Providing technical leadership and coordination for trachoma elimination

WHO’s mandate is to provide technical leadership and coordination to the international efforts aiming to eliminate trachoma as a public health problem. The recommended elimination strategy, known as “SAFE”, was adopted by WHO in 1996, and is a combination of interventions implemented as an integrated approach. SAFE is an acronym for:

• Surgery for trachomatous trichiasis
• Antibiotics to clear ocular C. trachomatis infection
• Facial cleanliness to reduce transmission of ocular C. trachomatis
• Environmental improvement, particularly improved access to water and sanitation.

The key sanitation intervention for trachoma control purposes is promotion of locally appropriate methods for hygienic disposal of solid human waste. This is thought to be important because female Musca sorbens flies, which are mechanical vectors of C. trachomatis, preferentially lay their eggs on human faeces left exposed on the soil.

In 1997, WHO launched the WHO Alliance for the Global Elimination of Trachoma by the year 2020 (GET2020).

GET2020 is a partnership which supports country implementation of the SAFE strategy and the strengthening of national capacity through epidemiological assessment, monitoring, surveillance, project evaluation and resource mobilization.

In 1998, the World Health Assembly – WHO’s decision-making body – passed a resolution (WHA 51.11) targeting trachoma for elimination as a public health problem by the year 2020. Interventions largely based on the SAFE strategy go beyond medical and surgical interventions and focus on addressing behavioural and environmental aspects in countries endemic for the disease.