Effect of biannual azithromycin distribution on antibody responses to malaria, bacterial, and protozoan pathogens in Niger

Ahmed M. Arzika, Ramatou Maliki, E. Brook Goodhew, Eric Rogier, Jeffrey W. Priest, Elodie Lebas, Kieran S. O’Brien, Victoria Le, Catherine E. Oldenburg, Thuy Doan, Travis C. Porco, Jeremy D. Keenan, Thomas M. Lietman, Diana L. Martin and Benjamin F. Arnold ()
Additional contact information
Ahmed M. Arzika: The Carter Center
Ramatou Maliki: The Carter Center
E. Brook Goodhew: Centers for Disease Control and Prevention
Eric Rogier: Centers for Disease Control and Prevention
Jeffrey W. Priest: Centers for Disease Control and Prevention
Elodie Lebas: University of California
Kieran S. O’Brien: University of California
Victoria Le: University of California
Catherine E. Oldenburg: University of California
Thuy Doan: University of California
Travis C. Porco: University of California
Jeremy D. Keenan: University of California
Thomas M. Lietman: University of California
Diana L. Martin: Centers for Disease Control and Prevention
Benjamin F. Arnold: University of California

Nature Communications, 2022, vol. 13, issue 1, 1-11

Abstract: Abstract The MORDOR trial in Niger, Malawi, and Tanzania found that biannual mass distribution of azithromycin to children younger than 5 years led to a 13.5% reduction in all-cause mortality (NCT02048007). To help elucidate the mechanism for mortality reduction, we report IgG responses to 11 malaria, bacterial, and protozoan pathogens using a multiplex bead assay in pre-specified substudy of 30 communities in the rural Niger placebo-controlled trial over a three-year period (n = 5642 blood specimens, n = 3814 children ages 1–59 months). Mass azithromycin reduces Campylobacter spp. force of infection by 29% (hazard ratio = 0.71, 95% CI: 0.56, 0.89; P = 0.004) but serological measures show no significant differences between groups for other pathogens against a backdrop of high transmission. Results align with a recent microbiome study in the communities. Given significant sequelae of Campylobacter infection among preschool aged children, our results support an important mechanism through which biannual mass distribution of azithromycin likely reduces mortality in Niger.

Date: 2022
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DOI: 10.1038/s41467-022-28565-5

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