Open Access Open Badges Research article

Longitudinal analysis of antibody responses to trachoma antigens before and after mass drug administration

Erica Brook Goodhew1, Sheri Maria G Morgan2, Andrew J Switzer3, Beatriz Munoz4, Laura Dize5, Charlotte Gaydos5, Harran Mkocha6, Sheila K West4, Ryan E Wiegand1, Patrick J Lammie1 and Diana L Martin1*

  • * Corresponding author: Diana L Martin

  • † Equal contributors

Author Affiliations

1 Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, USA

2 The Ohio State University College of Optometry, Columbus, OH, USA

3 St. Olaf College, Northfield, MN, USA

4 Dana Center for Preventative Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA

5 Center for Infectious Diseases, Johns Hopkins University, Baltimore, MD, USA

6 Kongwa Trachoma Project, Kongwa, United Republic of Tanzania

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BMC Infectious Diseases 2014, 14:216  doi:10.1186/1471-2334-14-216

Published: 22 April 2014



Blinding trachoma, caused by the bacteria Chlamydia trachomatis, is a neglected tropical disease targeted for elimination by 2020. A major component of the elimination strategy is mass drug administration (MDA) with azithromycin. Currently, program decisions are made based on clinical signs of ocular infection, but we have been investigating the use of antibody responses for post-MDA surveillance. In a previous study, IgG responses were detected in children lacking clinical evidence of trachoma, suggesting that IgG responses represented historical infection. To explore the utility of serology for program evaluation, we compared IgG and IgA responses to trachoma antigens and examined changes in IgG and IgA post-drug treatment.


Dried blood spots and ocular swabs were collected with parental consent from 264 1–6 year olds in a single village of Kongwa District, central Tanzania. Each child also received an ocular exam for detection of clinical signs of trachoma. MDA was given, and six months later an additional blood spot was taken from these same children. Ocular swabs were analyzed for C. trachomatis DNA and antibody responses for IgA and total IgG were measured in dried bloods spots.


Baseline antibody responses showed an increase in antibody levels with age. By age 6, the percentage positive for IgG (96.0%) was much higher than for IgA (74.2%). Antibody responses to trachoma antigens declined significantly six months after drug treatment for most age groups. The percentage decrease in IgA response was much greater than for IgG. However, no instances of seroreversion were observed.


Data presented here suggest that focusing on concordant antibody responses in children will provide the best serological surveillance strategy for evaluation of trachoma control programs.