Trachoma
Trachoma is a disease of the eye caused by infection with the bacterium Chlamydia trachomatis.
It is the world’s leading cause of preventable blindness of infectious origin.
How dangerous is Trachoma?
Repeated infections cause the eyelids to turn inward, at which point the eyelashes scrape and permanently scar the cornea. This stage of trachoma infection is called trichiasis and can lead to blindness.
Blindness from trachoma is irreversible.
Who is at risk?
As the disease spreads quickly through close personal contact and often is more common in areas where people live close together, trachoma infections are often common in the poorest communities.
How many people are affected by Trachoma?
540 million people are at risk in 55 countries, and 84 million are already infected.
About 1.9 million people are blind or visually impaired because of Trachoma.
Trachoma is particularly common in children who are less than five years of age and in the adults – mainly women – who care for them. In some rural communities, 60 – 90 percent of children are infected.
Where is Trachoma found?
Trachoma is hyperendemic in many of the poorest and most rural areas of 41 countries of Africa, Central and South America, Asia, Australia and the Middle East.
How do people get Trachoma?
Infection spreads through personal contact via hands, clothes or bedding and by flies that have been in contact with discharge from the eyes or nose of an infected person.
Environmental risk factors influencing the transmission of the disease include:
- poor hygiene
- crowded households
- water shortage
- inadequate latrines and sanitation facilities.
What are the signs and symptoms of Trachoma?
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.
How is the disease developing?
If left untreated, repeated trachoma infections can cause severe scarring of the inside of the eyelid and can cause the eyelashes to scratch the cornea which is called trichiasis. In addition to causing pain, trichiasis permanently damages the cornea and can lead to irreversible blindness.
More in-depth information:
In areas where trachoma is endemic, inflammatory trachoma is common among preschool-aged children with prevalence rates as high as 60–90 percent. Infection becomes less frequent and shorter in duration with increasing age.
An individual’s immune system can clear a single episode of infection, but in endemic communities, reacquisition of the organism occurs frequently.
The age at which visual impairment occurs depends on several factors including local transmission intensity. In very highly endemic communities, it can occur in childhood, though onset of visual impairment between the ages of 30 and 40 years is more typical.
Visual impairment or blindness worsen the living of affected people and their families, who are normally already amongst the poorest of the poor.
Women become blind four times more often as men, probably due to their close contact with infected children and therefore higher rate of infections.
How is Trachoma diagnosed?
Trachoma disease is usually clinically diagnosed. People are examined for clinical signs through the use of loupes. In most early stages, infection does not present visible signs of the disease. However, repeated infections cause scarring of the conjunctiva of infected individuals and the feeling of irritation on the eye.
How is Trachoma treated?
Trachoma is treated through:
- surgery to treat the blinding stage of the disease
- antibiotics to clear infection, particularly through mass drug ad-ministration (MDAs) of the antibiotic azithromycin, which is donated by the manufacturer to elimination programs, through the International Trachoma Initiative
- facial cleanliness
- environmental improvement, particularly improving access to water and sanitation
to prevent re-infection
How can I prevent infection?
Through personal and environmental hygiene
How is Trachoma transmitted?
Infection spreads through personal contact via hands, clothes or bedding and by flies that have been in contact with discharge from the eyes or nose of an infected person.
Environmental risk factors influencing the transmission of the disease include:
- poor hygiene
- crowded households
- water shortage
- inadequate latrines and sanitation facilities
What are the difficulties and challenges in fighting Trachoma?
The living conditions in very poor communities that lead to a lack of personal and environmental hygiene.
What programs exist against Trachoma?
The World Health Organization has targeted trachoma for elimination by 2020 through an innovative, multi-faceted public health strategy known as S.A.F.E.:
- surgery to correct the advanced, blinding stage of the disease called trichiasis
- antibiotics to treat active infection
- facial cleanliness
- environmental improvements in the areas of water and sanitation to reduce disease transmission
Overall, Africa remains the most affected continent, and the one with the most intensive control efforts.
In 2016, in the 26 countries of WHO’s Africa Region in which trachoma is known to be a public health problem, more than 247 000 people with trichiasis were given operations, which corresponds to 95% of the global total operated on for trichiasis, and nearly 83 million people in Africa were treated with antibiotics, which corre-sponds to 97% of the total given antibiotics for trachoma worldwide.
As of 1 July 2017, ten countries had reported achieving elimination goals, which signifies a major milestone in the campaign to elimi-nate trachoma. These countries are: Cambodia, China, Gambia, Ghana, Islamic Republic of Iran, Lao People’s Democratic Republic, Mexico, Morocco, Myanmar and Oman. Three of these countries – Mexico, Morocco and Oman – have been validated by WHO as having eliminated trachoma as a public health problem.
The comprehensive SAFE strategy combines measures for the treatment of active infection and trichiasis (S&A) with preventive measures to reduce disease transmission (F&E). Implementation of the full SAFE strategy in endemic areas increases the effectiveness of trachoma programs.
The F and E components of SAFE, which reduce disease transmission, are particularly critical to achieving sustainable elimination of trachoma.
The F in the SAFE strategy refers to facial cleanliness. Because trachoma is transmitted through close personal contact, it tends to occur in clusters, often infecting entire families and communities. Children, who are more likely to touch their eyes and have unclean faces that attract eye-seeking flies, are especially vulnerable to infection, as are women, the traditional caretakers of the home. Therefore, the promotion of good hygiene practices, such as hand washing and the washing of children’s faces at least once a day with water, is a key step in breaking the cycle of trachoma transmission.
The E in the SAFE strategy refers to environmental change. Improvements in community and household sanitation, such as the provision of household latrines, help control fly populations and breeding grounds. Increased access to water facilitates good hygiene practices and is vital to achieving sustainable elimination of the disease.
Separation of animal quarters from human living space, as well as safe handling of food and drinking water, are also important environmental measures that affected communities can take within a trachoma control program.
In 1998, Pfizer and the Edna McConnell Clark Foundation co-established the International Trachoma Initiative (ITI), an independent not-for-profit organization dedicated to eliminating trachoma management of the distribution of Pfizer’s donation of the antibiotic, Zithromax® (azithromycin), an antibiotic used to treat trachoma.
ITI collaborates with governmental and nongovernmental agencies at local, national, and international levels to implement the World Health Organization (WHO) recommended SAFE strategy for trachoma.
What does Bayer contribute to the fight against Trachoma?
currently no activities
What is the societal burden of Trachoma?
The burden of trachoma on affected individuals and communities is enormous. The economic cost in terms of lost productivity from blindness and visual impairment is estimated at US$ 2.9–5.3 billion annually, increasing to US$ 8 billion when trichiasis is included.
How did the history of the disease proceed?
- 8000 BC – first evidence of trachoma found in Australia
- 2600 BC – China has written therapies for trachoma
- 1550 BC – Ebers papyrus in Egypt has references to trachoma
- 431-404 BC– Trachoma spread with Peloponnesian War
- 200 BC – Hippocratic Corpus 60 mentions trachoma
- 90 – Discorides first uses the word trachoma
- 1095 – Crusades begin – trachoma spreads with them
- 1801 – Sir Ralph Abercromby’s troops return from Egypt and begin epidemic in England
- 1803 – Trachoma epidemic begins in Paris
- 1810 – England appoints experts to investigate trachoma
- 1815 – Belgian troops create epidemic in Belgium
- 1870 – England begins isolating students with trachoma into separate schools
- 1897 – Trachoma classified as a loathsome and contagious disease
- 1902 – Canada passes 1903 laws excluding immigrants with trachoma
- 1903 – Sir Ernest Cassel donates £40,000 for combating eye disease in Egypt
- 1905 – All immigrants enter- ing the US examined for trachoma
- Teddy Roosevelt visits Ellis Island – concern over inspection sanitation
- 1907 – trachoma identified as a probable bacterium
- 1913 – Pres. Wilson funds research, first trachoma hospital opened in the USA and MacCallan creates 4 stage classification of trachoma
- 1914 – Portugal prohibits entrance of immigrants with trachoma
- 1937 – Sulfonamides used to successfully treat trachoma
- 1940 – Penicillin Streptomycin used to treat trachoma
- 1943 – Streptomycin used to treat trachoma
- 1949 – First WHO assembly recognizes need for trachoma control
- 1952 – First WHO expert committee on trachoma meets
- 1954 – Chinese culture agent
- 1957 – West recognizes isolation of agent
- 1975 – International Associa- tion for the Preven- tion of Blind-ness established
- 1978 – WHO Program for the Prevention of Blindness established
- 1985 – EMCF publishes trachoma research plan
- 1987 – Simplified grading adopted by WHO
- 1991 – First discussions with Pfizer and EMCF
- 1996 – Global scientific meeting on trachoma - WHO recommends azithromycin
- 1997 – GET 2020 established
- 1998 – ITI founded
- 1999 – VISION 2020 established