Trachoma

Trachoma is the leading infectious cause of blindness in the world. It is caused by a bacterium called Chlamydia trachomatis. The infection is transmitted through contact with eye and nose discharge of infected people, particularly young children who are the principal reservoir of infection. It is also spread by flies that have been in contact with the eyes and noses of infected people. With repeated episodes of infection over many years, the eyelashes may be drawn in so that they rub on the surface of the eye, with pain and discomfort and permanent damage to the cornea. Blindness from trachoma is irreversible. Antibiotics can clear infection while maintaining facial cleanliness and improving access to water and sanitation are recommended preventative measures for endemic countries.

In the Western Pacific Region, Cambodia, China, Lao People's Democratic Republic and Vanuatu have eliminated trachoma as a public health problem. Trachoma remains endemic in 8 countries in the Region including Australia, Fiji, Papua New Guinea, Fiji, Kiribati, Nauru and Solomon Islands.  Most of the endemic countries are implementing the SAFE strategy focusing on surgery, antibiotics, facial washing, and environmental improvement.

Infection is associated with inflammatory changes in the conjunctiva known as “active trachoma”. An individual’s immune system can clear a single episode of infection, but in endemic communities, re-acquisition of the organism occurs frequently.

After years of repeated episodes of active trachoma, the inside of the eyelid can become so severely scarred (trachomatous conjunctival scarring) that it turns inwards and causes the eyelashes to rub against the eyeball (trachomatous trichiasis), resulting in constant pain and light intolerance; this and other alterations of the eye can lead to scarring of the cornea. Left untreated, this condition leads to the formation of irreversible opacities, with resulting visual impairment or blindness. The age at which this occurs depends on several factors including local transmission intensity. In very highly endemic communities, it can occur in childhood, though the onset of visual impairment between the ages of 30 and 40 years is more typical.

Women are blinded up to four times as often as men, probably due to more frequent contact with infected children.

Individuals living in the poorest and most remote communities of Africa, Asia, Australia, the Middle East, Central and South America, and the Pacific islands are at risk.

Trachoma can be prevented by limiting environmental risk factors. These include inadequate hygiene, crowded households, inadequate access to water, and inadequate access to and use of sanitation. Infections usually begin at an early age and grow less frequent and shorter in duration with increasing age. Infections are most often acquired through family and contact with others with active disease. Repeated infections cause the most serious symptoms of the disease.

Trachoma can be eliminated as a public health problem using the SAFE strategy, comprising:

• Surgery to treat trachomatous trichiasis, the blinding stage of the disease;
• Antibiotics to clear the infection, particularly mass drug administration of the antibiotic azithromycin, which is donated by the manufacturer to national programmes through the International Trachoma Initiative;
• Facial cleanliness; and 
• Environmental improvement, particularly better access to water and sanitation.