Trachoma: A Blinding Scourge from the Bronze Age to the Twenty-first Century

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  • 1 Adjunct Professor of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, NC 27599, E-mail: josephac@email.unc.edu

Most “tropical diseases” are diseases, which, although now found among the poor in the tropical developing world, are ancient and were once diseases of the now industrialized world linked to poverty, crowding, poor hygiene, and sanitation. There are abundant citations for many of these diseases in Egyptian papyrus records or the Bible.

Trachoma is one of these diseases, and Professor Hugh Taylor has produced a fascinating documentation of trachoma’s public health history. However, he has also undertaken not only to provide the history of this infectious cause of blindness but to provide the full story from biology to clinical and laboratory diagnosis and current control efforts. The book moves smoothly from history to clinical disease to control and, hopefully, towards elimination.

This is a remarkable book for several reasons. First, it has been written by one author. Taylor’s encyclopedic knowledge of this disease is truly extraordinary. Second, it is not a textbook in the general sense of dealing with a single bacterium. Rather, this book provides the social context of trachoma from Hippocrates onward, as well as the public policy decisions and implications of current efforts to eliminate this major infectious cause of blindness. The microbiologist, vaccinologist, and epidemiologist will find a full accounting of progress that has been made on these fronts up to 2007. Third, it is a beautifully produced book with generous illustrations and pictures, and many but not all are from the author’s extensive work around the world, especially in Australia.

Hugh Taylor was born in Melbourne, trained in ophthalmology and undertook his first field work on trachoma in 1976 under the tutelage of Fred Hollows, an indefatigable champion of improving health for the Australian aborigines. Later at Johns Hopkins University, Taylor conducted important studies in monkeys on the immunology of trachoma and conducted trachoma field projects on more than one continent. After serving as Chairman of the Department of Ophthalmology at University of Melbourne for the past 17 years, Professor Taylor is now the Harold Mitchell Professor of Indigenous Eye Heath at the University of Melbourne.

Between the chapters on trachoma history and public policy for trachoma control, there are authoritative and readable chapters on clinical and laboratory diagnosis, biology and epidemiology of the organism, pathogenesis, immunology and vaccine development, and the field studies that led to the current SAFE strategy (Surgery for trichiasis, Antibiotic therapy, Facial cleanliness, and Environmental change [water and sanitation]) of the World Health Organization (WHO). No one is better equipped to do this, because over the past 30 years, Hugh Taylor has wrestled with all of these pieces of the trachoma puzzle. Furthermore, along with his colleagues at WHO, he has been the architect of much of the progress that has been made in controlling trachoma over the past 20 years.

Who will want this book? I am tempted to say that anyone interested in infectious diseases will. It should be obtained by all departments of ophthalmology (so they may understand their own history) and divisions of infectious diseases. For public health policy makers, this book provides insight into the biology of the organism, the clinical manifestations and, perhaps most importantly, the social determinants of this disease that can guide control strategies. I believe it is significant that the epigram for his final chapter is a 1913 quote from John McMullen on the importance that must be given to trachoma control. John McMullen was the U.S. Public Health Service physician who organized a “trachoma train” to move through the southeastern United States to fight this blinding disease of the poor. It struck me that Hugh Taylor is the natural successor to John McMullen. In his case, he used a “trachoma jet” to tirelessly travel from continent to continent for field research and control programs, as well as to influence policy in meetings in Geneva and with the International Agency for Prevention of Blindness. Taylor’s valedictory dealing with the trachoma situation in Australia, applies to blinding trachoma everywhere because, with the SAFE strategy and azithromycin, the tools are available: “What is needed to eliminate trachoma as a blinding problem is sustained political will and the commitment to follow through.” This is a book that all who work in tropical infectious disease research and control will enjoy.

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