1. Trachoma in the Northern Territory July 2017
Paula Wines
NT Trachoma Program Coordinator

2. Defining the problem Internationally
Trachoma is the leading cause of infectious blindness in the world
Blindness from trachoma is entirely preventable
Occurs mainly in developing countries
Endemic in 41 Countries: 190 million people are at risk
1.9 Million people estimated blind or visual impaired due to trachoma
Cambodia, China, Gambia, Ghana, Islamic Iran, Lao, Mexico, Morocco, Myanmar and Oman have reported achieving elimination milestones

3. Defining the problem Internationally

4. Defining the problem in Australia
Australia is the only developed nation to still have
trachoma
Trachoma disappeared from mainstream Australia years ago
Trachoma remains a significant public health
problem in remote Aboriginal communities
today

5. Trachoma – the disease Trachoma is a bacterial infection of the eye
Trachoma is passed through direct and indirect contact with
infected eye and nose secretions (tears and snot)
Healthy Eye
Active Trachoma
Differential diagnosis
Inclusion conjunctivitis
Viral conjunctivitis
Bacterial conjunctivitis
Hypersensitivity conjunctivitis
Vernal conjunctivitis

6. Trachoma - Who is effected and why?
Active trachoma is usually seen in young children and adolescents
Preschool children aged 3-5 years have highest rates of active trachoma
Children share infected secretions with others, especially other children, causing repeated reinfections
As children grow up and have better hygiene, the amount of active trachoma is less.

7. Trachoma - Why do we worry about Trachoma?
WHO grading card – shows the progression of trachoma to trichiasis
Brief description of each stage – normal,
Trachomatous Inflammation – follicular TF
Trachomatous Inflammation - intense TI,
Scarring of the tarsal plate
Trachomatous Trichiasis - at least one eyelash rubs on the eyeball (cornea) or evidence of recent removal of eyelashes
Corneal Opacity
Tarsal conjunctiva

8. Trichiasis – who is affected?
Adults 40+ years – repeated trachoma infections in childhood
Untreated trichiasis can lead to corneal opacity and permanent blindness
Those who were children in the 70s and before
A few cases in younger people

9. Trachoma in Australia
2015
1970s the time of Fred Hollows, first mapping of trachoma
2014
Prevalence – 5.5% increase from %
Top End 1.3%
East Arhnem 1.1%
Katherine 3.3%
Barkley 28.7%
Alice Springs 21%

10. Trachoma reduction in Australia 2007- 2015

11. Trachoma in the Northern Territory - 2015

12. Trachoma in the NT

13. Australia’s commitment to elimination
Committed to WHO Global Elimination of Trachoma as a Public Health problem by 2020 – (GET 2020)
Dedicated Commonwealth funding since 2009
Current funding until June 2021
Implementation of the SAFE Strategy
across endemic areas

14. S – Surgery A – Antibiotics F – Facial cleanliness E – Environment
WHO SAFE Strategy
S – Surgery
A – Antibiotics
F – Facial cleanliness
E – Environment

15. S – Surgery for trichiasis

16. A - Antibiotics and screening for Trachoma

17. F – Facial Cleanliness

18. E – Environmental Improvements

19. Opportunities for Rotary
Environmental Improvement (WASH)
Safe and functioning health hardware in schools, community and homes
Workforce development
minor home repair teams
pool lifeguards
Swimming pool maintenance
Facial Cleanliness (behaviour change)
Multimedia hygiene health promotion program
community hygiene champions
role modelling (Youth leadership)
Subsidising hygiene products in community
stores
Supporting health promotion events