---
title: "Azithromycin MDA Impact on Trachoma and Ocular Chlamydia trachomatis in Naoero"
id: "pubmed-42748169"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42748169"
content_type: "clinical_feed_article"
specialty: "Pharmacology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42748169/"
doi: "10.1371/journal.pntd.0014679"
published_at: "2026-09-16T12:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Azithromycin MDA Impact on Trachoma and Ocular Chlamydia trachomatis in Naoero
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42748169
- **Specialty:** [Pharmacology](https://medichelpline.com/clinical-feed/pharmacology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42748169/)
- **DOI:** [10.1371/journal.pntd.0014679](https://doi.org/10.1371%2Fjournal.pntd.0014679)
- **Published At:** 2026-09-16T12:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- Study assessed the effect of two rounds of **azithromycin** mass drug administration (MDA) in Naoero on clinical trachoma and ocular **Chlamydia trachomatis** infection in children aged 1–9 years. - Population-level MDA coverage was estimated at **87%** for the first round and **93%** for the second round. - A two-stage cluster sampled impact survey was conducted 12 months after the second MDA; all residents ≥1 year were examined and conjunctival swabs for **PCR** were collected from children 1–9 years. - Overall 2,150 residents were examined, including 724 children aged 1–9 years; household surveys recorded water, sanitation, and hygiene access. - Age-adjusted prevalence of trachomatous inflammation–follicular (**TF**) in 1–9-year-olds was **6.0%** (95% CI 3.9–7.7); age-adjusted ocular **C. trachomatis** prevalence in the same group was **2.7%** (95% CI 0.3–5.1). - Trachomatous trichiasis (**TT**) previously unknown to the health system was identified in one resident aged ≥15 years among 1,114 examined; age- and gender-adjusted TT prevalence 0.04% (95% CI 0–0.12). - Household access to improved water for hygiene was reported in **99.8%** and access to an improved latrine in **99%** of households surveyed. - The post-MDA **C. trachomatis** prevalence was substantially lower than the pre-MDA estimate (reported as **39.4%**), indicating impact of antibiotic MDA on infection prevalence. - Authors note that while **PCR** adds value to clinical indicators for program decisions, standardised thresholds for interpreting **C. trachomatis** prevalence post-MDA are not yet established and are urgently needed. - Conflict of interest: some authors employed or supported by organizations that receive funding from Pfizer, manufacturer of azithromycin; declarations provided in the source.
## Clinical Analysis & Structured Key Points
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Affiliations Expand ### Affiliations * 1 The Kirby Institute, UNSW, Sydney, Australia. * 2 Ministry of Health and Medical Services, Denig, Naoero. * 3 Pacific Eye Care Society, Suva, Fiji. * 4 NSW State Reference Laboratory for HIV, St Vincent's Centre for Applied Medical Research, St Vincent's Hospital, Sydney, Australia. * 5 London School of Hygiene & Tropical Medicine, London, United Kingdom. * 6 Sightsavers, Haywards Heath, United Kingdom. * 7 International Trachoma Initiative, The Task Force for Global Health, Decatur, Georgia, United States of America. * 8 Malaria & Neglected Tropical Diseases Department, World Health Organization, Geneva, Switzerland. * 9 School of Public Health, University of Queensland, Herston, Australia. * PMID: **42748169** * DOI: [ 10.1371/journal.pntd.0014679 ](https://doi.org/10.1371/journal.pntd.0014679) Item in Clipboard # Impact of two rounds of azithromycin mass drug administration on active trachoma and ocular Chlamydia trachomatis infection in Naoero Carleigh S Cowling et al. PLoS Negl Trop Dis. 2026. Show details Display options Display options Format Abstract PubMed PMID PLoS Negl Trop Dis Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22PLoS+Negl+Trop+Dis%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22PLoS+Negl+Trop+Dis%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42748169/) . 2026 Sep 16;20(9):e0014679. doi: 10.1371/journal.pntd.0014679. eCollection 2026 Sep. ### Authors [Carleigh S Cowling](https://pubmed.ncbi.nlm.nih.gov/?term=Cowling+CS&cauthor_id=42748169)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42748169/#short-view-affiliation-1 "The Kirby Institute, UNSW, Sydney, Australia."), [Sue-Chen Apadinuwe](https://pubmed.ncbi.nlm.nih.gov/?term=Apadinuwe+SC&cauthor_id=42748169)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42748169/#short-view-affiliation-2 "Ministry of Health and Medical Services, Denig, Naoero."), [Anasaini Cama](https://pubmed.ncbi.nlm.nih.gov/?term=Cama+A&cauthor_id=42748169)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42748169/#short-view-affiliation-3 "Pacific Eye Care Society, Suva, Fiji."), [Mitchell Starr](https://pubmed.ncbi.nlm.nih.gov/?term=Starr+M&cauthor_id=42748169)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42748169/#short-view-affiliation-4 "NSW State Reference Laboratory for HIV, St Vincent's Centre for Applied Medical Research, St Vincent's Hospital, Sydney, Australia."), [Emma M Harding-Esch](https://pubmed.ncbi.nlm.nih.gov/?term=Harding-Esch+EM&cauthor_id=42748169)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42748169/#short-view-affiliation-5 "London School of Hygiene & Tropical Medicine, London, United Kingdom."), [Cristina Jimenez](https://pubmed.ncbi.nlm.nih.gov/?term=Jimenez+C&cauthor_id=42748169)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42748169/#short-view-affiliation-6 "Sightsavers, Haywards Heath, United Kingdom."), [Ana Bakhtiari](https://pubmed.ncbi.nlm.nih.gov/?term=Bakhtiari+A&cauthor_id=42748169)[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42748169/#short-view-affiliation-7 "International Trachoma Initiative, The Task Force for Global Health, Decatur, Georgia, United States of America."), [Sarah Boyd](https://pubmed.ncbi.nlm.nih.gov/?term=Boyd+S&cauthor_id=42748169)[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42748169/#short-view-affiliation-7 "International Trachoma Initiative, The Task Force for Global Health, Decatur, Georgia, United States of America."), [Sara Webster](https://pubmed.ncbi.nlm.nih.gov/?term=Webster+S&cauthor_id=42748169)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42748169/#short-view-affiliation-3 "Pacific Eye Care Society, Suva, Fiji."), [Anthony W Solomon](https://pubmed.ncbi.nlm.nih.gov/?term=Solomon+AW&cauthor_id=42748169)[ 8 ](https://pubmed.ncbi.nlm.nih.gov/42748169/#short-view-affiliation-8 "Malaria & Neglected Tropical Diseases Department, World Health Organization, Geneva, Switzerland."), [Simon Reid](https://pubmed.ncbi.nlm.nih.gov/?term=Reid+S&cauthor_id=42748169)[ 9 ](https://pubmed.ncbi.nlm.nih.gov/42748169/#short-view-affiliation-9 "School of Public Health, University of Queensland, Herston, Australia."), [John M Kaldor](https://pubmed.ncbi.nlm.nih.gov/?term=Kaldor+JM&cauthor_id=42748169)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42748169/#short-view-affiliation-1 "The Kirby Institute, UNSW, Sydney, Australia."), [Susana Vaz Nery](https://pubmed.ncbi.nlm.nih.gov/?term=Vaz+Nery+S&cauthor_id=42748169)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42748169/#short-view-affiliation-1 "The Kirby Institute, UNSW, Sydney, Australia.") ### Affiliations * 1 The Kirby Institute, UNSW, Sydney, Australia. * 2 Ministry of Health and Medical Services, Denig, Naoero. * 3 Pacific Eye Care Society, Suva, Fiji. * 4 NSW State Reference Laboratory for HIV, St Vincent's Centre for Applied Medical Research, St Vincent's Hospital, Sydney, Australia. * 5 London School of Hygiene & Tropical Medicine, London, United Kingdom. * 6 Sightsavers, Haywards Heath, United Kingdom. * 7 International Trachoma Initiative, The Task Force for Global Health, Decatur, Georgia, United States of America. * 8 Malaria & Neglected Tropical Diseases Department, World Health Organization, Geneva, Switzerland. * 9 School of Public Health, University of Queensland, Herston, Australia. * PMID: **42748169** * DOI: [ 10.1371/journal.pntd.0014679 ](https://doi.org/10.1371/journal.pntd.0014679) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Background:** Trachoma, caused by ocular infection with the bacterium Chlamydia trachomatis, is the primary infectious cause of blindness globally. To contribute to the elimination of trachoma as a public health problem, Naoero undertook two rounds of antibiotic mass drug administration (MDA) using azithromycin, with population-level coverage estimated at 87% and 93%. This study aimed to estimate the post-MDA prevalence of trachoma, and infection with C. trachomatis, in children aged 1-9 years. **Methods:** A two-stage cluster sampled survey was conducted 12 months after the second MDA round. All residents aged ≥1 year were examined for signs of trachoma, and conjunctival swabs were collected from children aged 1-9 years for PCR testing. Data on domestic access to water, sanitation, and hygiene services were also collected. **Results:** Overall, 2,150 residents were examined, with 724 aged 1-9 years. The age-adjusted prevalence of trachomatous inflammation-follicular (TF) in children aged 1-9 years was 6.0% (95%CI 3.9-7.7). The age-adjusted prevalence of C. trachomatis in the same age group was 2.7% (95%CI 0.3-5.1). There was evidence of trachomatous trichiasis (TT) previously unknown to the health system in one resident aged ≥15 years out of 1114 examined (age- and gender-adjusted prevalence 0.04%, 95%CI 0-0.12). Access to improved water sources for hygiene purposes was reported in 99.8% of households surveyed, and 99% of households reported access to an improved latrine. **Conclusions:** In Naoero, the impact survey prevalence of TF was above, and of TT was below, the thresholds defined by WHO as indicating "elimination as a public health problem". The C. trachomatis prevalence estimate was lower than it was pre-MDA (39.4%), demonstrating the impact of antibiotic MDA. Despite the potential value of PCR data in addition to clinical indicators to help inform the need for trachoma elimination interventions, particularly in post-MDA or low TF prevalence areas, standardised thresholds for interpreting C. trachomatis prevalence have yet to be established. They are urgently needed so that they can be formally used to guide future interventions. Copyright: © 2026 Cowling et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement I have read the journal’s policy and the authors of this manuscript have the following competing interests: AB and SB are employed by the International Trachoma Initiative at The Task Force for Global Health, which receives an operating budget and research funds from Pfizer Inc. (https://www.pfizer.com/), the manufacturers of Zithromax (azithromycin). EMHE receives salary support from the International Trachoma Initiative. This does not alter our adherence to PLOS policies on sharing data and materials. ## MeSH terms * Anti-Bacterial Agents* / administration & dosage Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Anti-Bacterial+Agents%2Fadministration+and+dosage%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Anti-Bacterial+Agents) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42748169/) * Anti-Bacterial Agents* / therapeutic use Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Anti-Bacterial+Agents%2Ftherapeutic+use%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Anti-Bacterial+Agents) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42748169/) * Azithromycin* / administration & dosage Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Azithromycin%2Fadministration+and+dosage%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Azithromycin) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42748169/) * Azithromycin* / therapeutic use Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Azithromycin%2Ftherapeutic+use%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Azithromycin) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42748169/) * Child Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Child%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Child) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42748169/) * Child, Preschool Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Child%2C+Preschool%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Child%2C+Preschool) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42748169/) * Chlamydia trachomatis* / drug effects Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Chlamydia+trachomatis%2Fdrug+effects%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https:
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