This supplement presents in published form the papers that were presented at the Centennial meeting of the American Society of Tropical Medicine and Hygiene in Philadelphia, December 2003: a symposium on control of blinding trachoma.
Trachoma was not considered a “tropical disease” when the society was founded. It was recognized to be contagious early on and was, in fact, common in this country and Europe. Eye hospitals in North America and Europe were founded to deal with trachoma. What it shares with “tropical diseases” in the past, and especially now, is that it is found where poverty, poor hygiene and limited access to water and sanitation exist. After cataract, it is the second major cause of world blindness. Trachoma was an exclusion criterion at Ellis Island one hundred years ago and the impact of this on families split apart or returned to Europe was enormous.1 The newspapers of New York City contained dire warnings about the threat of trachoma in public schools (and not incidentally the link to immigrants). However, at the same time the U.S. Public Health Service was engaged in a major campaign to control and eliminate this disease. Described as the “menace of trachoma,” the USPHS campaign did not end until the 1950s.2 This was a victory for public health but due probably to improved socio-economic conditions as much as to the use of sulfonamides and eventually tetracyclines.
A rebirth of interest in controlling trachoma has occurred among the prevention of blindness community as a result of the propagation of the World Health Organization’s SAFE strategy and the availability of azithromycin, a single oral dose antibiotic as effective as six weeks of tetracycline ointment. The papers in this supplement document progress that has been made on four years using SAFE with azithromycin, the new molecular tools available for public health application, continuing needs for operational research to improve the SAFE strategy and finally the aspirations of the WHO in their leadership role to eliminate blinding trachoma. That this could happen even ahead of the 2020 deadline cannot be in doubt. To eliminate blinding trachoma, we do not have to be rid of every last episode of active infection, nor consider eradication of the organism. We know that SAFE will work. Whether we can succeed in eliminating the blinding disease by 2020 will depend on political will in the countries where trachoma remains endemic, the mobilization of the public health infrastructure to put SAFE with azithromycin into practice, as well as the international public health community’s willingness to give this priority. We hope that the papers in this volume will contribute to increased understanding of the possibility of success and advance progress towards the 2020 goal.
Markel H, 2000. The “Eyes have it”: Trachoma, the Perception of Disease, the United States Public Health Service, and the American Jewish Immigration Experience, 1897–1924. Bull Hist Med 74 :525–560.