Trachoma is one of the major causes of preventable blindness globally.1 It is an eye infection caused by the bacterium Chlamydia trachomatis (C. trachomatis) serotypes A, B, Ba and C. The infection can be transmitted through close facial contact, hand-to-eye contact, via fomites (towels, clothing and bedding) or by flies. Trachoma is generally found in dry, dusty environments and is linked to poor living conditions. Overcrowding of households, limited water supply for bathing and general hygiene, poor waste disposal systems and high numbers of flies have all been associated with trachoma. Children generally have the highest prevalence of trachoma and are believed to be the main reservoirs of infection, due to longer duration of infection compared to adults.
Infections with C. trachomatis cause inflammation of the conjunctiva. Diagnosis of trachoma is by visual inspection, and the detection of the presence of follicles (white spots) and papillae (red spots) of the inner upper eye lid. Repeated infections with C. trachomatis, especially during childhood, may lead to scarring, contraction and distortion of the eyelid, which may in turn cause the eyelashes to rub against the cornea; this is known as trichiasis and can lead to blindness.2 3 Scarring of the cornea due to trichiasis is irreversible. However, if early signs of in-turned eyelashes are found, then surgery is usually effective in preventing further damage to the cornea.
Trachoma is usually treated by a single dose of azithromycin. Best public health practice involves treatment of all members of the household in which a case resides, whether or not they have trachoma. Depending on the prevalence of trachoma in a community, treatment may also be extended to all children aged six months to 14 years, or all members of the community, excluding or including infants less than six months of age.4
The Global Elimination of Blinding Trachoma (GET) 2020 initiative, supported by the World Health Organization (WHO) Alliance, advocates the implementation of the SAFE strategy, with its key components being Surgery (to correct trichiasis), Antibiotic treatment, Facial cleanliness and Environmental improvements. This strategy is ideally implemented through a primary care model within a community framework, ensuring consistency and continuity in screening, control measures, data collection and reporting, as well as the building of community capacity.5 6
Trachoma control in AustraliaAustralia is the only high income country where trachoma is endemic. It occurs primarily in remote and very remote Aboriginal communities in the Northern Territory, South Australia and Western Australia. In 2008, cases were also found in New South Wales and Queensland, where trachoma was believed to have been eliminated.4 7 8 In 2009, the Australian Government initiated the Improving Eye and Ear Health Services for Indigenous Australians for Better Education and Employment Outcomes measure which included committing $16 million over a four-year period towards eliminating trachoma in Australia. The funding is to be used for improving and expanding screening and control activities, as well as establishing a strong framework for monitoring and evaluation. As a result, an increased level of funding was provided to NT, SA and WA for trachoma control activities from 1 July 2010.
The surveillance and management of trachoma is guided by the Communicable Disease Network of Australia (CDNA) Guidelines for the Public Health Management of Trachoma in Australia, endorsed in 2006. This document was developed in the context of the WHO SAFE strategies and makes recommendations for improving data collection, collation and reporting systems.9