Effect of Biannual Azithromycin to Children under 5 Years on the Carriage of Respiratory Pathogens among Children Aged 7-11 Years

• Type of Material: Article
• Authors: Stephanie A Brennhofer, University of Virginia, Charlottesville; Elizabeth McQuade, Emory University; Jixian Zhang, University of Virginia, Charlottesville; Suporn Pholwat, University of Virginia, Charlottesville; Suzanne Stroup, University of Virginia, Charlottesville; James A Platts-Mills, University of Virginia, Charlottesville; Jie Liu, Emory University; Eric R Houpt, University of Virginia, Charlottesville
• Language: English
• Date: 2023-02-01
• Publisher: AMER SOC TROP MED & HYGIENE
• Publication Version: Final Published Version
• Copyright Statement: © The author(s)
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.4269/ajtmh.22-0583
• Title of Journal or Parent Work: AMERICAN JOURNAL OF TROPICAL MEDICINE AND HYGIENE
• Volume: 108
• Issue: 2
• Start Page: 428
• End Page: 432
• Grant/Funding Information: his work was supported by the Bill & Melinda Gates Foundation (OPP1179069 and INV-008606).
• Keywords: TRACHOMA; COLONIZATION; MORTALITY; RESISTANCE; PROTECTION; Tropical Medicine; Science & Technology; STREPTOCOCCUS-PNEUMONIAE; IMPACT; MENINGITIS; Public, Environmental & Occupational Health; Life Sciences & Biomedicine
• Research Categories: Health Sciences, Epidemiology

Abstract

In the MORDOR I trial, children under 5 years of age were randomized to receive biannual (every 6 months) azithromycin for 2 years in Niger, Malawi, and Tanzania. In 30 Nigerien communities, children aged 7–11 years, who were not enrolled in the MORDOR I trial to receive biannual azithromycin, were assessed for carriage of seven respiratory pathogens. We aimed to see whether there were effects on the carriage of these seven respiratory pathogens among 3,187 children aged 7–11 years living in the 30 communities via nasopharyngeal swabs collected at baseline (N 5 1,066), as well as at year 1 (N 5 1,019) and year 2 (N 5 1,102)—each about 6 months after azithromycin or placebo treatment of children under age five. Most children were positive for Haemophilus influenzae (baseline: 83.8%; interquartile range [IQR]: 78.7–90.4) and Streptococcus pneumoniae (baseline: 82.9%; IQR: 74.2–86.8) at all time points regardless of treatment group. There were no differences in prevalence nor quantity of H. influenzae (prevalence ratio: 0.95; 95% CI: 0.90, 1.02), S. pneumoniae (prevalence ratio: 1.01; 95% CI: 0.96, 1.07), or any of the other respiratory pathogens in the treatment versus control groups at any time point. S. pneumoniae serotype 6AB (7.7%) and Neisseria meningitidis serotype W135 (24.9%) were the most prevalent serotypes detected among all positive S. pneumoniae and N. meningitidis samples, respectively. Biannual azithromycin did not reduce carriage of respiratory pathogens 6 months after the most recent round of biannual azithromycin among older nontreated children (aged 7–11 years) living in treatment communities.