@article {1626, title = {Malaria Parasitemia after Mass Distribution of Azithromycin to Prevent Child Mortality in Burkina Faso: Results from a Cluster Randomized Trial.}, journal = {Am J Trop Med Hyg}, year = {2025}, month = {2025 Jun 17}, abstract = {

The twice-yearly mass distribution of azithromycin to children aged 1-59 months reduces all-cause child mortality. It has been suggested in some studies that mass azithromycin distributions may reduce malaria mortality and parasitemia; however, these studies have been conducted in the absence of seasonal malaria chemoprevention (SMC). Here, we evaluate malaria parasitemia in a cluster randomized trial of azithromycin versus a placebo in Burkina Faso, where SMC was being administered. Thin and thick smears were taken from a random sample of 15 children per cluster in 40 clusters that had been receiving twice-yearly azithromycin or a placebo for 36 months (six distributions). We found no evidence of a difference in malaria parasitemia between children in the azithromycin and placebo clusters (mean difference -6\% prevalence; 95\% CI -17\% to 6\%; P = 0.33). These results suggest that reductions in malaria parasitemia may not be a major contributor to the effect of azithromycin on child mortality in settings in which SMC is administered.

}, issn = {1476-1645}, doi = {10.4269/ajtmh.25-0093}, author = {Coulibaly, Boubacar and Sie, Ali and Ouattara, Mamadou and Bountogo, Mamadou and Compaor{\'e}, Guillaume and Compaor{\'e}, Adama and Nikiema, Moustapha and Sibiri, Nestor Demb{\'e}l{\'e} and Tiansi, J{\'e}r{\^o}me Nankon{\'e} and Lebas, Elodie and Fetterman, Ian and Hu, Huiyu and Doan, Thuy and Arnold, Benjamin F and Lietman, Thomas M and Oldenburg, Catherine E} } @article {1366, title = {Mass Azithromycin Distribution to Prevent Child Mortality in Burkina Faso: The CHAT Randomized Clinical Trial.}, journal = {JAMA}, volume = {331}, year = {2024}, month = {2024 Feb 13}, pages = {482-490}, abstract = {

IMPORTANCE: Repeated mass distribution of azithromycin has been shown to reduce childhood mortality by 14\% in sub-Saharan Africa. However, the estimated effect varied by location, suggesting that the intervention may not be effective in different geographical areas, time periods, or conditions.

OBJECTIVE: To evaluate the efficacy of twice-yearly azithromycin to reduce mortality in children in the presence of seasonal malaria chemoprevention.

DESIGN, SETTING, AND PARTICIPANTS: This cluster randomized placebo-controlled trial evaluating the efficacy of single-dose azithromycin for prevention of all-cause childhood mortality included 341 communities in the Nouna district in rural northwestern Burkina Faso. Participants were children aged 1 to 59 months living in the study communities.

INTERVENTIONS: Communities were randomized in a 1:1 ratio to receive oral azithromycin or placebo distribution. Children aged 1 to 59 months were offered single-dose treatment twice yearly for 3 years (6 distributions) from August 2019 to February 2023.

MAIN OUTCOMES AND MEASURES: The primary outcome was all-cause childhood mortality, measured during a twice-yearly enumerative census.

RESULTS: A total of 34 399 children (mean [SD] age, 25.2 [18] months) in the azithromycin group and 33 847 children (mean [SD] age, 25.6 [18] months) in the placebo group were included. A mean (SD) of 90.1\% (16.0\%) of the censused children received the scheduled study drug in the azithromycin group and 89.8\% (17.1\%) received the scheduled study drug in the placebo group. In the azithromycin group, 498 deaths were recorded over 60 592 person-years (8.2 deaths/1000 person-years). In the placebo group, 588 deaths were recorded over 58 547 person-years (10.0 deaths/1000 person-years). The incidence rate ratio for mortality was 0.82 (95\% CI, 0.67-1.02; P = .07) in the azithromycin group compared with the placebo group. The incidence rate ratio was 0.99 (95\% CI, 0.72-1.36) in those aged 1 to 11 months, 0.92 (95\% CI, 0.67-1.27) in those aged 12 to 23 months, and 0.73 (95\% CI, 0.57-0.94) in those aged 24 to 59 months.

CONCLUSIONS AND RELEVANCE: Mortality in children (aged 1-59 months) was lower with biannual mass azithromycin distribution in a setting in which seasonal malaria chemoprevention was also being distributed, but the difference was not statistically significant. The study may have been underpowered to detect a clinically relevant difference.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03676764.

}, issn = {1538-3598}, doi = {10.1001/jama.2023.27393}, author = {Oldenburg, Catherine E and Ouattara, Mamadou and Bountogo, Mamadou and Boudo, Valentin and Ouedraogo, Thierry and Compaor{\'e}, Guillaume and Dah, Clarisse and Zakane, Alphonse and Coulibaly, Boubacar and Bagagnan, Cheik and Hu, Huiyu and O{\textquoteright}Brien, Kieran S and Nyatigo, Fanice and Keenan, Jeremy D and Doan, Thuy and Porco, Travis C and Arnold, Benjamin F and Lebas, Elodie and Sie, Ali and Lietman, Thomas M} } @article {1571, title = {Seroepidemiology of trachoma in a low prevalence region receiving annual mass azithromycin distribution in Maradi, Niger.}, journal = {PLoS Negl Trop Dis}, volume = {18}, year = {2024}, month = {2024 Dec 09}, pages = {e0012727}, abstract = {

BACKGROUND: Trachoma programs use the indicator trachomatous inflammation--follicular (TF) to monitor indication for and response to treatment for trachoma at the district level. Alternative indicators, including serologic markers, are increasingly being evaluated for trachoma surveillance. We evaluated seroprevalence of IgG antibodies to the Pgp3 antigen in two districts in Maradi, Niger thought to have low TF prevalence.

METHODS: Data were collected as part of the baseline assessment of the Azithromycin Reduction to Reach Elimination of Trachoma (ARRET) trial in September 2021. A random sample of 80 communities was selected from Mayahi and Guidan Roumdji districts, both of which had TF prevalence <20\% at their most recent trachoma impact survey in 2018. A random sample of 50 children per community was sampled. We collected field grades, conjunctival swabs for processing PCR for ocular Chlamydia trachomatis, and dried blood spots for serologic assessment.

RESULTS: Of 3,994 children sampled in 80 communities, 49\% were female and median age was 4 years. Overall TF prevalence was 4.6\% (95\% CI 3.5 to 5.8\%) and trachomatous inflammation-intense (TI) prevalence was 0.6\% (95\% 0.3 to 0.9\%). The prevalence of ocular chlamydia was 0.03\% (95\% CI 0.08\%). Seroprevalence for Pgp3 antibodies was 6.3\% (95\% CI 5.5 to 7.1\%) in 1-9-year-olds and 3.7\% (95\% CI 2.9 to 4.4\%) in 1-5-year-olds. TF and Pgp3 seroprevalence were better correlated in 1-5-year-olds (correlation coefficient 0.29) compared to 1-9-year-olds (correlation coefficient 0.09).

CONCLUSIONS: In this low trachoma prevalence setting in Niger, seroprevalence of antibodies to Pgp3 were consistent with little ongoing transmission of C. trachomatis.

}, issn = {1935-2735}, doi = {10.1371/journal.pntd.0012727}, author = {Amza, Abdou and Kadri, Boubacar and Nassirou, Beido and Arzika, Ahmed and Gebreegziabher, Elisabeth and Hu, Huiyu and Zhong, Lina and Chen, Cindi and Yu, Danny and Abraham, Thomas and Liu, YuHeng and Wickens, Karana and Doan, Thuy and Martin, Diana and Arnold, Benjamin F and Lietman, Thomas M and Oldenburg, Catherine E} } @article {1036, title = {Effect of Single-dose Azithromycin on Pneumococcal Carriage and Resistance: A Randomized Controlled Trial.}, journal = {Pediatr Infect Dis J}, volume = {41}, year = {2022}, month = {2022 Sep 01}, pages = {728-730}, abstract = {

We evaluated antibiotic resistance selection in Streptococcus pneumoniae isolates from children participating in an individually randomized trial of single-dose azithromycin versus placebo. After 14 days, the prevalence of resistance to erythromycin, oxacillin, and clindamycin was elevated in the azithromycin versus placebo group. There was no difference at 6 months.

}, issn = {1532-0987}, doi = {10.1097/INF.0000000000003585}, author = {Coulibaly, Boubacar and Kiemde, Dramane and Zonou, Guillaume and Sie, Ali and Dah, Clarisse and Bountogo, Mamadou and Brogdon, Jessica and Hu, Huiyu and Lebas, Elodie and Porco, Travis C and Doan, Thuy and Lietman, Thomas M and Oldenburg, Catherine E} }