Lecture 8: Trachoma and Teamwork Flashcards
What is trachoma?
an infectious eye disease caused by chlamydia trachomatis
It is the leading infectious cause of ____ worldwide
blindness
What is unique about trachoma?
No animal reservoir, only found in humans
Which 3 countries recently eliminated trachoma in 2017?
Mexico, Oman, Morocco
Where is trachoma most highly prevalent and in what population?
5 countries in Sub Saharan Africa
Children with ocular infection <10y/o are primary reservoir
What kinds of diseases is chlamydia trachomatis associated with?
ocular (trachoma)
genitourinary (pelvic inflammatory diseases)
respiratory (pneumonia)
What are 4 characteristics of diseases caused by chlamydia trachomatis?
- infections that are long lasting w/out tx
- repeated infections (body does not retain immunologic memory of chlamydia)
- infections that are asymptomatic or minimal sx.
- infections that produce inflammation and scarring without tx (blindness in trachoma occurs over time- can often be minimally symptomatic until that point, scarring of fallopian tubes can result in ectopic pregnancy)
What kind of bacteria is chlamydia trachomatis?
obligate intracellular bacterium
What are the target cells of chlamydia trachomatis?
epithelial cells of endocervix and upper genital tract in women
conjunctiva, urethra, rectum in men and women
Does natural infection with chlamydia trachomatis protect against reinfection?
No
How is trachoma infection spread?
- direct contact with eye secretions
- spread via fomites (inanimate objects)
- eye seeking flies
What occurs for trachoma to be considered “active trachoma”?
ocular infection with chlamydia occurs
conjunctivital inflammation and follicle formation
transmission can lead to repeat infections
What is cicatricial disease and how does it occur?
Long term effects of chronic trachoma/reinfection:
- chronic inflammation and recurring infections leads to eyelid scarring and ingrown eyelashes
- longer exposure occurs leads to corneal opacification (scar tissue over the eye) and blindness
2 main clinical manifestations of trachoma?
active trachoma (inflammation) and cicatricial disease (scarring)
What criteria do flies need to be considered a vector of trachoma?
- be present in area
- come into contact with disease
- spread disease
- transfer disease to new hosts
Which fly species causes trachoma?
-M. SORBENS was the main species of flies that transmit trachoma from person to person
M domestica and C albiceps were also caught in fish bait traps but not enough were found on kids eyes
What does the trachoma graph show?
Over time recurring trachoma leads to blindness
infection as children leads to scarring + blindness as adults
Active trachoma symptoms?
majority asymptomatic
white inflammatory patches w/discharge
follicle
Cicatricial disease symptoms?
eyelid scarring
inward rolling of eyelid (entropion)
ingrown eyelashes (trichiasis)
blindness
Main risk factors for trachoma?
poverty, crowding, poor sanitation
Is trachoma diagnosed clinically or microscopically?
Clinically
using WHO clinical manifestation chart and pictures to make it easier to diagnose
What is GET2020?
Team founded in response to stop blinding trachoma
- Alliance between WHO and various NGOs
- Goal: to prevent BLINDNESS from trachoma
- Uses SAFE strategy
What is the SAFE strategy?
• Active Form
- Surgery (for trichiasis)
- Antibiotics
- Facial cleanliness
- Environmental improvements
AFE are used more widely for active trachoma*
S is done for more severe
How effective is surgery as tx and who is trained to do it?
- important that other providers are taught to do surgery because trachaisis can reoccur and can be pretty common
- improves visual acuity but doesn’t necessarily prevent blindness
- RNS are taught to do it
- epilation used when surgery not an option
What antibiotics are used to treat trachoma?
Azithromycin
-treats individual infections and prevent transmission
Tetracyline eye ointment
What has been Pfizer’s role in treating trachoma?
Pfizer has been donating Azithromycin to alleviate trachoma burden
Why is mass drug administration effective?
- trachoma is human reservoir only
2. 1 dose of Azithromycin is effective
What do countries need to be eligible for Azithromycin donation?
> 5% prevalence
implement SAFE strategy
Plan for distribution- paying staff and transporation
Providing education and social engagement
Ensuring health workers are competent in administering and monitoring patients
How is facial cleanliness best achieved?
Clean water and hygiene practices
- difficult without good water and sanitation
- bad sanitation increases breeding ground for flies that spread disease
What are some environmental improvements for trachoma?
- installing ventilated latrines is an important initiative and best one to do in resource limited setting
- use concrete slab over waste to prevent infection
Community engagement for trachoma?
- Holding government accountable.
- Participating in MDA
- Undergoing surgery if needed
risk factors that made Morocco more susceptible to trachoma?
“improved drinking water” (covered well, rainwater) was mainly accessible to urban areas
-rural areas mainly had access to “unimproved water” (lower sanitation, rivers, dams, uncovered well)
-“Unimproved sanitation”: open pit latrine, hanging toilet- anything with exposure to feces/human waste
-urban areas had better access to
“improved sanitation”- pour flush/septic tank
What is the National Blindness Control Program? (NBCP_
- started in 1991 targeting rural areas in Morocco
- unimproved water + sanitation in 5 rural provinces
- adopted SAFE strategy in late 90s
Who collaborated to form NBCP?
paired up with international orgs and govt
WHO, UNICEF, Ministry of health, Min. of education, min. of employment
What goal did Morocco achieve to eliminate trachoma?
Prevalence rate < 2.5%
7 work team Characteristics of eye surgery work team in Morocco?
- shared goal: removing infected lashes
- shared responsibility: working in OR
- defined membership: working w/surgeons/RNs
- authority to take action: specialized training and authority from ministry of health
- interdependency: require other ppl’s skills to do surgery
- absence of larger subgroups: just need an OR team
- accountability : to WHO and MoH
What type of team is the eye surgery team?
Template team
- has all 7 characteristics
- clear leader
- time limited care and people are replaceable
Assessing competencies in eye surgery?
- Safety- training people to do surgeries
- Effectiveness- randomized control trials
- Patient Centeredness- reaching rural community
- Timelineness- doing surgeries quickly after dx
- Efficiency- quick and efficient, can be done by RN/MD
- Equity- treating everyone in need
