Better late than never: a national approach to trachoma control.

n line with its Vision 2020 initiative, the World Health Organization adopted a resolution to eliminate blinding trachoma by 2020. To achieve this goal, WHO recommends the SAFE strategy (Surgery, Antibiotics, Facial cleanliness and Environmental improvement) for countries implementing tra-choma control programs. Australia is the only developed country of the 57 trachoma endemic countries listed by WHO. 1 Trachoma was endemic and a significant cause of blindness in many parts of the Western world, including Australia, until the early 1900s. As housing, hygiene and living conditions improved, tra-choma disappeared from most parts of Australia. 2 However, these improvements are yet to occur in remote Aboriginal populations in Australia, where trachoma is still endemic. Why is Australia the only developed country with endemic tra-choma? Firstly, the socioeconomic determinants of trachoma (ie, poverty and overcrowded living conditions) are highly prevalent among Aboriginal people living in remote areas. Secondly, Australia's tra-choma control efforts have been patchy and inconsistent since the National Trachoma and Eye Health Program finished in 1978. 3 In the absence of a national approach, some trachoma-endemic states or areas have prioritised trachoma control and have implemented programs based on the 1993 WHO trachoma control guidelines, while others have not. Furthermore, while all current programs include periodic trachoma screening and antibiotic treatment, very few include the " S " , " F " and " E " components. Thirdly, epidemiological data on trachoma, an essential element of any control program, are difficult to obtain and interpret because each trachoma control program has its own data collection system, and data from different regions and states are not collated. Trachoma is not a nationally notifiable disease. Thus, despite availability of a highly effective one-dose treatment (azithromycin) provided free through remote Indigenous health clinics and regional population health units since 1998, tra-choma transmission continues. Recent molecular epidemiological research from the Northern Territory showed different Chlamydia trachomatis strains in coastal compared with inland communities, indicating that trachoma transmission may occur more within communities or within groups of neighbouring communities rather than between far-flung, distant communities. 4 In contrast, a similar Western Australian study showed that most WA trachoma strains were of the Ba Apache type, which circulated in both coastal and central communities across the length and breadth of WA and was identical to one of the NT strains. 5 This finding is consistent with anecdotal reports of high levels of mobility of Indigenous people …