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MMWR. Morbidity and Mortality Weekly Report. 2018 May 4; 67(17):491-495.In 2005, the Regional Committee for the World Health Organization (WHO) Western Pacific Region (WPR)* established a goal for measles elimination(dagger) by 2012 (1). To achieve this goal, the 37 WPR countries and areas implemented the recommended strategies in the WPR Plan of Action for Measles Elimination (2) and the Field Guidelines for Measles Elimination (3). The strategies include 1) achieving and maintaining >/=95% coverage with 2 doses of measles-containing vaccine (MCV) through routine immunization services and supplementary immunization activities (SIAs), when required; 2) conducting high-quality case-based measles surveillance, including timely and accurate testing of specimens to confirm or discard suspected cases and detect measles virus for genotyping and molecular analysis; and 3) establishing and maintaining measles outbreak preparedness to ensure rapid response and appropriate case management. This report updates the previous report (4) and describes progress toward measles elimination in WPR during 2013-2017. During 2013-2016, estimated regional coverage with the first MCV dose (MCV1) decreased from 97% to 96%, and coverage with the routine second MCV dose (MCV2) increased from 91% to 93%. Eighteen (50%) countries achieved >/=95% MCV1 coverage in 2016. Seven (39%) of 18 nationwide SIAs during 2013-2017 reported achieving >/=95% administrative coverage. After a record low of 5.9 cases per million population in 2012, measles incidence increased during 2013-2016 to a high of 68.9 in 2014, because of outbreaks in the Philippines and Vietnam, as well as increased incidence in China, and then declined to 5.2 in 2017. To achieve measles elimination in WPR, additional measures are needed to strengthen immunization programs to achieve high population immunity, maintain high-quality surveillance for rapid case detection and confirmation, and ensure outbreak preparedness and prompt response to contain outbreaks.
Baltimore, Maryland, Jhpiego, 2018. 92 p. (USAID Award No. HRN-A-00-98-00043-00; USAID Leader with Associates Cooperative Agreement No.GHS-A-00-04-00002-00)The Malaria in Pregnancy reference manual and clinical learning materials are intended for skilled providers who provide antenatal care, including midwives, nurses, clinical officers, and medical assistants. The clinical learning materials can be used to conduct a 2-day workshop designed to provide learners with the knowledge and skills needed to prevent, recognize, and treat malaria in pregnancy as they provide focused antenatal care services.
Washington, D.C., PAHO, 2017. 38 p.This document provides technical content on ZIKV, its manifestations, complications, modes of transmission, and prevention measures to be used in answering frequently asked questions and conveying messages in information and communication materials, community talks, press conferences, etc. Recommendations for the preparation of risk communication and action plans to respond to ZIKV are included. This guide to activities and recommendations for managing risk communication on ZIKV is designed for spokespersons, health authorities and health workers, other sectors, and partners inside and outside the health sector to assist them in tailoring communication initiatives to the needs of each country and target audience. The elimination of mosquito breeding sites remains the most important strategy for the prevention and control of ZIKV (as well as dengue and chikungunya) infection. Therefore, communication plans for the response to ZIKV should include intersectoral action and community engagement to modify behaviors and encourage sustained practices to eliminate breeding sites and control the mosquito, as well as to inform and educate target audiences about the steps they can take to prevent ZIKV transmission. The fourth meeting of the Emergency Committee under the International Health Regulations agreed that, “due to continuing geographic expansion and considerable gaps in understanding of the virus and its consequences, Zika virus infection and its associated congenital malformations and other related neurological disorders, ZIKV continues to be a public health emergency of intenational concern.
[Geneva, Switzerland], WHO, 2016 Jun 9.  p.As of 8 June 2016, 60 countries and territories report continuing mosquito-borne transmission of which: 46 countries are experiencing a first outbreak of Zika virus since 2015, with no previous evidence of circulation, and with ongoing transmission by mosquitos. 14 countries reported evidence of Zika virus transmission between 2007 and 2014, with ongoing transmission. In addition, four countries or territories have reported evidence of Zika virus transmission between 2007 and 2014, without ongoing transmission: Cook Islands, French Polynesia, ISLA DE PASCUA -Chile and YAP (Federated States of Micronesia). Ten countries have reported evidence of person-to-person transmission of Zika virus, probably via a sexual route. In the week to 8 June 2016, no new country reported mosquito-borne or person-to-person Zika virus transmission. As of 8 June 2016, microcephaly and other central nervous system (CNS) malformations potentially associated with Zika virus infection or suggestive of congenital infection have been reported by eleven countries or territories. Three of those reported microcephaly borne from mothers with a recent travel history to Brazil (Slovenia, United States of America) and Colombia (Spain), for one additional case the precise country of travel in Latin America is not determined. In the context of Zika virus circulation, 13 countries and territories worldwide have reported an increased incidence of Guillain-Barré syndrome (GBS) and/or laboratory confirmation of a Zika virus infection among GBS cases. As of 8 June, Cabo Verde has reported a total of six cases of microcephaly and other neurological abnormalities with serological indication of previous Zika infection. Based on research to date, there is scientific consensus that Zika virus is a cause of microcephaly and GBS. The global Strategic Response Framework launched by the World Health Organization (WHO) in February 2016 encompasses surveillance, response activities and research. An interim report has been published on some of the key activities being undertaken jointly by WHO and international, regional and national partners in response to this public health emergency. A revised strategy for the period July 2016 to December 2017 is currently being developed with partners and will be published in mid-June. WHO has developed new advice and information on diverse topics in the context of Zika virus. WHO’s latest information materials, news and resources to support corporate and programmatic risk communication, and community engagement are available online. (Excerpt)
[Geneva, Switzerland], WHO, 2016 Feb.  p.This fact sheet on Zika virus contains a list of key facts and information on its signs and symptoms, potential complications, transmission, diagnosis, prevention, treatment, and WHO response.
Releve Epidemiologique Hebdomadaire / Section D'hygiene Du Secretariat De La Societe Des Nations. 2014 Oct 31; 89(44):493-9.Add to my documents.
Releve Epidemiologique Hebdomadaire / Section D'hygiene Du Secretariat De La Societe Des Nations. 2014 Oct 31; 89(44):500-4.Add to my documents.
WHO guidelines for antimicrobial treatment in children admitted to hospital in an area of intense Plasmodium falciparum transmission: prospective study.
BMJ. British Medical Journal. 2010; 340:c1350.OBJECTIVES: To assess the performance of WHO's "Guidelines for care at the first-referral level in developing countries" in an area of intense malaria transmission and identify bacterial infections in children with and without malaria. DESIGN: Prospective study. SETTING: District hospital in Muheza, northeast Tanzania. PARTICIPANTS: Children aged 2 months to 13 years admitted to hospital for febrile illness. MAIN OUTCOME MEASURES: Sensitivity and specificity of WHO guidelines in diagnosing invasive bacterial disease; susceptibility of isolated organisms to recommended antimicrobials. RESULTS: Over one year, 3639 children were enrolled and 184 (5.1%) died; 2195 (60.3%) were blood slide positive for Plasmodium falciparum, 341 (9.4%) had invasive bacterial disease, and 142 (3.9%) were seropositive for HIV. The prevalence of invasive bacterial disease was lower in slide positive children (100/2195, 4.6%) than in slide negative children (241/1444, 16.7%). Non-typhi Salmonella was the most frequently isolated organism (52/100 (52%) of organisms in slide positive children and 108/241 (45%) in slide negative children). Mortality among children with invasive bacterial disease was significantly higher (58/341, 17%) than in children without invasive bacterial disease (126/3298, 3.8%) (P<0.001), and this was true regardless of the presence of P falciparum parasitaemia. The sensitivity and specificity of WHO criteria in identifying invasive bacterial disease in slide positive children were 60.0% (95% confidence interval 58.0% to 62.1%) and 53.5% (51.4% to 55.6%), compared with 70.5% (68.2% to 72.9%) and 48.1% (45.6% to 50.7%) in slide negative children. In children with WHO criteria for invasive bacterial disease, only 99/211(47%) of isolated organisms were susceptible to the first recommended antimicrobial agent. CONCLUSIONS: In an area exposed to high transmission of malaria, current WHO guidelines failed to identify almost a third of children with invasive bacterial disease, and more than half of the organisms isolated were not susceptible to currently recommended antimicrobials. Improved diagnosis and treatment of invasive bacterial disease are needed to reduce childhood mortality.
Clinical Pharmacokinetics. 2008; 47(2):91-102.Malaria, a disease transmitted by the female Anopheles mosquito, has had devastating effects on human populations for more than 4000 years. Treatment of the disease with single drugs, such as chloroquine, sulfadoxine/pyrimethamine or mefloquine, has led to the emergence of resistant Plasmodium falciparum parasites that lead to the most severe form of the illness. Artemisinin-based combination therapies are currently recommended by WHO for the treatment of uncomplicated P. falciparum malaria. Artemisinin and semisynthetic derivatives, including artesunate, artemether and dihydroartemisinin, are short-acting antimalarial agents that kill parasites more rapidly than conventional antimalarials, and are active against both the sexual and asexual stages of the parasite cycle. Artemisinin fever clearance time is shortened to 32 hours as compared with 2-3 days with older agents. To delay or prevent emergences of resistance, artermisinins are combined with one of several longer-acting drugs - amodiaquine, mefloquine, sulfadoxine/pyrmethamine or lumefantrine - which permit elimination of the residual malarial parasites. The clinical pharmacology of artemisinin-based combination therapies is highly complex. The short-acting artemisinins and their long-acting counterparts are metabolized and/or inhibit/induce cytochrome P450 enzymes, and may thus participate in drug-drug interactions with multiple drugs on the market. Alterations in antimalarial drug plasma concentrations may lead to either suboptimal efficacy or drug toxicity and may compromise treatment. (author's)
New York, New York, United Nations Population Fund [UNFPA], 2007.  p.The influence behind faith-based organizations is not difficult to discern. In many developing countries, FBOs not only provide spiritual guidance to their followers; they are often the primary providers for a variety of local health and social services. Situated within communities and building on relationships of trust, these organizations have the ability to influence the attitudes and behaviours of their fellow community members. Moreover, they are in close and regular contact with all age groups in society and their word is respected. In fact, in some traditional communities, religious leaders are often more influential than local government officials or secular community leaders. Many of the case studies researched for the UNFPA publication Culture Matters showed that the involvement of faith-based organizations in UNFPA-supported projects enhanced negotiations with governments and civil society on culturally sensitive issues. Gradually, these experiences are being shared across countries andacross regions, which has facilitated interfaith dialogue on the most effective approaches to prevent the spread of HIV. Such dialogue has also helped convince various faith-based organizations that joining together as a united front is the most effective way to fight the spread of HIV and lessen the impact of AIDS. This manual is a capacity-building tool to help policy makers and programmers identify, design and follow up on HIV prevention programmes undertaken by FBOs. The manual can also be used by development practitioners partnering with FBOs to increase their understanding of the role of FBOs in HIV prevention, and to design plans for partnering with FBOs to halt the spread of the virus. (excerpt)
Geneva, Switzerland, UNAIDS, 2007.  p. (UNAIDS/07.07E; JC1274E)These Practical Guidelines for Intensifying HIV Prevention: Towards Universal Access are designed to provide policy makers and planners with practical guidance to tailor their national HIV prevention response so that they respond to the epidemic dynamics and social context of the country and populations who remain most vulnerable to and at risk of HIV infection. They have been developed in consultation with the UNAIDS cosponsors, international collaborating partners, government, civil society leaders and other experts. They build on Intensifying HIV Prevention: UNAIDS Policy Position Paper and the UNAIDS Action Plan on Intensifying HIV Prevention. In 2006, governments committed themselves to scaling up HIV prevention and treatment responses to ensure universal access by 2010. While in the past five years treatment access has expanded rapidly, the number of new HIV infections has not decreased - estimated at 4.3 (3.6-6.6) million in 2006 - with many people unable to access prevention services to prevent HIV infection. These Guidelines recognize that to sustain the advances in antiretroviral treatment and to ensure true universal access requires that prevention services be scaled up simultaneously with treatment. (excerpt)
In: The HIV challenge to education: a collection of essays, edited by Carol Coombe. Paris, France, UNESCO, International Institute for Educational Planning, 2004. 253-263. (Education in the Context of HIV / AIDS)Twenty years after the identification of AIDS, some 60 million people have been infected by HIV, a number corresponding to the entire population of France, the United Kingdom or Thailand. Those who have died equal the population of Norway, Sweden, Finland and Denmark combined. Those currently infected - more than 40 million - number more than the entire population of Canada. The number of children thought to be orphaned by HIV/AIDS - some 14 million - is already more than the total population of Ecuador. Over the coming decade their numbers may rise to a staggering 50 million worldwide. In other words, the extent of this pandemic is unprecedented in human history. And the worst is yet to come, for many millions more will be infected, many millions more will die, many millions more will be orphaned. On September 11 2001, more than 3,000 people died in the New York bombings. Every day, around the world, HIV infects at least five times that number. But it is not only individuals who are at risk. The social fabric of whole communities, societies and cultures is threatened. The disease is certain to be a scourge throughout our lifetime. (excerpt)
Lancet Infectious Diseases. 2006 Jan; 6(1):10.On World AIDS Day 2005, the United Nations (UN) announced that almost 5 million people in the world were newly infected by HIV in 2005--the highest jump since the first reported case in 1981. The 4.9 million new infections were fuelled by the epidemic's continuing rampage in sub-Saharan Africa and a spike in the former Soviet Union, eastern Europe, central Asia, and east Asia, the UNAIDS body said in its annual report. 2 days later, the Joint United Nations Programme on HIV/AIDS, the WHO, and the United Nations Population Fund endorsed another announcement by the European Union to intensify HIV prevention efforts to get ahead of the epidemic. "The problem", says Adamson Muula (Department of Community Health, University of Malawi) "is prevention means many things to many people". This can be a good thing if we deal with the HIV problem from different angles but it can also result in all of us trying to pull in different directions, he says. Education is certainly important and must continue, but Muula warns that targeting is vital. "When teaching about virus transmission, we need to go beyond politically correct thinking. Anal sex between a male and a heterosexual female certainly happens in Africa but it is rarely spoken of; this must change", he says. There is also a need to recognise that homosexuality happens, even though societies are intolerant of it and even though it is regarded as illegal in some countries. (excerpt)
Manila, Philippines, WHO, Regional Office for the Western Pacific, STI, HIV and AIDS Focus, 2002 Jul.  p.Sexually transmitted infections (STIs) are infectious diseases that are transmitted from person to person during sexual contact, not necessarily vaginal intercourse. A large number of bacteria, viruses, fungi and other organisms may be sexually transmissible and may result in disease. Most bacterial, fungal and parasitic infections can be cured with antimicrobial agents. On the other hand, most viral infections cannot be cured. Antiviral drugs can sometimes contain the progression or effects of viral infections, although such treatments are often expensive, are inaccessible to many individuals, and may have substantial side effects. Persons with sexually transmitted infections are infectious to their sexual partners even though they may have no symptoms or signs of infection. In fact, many people - men and women - have STIs without symptoms or signs, although they can develop serious complications. STIs are a public health problem because of their potential to cause serious complications such as infertility, chronic disability and death in men, women and children. STIs can affect the foetus, neonate and infant, resulting in eye infection, blindness and pneumonia. The public health importance of STIs has taken on an even greater dimension with the advent of human immunodeficiency virus (HIV) infection. HIV infection is sexually transmissible, is not curable and leads to the acquired immunodeficiency syndrome (AIDS). (excerpt)
Annual Review of Public Health. 1987; 8:75-110.The global program of malaria eradication coordinated and supported by the World Health Organization (WHO) since 1957 has been successful in most the countries in the temperate climate zones of the globe. However, by the end of the 1960s it became evident that technical problems, such as resistance of mosquito vectors to insecticides and resistance of malaria parasites to drugs, presented serious obstacles to the pursuit of eradication programs in many tropical countries. Moreover, the administrative and financial difficulties of the developing countries were such that a revised strategy of antimalaria campaigns became necessary. In 1969 the World Health Organization recommended that although eradication of malaria should remain an ultimate goal, in countries where eradication does not appear to be feasible, malaria control operations may form a transitional stage. All effective methods of attack on the parasite and on the Anopheles vector should be employed according to epidemiological conditions of the area involved and in relation to their technical and logistic feasibility. Nevertheless, during the past decade the malaria situation has deteriorated in several countries, especially in southern and southeast Asia and some parts of Latin America. There has been no improvement in the highly endemic countries of tropical Africa. (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)
Perspectives in Health. 2003; 8(2):15-21.Andean ministers of health meeting last April proposed an Andean vaccination week. The idea was soon expanded to include South America and later Mexico, Central America and the Caribbean. Eventually 19 countries joined together for the first Vaccination Week in the Americas. The focus was on children who had never been vaccinated: those in hard-to-reach rural areas or marginal urban zones whom earlier campaigns had left behind. (excerpt)
New York, New York, Global Alliance for TB Drug Development, 2002. 2 p.A Lethal Synergy: While HIV/AIDS has exploded over the last decade, TB has increased 20% rise and today TB kills one out of three AIDS patient worldwide. The two diseases represent a deadly combination, since both are more destructive together than either is alone. HIV infection is the most potent risk factor for converting latent TB into active transmissible TB - accelerating the spread of the disease - while TB bacteria help accelerate the progress of the AIDS infection in the patient. Today TB is the leading cause of death in persons who are HIV positive. (excerpt)
Transmission intensity index to monitor filariasis infection pressure in vectors for the evaluation of filariasis elimination programmes.
Tropical Medicine and International Health. 2003 Sep; 8(9):812-819.We conducted longitudinal studies on filariasis control in Villupuram district of Tamil Nadu, south India, between 1995 and 2000. Overall, 23 entomological (yearly) data sets were available from seven villages, on indoor resting collections [per man hour (PMH) density and transmission intensity index (TII)] and landing collections on human volunteers [PMH and annual transmission potential (ATP)]. All four indices decreased or increased hand-in-hand with interventions or withdrawal of inputs and remained at high levels without interventions under varied circumstances of experimental design. The correlation coefficients between parameters [PMH: resting vs. landing (r = 0.77); and TII vs. ATP (r = 0.81)] were highly significant (P < 0.001). The former indices from resting collections stand a chance of replacing the latter from landing collections in the evaluation of global filariasis elimination efforts. The TII would appear to serve the purpose of a parameter that can measure infection pressure per unit time in the immediate household surroundings of human beings and can reflect the success or otherwise of control/elimination efforts along with human infection parameters. Moreover, it will not pose any additional risk of new infection(s) and avoids infringement of human rights concerns by the experimental procedures of investigators, unlike ATP that poses such a risk to volunteers. (author's)
Variation in incidence of serious adverse events after onchocerciasis treatment with ivermectin in areas of Cameroon co-endemic for loiasis.
Tropical Medicine and International Health. 2003 Sep; 8(9):820-831.Objective: To determine the incidence of serious adverse events (SAEs) after mass treatment with ivermectin in areas co-endemic for loiasis and onchocerciasis, and to identify potential risk factors associated with the development of these SAEs, in particular encephalopathic SAEs. Methods: We retrospectively analysed SAEs reported to have occurred between 1 December 1998 and 30 November 1999 in central-southern Cameroon by chart review, interview and examination of a subset of patients. Results: The overall incidence of SAEs for the three provinces studied was 6 per 100,000. However, for Central Province alone the incidence of SAEs was 2.7 per 10,000 overall, and 1.9 per 10,000 for encephalopathic SAEs associated with Loa loa microfilaremia (PLERM). The corresponding rates for the most severely affected district within Central Province (Okola) were 10.5 per 10,000 and 9.2 per 10,000 respectively. Symptoms began within the first 24–48 h of ivermectin administration but there was a delay of approximately 48–84 h in seeking help after the onset of symptoms. First-time exposure to ivermectin was associated with development of PLERM. Conclusion: In Cameroon, the incidence of SAEs following ivermectin administration in general, and PLERM cases in particular, varies substantially by district within the areas co-endemic for loiasis and onchocerciasis. More intense surveillance and monitoring in the first 2 days after mass distribution in ivermectin-naïve populations would assist in early recognition, referral and management of these cases. The increased reporting of SAEs from Okola is unexpected and warrants further investigation. Research is urgently needed to find a reliable screening tool to exclude individuals (rather than communities) at risk of PLERM from the mass treatment program. (author's)
Advances in Reproduction. 2003; 7(4):217-219.Men suffer from a wide variety of STIs. Many of the more serious sexually transmitted infections infect men without causing any symptoms. Population based surveys relying only upon self-reported morbidity will miss the majority of infected men. Objective measures requiring laboratory validation are needed for sexually transmitted infection prevalence estimates. It is clinically easier and more effective to treat STI symptoms in men than in women. The predictive value of these symptoms in men is high: they are more likely to be due to a STI than to anything else. The picture in women is more problematic as endogenous, non-STIs are more common. Management of men with STI should always include treatment options for their sexual partners as well. Untreated STIs in man can lead to male infertility, acquisition and transmission of HIV, and STI transmission to female sexual partners, who may subsequently pass the infection to their unborn children. Not only is male-to-female STI transmission more efficient biologically, social and cultural factors often inhibit women's ability to protect themselves from infection. (author's)
Epidemiology of measles in the central region of Ghana: a five-year case review in three district hospitals.
East African Medical Journal. 2003 Jun; 80(6):312-317.Objective: As part of a national accelerated campaign to eliminate measles, we conducted a study, to define the epidemiology of measles in the Central Region. Design: A descriptive survey was carried out on retrospective cases of measles. Setting: Patients were drawn from the three district hospitals (Assin, Asikuma and Winneba Hospitals) with the highest number of reported cases in the region. Subjects: Records of outpatient and inpatient measles patients attending the selected health facilities between 1996 and 2000. Data on reported measles eases in all health facilities in the three study, districts were also analysed. Main outcome measures: The distribution of measles eases in person (age and sex), time (weekly, or monthly, trends) anti place (residence), the relative frequency, of eases, and the outcome of treatment. Results: There was an overall decline in reported eases of measles between 1996 and 2000 both in absolute terms and relative to other diseases. Females constituted 48%- 52% of the reported 1508 eases in the hospitals. The median age of patients was 36 months. Eleven percent of eases were aged under nine months; 66% under five years and 96% under 15 years. With some minor variations between districts, the highest and lowest transmission occurred in March and September respectively. Within hospitals, there were sporadic outbreaks with up to 34 weekly eases. Conclusion: In Ghana, children aged nine months to 14 years could be appropriately targeted for supplementary, measles immunization campaigns. The best period for the campaigns is during the low transmission months of August to October. Retrospective surveillance can expediently inform decisions about the timing and target age groups for such campaigns. (author's)
Guttmacher Report on Public Policy. 2003 Aug; 6(3):4-5, 14.In the United States and other developed countries, where Pap tests are widely available and easily accessible, deaths from cervical cancer have plunged in recent decades, even in the presence of high HPV rates. Death rates remain high in developing countries because women lack access to Pap tests or other effective screening programs. The evidence strongly suggests, then, that while keeping the focus on HPV and its sexual transmission may be politically useful in advancing a morality-based, abstinence-until- marriage agenda, a more realistic campaign against cervical cancer deaths would focus on increasing access to cervical cancer screening among women around the world. (excerpt)
Social Science and Medicine. 2003 Oct; 57(8):1397-1407.The battle to completely control cholera continues. Multiple strains, high levels of morbidity in some regions of the world, and a complex of influences on its distribution in people and the environment are accompanied by only rough resolution prediction of outbreaks. Uncertainty as to the most effective array of interventions for one of the most researched infectious diseases thwarts further progress in providing cost-effective solutions. Progress on the research front consistently points towards the importance of disease ecology, coastal environments, and the sea. However, evaluation of the link between cholera in people and environment can only be effective with analysis of human vulnerability to variable coastal cholera ecologies. As there are some clear links between the organism, cholera incidence and the sea, it is appropriate that cholera research should examine the nature of coastal population vulnerability to the disease. The paper reviews the cholera risks of human–environment interactions in coastal areas as one component of the evaluation of cholera management. This points to effective intervention through integrative knowledge of changing human and environmental ecologies, requiring improved detection, but also an acceptance of complex causality. The challenge is to identify indicators and interventions for case specific ecologies in variable locales of human vulnerability and disease hazard. Further work will therefore aim to explore improved surveillance and intervention across the sociobehavioural and ecological spectrum. Furthermore, the story of cholera continues to inform us about how we should more effectively view emergent and resurgent infectious disease hazards more generally. (author's)
Lancet. 2003 Jul 19; 362(9379):223-229.Trachoma is the most common infectious cause of blindness. It is caused by ocular serovars of Chlamydia trachomatis. Transmission is favoured in poor communities, where crowding is common and access to water and sanitation inadequate. Repeated reinfection over many years causes dense scarring of the upper eyelid. The resultant inversion of the lashes abrades the eyeball, and the abrasion leads to corneal opacification and visual impairment. The host immune response is probably at least partly the cause of this process. The “SAFE” strategy is used for the control of trachoma: surgery for inturned lashes, antibiotics for active disease, facial cleanliness, and environmental improvement. The demonstration that a single oral dose of the antibiotic azithromycin is as effective as 6 weeks of topical tetracycline was an important advance in trachoma control. By means of the SAFE strategy, WHO and its partners aim to eliminate trachoma as a public-health problem by the year 2020. (author's)