Trachoma is the world’s leading infectious eye disease, caused by infection with the chlamydia trachomatis bacteria. Repeated infections of C. trachomatis, particularly in children may lead to scarring of the eyelid, causing it to contract and distort, leading to the eyelashes turning inwards, trichiasis, and scratching of the surface of the cornea, which may lead to irreversible blindness. Australia is the only high-income country with endemic trachoma, primarily in remote and very remote Indigenous communities in the NT, SA, and WA. Australia is committed to eliminating trachoma as a public health problem.
Trachoma control programs in Australia are guided by national guidelines based on the WHO SAFE strategy. The SAFE acronym highlights the key components of the strategy, which are:
- Surgery for trichiasis,
- Antibiotic treatment regimens via the use of azithromycin at the individual, household or community levels,
- and the promotion of facial cleanliness and environmental improvements.
The strategy is designed to be implemented within a community health framework to ensure consistency and continuity of approach in the required screening, control measures, data collection and reporting, as well as building community capacity.
Trachoma control activities focus on communities designated as at-risk. Data collected at the community level, are completed and forwarded to the National Trachoma Surveillance and Reporting Unit for analysis and reporting. This includes the number of:
- Indigenous children screened for clean faces and the number with clean faces, by age group
- Indigenous children screened for trachoma and the number with trachoma, by age group
- Episodes of treatment for trachoma, and treatment strategies
- Indigenous adults screened for trichiasis, with trichiasis, and had surgery for trichiasis
- Health promotion and environmental improvement activities.
- Screening was undertaken for 91% (79/86) of the communities determined to require screening for trachoma.
- Within the screened communities, 1,833 of an estimated 2,042 resident children (90%) aged 5–9 years were screened.
- The overall prevalence of clean faces in children aged 5–9 years was 75%, with 84% in the NT, 75% in QLD, 74% in SA and 57% in WA.
- The overall prevalence of trachoma in children aged 5–9 years was 3.3%, with 3.8% in the NT, 0% in QLD, 0.9% in SA, and 5% in WA.
- Jurisdictional trachoma programs delivered a total of 1,815 doses of azithromycin.
Trachoma prevalence has declined substantially at the jurisdictional level and now Australia is at the verge of reaching WHO elimination targets. This is predominately due to high coverage rates of azithromycin treatment. Levels at the regional and community level are less stable and continue to show epidemic levels of trachoma. There is also evidence of wide spread treatment fatigue in endemic regions, highlighting the importance of increasing efforts in health promotion and environmental improvement activities to ensure sustainable trachoma elimination in Australia.
Indigenous Health, Primary and Community Care, Australian Government Department of Health and Aged Care; Trachoma Surveillance and Control Reference Group; Population Health Unit, Western NSW Local Health District; Aboriginal Medical Services Alliance Northern Territory; Public Health Unit, Central Australia Health Service, Northern Territory Department of Health; Primary Health Care (Outreach/Remote), Central Australia Health Service, Northern Territory Department of Health; Aboriginal Health Council of South Australia; Eyre and Far North Local Health Network, SA Health; Communicable Diseases Branch, Queensland Health; WA State Trachoma Reference Group; Aboriginal Community Controlled Health Services; Communicable Disease Control Directorate, Department of Health WA; Environmental Health Directorate, Department of Health WA; Goldfields Population Health Unit, WA Country Health Service; Kimberley Population Health Unit, WA Country Health Service; Midwest Population Health Unit, WA Country Health Service; Pilbara Population Health Unit, WA Country Health Service.
Australian Government Department of Health and Aged Care.