Defining ocular Chlamydia trachomatis infection prevalence thresholds for the trachoma elimination endgame

Trachoma is the leading infectious cause of blindness worldwide and is targeted for global elimination as a public health problem by 2030. As we approach this target, defining when population-level trachoma control interventions can be stopped, and determining how post-intervention surveillance should be performed, are becoming increasingly important. Molecular diagnosis of ocular Chlamydia trachomatis (Ct) using polymerase chain reaction (PCR) provides a highly sensitive and specific indicator of infection, yet there are currently no programmatic guidelines based on Ct infection. We assembled 86 cross-sectional surveys of ocular Ct infection from 13 countries, representing data from 46,914 children aged 1-5 years. Our analyses suggest that infection prevalence of 0.81% in this age group corresponds to a threshold below which population-level interventions can be stopped with at least 90% confidence. Correspondingly, with confidence exceeding 90%, we propose that interventions should continue when infection prevalence is greater than 1.99%. Interpretation of infection surveillance data is a generalisable challenge in low-prevalence settings for many infectious diseases. This study proposes a robust framework for how Ct infection surveillance could support accurate population-level assessments of trachoma endemicity and could allow a step-change in decision-making precision for programmes as we approach the endgame for trachoma elimination.

Authors

Institutions

Publication Details

Journal
medRxiv
Published
2026-11-03
DOI
https://doi.org/10.64898/2026.11.02.26366918
Primary Topic
Ocular Infections and Treatments
Type
preprint
Controls
|||
ALL TIME
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
preprint

Defining ocular Chlamydia trachomatis infection prevalence thresholds for the trachoma elimination endgame

Sandra Liliana Talero, Kathleen D. Lynch, Teshome Gebre, Catherine E. Oldenburg et al.
medRxiv
Ocular Infections and Treatments
preprint

Defining ocular Chlamydia trachomatis infection prevalence thresholds for the trachoma elimination endgame

Sandra Liliana Talero, Kathleen D. Lynch, Teshome Gebre, Catherine E. Oldenburg, Caleb Damilep Mpyet, Laura G. Senyonjo, Benjamin F. Arnold, Sylvie Biyaki Araka, Anna Borlase, Emma Michelle Taylor, Henis Mior Sitoe, Michael Dejene, Martha Saboyá, Adisu Abebe Dawed, Scott D. Nash, Kimberly A. Jensen, Michael Peter Masika, Emma Michele Harding-Esch, Mawo Fall, Eshetu Sata, Mabula Joseph Kasubi, Amir Bedri Kello, Yak Yak Bol, Benard Chieng, Dorothy Yeboah‐Manu, Henry Muriuki Kanyi, Sammy M. Njenga, Hiwot Solomon, Angelia M. Sanders, Mohammed Feyisso Shaka, Stephen Begumisa, Zebene Ayele, Benjamin Marfo, Dionna M. Wittberg, William Edward Oswald, Fikre Seife, Katherine Gass, David Chaima, Nicholas P. Olobio, Stephen Gabriel Mbwambo, Esther A. Shiraho, Cristina Jimenez, Fikreab Kebede, Jeremiah Ngondi, Lochebe Boniface, Ana Bakhtiari, Kangwa I. M. Muma, Solomon Aragie, Fatai Oyediran, Stephen Bernard Lambert, Elizabeth Kelly Callahan, Tàye Zeru, Anthony W. Solomon, Jeremy David Keenan, Richelle W. Kihoro, John Martin Kaldor, Thomas M. Lietman, Paul Akampurira, Stephen Ohidor, Ambahun Chernet, Belgesa E Elshafie, Sarah Elizabeth Boyd, Everlyn Kamau, Kristen K. Renneker, Robin L. Bailey, Sheila K. West, Sara Lavinia Brair, Beido Nassirou, Sue-Chen Apadinuwe, Rapheal Opon, Tamimo Momade, Henry Emisiko, Jacob A. Cohen, Boubacar Kadri, Pamela J. Hooper, Dereje Duguma, Teyil Wamyil-Mshelia, Abdou Amza, Mohamed S. Bah, Khumbo Kalua, Harran A. Mkocha, Mulat Zerihun, Tania A. Gonzalez, Namasiku Siyumbwa Kunda, Rosemary Pearson-Clarke, Tesfahun Bishaw Mengiste, Getahun Ayenew, Susana Vaz Nery, Titus Watitu Kimani, Zerihun Tadesse Gebreselassie, Jesse Speer, Samuel Eshitemi Omukuba, Clarer Jones, Fentahun Tadesse Akale, Constity Mwale
preprint en

Abstract

Trachoma is the leading infectious cause of blindness worldwide and is targeted for global elimination as a public health problem by 2030. As we approach this target, defining when population-level trachoma control interventions can be stopped, and determining how post-intervention surveillance should be performed, are becoming increasingly important. Molecular diagnosis of ocular Chlamydia trachomatis (Ct) using polymerase chain reaction (PCR) provides a highly sensitive and specific indicator of infection, yet there are currently no programmatic guidelines based on Ct infection. We assembled 86 cross-sectional surveys of ocular Ct infection from 13 countries, representing data from 46,914 children aged 1-5 years. Our analyses suggest that infection prevalence of 0.81% in this age group corresponds to a threshold below which population-level interventions can be stopped with at least 90% confidence. Correspondingly, with confidence exceeding 90%, we propose that interventions should continue when infection prevalence is greater than 1.99%. Interpretation of infection surveillance data is a generalisable challenge in low-prevalence settings for many infectious diseases. This study proposes a robust framework for how Ct infection surveillance could support accurate population-level assessments of trachoma endemicity and could allow a step-change in decision-making precision for programmes as we approach the endgame for trachoma elimination.

medRxiv
Family Health International 360 (US), Carter Center (US), Translational Research Institute (AU), Ministry of Health (ZM), Johns Hopkins University (US), University of Jos (NG), The University of Queensland (AU), RTI International (US), University of California, San Francisco (US), University of Lusaka (ZM), Federal Ministry of Health (NG), Kampala International University (UG), Johns Hopkins Medicine (US), Government of Ethiopia (ET), Kamuzu Central Hospital (MW), San Francisco Foundation (US), Kenya Medical Research Institute (KE), UNSW Sydney (AU), University of Oxford (GB), World Health Organization Regional Office for the Americas (US), London School of Hygiene & Tropical Medicine (GB), Amhara Regional Health Bureau (ET), Vector & Vector-Borne Diseases Research Institute (TZ), Noguchi Memorial Institute for Medical Research (GH), Ministry of Health (UG), Federal Ministry of Health (ET), Instituto de Medicina Tropical (PY), Sightsavers (GB), World Health Organization (CH), The Carter Center (ET), Federal Ministry of Health (SD), Ministry of Health (MW), The Task Force for Global Health (US), Blantyre Institute for Community Ophthalmology (MW), Instituto Nacional de Saúde (MZ), Muhimbili National Hospital (TZ), International Trachoma Initiative (ET), World Health Organization Regional Office for Africa (CG), International Trachoma Initiative (US), Ministry of Health (ME), Ghana Health Service (GH), Ministry of Health (MZ), AfricArXiv (MW), Kirby Institute (AU)
Ocular Infections and Treatments
DOISourceOpenAlex
AI Navigator

Ask Laika to Summarize, Analyze, and Connect papers live on the map.

Summarize Papers & Methodologies

Extract key findings, datasets, and comparative methods across publications.

Benchmark Rankings & Visual Analytics

Rank top research institutions, authors, funders, topics, and journals by Field-Weighted Citation Impact (FWCI) and paper volume with instant charts.

Connect Distant Disciplines

Bridge topological clusters on the map to find hidden collaborative intersections.

Laika access coming soon