We read with great interest the article by Mariotti et al. estimating the global prevalence of trachoma. For the country of Egypt, the article refers only to the published survey in Menofiya Governorate in the Nile Delta, suggesting that only this single governorate is endemic for trachoma. This is far from the case, however, as two other studies shed light on trachoma in other areas of Egypt. Both studies were presented and reported in the meetings of the WHO Alliance for the Global Elimination of Trachoma by 2020 for the years 2004 & 2005 and submitted to the Ministry of Health & Population. A population based survey of trachoma (sample size = 4,500) was conducted in Menia Governorate (3.5 million) in 2002; among children age 2-10 years the prevalence of active trachoma was 42% while among adults age 50+ the prevalence of trachomatous trichiasis was 6.2%. This survey has formed the basis for interventions by the Ministry of Health and the Al Noor Foundation to address trachoma in Upper Egypt. Separately, a Trachoma Rapid Assessment was carried out in 15 villages in Fayoum Governorate in 2003. This work identified trachoma as a severe public health problem in these communities with village prevalence of active disease among children (ages 2-10) ranging from 15.9% to 85.2%. Similar to Menia, trichiasis was common with 7.7% of adults age 50+ having trichiasis. In both of these settings, and throughout much of rural Egypt, the conditions with encourage trachoma transmission are still evident—poor sanitation and poor facial cleanliness being the most notable.

Clearly, there is a need for more systematic epidemiologic surveys and mapping of trachoma in Egypt in order to estimate the prevalence of active trachoma and trichiasis in the country. The current evidence from Egypt, however suggests that the figures presented in the paper by Mariotti and colleagues is a significant underestimate of the distribution and magnitude of the trachoma in the country.