Trachoma is one of the major causes of preventable blindness globally (reference 3). It is an eye infection caused by the bacteria Chlamydia 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 generally occurs 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, because the infection in children has a longer duration than in adults (reference 4).
Infection with the relevant C. trachomatis serotype causes inflammation of the conjunctiva. Diagnosis of trachoma is by visual inspection, and the detection of follicles (white spots) and papillae (red spots) on the inner upper eyelid. Repeated infections with C. trachomatis, especially during childhood, may lead to scarring with contraction and distortion of the eyelid, which may in turn cause the eyelashes to rub against the cornea; this condition is known as trichiasis which leads to gradual vision loss and blindness (reference 1, references 5 to 6). 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.
The Alliance for the Global Elimination of Blinding Trachoma by 2020 (GET 2020) initiative, supported by the World Health Organization (WHO), advocates the implementation of the SAFE strategy, with its key components of 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 (references 7 to 9).
Trachoma is usually treated by a single dose of the antibiotic azithromycin repeated on an annual basis according to trachoma prevalence. Best public health practice involves treatment of all members of the household in which a case resides, whether or not they have evidence of trachoma. In hyperendemic communities, it is recommended that treatment is also extended to all children over 3 kg in weight up to 14 years of age, or to all members of the community over 3 kg in weight (reference 4, reference 10).Top of page
Trachoma control in Australia
Australia is the only high-income country where trachoma is endemic. It occurs primarily in remote and very remote Aboriginal communities in the Northern Territory (NT), South Australia (SA) and Western Australia (WA). In 2008, cases were also found in New South Wales (NSW) and Queensland (Qld), states where trachoma was believed to have been eliminated. However, cases of trichiasis are believed to be present in all jurisdictions and sub-jurisdictional regions of Australia (reference 4, reference 11). In 2009, the Australian Government invested in the Closing the Gap - Improving Eye and Ear Health Services for Indigenous Australians measure which included committing $16 million over a 4-year period towards eliminating trachoma in Australia. In 2013, the Australian Government committed a further $16.5 million to continue, improve and expand trachoma control initiatives in jurisdictions with known endemic levels of trachoma. Funding was also provided to jurisdictions with a previous history of trachoma for screening activities to ascertain if control programs were also required. These funds were also committed to establishing a strong framework for monitoring and evaluation (reference 12).
The surveillance and management of trachoma in 2013 in all jurisdictions except the NT was guided by the Communicable Disease Network Australia (CDNA) 2006 Guidelines for the public health management of trachoma in Australia (reference 1). These guidelines underwent review in 2013 and were revised in 2014 (reference 2). One of the main changes to the guidelines was the option of not screening all endemic communities every year. The NT trachoma control program in 2013 was guided by the revised National guidelines for the public health management of trachoma in Australia (reference 2). The guidelines were developed in the context of the WHO SAFE strategy and make recommendations for improving data collection, collation and reporting systems in relation to trachoma control in Australia.
The National Trachoma Surveillance and Reporting Unit
The National Trachoma Surveillance and Reporting Unit (NTSRU) is responsible for data collation, analysis and reporting related to the ongoing evaluation of trachoma control strategies in Australia. It operates under contract with the Australian Government Department of Health. The primary focus of reporting by the NTSRU from 2006 - 2011 was on trachoma levels and trends in the three jurisdictions (NT, SA and WA) funded by the Australian Government to undertake trachoma control activities.
In 2012, Queensland Health was funded to undertake a baseline screening of remote communities to establish whether trachoma was a public health concern in Queensland. Findings from this exercise were reported in the 2012 Annual report. In one community in the Torres Strait, follicles were observed in eight children. PCR swabs were taken from the eight children and household contacts. Results from the PCR test were all negative for C. trachomatis. Azithromycin was administered to the eight children and household contacts prior to the results of the PCR test being available. Planning for future screening in this and a limited number of neighbouring communities in the Torres Strait is underway.
In 2013, the NSW Ministry of Health was funded to undertake a baseline screening of selected remote communities to establish whether trachoma was a public health concern in NSW. These data are included in the 2013 report along with WA, NT and SA data. From the end of 2010, the NTSRU has been managed by The Kirby Institute, UNSW Australia (reference 13). For previous reports from 2006 to 2008, the NTSRU was managed by The Centre for Eye Research Australia (references 14 to 16) and the 2009 report was managed by the Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, the University of Melbourne (reference 17).Top of page