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Geneva, Switzerland, WHO, Department of Immunization, Vaccines and Biologicals, 2004.  p. (WHO/EPI/TRAM/93.5 (updated 2004); WHO/PBL/93.31)This teaching aid is about measles, and its potentially harmful effects on the eyes of children.1 Understanding the risks of damage to the eye from measles is the first step before learning what action to take to save sight. Measles causes a great amount of unnecessary death and blindness in children, especially in Africa and parts of Asia. Death and loss of sight due to measles are health care disasters that simply should not occur. Measles is a highly infectious disease preventable by immunization. Reducing deaths due to measles is a global health priority. Immunized children rarely get measles and the cost of immunization is low. The road to good health is also the road to good vision. Since the eye problems due to measles are especially dangerous in children who eat less well, this teaching aid also presents good feeding habits and how to improve the diet for the malnourished child. Protein-energy malnutrition is the most widespread form of malnutrition. It is not easily preventable in poor communities or where there is serious shortage of food as in famine situations and civil strife. (excerpt)
CMAJ: Canadian Medical Association Journal. 2004 Apr 13; 170(8):1225.Trachoma is a chronic keratoconjunctivitis caused by repeated infection with the ocular serovars A, B, Ba and C of Chlamydia trachomatis. The name, derived from the Greek word for “rough,” describes the appearance of the lymphoid follicles apparent with trachomatous inflammation when the upper eyelid is everted and the upper tarsal conjunctiva inspected. A single episode of C. trachomatis ocular infection produces a self-limiting mucopurulent conjunctivitis. Repeated infections lead to conjunctival scarring and distortion of the lid margin, which causes the eyelashes to turn inward (entropion) and repeatedly rub against the cornea (trichiasis). The catastrophic outcome is corneal opacification and, ultimately, blindness. Trachoma is second only to cataracts as a cause of blindness and accounts for about 15% of cases of blindness in the world. In 1997 the World Health Organization (WHO) estimated that 146 million people were actively infected, more than 10 million had trichiasis, and about 6 million were blind from corneal scarring. Active disease is most often seen in children, and women more often than men experience the visual loss that results from chronic, untreated disease, probably because of their greater direct contact with children. (excerpt)
Lancet Infectious Diseases. 2003 Feb; 3(2):65.A 30-year campaign has successfully ended the blight of river blindness in west Africa. This monumental achievement is the result of the Onchocerciasis Control Programme (OCP), established in 1974 under the joint auspices of the United Nations Development Programme, World Bank, WHO, and the UN Food and Agriculture Organization. (author's)
Lancet. 2003 Jul 19; 362(9379):198-204.Background: Antibiotics are an important part of WHO’s strategy to eliminate trachoma as a blinding disease by 2020. At present, who needs to be treated is unclear. We aimed to establish the burden of ocular Chlamydia trachomatis in three trachomaendemic communities in Tanzania and The Gambia with real-time quantitative PCR. Methods: Conjunctival swabs were obtained at examination from 3146 individuals. Swabs were first tested by the qualitative Amplicor PCR, which is known to be highly sensitive. In positive samples, the number of copies of omp1 (a single-copy C trachomatis gene) was measured by quantitative PCR. Findings: Children had the highest ocular loads of C trachomatis, although the amount of pooling in young age groups was less striking at the site with the lowest trachoma frequency. Individuals with intense inflammatory trachoma had higher loads than did those with other conjunctival signs. At the site with the highest prevalence of trachoma, 48 of 93 (52%) individuals with conjunctival scarring but no sign of active disease were positive for ocular chlamydiae. Interpretation: Children younger than 10 years old, and those with intense inflammatory trachoma, probably represent the major source of ocular C trachomatis infection in endemic communities. Success of antibiotic distribution programmes could depend on these groups receiving effective treatment. (author's)
Lancet. 2002 Jun 29; 359:2258.During a meeting of donors and ophthalmologists on June 18-20, 2002, WHO launched a 5-year program to reduce the burden of avoidable blindness in children in 30 developing countries. The US$3.75 million project, funded by the Lions Clubs International Foundation, will help countries establish comprehensive primary care eye programs, pediatric units, and low vision services. It is noted that half of the 1.5 million cases of childhood blindness have preventable causes including measles, ophthalmia neonatorum, vitamin A deficiency, and harmful traditional medicine eye treatments. Furthermore, of the 500,000 children who become blind each year, 60% die from the causes that resulted in their blindness. WHO warned that blindness and visual impairment among children have "far reaching social, economic, and personal implications serious barriers to the development of the child at a formative stage". The funds and aims of this program will complement other WHO-led projects already in place.
Reliability of clinical diagnosis in identifying infectious trachoma in a low-prevalence area of Nepal.
BULLETIN OF THE WORLD HEALTH ORGANIZATION.. 1999; 77(6):461-5.This article assesses the reliability of clinical diagnosis in identifying trachoma in a low prevalence area in Nepal. WHO s Alliance for Global Elimination of Trachoma by the year 2020 depends on the identification of communities in which blinding trachoma is present and of individuals in these communities who are seeking treatment. All children aged 1-10 from 6 villages in the Surkhet district of the Bheri zone underwent clinical tests, which were administered between November 17 and December 1, 1997. 726 out of 765 children were examined. 125 among these were further evaluated by photography and DNA testing on their right conjunctivae. Clinically active disease was found in 46 out of 726 children seen by the first examiner. Photographic evaluation showed that 32 of these 46 children had clinically active disease, while 14 of 79 children were found negative of the disease on examination. The results revealed that there was a low prevalence of active conjunctival disease in this area: only 6% of the children were clinically active on examination, and none were found to have chlamydia infection as assessed by the most sensitive DNA amplification test available. The WHO policy of not recommending an intensive trachoma control effort when the prevalence of clinically active trachoma is less than 10% in children is therefore appropriate for this area in Nepal. Clinical examination is the only feasible way of estimating the prevalence of infection; however, very low prevalence of active trachoma is not evidence for the presence of chlamydial infection.
BULLETIN OF THE WORLD HEALTH ORGANIZATION.. 1999; 77(6):453.This editorial discusses the global initiative for the elimination of avoidable blindness. Globally, estimated cases of blindness stand at about 45 million. WHO and nongovernmental organizations have launched Vision 2020 toward effectively controlling treatable causes of blindness like cataract and trachoma, particularly in developing countries. Implantation of intra-ocular lenses is common in most developed countries, but it is done in only 11% of cataract operations in India. The sight-restoring rate found by Limburg et al. was only 21%. Consideration toward addressing unoperated cases should be taken with this fact in view. For trachoma, a four-pronged intervention strategy has been worked out, involving surgery for eyelids, antibiotic treatment, facial cleanliness, and environmental hygiene (SAFE).
AFRICA HEALTH. 1999 Mar; 21(3):5-6.The Global Initiative for the Elimination of Avoidable Blindness is a 25-year plan established by the WHO Program for the Prevention of Blindness. Together with several nongovernmental development organizations, the initiative seeks to address the problem of the growth in the number of blind people worldwide. It is estimated that there are over 45 million blind people in the world, 7 million of whom live in Africa. Some 135 million more are identified as having low vision. The aim of the program is to mobilize the resources (financial, personnel, infrastructure, technology, and awareness) necessary to eliminate the main causes of blindness. Knowing the root cause of blindness would allow interest groups to coordinate and focus their efforts toward the prevention of blindness and to determine effective and efficient strategies to minimize the problem.
AFRICA HEALTH. 1998 Jul; 20(5):38.The number of blind and visually impaired is expected to double by the year 2020; 90% of blind people live in developing countries. It is estimated that 80% of the world's blindness is preventable or curable. The World Health Organization (WHO) and a consortium of nongovernmental organizations (NGOs) have launched the Global Initiative for the Elimination of Avoidable Blindness. According to Dr. Bjorn Thylefors, Director of WHO's Programme for the Prevention of Blindness and Deafness, the global initiative will focus on disease control, human resource development, infrastructure, and technology. Priority will be given to the following: 1) cataracts, with a backlog of 16-20 million cases; 2) trachoma, the most common cause of preventable blindness with some 5.6 million blind and 146 million active cases in need of treatment; 3) childhood blindness caused by vitamin A deficiency, measles, conjunctivitis in the newborn, or retinopathy of prematurity; 4) river blindness (onchocerciasis); and 5) refractive errors and low vision. Treatment for trachoma will follow the surgery, antibiotics, facial cleanliness, and environmental hygiene strategy. Dr. Thylefors believes trachoma can be eliminated globally by 2020.