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Other Talks in the Series: Neglected Tropical Diseases

My name is Dr. Paul Emerson. I'm the Director of the International Trachoma Initiative here at the Task Force for Global Health at Emory University, in Atlanta. In the first part of the trachoma talk, we discussed the epidemiology of trachoma and how we have mapped the disease. In this part, we will discuss and we have applied our knowledge of the epidemiology and global mapping to look at the elimination of trachoma as a public health problem, and progress, and challenges to elimination.
The next section of the talk is about the program to eliminate trachoma, and we're going to talk about the aims of the program, some of the inbuilt compromises, and how it's being delivered.
So the elimination of blinding trachoma is through an integrated strategy with four pillars. We've talked about the stages or the grades of the disease, and the one in which a patient on immediate risk of blindness is TT. TT is reversible through surgery and that forms the S of SAFE strategy. We talked about how it is caused by a bacterial infection, and bacterial means that it can be treated with antibiotics and the antibiotics from the A part of the SAFE strategy, the majority of that is azithromycin donated by Pfizer. We've talked about how the disease is transmitted, and it's transmitted mechanically from the eyes and possibly from nasal secretions of people with disease, particularly those with TI. So that gives us F, facial cleanliness. Washing your hands and face with soap and water can do two things; firstly, it washes away those elementary bodies from your face so that you are a reduced source of infection. Secondly, it makes you less attractive to eye seeking flies, so they are less likely to come to you and pick up the infection to pass it on. Finally, the E is environmental improvement. We've spoken about how it's an environmental disease. Access to water is required for facial cleanliness and hygiene. Hygiene promotion in the absence of water is meaningless and needs to the access to water. We also promote access to sanitation because the fly that transmits trachoma, Musca sorbens, breeds in human feces, but only human feces that lying on the soil surface. If it's disposed of safely in latrines, then it is no longer a source for fly breeding. So that gives us the SAFE strategy. It's a wonderful integrated strategy.