the trachoma elimination strategy.
Conclusion: Active trachoma is prevalent in the Solomon Islands. However, there is little evidence of the blinding complications of trachoma being a public health problem there. Further research into the explanation for this phenomenon is warranted.
Yaws is a neglected tropical disease targeted for eradication by 2020. Kiribati, a Pacific Island nation, was previously endemic for yaws but lacks recent data from which its current endemicity ...status could be determined. This study tested antibody responses to
to determine if transmission of yaws is taking place among children in Kiribati. Using a commercially available
particle agglutination kit (Serodia
, Fujirebio Inc., Tokyo, Japan), we tested dried blood spots, collected during population-based trachoma prevalence surveys on Tarawa Atoll and Kiritimati Island, for long-lived treponemal antibodies. Dried blood spots from 1,420 children aged 1-9 years were tested. Only two were positive, suggesting
is not being widely transmitted among children in the settings sampled. These data require support from additional surveys to demonstrate the absence of clinical signs of disease and molecular evidence of infection, to confirm that yaws is no longer endemic in Kiribati.
Photography could be used to train individuals to diagnose trachomatous inflammation-follicular (TF) as trachoma prevalence decreases and to ensure accurate field TF grading in trachoma prevalence ...surveys. We compared photograph and field TF grading and determined the acceptability and feasibility of eyelid photography to community members and trachoma survey trainers.
A total of 100 children ages 1-9 y were examined for TF in two Maasai villages in Tanzania. Two images of the right everted superior tarsal conjunctiva of each child were taken with a smartphone and a digital single-lens reflex (DSLR) camera. Two graders independently graded all photos. Focus group discussions (FGDs) were conducted with community members and Tropical Data trainers.
Of 391 photos, one-fifth were discarded as ungradable. Compared with field grading, photo grading consistently underdiagnosed TF. Compared with field grading, DSLR photo grading resulted in a higher prevalence and sensitivity than smartphone photo grading. FGDs indicated that communities and trainers found photography acceptable and preferred smartphones to DSLR in terms of practicalities, but image quality was of paramount importance for trainers.
Photography is acceptable and feasible, but further work is needed to ensure high-quality images that enable accurate and consistent grading before being routinely implemented in trachoma surveys.
Mass drug administration (MDA) of 20 mg/kg (maximum 1 g in adults) azithromycin for ocular
(CT) infection is a key component of the WHO trachoma elimination strategy. However, this dose may be ...suboptimal in
infection and may encourage emergence of antimicrobial resistance (AMR) to azithromycin.
To determine the effect of MDA for trachoma elimination on
prevalence, strain type and azithromycin resistance.
A secondary analysis of CT-negative vulvovaginal swabs from three outpatient antenatal clinics (Honiara, Solomon Islands) from patients recruited either pre-MDA, or 10 months post-MDA in two cross-sectional surveys was carried out. Swabs were tested for
infection using Fast Track Diagnostics Urethritis Plus nucleic acid amplification assay.
-positive samples were subsequently tested for azithromycin resistance by sequencing domain V of the 23S rRNA DNA region of
and underwent phylogenetic analysis by dual locus sequence typing.
prevalence was 11.9% (28/236) in women pre-MDA and 10.9% (28/256) 10 months post-MDA (p=0.7467). Self-reported receipt of azithromycin as part of MDA was 49.2% in women recruited post-MDA and 17.9% (5/28) in those who tested
positive. Of samples sequenced (21/28 pre-MDA, 22/28 post-MDA), all showed a macrolide susceptible genotype. Strain typing showed that sequence types diverged into two lineages, with a suggestion of strain replacement post-MDA.
A single round of azithromycin MDA in an island population with high baseline
prevalence did not appear to impact on either prevalence or azithromycin resistance, in contrast to reported decreased genital CT prevalence in the same population. This may be due to limitations such as sample size, including CT-negative samples only, and low MDA coverage. Further investigation of the impact of multiple rounds of MDA on
azithromycin AMR in antibiotic experienced and naïve populations is warranted.
Core Ideas
Do agricultural travel courses have an impact on the student‐travelers’ careers, and do the employer and employee perceive any benefits?
We surveyed 335 students who had participated in an ...Iowa State ag‐led international ag study course between 1964 and 1990.
Overall the survey showed strong impacts and favorable attitudes decades after participation in an international agricultural travel course.
Iowa State University College of Agriculture and Life Sciences (CALS) has offered international agricultural travel courses since 1963. Students traveled to Europe, Eastern Europe, or Asia on roughly a bi‐annual basis. We were interested in learning if agricultural travel courses had an impact on the student‐travelers’ careers, and if the employer and employee perceived any benefits. Lists of student travelers collected over decades in the Agronomy Department at Iowa State University gave a unique opportunity to take a long‐term perspective. We sent 335 surveys to students who had participated in a CALS‐led international ag study course between 1964 and 1990. We received 132 valid responses. Respondents were asked to rate on a 5‐point Likert scale to what extent they agreed or disagreed with statements regarding their international study course and career advancement and their personal development and attitudes regarding international awareness and humanitarianism. The responses relating to significant career advancement correlated with overall positive attitudes, a mean of 3.70 on the 5‐point scale, toward the effect of student travel. Most respondents felt their employers benefitted as well. The questions on personal development such as improved self‐confidence had a mean score of 3.86, and broadened attitudes regarding others’ customs and beliefs scored 4.22. One question regarding increased international interest had a mean score of 4.16. Overall the survey showed strong impacts and favorable attitudes decades after participation in an international agricultural travel course.
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