{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T06:04:03Z","timestamp":1789625043645,"version":"build-2803163510"},"reference-count":38,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2022,4,19]],"date-time":"2022-04-19T00:00:00Z","timestamp":1650326400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/3.0\/igo\/"}],"funder":[{"DOI":"10.13039\/100014445","name":"The Fred Hollows Foundation","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100014445","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100002152","name":"International Trachoma Initiative","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100002152","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004324","name":"Sightsavers International","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004324","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008199","name":"RTI International","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008199","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100014445","name":"The Fred Hollows Foundation","doi-asserted-by":"crossref","award":["1954-0"],"award-info":[{"award-number":["1954-0"]}],"id":[{"id":"10.13039\/100014445","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>The epidemiology of trachoma in several Pacific Islands differs from other endemic settings, in that there is a high prevalence of clinical signs of trachoma, particularly trachomatous inflammation\u2014follicular (TF), but few cases of trichiasis and limited evidence of ocular chlamydial infection. This so-called \u201cPacific enigma\u201d has led to uncertainty regarding the appropriate public health response. In 2019 alongside Nauru\u2019s national trachoma population survey, we performed bacteriological and serological assessments of children to better understand the typology of trachoma and to determine whether there is a need for trachoma interventions.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We used two-stage cluster sampling, examining residents aged \u22651 year and collecting household-level water, sanitation, and hygiene (WASH) variables. Children aged 1\u20139 years provided conjunctival swabs and finger-prick dried blood spots to investigate the presence of <jats:italic>Chlamydia trachomatis<\/jats:italic> nucleic acid and anti-Pgp3 antibodies, respectively.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Principal Findings<\/jats:title>\n<jats:p>In 818 participants aged 1\u20139 years, the age-adjusted TF prevalence was 21.8% (95% CI 15.2\u201326.2%); ocular <jats:italic>C<\/jats:italic>. <jats:italic>trachomatis<\/jats:italic> prevalence was 34.5% (95% CI 30.6\u201338.9), and anti-Pgp3 antibody prevalence was 32.1% (95% CI 28.4%\u201336.3%). The age- and gender-adjusted prevalence of trichiasis in \u226515-year-olds was 0.3% (95% CI 0.00\u20130.85), but no individual with trichiasis had trachomatous scarring (TS). Multivariable analysis showed an association between age and both TF (OR per year of age 1.3 [95% CI 1.2\u20131.4]) and anti-Pgp3 positivity (OR 1.2 [95% CI 1.2\u20131.3]). There were high rates of access to water and sanitation and no WASH variable was associated with the presence of TF.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>TF, nucleic acid, and age-specific antibody prevalence collectively indicate that high levels of <jats:italic>C<\/jats:italic>. <jats:italic>trachomatis<\/jats:italic> transmission among children present a high risk of ocular damage due to trachoma. The absence of trichiasis with trachomatous scarring suggest a relatively recent increase in transmission intensity.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pntd.0010275","type":"journal-article","created":{"date-parts":[[2022,4,19]],"date-time":"2022-04-19T17:37:19Z","timestamp":1650389839000},"page":"e0010275","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":11,"title":["A national survey integrating clinical, laboratory, and WASH data to determine the typology of trachoma in Nauru"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8335-8259","authenticated-orcid":true,"given":"Kathleen D.","family":"Lynch","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sue 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