• Kathleen D Lynch, Wendy Morotti, Garry Brian, Lenore Ketchup, Kozue Kingston, Mitchell Starr, Robert S Ware, Beth Everill, Nazihah Asgar, Anne O'Keefe, Lisa J Whop, John M Kaldor, and Stephen B Lambert.
• UQ Centre for Clinical Research, University of Queensland, Brisbane, QLD.
• Med. J. Aust. 2022 Nov 21; 217 (10): 538543538-543.

ObjectivesTo compare the findings of standard clinical assessments and of complementary clinical and laboratory methods for determining whether community-wide treatment for trachoma is warranted in a remote Queensland community.DesignThree cross-sectional screening surveys, 2019-2021, complemented by laboratory pathology testing.SettingSmall community in northwest Queensland with geographic and cultural ties to Northern Territory communities where trachoma persists.ParticipantsChildren aged 1-14 years; opportunistic screening of people aged 15 years or more.Main Outcome MeasuresPrevalence of clinical signs of trachoma, Chlamydia trachomatis infection, ocular non-chlamydial infections, and seropositivity for antibodies to the C. trachomatis Pgp3 protein.ResultsDuring the three surveys, 73 examinations of 58 children aged 1-4 years, 309 of 171 aged 5-9 years, and 142 of 105 aged 10-14 years for trachoma were undertaken, as were 171 examinations of 164 people aged 15 years or more; 691 of 695 examinations were of Aboriginal or Torres Strait Islander people (99%), 337 were of girls or young women (48%). Clinical signs consistent with trachomatous inflammation-follicular were identified in 5-9-year-old children 23 times (7%), including in eleven with non-chlamydial infections and one with a C. trachomatis infection. One child (10-14 years) met the criteria for trachomatous scarring. Two of 272 conjunctival swab samples (all ages) were polymerase chain reaction-positive for C. trachomatis (0.7%). Two of 147 people aged 15 years or more examined in 2019 had trichiasis, both aged 40 years or more. Seven of 53 children aged 1-9 years in 2019 and seven of 103 in 2021 were seropositive for anti-Pgp3 antibodies.ConclusionsDespite the prevalence of clinical signs consistent with trachomatous inflammation-follicular among 5-9-year-old children exceeding the 5% threshold for community-wide treatment, laboratory testing indicated that childhood exposure to ocular C. trachomatis is rare in this community. Laboratory testing should be integrated into Australian trachoma guidelines.© 2022 The Authors. Medical Journal of Australia published by John Wiley & Sons Australia, Ltd on behalf of AMPCo Pty Ltd.

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