Trachoma is the world’s leading infectious cause of blindness and one of 20 neglected tropical diseases (NTDs) that affect over one billion of the world’s poorest people. It is caused by the bacterium Chlamydia trachomatis.
The bacteria are spread through contact with eye discharge from an infected person – via hands, towels and sheets. Trachoma thrives in areas where there is poor sanitation and limited access to water for personal hygiene.
Repeated infection damages the eyelids causing the eyelashes to turn inwards and rub painfully against the eyeball surface. This advanced stage of the disease, trachomatous trichiasis, is extremely painful and has a profoundly negative impact on an individual’s quality of life. Trichiasis can be corrected by eyelid surgery, however if left untreated it may lead to irreversible vision loss and blindness.
Trachoma is estimated to be responsible for the visual impairment of about 1.9 million people, of whom 1.2 million are irreversibly blind, with approximately 157.7 million people worldwide living in trachoma-endemic districts. Trachoma can destroy the economic well-being of entire communities, keeping affected families trapped in a cycle of poverty as the disease passes from one generation to the next.
While children are the most susceptible to infection, the blinding effects of repeated infection do not usually develop until adulthood. Women are up to four times more likely than men to develop trichiasis, in part because of repeated exposure to their children's infections. The disabling effects of vision loss further compound other common challenges faced by poor and marginalized people.
In 1996, the World Health Organization (WHO) Alliance for the Global Elimination of Trachoma by 2020 (GET 2020 Alliance) was created to address this health and development issue. The GET2020 Alliance is the principal platform through which the trachoma community works together towards a shared goal. It includes representatives from country governments as well as other non-government organizations (NGOs), academic institutions, donors and private sector stakeholders.
Adding further support to the Alliance, in May 1998, the 51st World Health Assembly adopted a resolution calling for the elimination of trachoma as a public health problem and recommended that ministries of health implement the SAFE strategy in endemic areas (WHA Resolution 51.11). The WHO-recommended SAFE strategy consists of surgery (S), antibiotics (A), facial cleanliness (F) and environmental improvement (E) interventions.
The antibiotics component of the SAFE strategy aims to reduce the prevalence of active disease in a population while the surgery component provides corrective surgery to people with the blinding stage of the disease. Facial cleanliness and environmental improvement interventions help to reduce rates of transmission and are critical for the sustainability of trachoma elimination. Importantly, trachoma interventions are undertaken within national health systems and integrated into national priorities, contributing to health system strengthening through the building of knowledge, skills and capacity.
For more information about the story of trachoma, read Katherine Schlosser's article on the history of trachoma.
Trachoma - a devastating infectious eye disease made by Dr Ranil Appuhamy