Fifty-five million people are infected with trachoma, the leading infectious cause of blindness. The World Health Organization campaign to combat the disease includes a combination of surgery, antibiotics, face washing and access to clean water and sanitation. According to a study by the London School of Hygiene and Tropical Health reported in the New England Journal of Medicine, www.nejm.org a community in Tanzania has reduced its trachoma infection rate to near zero after two years.
In a companion article Joseph Cook, adjunct professor of epidemiology at the University of North Carolina, says he is encouraged by the findings. "There is great hope that the goal that WHO has set – elimination of blinding trachoma by the year 2020 – can be achieved."
Cook says the oral antibiotic azithromycin has been extremely effective. "The previous treatment was using tetracycline ointment twice a day for six weeks. Trying to get people to do this for six weeks was very difficult." Cook says that in this case there is a single oral dose and no further treatment then for another year.
WHO recommends three doses of the antibiotic. The Tanzanian community dramatically reduced its infection rate after just two doses. Cook says it remains to be seen whether similar results can be replicated elsewhere. "When you move a program from a community of this size of around 1,000 people to literally millions of people, you have an uphill battle to get the attention of people to participate in the program, to accept the antibiotic, to improve facial hygiene."
Cook says while it is a huge educational effort, trachoma is beatable. He expects the victory will be much easier than the hard-won triumph over the smallpox virus. "Although there may still be the c. trachomatis, the agent, in the community, or there might even be a case or two of trachoma, it will not occur to the extent that it will cause blindness. So unlike the other programs, this is a program to eliminate the disease not to eliminate the infection."
Cook recommends that countries include the single-dose antibiotic along with on-going programs designed to control other so-called neglected tropical diseases.