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Trachoma is the leading cause of preventable blindness worldwide.1 Although it disappeared long ago from Western Europe and the United States, trachoma is still as endemic as ever in parts of Africa, the Middle East, Australia, and South East Asia.2 Ocular strains of Chlamydia trachomatis cause repeated episodes of conjunctivitis in children. In teenagers and adults, the disease progresses through a cascade of conjunctival scarring, entropion, trichiasis, and finally blinding corneal ulceration.3 Most cases of the infectious conjunctivitis are not apparent without flipping a child's lids, so affected children rarely receive appropriate treatment. Treatment with oral or prolonged topical antibiotics can eliminate chlamydia in the majority of cases,45 but treated children will almost inevitably be reinfected unless infection in the rest of the community is addressed.6 Thus, trachoma can only be reduced significantly through an extensive public health campaign that targets whole communities.
The World Health Organization (WHO), in conjunction with non-governmental organisations and national health services, recently began implementing a programme designed to eliminate blinding trachoma.2 The WHO's GET 2020 programme (global elimination of trachoma by the year 2020) has adopted a comprehensive set of control measures for trachoma endemic areas summarised as the SAFE strategy (Surgery for entropion/trichiasis, Antibiotics for infectious trachoma, Facial cleanliness to reduce transmission, and Environmental improvements such as access to clean water and control of disease-spreading flies).7 Antibiotics are a key component of this programme, and Pfizer Inc has already donated nearly a million doses of azithromycin to Morocco and Tanzania for trachoma control, and has committed at least a million more to Mali, Ghana, and Vietnam. The GET 2020 strategy has been carefully designed by a consortium of scientists and public health experts from around the world. Optimism is high, but …
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