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Background  After approximately 5 years of SAFE (surgery, antibiotics, facial cleanliness, environmental improvement) interventions for trachoma, hyperendemic (trachomatous inflammation-follicular (TF) ≥30%) districts remained in Amhara, Ethiopia. This study’s aim was to characterize the epidemiology of  Chlamydia trachomatis (Ct)  infection and load among pre-school aged children living under the SAFE strategy.    Methods  Conjunctival swabs from a population-based sample of children aged 1–5 years collected between 2011 and 2015 were assayed to provide  Ct  infection data from 4 endemic zones (comprised of 58 districts).  Ct  load was determined using a calibration curve. Children were graded for TF and trachomatous inflammation-intense (TI).    Results  7,441 children were swabbed in 4 zones. TF and TI prevalence were 39.9% (95% confidence Interval [CI]: 37.5%, 42.4%), and 9.2% (95% CI: 8.1%, 10.3%) respectively.  Ct  infection prevalence was 6.0% (95% CI: 5.0%, 7.2%). Infection was highest among children aged 2 to 4 years (6.6%-7.0%). Approximately 10% of infection occurred among children aged 1 year.  Ct  load decreased with age (P = 0.002), with the highest loads observed in children aged 1 year (P = 0.01) vs. aged 5 years. Participants with TF (P = 0.20) and TI (P<0.01) had loads greater than individuals without active trachoma.    Conclusions  In this hyperendemic setting, it appears that the youngest children may contribute in meaningful ways towards persistent active trachoma.

plos neglected tropical diseases

Ocular Chlamydia trachomatis infection and infectious load among pre-school aged children within trachoma hyperendemic districts receiving the SAFE strategy, Amhara region, Ethiopia