Sustaining trachoma control and elimination : the basis for environmental indicators in the certification of the elimination of blinding trachoma

Trachoma, a highly infectious eye-disease, which may result in blindness, is endemic in the poorest and most remote areas of 56 countries, most of which are located in Sub-Saharan Africa and Southeast Asia. GET 2020 is in the process of developing indicators and specific standards, which will be used to certify elimination of blinding trachoma. The identified indicators and efforts place greater emphasis on treatment, rather than prevention. Relying primarily on treatment through antibiotics is not cost-effective as the benefits from resolving the infection are only temporary and individuals may become re-infected. Preventing trachoma transmission through environmental interventions, such as providing improved sanitation, is cost effective, especially when done in collaboration with existing international initiatives, such as those being carried out to meet the U.N. MDGs. The body of this report is organized in three sections. Section 2 investigates the basis for disease elimination : according to the principles of epidemiology and pathology and experiences of other infectious disease control efforts, the elements necessary to reduce and sustain elimination of trachoma have to be determined. Section 3, a preliminary analysis of environmental indicators and trachoma, investigates the extent of links between environmental indicators and trachoma prevalence. In section 4, the use of environmental indicators in the trachoma campaign is clarified. From the current body of literature on environmental indicators and the statistical analysis the most effective indicators and the framework under which such indicators can be implemented within the current trachoma elimination campaign are determined.