Background and objectives: Chlamydia trachomatis can be directly transmitted by sexual or perinatal contact and indirectly transmitted by flies or fomites. Whether distinct epidemiologic forces among human populations or biologic characteristics of the organism are responsible for the different routes of transmission is uncertain.
Study design: To determine if ophthalmia neonatorum and trachoma are linked epidemiologically, 38 infants with ophthalmia and 277 children with trachoma were studied for evidence of C. trachomatis infection using culture, antigen and DNA detection tests. The study was performed in a trachoma endemic area of central Kenya.
Results: Of infants with ophthalmia neonatorum, 8% to 9% had microbiologic evidence of ocular C. trachomatis infection. Of the children with trachoma, 31% had evidence of chlamydial infection. Ninety-two percent of the 59 identified strains causing trachoma belonged to the classic trachoma serovars (A, B, Ba and C). Neither of the two chlamydial strains recovered from infants with ophthalmia was a trachoma serovar. Mothers rarely (3%) had cervical C. trachomatis infection.
Conclusion: This study does not support a major role for perinatally transmitted C. trachomatis infection in trachoma epidemiology.
PIP: Chlamydia trachomatis can be directly transmitted by sexual or perinatal contact and indirectly by flies or fomites. To determine if ophthalmia neonatorum and trachoma are linked epidemiologically, 38 infants with ophthalmia (mean age of 1.8 +or- 2.5 months) and 277 children with trachoma (3 months - 14 years old) were studied for evidence of C trachomatis infection using culture, antigen, and DNA detection tests. The study was performed in a trachoma endemic area in 2 rural health centers (Lare and Mutuwati) in the Meru District in central Kenya over a 2 1/2-year period between 1988-1991. 29 mothers of the 38 infants had tests for cervical C. trachomatis infection. 53 children with trachomatous inflammation (follicular) (TF) and 224 children with trachoma inflammation (intense) with or without TF were enrolled. Subjects were classified according to the World Health Organization trachoma grading scheme. 167 mothers of these 277 children were examined for evidence of cervical C trachomatis infection. Of infants with ophthalmia neonatorum, 8-9% had microbiologic evidence of ocular G trachomatis infection. Of the children with trachoma, 31% had evidence of chlamydial infection. 92% of the 59 identified strains causing trachoma belonged to the classic trachoma serovars (A, B, Ba and C). 3% of mothers had cervical C trachomatis infection. Among children with trachoma, 10% had positive ocular cultures for C. trachomatis, 24 had positive EIA tests, and 31% had positive PCR tests. Among infants with ophthalmia neonatorum, evidence of C. trachomatis infection was rare. 9% (2 of 22) had positive EIA tests, and 8% (2 of 26) had positive PCR tests. Among the mothers of children with trachoma, 3% had positive C. trachomatis cervical cultures and 2% had positive EIA tests. No mother of an infant with ophthalmia neonatorum had positive cervical tests for C. trachomatis. There was no evidence of a major role for perinatally transmitted C trachomatis infection in trachoma epidemiology.