Conclusions & Recommendations

TEC congratulates the researchers for an excellent study to explore unusual presentation of trachoma in the Pacific Islands. TEC thanks the researchers for the clear presentation of research findings and implications of results. These findings are likely to be informative as TEC considers any future requests for Zithromax® from the study countries.

TEC encourages future research on the rational use of antibiotics, including exploration of Ct infection load by age group.

TEC appreciates the work of the MORDOR study and on the basis of the discussion would welcome further research on alternative treatment strategies, including decreasing the treatment age with Zithromax® POS to 1 month olds (with appropriate precautions to avoid treating premature infants).

Azithromycin is for the most part not used in trachoma-endemic areas, outside of trachoma programs. The related erythromycin is used, but not nearly as commonly as amoxicillin, sulfas, and fluoroquinolones.
In trachoma-endemic areas, commonly-used antibiotics include penicillins, cephalosporins, sulfonamides, tetracyclines, fluoroquinolones, and chloramphenicol. MDA with azithromycin has NOT been shown to increase resistance to these important agents.
TEC notes the importance of continued monitoring for the development of resistance in non-target organisms, and recommends that ITI work with ICTC and other relevant parties to develop talking points for responsive communications as needed.

TEC noted with relief that our Pfizer colleagues are safe following Hurricane Maria and remain concerned that much of the island is still in need of continued support and recovery efforts. TEC noted with gratitude that the production and packaging facilities are already up and running.

TEC recommends to ITI that a letter be sent by ITI Director and TEC Chair expressing our thanks to the Pfizer colleagues in Puerto Rico.

TEC noted the preliminary coverage analysis which indicated little association between reported coverage and subsequent survey results. TEC recommends that:
- ITI analyze the data further as “Ethiopia versus Rest of World”
- Look at the districts for which the antibiotic distribution figures have been validated through coverage surveys
- ITI circulate the revised results to TEC for their final consideration

In response to the data presented on the approaching elimination targets, TEC recommends that multiple endpoint outcomes (monitoring clinical signs, serology, and ocular infection with Chlamydia trachomatis) are collected in multi-country settings, with linkages to the NTD Modelling Consortium and the NTD Support Center. This will facilitate identification of signals that may indicate resurgence or recrudescence of clinical disease.

In response to a query from the implementing partner for Chikwawa district in Malawi and in accordance with WHO guidelines for trachoma, the TEC recommends that the 2017 survey be considered an impact survey, necessitating a surveillance survey in 2019 (which matches other district survey plans in 2019). Additionally, in accordance with WHO guidelines, trichiasis surgeries should continue until the trichiasis elimination threshold has been reached at the evaluation unit level according to population-based prevalence surveys, and surgical services must then continue to be offered through the routine health system.

TEC encourages ITI management to hold similarly-formatted meetings in other countries at future TEC meetings.