Trachoma in the Northern Territory July 2017 Paula Wines NT Trachoma Program Coordinator

Defining the problem Internationally Trachoma is the leading cause of infectious blindness in the world Blindness from trachoma is entirely preventable Occurs mainly in developing countries Endemic in 41 Countries: 190 million people are at risk 1.9 Million people estimated blind or visual impaired due to trachoma Cambodia, China, Gambia, Ghana, Islamic Iran, Lao, Mexico, Morocco, Myanmar and Oman have reported achieving elimination milestones

Defining the problem Internationally

Defining the problem in Australia Australia is the only developed nation to still have trachoma Trachoma disappeared from mainstream Australia 70 - 100 years ago Trachoma remains a significant public health problem in remote Aboriginal communities today

Trachoma – the disease Trachoma is a bacterial infection of the eye Trachoma is passed through direct and indirect contact with infected eye and nose secretions (tears and snot) Healthy Eye Active Trachoma Differential diagnosis Inclusion conjunctivitis Viral conjunctivitis Bacterial conjunctivitis Hypersensitivity conjunctivitis Vernal conjunctivitis

Trachoma - Who is effected and why? Active trachoma is usually seen in young children and adolescents Preschool children aged 3-5 years have highest rates of active trachoma Children share infected secretions with others, especially other children, causing repeated reinfections As children grow up and have better hygiene, the amount of active trachoma is less.

Trachoma - Why do we worry about Trachoma? WHO grading card – shows the progression of trachoma to trichiasis Brief description of each stage – normal, Trachomatous Inflammation – follicular TF Trachomatous Inflammation - intense TI, Scarring of the tarsal plate Trachomatous Trichiasis - at least one eyelash rubs on the eyeball (cornea) or evidence of recent removal of eyelashes Corneal Opacity Tarsal conjunctiva

Trichiasis – who is affected? Adults 40+ years – repeated trachoma infections in childhood Untreated trichiasis can lead to corneal opacity and permanent blindness Those who were children in the 70s and before A few cases in younger people

Trachoma in Australia 2015 1970s the time of Fred Hollows, first mapping of trachoma 2014 Prevalence – 5.5% increase from 2013 2.4% Top End 1.3% East Arhnem 1.1% Katherine 3.3% Barkley 28.7% Alice Springs 21%

Trachoma reduction in Australia 2007- 2015

Trachoma in the Northern Territory - 2015

Trachoma in the NT 2007-2015

Australia’s commitment to elimination Committed to WHO Global Elimination of Trachoma as a Public Health problem by 2020 – (GET 2020) Dedicated Commonwealth funding since 2009 Current funding until June 2021 Implementation of the SAFE Strategy across endemic areas

S – Surgery A – Antibiotics F – Facial cleanliness E – Environment WHO SAFE Strategy S – Surgery A – Antibiotics F – Facial cleanliness E – Environment

S – Surgery for trichiasis

A - Antibiotics and screening for Trachoma

F – Facial Cleanliness

E – Environmental Improvements

Opportunities for Rotary Environmental Improvement (WASH) Safe and functioning health hardware in schools, community and homes Workforce development minor home repair teams pool lifeguards Swimming pool maintenance Facial Cleanliness (behaviour change) Multimedia hygiene health promotion program community hygiene champions role modelling (Youth leadership) Subsidising hygiene products in community stores Supporting health promotion events