National Trachoma Surveillance and Reporting Unit
Trachoma is the world’s leading infectious cause of preventable blindness and is linked to lack of equitable access to housing and environmental conditions to support good health. Repeated infections with ocular strains of the bacterium Chlamydia trachomatis can lead to scarring of the upper eyelid causing the eyelashes to turn inwards to scratch the cornea, eventually leading to vision loss or blindness.
Although trachoma was eliminated from most parts of Australia by the mid-20th century, trachoma remained a significant public health problem in some remote Aboriginal communities in northern, central and western Australia. Following decades of efforts by communities, First Nations organisations, public and environmental health services, the World Health Organization (WHO) officially validated Australia as having eliminated trachoma as a public health problem in April 2026. ‘Elimination as a public health problem’ is a technical definition that does not mean the spread of infection has ceased. Post-validation surveillance and community-led action will need to continue in remote communities to sustain achievements and prevent disease reemergence.
WHO, through the Alliance for the Global Elimination of Trachoma advocates the SAFE strategy for trachoma control. The SAFE acronym refers to: Surgery for trachomatous trichiasis (the advanced disease stage), Antibiotic treatment for C. trachomatis infection, and the promotion of Facial cleanliness and Environmental improvement to reduce transmission and prevent reinfection. The Australian Government funds the National Trachoma Surveillance and Reporting Unit (NTSRU) to provide a national mechanism for monitoring trachoma prevalence and the implementation of the SAFE strategy.
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.
- In 2022 Australia reached World Health Organization (WHO) benchmarks for elimination of trachoma as a public health problem, defined as: trachomatous inflammation-follicular (active trachoma) prevalence <5% in children and trichiasis (severe advanced disease) prevalence ‘previously unknown to the health system’ <0.2% in persons 15+ years. Australia must maintain these levels in each formerly endemic evaluation unit (state/territory) for a further two years before being eligible to apply for validation of elimination as a public health problem.
- There were 88 communities considered currently at risk of trachoma in 2023. Since 2014, the number of communities at risk of trachoma has fallen by 45% in NT (78 in 2014 to 43 in 2023), 48% in SA (21 in 2014 to 11 in 2023) and 50% in WA (68 in 2014 to 34 in 2023).
- Overall trachoma prevalence, which includes estimates from all communities ever considered at-risk, remained below 5% in 2023 at 2.3% in NT, 0% in SA, 1.6% in WA.
- Trachomatous trichiasis (TT) ‘previously unknown to the health system’ was reported in screened populations at a rate of 0.01% in NT, 0% in SA and 0.2% in WA. Estimates derived from screening predominately aligned to current endemic regions are likely to over-estimate the true population level prevalence of TT in Australian jurisdictions, as the broader First Nations population does not have the same exposure risk.
- If these trends continue, Australia is on track to eliminate trachoma as a public health problem, by 2025.
- Trachoma however remains a health issue in some remote First Nations communities, with nearly one-quarter of communities screened in 2023 reporting endemic or hyper endemic trachoma. This indicates a strong post-elimination plan, led by First Nations communities and community-controlled organisations, will be critical to sustaining elimination.
Elimination as a public health problem has been achieved through real partnership with Aboriginal and Torres Strait Islander communities and it will only be sustained the same way. Australia is adapting SAFE strategies for a post-validation setting. Continuing prevention activities through environmental improvements and First Nations led-health promotion activities is the cornerstone of maintaining elimination.
In communities where trachoma remains a public health concern, ongoing surveillance mechanisms are being adapted based on new technologies, community acceptability, and the evolving evidence base. Strong mechanisms for the identification of trachomatous trichiasis and referral for surgical management will continue in both primary healthcare and specialist outreach programs, as trachomatous trichiasis is a slowly progressing condition and blindness can occur many years after C. trachomatis transmission has waned or ceased.
National Trachoma Surveillance and Control Reference Group; First Nations Health Division, Australian Government Department of Health and Aged Care; Population Health Unit, Western NSW Local Health District; Aboriginal Medical Services Alliance Northern Territory and affiliates; 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; Indigenous Eye Health Unit, The University of Melbourne; Aboriginal Health Council of South Australia and affiliates; Eyre and Far North Local Health Network, SA Health; Communicable Diseases Branch, Queensland Health; WA State Trachoma Reference Group; Aboriginal Health Council of Western Australia and affiliates; 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.
