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USAID's NTD Program
USAID's NTD Program

Trachoma

Treatment, Prevention, and Elimination*

The combination of individual and community-oriented measures provides the basis for WHO's SAFE strategy described below.5,6 The SAFE strategy is being implemented on a global scale as part of the WHO initiative to eliminate trachoma as a cause of blindness by the year 2020 .5 It consists of four inter-related components.5,7

Surgery for trichiasis: Persons with trichiasis have an increased risk of becoming blind.8 These individuals need to be identified and operated on to reduce the pain of TT and to prevent or slow the progression toward blindness.8 The surgery consists of tarsal rotation.8,9 Furthermore, the finding of trachoma in children should prompt the active search for trichiasis in persons over 15 years of age and especially those over 40 years of age.10

Antibiotics for active infection: The basis of active trachoma treatment is antibiotics.11,12 The two recommended antibiotics are oral azithromycin (single dose of 20 mg/kg) and a tetracycline eye ointment (six-week course).11,13 Both have been shown to be effective in eliminating chlamydia infection and decreasing the occurrence of clinical signs.11,14 Azithromycin is expensive; however, a donation program set up by Pfizer provides the drug free of charge to many countries in which trachoma is endemic. If the prevalence of trachoma is greater than 10 percent in children 1 through 9 years of age, then everyone in the community should be treated with antibiotics annually for at least three years (Singer and Dana, 2006). Annual mass treatment should continue until the prevalence of trachoma is less than 5 percent.7,15 If available, azithromycin should be used, as compliance may be an issue with tetracycline.15,16

Facial cleanliness: Facial cleanliness should be promoted within the community through behavior change communication and low-cost hygienic interventions.17,18 Adequate facilities for children to clean their faces need to be provided.19 It has been shown that clean-face campaigns can significantly reduce trachoma, particularly intense trachoma.20,21 Children with dirty faces are two to three times more likely to have trachoma.22

Many trachoma control programs actively advocate for general improvements in water supply (for face washing) and sanitation (to suppress fly populations). This drive, if achieved, will fulfill some of the United Nations’ Millennium Development Goals (MDG). The target for the seventh MDG is to halve the number of people without safe water and basic sanitation by 2015. This means that many more organizations and resources are being mobilized in this endeavor than would have been the case for trachoma control alone.1

  Photo of a bottle of Zithromax tablets.
   

Environmental changes: This strategy takes into account the role of the vector and the value of environment improvement by addressing the risk factors for trachoma: overcrowding, poor access to adequate latrines, flies, and poor access to water.19, 23-25

In the early stages of trachoma, treatment with antibiotics alone may be enough to eliminate the infection. The two drugs currently in use include a tetracycline eye ointment and oral azithromycin (Zithromax). Azithromycin appears to be more effective than tetracycline, but it is more expensive.1 In poor communities, the drug used often depends on which one is available and affordable.

*retrieved from Sankara D. Thesis RSPH-Emory University 2007.

 

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References

  1. . Burton, M.J. Trachoma: An overview. British Medical Bulletin. 84: 99-116, 2007.
  2. Thylefors, B., Negrel, AD., Pararajasegaram, R. et al. Global data on blindness. Bulletin of the World Health Organization, World Health Organization, Geneva, Switzerland. 73: 115-121, 1995.
  3. Berhane, Y., Worku, A., Bejiga, A. National Survey on Blindness, Low Vision and Trachoma in Ethiopia. Federal Ministry of Health of Ethiopia, 2006.
  4. Solomon, A.W., Holland, M.J., Burton, M.J., et al. Strategies for control of trachoma: Observational study with quantitative PCR. Lancet. 362: 198-204, 2003.
  5. Mariotti, S.P., Pararajasegaram, R., Resnikoff, S., Trachoma: Looking forward to Global Elimination of Trachoma by 2020 (GET 2020). American Journal of Tropical Medicine & Hygiene. 69: 33-35, 2003.
  6. Mariotti, S.P., Pascolini, D., Rose-Nussbaumer, J., Trachoma: Global magnitude of a preventable cause of blindness. Br. J. Ophthalmol. published online 19 Dec 2008.
  7. Mecaskey, J.W., Knirsch, C.A., Kumaresan, J.A., & Cook, J.A. The possibility of eliminating blinding trachoma. The Lancet Infectious Diseases. 3: 728-734, 2003.
  8. Frick, K.D., Melia, B.M., Buhrmann, R.R., & West, S.K., Trichiasis and Disability in a Trachoma-Endemic Area of Tanzania. Archives of Ophthalmology. 119: 1,839-1,844, 2001.
  9. Claiborne, J.H. The Operation of excision of Tarsus and Conjunctiva (Heisrath) in Old Trachoma, Together with Demonstration of a New Instrument, and a Description of a New Method of Performing It. Transactions of the American Ophthalmological Society. 12: 767-777, 1911.
  10. Regassa, K., Teshome, T., Regassa, K., Teshome, T. Trachoma among adults in Damot Gale District, South Ethiopia. Ophthalmic Epidemiology. 11: 9-16, 2004.
  11. West, S.K., West, E.S., Alemayehu, W., Melese, M., Munoz, B., Imeru, A., et al. Single-dose azithromycin prevents trichiasis recurrence following surgery: randomized trial in Ethiopia. SO - Archives of Ophthalmology. American Medical Association. Chicago, USA: 2006. 124: 3, 309-314, 2006.
  12. Whitty C.J., Glasgow, K.W., Sadiq, S.T., Mabey, D.C., Bailey, R., Whitty, C.J., et al. Impact of community-based mass treatment for trachoma with oral azithromycin on general morbidity in Gambian children. Pediatric Infectious Disease Journal. 18: 955-958, 1999.
  13. Fraser-Hurt, N., Bailey, R.L., Cousens, S., Mabey, D., Faal, H., Mabey, D.C.W. Efficacy of oral azithromycin versus topical tetracycline in mass treatment of endemic trachoma. Bulletin of the World Health Organization. World Health Organization, Geneva, Switzerland: 2001. 79: 7, 632-640. 38 ref, 2001.
  14. Kacmar, J., Cheh, E., Montagno, A., Peipert, J.F. A randomized trial of azithromycin versus amoxicillin for the treatment of Chlamydia trachomatis in pregnancy. SO - Infectious Diseases in Obstetrics and Gynecology. Hindawi Publishing Corporation, New York, USA: 2001. 9: 4, 197-202. 17 ref, 2001.
  15. Gaynor, B.D.,Yi, E., Lietman, T. Rationale for mass antibiotic distribution for trachoma elimination. International Ophthalmology Clinics. 42: 85-92, 2002.
  16. Mak, D.B., O'Neill, L.M., Herceg, A., McFarlane, H. Prevalence and control of trachoma in Australia, 1997-2004. SO - Communicable Diseases Intelligence. Surveillance Section, Biosecurity and Disease Control Branch, Canberra, Australia: 2006. 30: 2, 236-247. 40 ref, 2006.
  17. De Sole, G. Elimination of trachoma: Follow up. British Journal of Ophthalmology. 82: 590, 1998.
  18. Khandekar, R., Mabry, R., Al Hadrami, K., Sarvanan, N., et al. Active trachoma, face washing (F) and environmental improvement (E) in a high-risk population in Oman. Eastern Mediterranean Health Journal. 11: 402-409, 2005.
  19. Pruss, A., Mariotti, S.P. Preventing trachoma through environmental sanitation: a review of the evidence base. Bulletin of the World Health Organization. 78: 258-266, 2000.
  20. Emerson, P.M., Lindsay, S.W., Alexander, N., Bah, M., Dibba, S. M., Faal, H.B., et al. Role of flies and provision of latrines in trachoma control: Cluster-randomised controlled trial.[see comment]. Lancet. 363: 1,093-1,098, 2004.
  21. Polack, S., Kuper, H., Solomon, A.W., Massae, P.A., Abuelo, C., Cameron, E., et al. The relationship between prevalence of active trachoma, water availability and its use in a Tanzanian village. SO - Transactions of the Royal Society of Tropical Medicine and Hygiene. Elsevier, Oxford, UK: 2006. 100: 11, 1,075-1,083. 38 ref, 2006.
  22. Lee, D.C., Chidambaram, J.D., Porco, T.C., Lietman, T.M., et al. Seasonal effects in the elimination of trachoma. American Journal of Tropical Medicine & Hygiene. 72: 468-470, 2005.
  23. Emerson, P.M., Baily, R.L., Walraven, G.E., Lindsay, S.W. Human and other faeces as breeding media of the trachoma vector Musca sorbens. Medical & Veterinary Entomology. 15: 314-320, 2001.
  24. TCC. Trachoma Control Program (Publication. Retrieved 2008: http://www.cartercenter.org/health/trachoma/index.html).
  25. WHO. (2006). Blinding trachoma: Progress towards global elimination by 2020 (Publication. Retrieved 2008: http://www.who.int/blindness/publications/get2020/en/index.html).