Primary prevention

The neglected tropical diseases road map 2021-2030, endorsed by the World Health Assembly in 2020, has set 2030 as the target date for global elimination of trachoma.[1][21]

The public health approach recommended by the World Health Organization (WHO) to prevent and treat trachoma is called the SAFE strategy.[22] This acronym stands for:

  • Surgery for trichiasis

  • Antibiotics for active infection

  • Facial cleanliness

  • Environmental improvements.

Interventions tailored to the local epidemiology may be of benefit in areas where persistent disease remains.[1][23][24]

Mass drug administration (MDA), representing the A component of SAFE, is effective in reducing active trachoma prevalence, though one systematic review noted that the effectiveness of azithromycin MDA was dependent on baseline prevalence.[25][26]​​ Enhanced MDA is probably needed in hyper-endemic areas in order to achieve and sustain trachoma elimination.[26][27][28]

WHO has recommended that future research focus on identifying critical F and E interventions to reduce trachoma transmission.[21]​ Evidence to support the efficacy of interventions targeting F and E components is limited. One cluster-randomised trial reported no reduction in ocular chlamydia prevalence among both intervention and control groups 36 months after the implementation of a facial cleanliness plus environmental improvement programme.[29]​ The trial is ongoing.​

International Coalition for Trachoma Control: about trachoma Opens in new window

Secondary prevention

Surgery is part of the SAFE strategy (surgery, antibiotics, facial cleanliness, environmental improvements). Prompt surgery must be offered to all patients who have trichiasis in order to prevent blindness.

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