Surveillance for peri-elimination trachoma recrudescence: Exploratory studies in Ghana.

<h4>Introduction</h4>To date, eleven countries have been validated as having eliminated trachoma as a public health problem, including Ghana in 2018. Surveillance for recrudescence is needed both pre- and post-validation but evidence-based guidance on appropriate strategies is lacking. W...

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Autores principales:	Laura Senyonjo, James Addy, Diana L Martin, David Agyemang, Dorothy Yeboah-Manu, Sarah Gwyn, Benjamin Marfo, Adwoa Asante-Poku, Agatha Aboe, Ernest Mensah, Anthony W Solomon, Robin L Bailey
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/d996fc18c85d4896b9f5607cae79f139
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spelling	oai:doaj.org-article:d996fc18c85d4896b9f5607cae79f1392021-12-02T20:24:04ZSurveillance for peri-elimination trachoma recrudescence: Exploratory studies in Ghana.1935-27271935-273510.1371/journal.pntd.0009744https://doaj.org/article/d996fc18c85d4896b9f5607cae79f1392021-09-01T00:00:00Zhttps://doi.org/10.1371/journal.pntd.0009744https://doaj.org/toc/1935-2727https://doaj.org/toc/1935-2735<h4>Introduction</h4>To date, eleven countries have been validated as having eliminated trachoma as a public health problem, including Ghana in 2018. Surveillance for recrudescence is needed both pre- and post-validation but evidence-based guidance on appropriate strategies is lacking. We explored two potential surveillance strategies in Ghana.<h4>Methodology/principal findings</h4>Amongst randomly-selected communities enrolled in pre-validation on-going surveillance between 2011 and 2015, eight were identified as having had trachomatous-inflammation follicular (TF) prevalence ≥5% in children aged 1-9 years between 2012 and 2014. These eight were re-visited in 2015 and 2016 and neighbouring communities were also added ("TF trigger" investigations). Resident children aged 1-9 years were then examined for trachoma and had a conjunctival swab to test for Chlamydia trachomatis (Ct) and a dried blood spot (DBS) taken to test for anti-Pgp3 antibodies. These investigations identified at least one community with evidence of probable recent Ct ocular transmission. However, the approach likely lacks sufficient spatio-temporal power to be reliable. A post-validation surveillance strategy was also evaluated, this reviewed the ocular Ct infection and anti-Pgp3 seroprevalence data from the TF trigger investigations and from the pre-validation surveillance surveys in 2015 and 2016. Three communities identified as having ocular Ct infection >0% and anti-Pgp3 seroprevalence ≥15.0% were identified, and along with three linked communities, were followed-up as part of the surveillance strategy. An additional three communities with a seroprevalence ≥25.0% but no Ct infection were also followed up ("antibody and infection trigger" investigations). DBS were taken from all residents aged ≥1 year and ocular swabs from all children aged 1-9 years. There was evidence of transmission in the group of communities visited in one district (Zabzugu-Tatale). There was no or little evidence of continued transmission in other districts, suggesting previous infection identified was transient or potentially not true ocular Ct infection.<h4>Conclusions/significance</h4>There is evidence of heterogeneity in Ct transmission dynamics in northern Ghana, even 10 years after wide-scale MDA has stopped. There is added value in monitoring Ct infection and anti-Ct antibodies, using these indicators to interrogate past or present surveillance strategies. This can result in a deeper understanding of transmission dynamics and inform new post-validation surveillance strategies. Opportunities should be explored for integrating PCR and serological-based markers into surveys conducted in trachoma elimination settings.Laura SenyonjoJames AddyDiana L MartinDavid AgyemangDorothy Yeboah-ManuSarah GwynBenjamin MarfoAdwoa Asante-PokuAgatha AboeErnest MensahAnthony W SolomonRobin L BaileyPublic Library of Science (PLoS)articleArctic medicine. Tropical medicineRC955-962Public aspects of medicineRA1-1270ENPLoS Neglected Tropical Diseases, Vol 15, Iss 9, p e0009744 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270
spellingShingle	Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 Laura Senyonjo James Addy Diana L Martin David Agyemang Dorothy Yeboah-Manu Sarah Gwyn Benjamin Marfo Adwoa Asante-Poku Agatha Aboe Ernest Mensah Anthony W Solomon Robin L Bailey Surveillance for peri-elimination trachoma recrudescence: Exploratory studies in Ghana.
description	<h4>Introduction</h4>To date, eleven countries have been validated as having eliminated trachoma as a public health problem, including Ghana in 2018. Surveillance for recrudescence is needed both pre- and post-validation but evidence-based guidance on appropriate strategies is lacking. We explored two potential surveillance strategies in Ghana.<h4>Methodology/principal findings</h4>Amongst randomly-selected communities enrolled in pre-validation on-going surveillance between 2011 and 2015, eight were identified as having had trachomatous-inflammation follicular (TF) prevalence ≥5% in children aged 1-9 years between 2012 and 2014. These eight were re-visited in 2015 and 2016 and neighbouring communities were also added ("TF trigger" investigations). Resident children aged 1-9 years were then examined for trachoma and had a conjunctival swab to test for Chlamydia trachomatis (Ct) and a dried blood spot (DBS) taken to test for anti-Pgp3 antibodies. These investigations identified at least one community with evidence of probable recent Ct ocular transmission. However, the approach likely lacks sufficient spatio-temporal power to be reliable. A post-validation surveillance strategy was also evaluated, this reviewed the ocular Ct infection and anti-Pgp3 seroprevalence data from the TF trigger investigations and from the pre-validation surveillance surveys in 2015 and 2016. Three communities identified as having ocular Ct infection >0% and anti-Pgp3 seroprevalence ≥15.0% were identified, and along with three linked communities, were followed-up as part of the surveillance strategy. An additional three communities with a seroprevalence ≥25.0% but no Ct infection were also followed up ("antibody and infection trigger" investigations). DBS were taken from all residents aged ≥1 year and ocular swabs from all children aged 1-9 years. There was evidence of transmission in the group of communities visited in one district (Zabzugu-Tatale). There was no or little evidence of continued transmission in other districts, suggesting previous infection identified was transient or potentially not true ocular Ct infection.<h4>Conclusions/significance</h4>There is evidence of heterogeneity in Ct transmission dynamics in northern Ghana, even 10 years after wide-scale MDA has stopped. There is added value in monitoring Ct infection and anti-Ct antibodies, using these indicators to interrogate past or present surveillance strategies. This can result in a deeper understanding of transmission dynamics and inform new post-validation surveillance strategies. Opportunities should be explored for integrating PCR and serological-based markers into surveys conducted in trachoma elimination settings.
format	article
author	Laura Senyonjo James Addy Diana L Martin David Agyemang Dorothy Yeboah-Manu Sarah Gwyn Benjamin Marfo Adwoa Asante-Poku Agatha Aboe Ernest Mensah Anthony W Solomon Robin L Bailey
author_facet	Laura Senyonjo James Addy Diana L Martin David Agyemang Dorothy Yeboah-Manu Sarah Gwyn Benjamin Marfo Adwoa Asante-Poku Agatha Aboe Ernest Mensah Anthony W Solomon Robin L Bailey
author_sort	Laura Senyonjo
title	Surveillance for peri-elimination trachoma recrudescence: Exploratory studies in Ghana.
title_short	Surveillance for peri-elimination trachoma recrudescence: Exploratory studies in Ghana.
title_full	Surveillance for peri-elimination trachoma recrudescence: Exploratory studies in Ghana.
title_fullStr	Surveillance for peri-elimination trachoma recrudescence: Exploratory studies in Ghana.
title_full_unstemmed	Surveillance for peri-elimination trachoma recrudescence: Exploratory studies in Ghana.
title_sort	surveillance for peri-elimination trachoma recrudescence: exploratory studies in ghana.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/d996fc18c85d4896b9f5607cae79f139
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Surveillance for peri-elimination trachoma recrudescence: Exploratory studies in Ghana.

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