In order to investigate risk factors for the acquisition of trachoma, and to study the effect of continued exposure to ocular chlamydial infection on the severity of inflammatory trachoma and its cicatricial sequelae, a longitudinal study was conducted in a Gambian village. Over a 20-month period, the incidence of active (inflammatory) trachoma was significantly higher among those sharing a bedroom with an active case (64/561, 11·4%) than among those who were not exposed in this way (37/658, 5·6%) (relative risk 1·97, 95% confidence interval 1·33–2.90). There was a positive trend in the odds ratio for severe to moderate inflammatory disease versus mild disease as the number of active cases in the bedroom increased, but this failed to achieve statistical significance (P = 0·0506). Individuals with inflammatory trachoma of moderate or severe intensity at one survey were significantly more likely than others to have moderate or severe inflammatory changes at a previous or subsequent survey (odds ratio 14·9, 95% confidence interval 3·9–68·0), implying that host factors may be more important determinants of severity than the frequency of exposure to reinfection.
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