Risk of Infection with Chlamydia trachomatis from Migrants to Communities Undergoing Mass Drug Administration for Trachoma Control

Abstract

Purpose: To determine the risk of infection with Chlamydia trachomatis in children who are migrants to communities who are undergoing mass drug administration (MDA), and if their neighborhoods have higher rates of infection over time.

Methods: In four communities in Kongwa, Tanzania, all children were enrolled in a longitudinal study of infection and trachoma. New children were identified at census updates as having not been in the community at the previous census. Within communities, neighborhoods were defined as spatially close groups of households, or “balozi”. All children in the communities were invited to be examined for trachoma, and have ocular swabs taken for evidence of infection. Trachoma was graded using the World Health Organization simplified grading scheme, and swabs were processed using Amplicor.

Results: Children who were migrants were more likely to be infected and to have trachoma than children who were resident in the community, which was significant by the time of the survey following the third year of MDA (odds ratio, OR, 2.49, 95% confidence interval, CI, 1.03–6.05). The neighborhoods where newcomers resided were more likely to have infection a year later than neighborhoods with no migrants, which was most pronounced following the third year of MDA (OR 2.86, 95% CI 1.07–7.65).

Conclusion: Migrants to communities may be an important source of re-emergent infection, especially as MDA lowers infection among residents. Highly migrant populations may need a special surveillance and treatment program to avoid slowing progress in communities under MDA.

• Ocular Chlamydia trachomatis
• population
• prospective study
• Tanzania
• trachoma

DECLARATION OF INTEREST

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

This study was supported by a grant [EY022584] from the National Institutes of Health, National Eye Institute, and in part by the Division of Intramural Research, NIAID, NIH.