October 25, 2008
4 min read
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Initiative moves toward eliminating trachoma worldwide

Ophthalmic organization provides antibiotics and volunteer support to prevent the blinding disease in countries around the world.

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John A. Hovanesian MD, FACS
John A. Hovanesian

Trachoma is a disease of poverty and has affected an estimated 41 million people around the world, causing irreversible visual loss or blindness in about 10 million. The majority are those most vulnerable to poverty: young children and women.

“As trachoma is closely associated with poverty, you only find it among poor people who are living in poor environments,” Ibrahim Jabr, president of the International Trachoma Initiative (ITI), said. “They have limited income, and they live in overcrowded houses.”

The social impact of the disease can be devastating, he said. Children are infected by trachoma as young as 3 or 4 years of age and often stop going to school when their vision becomes impaired. Infection and re-infection are common, not only in children but also in their mothers, who are often exposed to the disease through interaction with them.

Ophthalmic Outreach

Speaking in a telephone interview with Ocular Surgery News, Mr. Jabr said he has seen families torn apart when a parent is blinded by the disease.

“When you’re poor and you’re not productive, because of blindness from trachoma, your people drop you and move on. In a situation of survival, poor families sacrifice the weak,” he said.

Eliminating the disease

Understanding the disease and its impact are important to sustainable treatment and prevention of trachoma worldwide, and ITI has been working with the World Health Organization (WHO) to eliminate the disease, Mr. Jabr said.

In 1998, WHO established the Alliance for the Global Elimination of Blinding Trachoma by the year 2020 (GET 2020), an international coalition collaborating to eliminate the disease by the 2020 deadline. GET 2020 partners implement the WHO-developed intervention strategy — called “SAFE,” an acronym spelling out guidelines to combat the disease: S (surgery to correct trichiasis); A (antibiotics to treat active infection); F (facial cleanliness to prevent transmission of the disease); and E (environmental improvements, such as improved access to clean water and sanitation).

An Ethiopian girl practices face-washing, an important component of the SAFE strategy to eliminate trachoma
An Ethiopian girl practices face-washing, an important component of the SAFE strategy to eliminate trachoma.
Image: International Trachoma Initiative, Elizabeth Gilbert

SAFE, implemented with assistance from ITI, has led to Morocco reaching its goal of elimination of trachoma. WHO expects to soon certify that trachoma is no longer a public health problem in Morocco, Mr. Jabr said.

Other countries are following suit. Ghana, Vietnam, The Gambia and Mauritania have made strides in treating and preventing the disease and could possibly have the disease nearly eliminated within the next 2 years.

ITI has been a key partner of the GET 2020 alliance from the start. ITI was founded in 1998 by Pfizer and the Edna McConnell Clark Foundation in response to WHO’s call to eliminate trachoma by 2020. Pfizer donates the antibiotic Zithromax (azithromycin) to ITI for the treatment of trachoma, Mr. Jabr said. At that time, the Clark Foundation was working with Pfizer on research to test the effectiveness of azithromycin in the treatment of trachoma – and the drug was a success.

“Pfizer and the Clark Foundation got excited about the impact of this (medical) breakthrough and decided to get together and create a non-governmental organization, whose main focus would be to help eliminate the disease worldwide. This was how, in November 1998, the International Trachoma Initiative came to be,” Mr. Jabr said.

How ITI works

Trachoma is an easily spread disease. It is caused by the bacterium Chlamydia trachomatis and is transmitted through touching an infected person’s hands or clothing. Flies that have touched dirty faces or hands can also spread the disease, experts say.

That is why it is important that people understand the need for cleanliness and are provided with antibiotics and clean water, Mr. Jabr said.

Book examines history of disease

Trachoma infections have existed for thousands of years, researcher finds

Trachoma is not a recent health problem, according to Hugh R. Taylor, AC, MD.

Prof. Taylor wrote a book, Trachoma: A Blinding Scourge from the Bronze Age to the Twenty-First Century, that outlines the trajectory of the disease, from the bacterium Chlamydia trachomatis’ origins in the Jurassic Period to the World Health Organization’s SAFE intervention current strategy for addressing the disease.

The book touches on such historical anecdotes as U.S. President Woodrow Wilson declaring “war” on trachoma in 1913, the spread of the disease in cities in the industrial era and how it decimated up to a quarter of the troops in the Napoleonic Wars, causing battles to be canceled because of a lack of fighting men who could see.

Prof. Taylor said he was impressed by how knowledgeable ancient civilizations were about the disease and effective treatment, especially the Greek and Roman cultures.

“Their descriptions are the same as we use today, and a lot of the treatment principles are the same as we use today,” Prof. Taylor said.

To find out more about the book, go to www.cera.org.au.

For more information:

  • Hugh R. Taylor, AC, MD, can be reached at the Melbourne School of Population Health, The University of Melbourne, Level 5, 207 Bouverie St., Carlton , Victoria 3053, Australia; 61-03-8344-9320; e-mail: h.taylor@unimelb.edu.au.

Mainly, ITI provides medicine and technical support to local governments in trachoma endemic areas. ITI also establishes relationships with the “active supporter” of the local water supplies and sanitation in different countries, working for safe and clean water distribution. In addition, ITI raises funds and helps national trachoma control programs mobilize resources to carry out surgeries to correct trichiasis.

“We have been created as a partnership between the private sector and the public sector, and we’re promoting the same thing at the country level, trying to bring the private, public and non profit sectors together in order to achieve that success,” he said.

One of the most important aspects of ITI is its distribution of free Pfizer-donated azithromycin to everyone in endemic zones, Mr. Jabr said. In 2007, ITI received 34 million treatments from the company, at an estimated value of $680 million.

Three tasks

ITI encourages governments to perform three tasks before establishing intervention programs, Mr. Jabr said. First, officials must determine the extent of the trachoma problem in the country. Second, they must commit to eliminating the disease there, assigning people to a national coordinating committee. Finally, ITI brings partners in to help the country’s program.

“This way, we can ensure national ownership, and we can ensure there’s a continuation in the work, and we can ensure that there are sustainable efforts to get to the finish line,” he said.

ITI has established six country offices since 2000 in Ghana, Mali, Niger, Ethiopia, Tanzania and Vietnam. It has 16 national programs, and since ITI’s start 10 years ago, 352,000 sight-saving surgeries have been performed, and more than 77 million azithromycin treatments have been administered by national trachoma control programs.

“To us, when you bring this effort and try to solve this problem, worldwide, you’re giving hope for a better future to those who have lost hope,” Mr. Jabr said.

For more information:

  • Ibrahim Jabr can be reached at 441 Lexington Ave., Suite 1101, New York, NY 10017-3910; 212-490-6460; fax: 212-490-6461; e-mail: communications@trachoma.org.
  • To learn more about the International Trachoma Initiative, go to www.trachoma.org.