Blinding trachoma -- a type of conjunctivitis caused by infection of the eye with Chlamydia trachomatis -- should be eliminated by 2020 thanks to the WHO SAFE initiative launched in 1998. This target and the issues surrounding this disease which has a devastating effect on developing world populations are discussed in a Seminar in this week's edition of The Lancet, authored by Dr Heathcote Wright, Centre for Eye Research Australia, Melbourne, VIC, Australia, and colleagues.
Repeated episodes of infection with C trachomatis lead to scarring and then severe inflammation and scarring of the eyelid. Trichiasis develops when scarring distorts the upper eyelid sufficiently to cause eyelashes to abrade the cornea, scarring it and in turn causing blindness. Trachoma is a family-based disease which clusters in certain communities and specific families. Households that have young children, inadequate access to water, and poor sanitation are most at risk. Active trachoma affects an estimated 84 million people, almost all in developing nations. Of these, 7.6 million have end-stage disease, of which about 1.3 million are blind. Encouragingly, the proportion of world blindness caused by trachoma has dropped from 15% in 1995, to 4% in 2004. This is partly because of improvements in socioeconomic conditions, and possibly more accurate data, but could also be because of widespread implementation of the SAFE strategy.
The SAFE strategy consists of four strands: surgery, antibiotics, facial cleanliness, and environmental improvements. Surgery has an acceptable complication profile but there are concerns about recurrence. Mass antibiotic treatment is effective as it reduces the reservoir of C trachomatis within infected families. Facial cleanliness is regarded as the most important risk factor for trachoma, with a randomised controlled trial suggesting a benefit of facial cleanliness campaigns. Environmental improvements, such as to water supply, refuse disposal, sanitation, presence of animals, and fly density, could also all have a significant impact.
The authors conclude: "Increasing people's standard of living and making necessary environmental improvements are the definitive interventions for active trachoma, attested to by the fact that trachoma has been eliminated from all developed cities in the world." The Seminar ends with a quote from the late Lee Jong-Wook, former Director-General of WHO, who said before his passing: "If countries continue at this rate, the global goal to eliminate trachoma as a public health problem by 2020 can be achieved."
Dr Heathcote Wright, Centre for Eye Research Australia, Melbourne, VIC, Australia T) +61 (0) 417006 193 (please note during Australian daytime hours only) E) heathcote27@hotmail.com
http://multimedia.thelancet.com/pdf/press/trachoma.pdf
Journal
The Lancet