April 24, 2008
Photograph, Dr. Joseph Cook

Photograph, Dr. Joseph Cook

Trachoma, a bacterial infection that can lead to blindness if untreated, has been all but eliminated in the United States, Europe and other parts of the developed world. Now, there’s hope that the disease can be controlled in developing countries as well, according to University of North Carolina at Chapel Hill School of Public Health adjunct epidemiology professor, Dr. Joseph A. Cook, MPH, writing in the April 24, 2008 issue of the New England Journal of Medicine (NEJM).

Trachoma is the world’s leading infectious cause of blindness. According to the World Health Organization (WHO), 55 million people worldwide are infected and 3 million are visually impaired or blind because of trachoma. Repeated infections can cause scaring and shortening of the upper eyelid. Lashes then scratch the cornea, causing blindness. The bacteria are spread from eye to eye by hands or towels used on the face. Flies also may spread the disease. Trachoma is caused by certain strains of the same bacteria, Chlamydia trachomatis, which is the leading sexually transmitted disease.

A four-step strategy developed by WHO is proving effective in eliminating blinding trachoma, Cook said. The strategy, called SAFE, involves surgery to halt corneal damage, antibiotic treatment, face washing or improved facial hygiene, and environmental changes which include access to water and improved sanitation.

A letter to the editor in the April 24 issue of the NEJM from researchers at the London School of Hygiene and Tropical Medicine reports that by using the WHO’s approach – focusing especially on two mass treatments of single-dose azithromycin antibiotic to treat trachoma – a village in Tanzania was able to wipe out the disease from all 859 residents.

“The report strengthens the view that trachoma as a cause of blindness need not persist beyond the first quarter of this century,” Cook writes in his perspective.

The biggest obstacles to controlling trachoma are economic, Cook said. Pfizer, the pharmaceutical company that makes and distributes azithromycin to treat many infections, is donating the antibiotic for this purpose. But other improvements – primarily access to clean water and improved sanitation – are not as easily found.

Much work remains to be done, Cook said. Improving sanitation and access to clean water are too expensive for some countries. The success in the Tanzanian village may not be repeatable in large areas. And mass treatment with antibiotics raises the possibility of bacterial resistance, although this has not been a problem so far.

“There’s much reason to be hopeful,” Cook said. “We’ve eliminated blindness caused by trachoma from the United States and Europe. With the use of azithromycin in the SAFE strategy, we’re making great progress in the rest of the world.”

Cook noted that around the turn of the 20th century, immigrants coming to Ellis Island were either detained or denied entry into the United States if they were infected with trachoma. Many of those infected were children, and families were often separated if some members were not allowed into the country.


Note: Cook can be reached at (919) 542-7398 or josephac@email.unc.edu. His perspective and accompanying slides are available at www.nejm.org.

School of Public Health contact: Ramona DuBose, director of communications, (919) 966-7467 or ramona_dubose@unc.edu.



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