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Water, Sanitation, and Environmentally Related Hygiene (WASH)
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Water, Sanitation, and Environmentally Related Hygiene (WASH)
Water, Sanitation, and Environmentally Related Hygiene (WASH) Home
 1. Water, Sanitation, and Environmentally Related Hygiene
 2. Hygiene-related Diseases




TRACHOMA

Trachoma
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Trachoma causes more vision loss and blindness than any other infection in the
world.1 This disease is caused by Chlamydia trachomatis bacteria. Other variants
or strains of these bacteria can cause a sexually transmitted infection
(chlamydia) and disease in lymph nodes.  



Trachoma is easily spread through direct personal contact such as from fingers,
through shared towels and clothes, and through flies that have been in contact
with the eyes or nose of an infected person. When left untreated, repeated
Chlamydia trachomatis infections in the eye can cause severe scarring on the
inside of the eyelid. This can cause the eyelashes to scratch the cornea
(trichiasis). In addition to causing pain, trichiasis permanently damages the
cornea and can lead to irreversible blindness.

Chlamydia trachomatis infections spread in areas that lack access to safely
managed drinking water and sanitation systems. Trachoma affects the most
resource-limited communities in the world. Globally, almost 1.9 million people
have vision loss because of trachoma, and it causes 1.4% of all blindness
worldwide.1 In 2021, 136 million people lived in trachoma-endemic areas and were
at risk of trachoma blindness.2


THE SAFE STRATEGY

To support the elimination of trachoma, the World Health Organization (WHO)
established a public health strategy known as SAFE:

 * Surgery to treat the advanced, blinding stage of the disease (trichiasis)
 * Antibiotics to treat active infection
 * Facial cleanliness
 * Environmental improvements, specifically increasing access to water and
   sanitation.

The SAFE strategy [PDF – 56 pages] combines surgery to correct trichiasis (S),
antibiotics to clear infection (A), and prevention measures to keep the disease
from spreading (F, & E).

Surgery to correct trichiasis (“S” in the SAFE strategy). Surgery relieves the
pain of lashes rubbing against the eye. It also stops the lashes from scratching
the cornea, which stops blindness from progressing.

Antibiotics (A). Pfizer donates the antibiotic Zithromax™ to trachoma programs,
and the International Trachoma Initiative manages distribution. Antibiotics are
given annually to entire districts affected by trachoma. These mass drug
administration programs continue until trachoma levels drop below levels
recommended by WHO.

Facial cleanliness (F). Since trachoma is spread through close personal contact,
it typically infects children and their caretakers. Children are more likely to
touch their eyes and have unclean faces that attract eye-seeking flies, so they
are especially vulnerable to infection. Women are blinded by trachoma 4 times as
often as men. This is likely due to their close contact with infected children
and their increased frequency of getting infected.3 Good hygiene practices such
as washing hands with soap, and washing faces with water to remove discharge
from eyes and nose help reduce the spread of trachoma.4

Environmental improvement (E). Improvements in community and household
sanitation, such as access to household latrines, help control fly populations
and breeding grounds. By increasing access to safely managed water and
sanitation, communities can support good hygiene practices and long-term
elimination of the disease. Affected communities can also help control trachoma
by separating animal living quarters from human living space. They can also
handle food and drinking water safely.

More Information
 * WHO. Trachoma
 * International Trachoma Initiative
 * The Carter Center. Trachoma
 * The Carter Center. Implementing the SAFE Strategy for Trachoma Control [PDF –
   56 pages]


References
 1. Burton MJ, Mabey DC. (2009) The global burden of trachoma: a review.PLoS
    Negl Trop Dis. 2009;3(10):e460.
 2. Trachoma. 2021
 3. Courtright, P., & West, S. K. (2004). Contribution of sex-linked biology and
    gender roles to disparities with trachoma.Emerging infectious
    diseases, 10(11), 2012–2016.
 4. Stocks ME, Ogden S, Haddad D, Addiss DG, McGuire C, et al. (2014) Effect of
    water, sanitation, and hygiene on the prevention of trachoma: A systematic
    review and meta-analysis. PLOS Medicine 11(2): e1001605.


Last Reviewed: June 15, 2022
Source: Centers for Disease Control and Prevention
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 * Infant Hygieneplus icon
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