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BMJ (CLINICAL RESEARCH ED.). 1996 Dec 7; 313(7070):1428.The World Health Organization (WHO) has developed a strategy, SAFE, to eradicate trachoma globally: it includes surgery for trichiasis, antibiotics, facial cleanliness, and environmental improvement. Goals of the alliance of governments, international organizations, and nongovernmental organizations assembled by WHO include: 1) to identify countries where trachoma is epidemic; 2) to map the disease; 3) to initiate community-based hygiene programs; and 4) to make surgery widely available. 15% of the world's blindness is due to trachoma; about 6 million people have been irreversibly blinded, and an estimated 146 million require treatment to avoid blindness. David Mabey, professor of communicable diseases at the London School of Hygiene and Tropical Medicine, describes trachoma, which is spreading in Africa, as "the forgotten disease of the poorest people in the world." The disease, which is caused by Chlamydia trachomatis, is associated with overcrowding, poor hygiene, and limited access to water and sanitation. Contact with the eye discharge of an infected person, or with flies that seek eyes, transmits the disease. Treatment with tetracycline requires daily doses of eye ointment for 6 weeks. Azithromycin, which is expensive, can be given in 1 dose, and is currently being tested. Since people are reinfected quickly, whole communities are being treated in studies in Gambia and Tanzania. A vaccine is being developed.