{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T17:25:57Z","timestamp":1782321957191,"version":"3.54.5"},"update-to":[{"DOI":"10.1371\/journal.pntd.0009744","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2021,10,15]],"date-time":"2021-10-15T00:00:00Z","timestamp":1634256000000}}],"reference-count":48,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2021,9,20]],"date-time":"2021-09-20T00:00:00Z","timestamp":1632096000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"funder":[{"name":"coalition of operational research on neglected tropical diseases","award":["NTD-SC 150D, NTD-SC 055"],"award-info":[{"award-number":["NTD-SC 150D, NTD-SC 055"]}]}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>To date, eleven countries have been validated as having eliminated trachoma as a public health problem, including Ghana in 2018. Surveillance for recrudescence is needed both pre- and post-validation but evidence-based guidance on appropriate strategies is lacking. We explored two potential surveillance strategies in Ghana.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methodology\/principal findings<\/jats:title>\n<jats:p>Amongst randomly-selected communities enrolled in pre-validation on-going surveillance between 2011 and 2015, eight were identified as having had trachomatous-inflammation follicular (TF) prevalence \u22655% in children aged 1\u20139 years between 2012 and 2014. These eight were re-visited in 2015 and 2016 and neighbouring communities were also added (\u201cTF trigger\u201d investigations). Resident children aged 1\u20139 years were then examined for trachoma and had a conjunctival swab to test for <jats:italic>Chlamydia trachomatis (Ct)<\/jats:italic> and a dried blood spot (DBS) taken to test for anti-Pgp3 antibodies. These investigations identified at least one community with evidence of probable recent <jats:italic>Ct<\/jats:italic> ocular transmission. However, the approach likely lacks sufficient spatio-temporal power to be reliable.<\/jats:p>\n<jats:p>A post-validation surveillance strategy was also evaluated, this reviewed the ocular <jats:italic>Ct<\/jats:italic> infection and anti-Pgp3 seroprevalence data from the TF trigger investigations and from the pre-validation surveillance surveys in 2015 and 2016. Three communities identified as having ocular <jats:italic>Ct<\/jats:italic> infection &gt;0% and anti-Pgp3 seroprevalence \u226515.0% were identified, and along with three linked communities, were followed-up as part of the surveillance strategy. An additional three communities with a seroprevalence \u226525.0% but no <jats:italic>Ct<\/jats:italic> infection were also followed up (\u201cantibody and infection trigger\u201d investigations). DBS were taken from all residents aged \u22651 year and ocular swabs from all children aged 1\u20139 years. There was evidence of transmission in the group of communities visited in one district (Zabzugu-Tatale). There was no or little evidence of continued transmission in other districts, suggesting previous infection identified was transient or potentially not true ocular <jats:italic>Ct<\/jats:italic> infection.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Conclusions\/significance<\/jats:title>\n<jats:p>There is evidence of heterogeneity in <jats:italic>Ct<\/jats:italic> transmission dynamics in northern Ghana, even 10 years after wide-scale MDA has stopped. There is added value in monitoring <jats:italic>Ct<\/jats:italic> infection and anti-<jats:italic>Ct<\/jats:italic> antibodies, using these indicators to interrogate past or present surveillance strategies. This can result in a deeper understanding of transmission dynamics and inform new post-validation surveillance strategies. Opportunities should be explored for integrating PCR and serological-based markers into surveys conducted in trachoma elimination settings.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pntd.0009744","type":"journal-article","created":{"date-parts":[[2021,9,20]],"date-time":"2021-09-20T18:29:25Z","timestamp":1632162565000},"page":"e0009744","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":5,"title":["Surveillance for peri-elimination trachoma recrudescence: Exploratory studies in 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L.","family":"Martin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7571-4695","authenticated-orcid":true,"given":"David","family":"Agyemang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorothy","family":"Yeboah-Manu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Gwyn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Marfo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8929-193X","authenticated-orcid":true,"given":"Adwoa","family":"Asante-Poku","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agatha","family":"Aboe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ernest","family":"Mensah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7101-6649","authenticated-orcid":true,"given":"Anthony 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