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 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.
WHO adopted the SAFE strategy in 1993 and continues in its mandate to provide leadership and coordination of international efforts to eliminate trachoma as a public health problem.
Trachoma
Trachoma is a disease of the eye and the leading infectious cause of blindness worldwide. It is caused by an obligate intracellular bacterium called Chlamydia trachomatis. Infection is transmitted among people by direct or indirect transfer of ocular and nasal discharges of infected people; indirect transfer includes carriage on the body of particular species of flies. Preschool-age children harbour the principal reservoir of infection. Models suggest that an individual requires more than 150 lifetime infections to develop the blinding complications of trachoma.
Trachoma is endemic to some of the world’s poorest and most rural areas. Africa is the most effected continent, but it also has the most effective control efforts. The disease is also found in Central and South America, Asia, Australia, and the Middle East. As of 2 January 2020, 13 countries had reported achieving elimination goals. In 2018 alone, 146 112 people received surgical treatment for advanced trachoma and 89.1 million were treated with antibiotics. Despite these successes, the disease remains a serious public health concern. It is estimated that trachoma and trichiasis cause up to US$ 8 billion annually due to lost productivity from blindness and visual impairment.
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