What is Trachoma?
Trachoma is the world’s leading infectious cause of blindness. It affects people living in remote and rural communities with inadequate sanitation and poor personal and community hygiene. The bacteria Chlamydia trachomatis causes inflammation and swelling under the inner eyelid leading to scarring. The scars cause eyelashes to turn inward and scratch the eye, producing intense pain made worse by blinking. Eventually, the scratched cornea becomes cloudy leading to irreversible blindness.(1)
(1) World Health Organization. (2016) Trachoma. (online) Available at: http://www.who.int/mediacentre/factsheets/fs382/en/
Where is Trachoma?
In 2016 an estimated 200 million people are at risk of trachoma in 42 countries mainly in Sub-Saharan African countries like Ethiopia where 75 million people are at risk but also Afghanistan, India, Brazil, Colombia and some Pacific Island nations. Low-income countries like Oman, Morocco, Ghana, Gambia, Iran, Mexico, Nepal, China, Cambodia and Laos have eliminated trachoma in the last 10 years while Australia remains the only high income country to still have trachoma.(2)
Trachoma disappeared from mainstream Australia over one hundred years ago when improved hygiene facilities, water infrastructure and living conditions were introduced. Trachoma persists in the remote Aboriginal communities due to lack of safe, washing facilities in notoriously poor and chronically overcrowded housing infrastructure and poor hygiene. Young children with constant eye and nose secretions in remote endemic communities sometimes go unnoticed and washing a child’s face whenever its dirty is not always common.(3)
(2) The Trachoma Atlas http://www.trachomaatlas.org
(3) Taylor HR (2008). Trachoma: A Blinding Scourge from the Bronze Age to the Twenty-first Century. Melbourne, Centre for Eye Research Australia
How is Trachoma Spread?
The infection is passed from one child to another when they have infected eye and nose secretions (dirty faces) which easily spread. Unlike other infectious diseases, for trachoma a single episode of infection is often not uncomfortable or noticed as being different. The problem is that repeated infections keep the inflammation present. The longer the inflammation goes on the more discomfort and severe the scarring, and the more severe the scarring the greater the risk of blindness.
A child easily may have between 30-40 episodes of reinfection during childhood and they may have had 160-180 infections to have scarring severe enough to cause blindness in later life(4). Each episode of infection may last a few months, but repeated reinfection leads to the appearance of continuing infection and disease.
(4) Gambhir M, Basanez MG, Burton MJ, Solomon AW, Bailey RL, Holland MJ, et al. The development of an age-structured model for trachoma transmission dynamics, pathogenesis and control. PLoS Negl Trop Dis. 2009;3(6):e462 doi: 10.1371/journal.pntd.0000462 [PMC free article] [PubMed]
How is Trachoma Eliminated?
The World Health Organization developed the SAFE strategy to eliminate trachoma; Surgery to correct the in-turned eye lashes that rub on the eye and lead to blindness, Antibiotics to reduce level of infection, promotion of Facial Cleanliness to stop transmission, and Environmental Improvements in water and sanitation for supporting good hygiene.
The antibiotic treatment, Azithromycin, is making definite progress. It is given every 6 to 12 months to all household members or everybody in the community. This brings down the level of infection, but without stopping the possibility of transmission, trachoma will bounce back and this is why keeping every child’s face clean is so important. The essential and sustainable strategy comes back to clean faces, and having safe and functional bathrooms and washing facilities. Improved hygiene will also help to reduce other common, but very serious infections in remote Indigenous communities.
How Does Trachoma Health Promotion Help?
Health promotion activities play a very important role in stopping transmission of trachoma by promoting “Clean Faces, Strong Eyes”. Initially supported entirely by private donations and philanthropy, the Indigenous Eye Health group at the University of Melbourne worked closely with community groups to develop a suite of health promotion materials. This work is now also receiving Commonwealth support. The materials include posters, flip charts, and radio and tv ads. Milpa the trachoma goanna mascot features in the materials and is involved in the community activities such as the development of music videos, roadshows and football clinics.
How is Trachoma Elimination Progressing?
In 2009 the Australian government committed to eliminate trachoma by the year 2020. At that time the rates were poorly established and ranged between 15 and 20%. The data from 2015 show a massive change with the national average for children in the endemic areas to be 4.6%. Of equal importance is the dramatic reduction in the number of communities with trachoma. Now more than 150 of the 200 or so at-risk communities no longer have trachoma and there are only a small number of communities with high rates, the “hotspots”. These are mainly in and around Central Australia.
So we are making a big impact. However, we need to keep the pressure on until trachoma has gone for all the communities and we need to make sure good levels of facial cleanliness are maintained to stop it bouncing back.