Bangkok--Jul 8--PR & Associates
Comprehensive five-year strategy expected to end "Leading Cause of Preventable Blindness”
Disease once common throughout country Now limited to pockets in North as final push begins
Vietnam is on track to become one of the first countries in more than 50 years to eliminate blinding trachoma as part of an international effort to eliminate blindness from the disease worldwide. The country’s national trachoma-control program headed by its Ministry of Health is expected to be successful by 2010, ten years before the global elimination target date set by the World Health Organization.
“We are proud to have reduced the incidence of trachoma so dramatically as a result of our national trachoma control strategy,” said the Vietnamese Vice Minister of Health Tran Chi Liem at the 2004 trachoma strategic planning workshop. “The Vietnamese people have worked very successfully with our partner organizations, and the entire country will benefit from eliminating this tragic disease.”
Trachoma is the world’s leading cause of preventable blindness. Caused by the bacterium Chlamydia trachomatis, the disease was once prevalent in many parts of the world but is now limited to approximately 56 countries, primarily regions in the developing world where water and sanitation services are not readily available. The disease is easily spread through casual contact and mother-to-child contact, but it can be controlled through improved hygiene, sanitation, use of antibiotics and simple surgery in advanced cases.
Approximately eight million people worldwide are visually impaired as a result of trachoma, with 84 million suffering from active infection. The WHO estimates that 10 percent of the world’s population is at risk for trachoma, making it a major public health threat. In Vietnam, an estimated 11 million people are at risk of trachoma infection, with 300,000 cases of trachoma-related blindness.
Repeated trachoma infections over time, if untreated, result in in-turned eyelashes which then scratch and scar the cornea, leading to blindness. Children in the age range of 1-5 years are most prone to infection, and women are two to three times more likely than men to be infected by trachoma as they care for their children and thus likely to experience repeated infections. Because the disease causes blindness in the most productive years of a person’s life, it can ruin the economic well being of entire families and communities. Developing countries lose almost $3 billion in productivity per year to blindness caused by trachoma.
The Vietnamese trachoma elimination effort is being implemented by the Vietnamese Ministry of Health with the assistance of international non-governmental organizations and public health organizations including ITI.
ITI was founded in 1998 by the Edna McConnell Clark Foundation and the research-based pharmaceutical company Pfizer. Today ITI has trachoma elimination program in 11 countries worldwide, including Vietnam and Nepal in Asia.
“Our partnership with the Vietnamese government on trachoma control efforts has been extraordinary,” said Jacob Kumaresan, M.D., president of ITI. “The country had made great strides to reduce trachoma infections during the last 50 years, and we are now confident that blindness from the disease will be eliminated within the next five years.”
Global Campaign Uses Unique Strategy
The ITI uses a unique strategy called SAFE to fight trachoma.
The SAFE acronym stands for: "S" for surgery to treat complications that may cause blindness if left untreated; "A" for antibiotics to treat active trachoma infections; "F" to encourage face washing to reduce disease transmission; and "E" for environmental changes to improve sanitation and access to clean water. SAFE is recommended by the World Health Organization for trachoma control.
Since ITI’s inception, Pfizer has donated its patented broad-spectrum antibiotic Zithromax for use in the “A” part of the treatment and prevention regimen. The company committed itself to this cause after learning that a single, annual, oral dose of Zithromax was as effective, yet much easier to administer, than the existing treatment -- multiple daily doses of tetracycline eye ointment applied directly to the eye for two weeks.
Pfizer donated eight million Zithromax treatments to ITI’s global effort in its first five years, which included 1.3 million doses in Vietnam. Pfizer increased its global commitment to 135 million more doses for the second five years — a 15-fold increase — in response to ITI’s remarkable success in its program countries. In total, the global Zithromax donation during the first 10 years of the global effort will be the largest donation of an on-patent medication in history.
“Pfizer continues to be enthusiastic about the potential for global elimination of trachoma-related blindness by 2020, with Vietnam serving as a strong example of how successful the SAFE strategy can be,” said Pfizer Vice President Chuck Hardwick. “As a company, we are pleased to have contributed such significant amounts of Zithromax to ITI in the last seven years, and we look forward to increasing our donation level as the effort continues, including here in Vietnam.”
Trachoma in Vietnam
ITI's support to Vietnam began in 2000 and targeted 24 rural districts, mostly in the north of the country. Vietnam had been chosen as one of ITI's first program countries in part because the Vietnamese government had already had a great degree of success in controlling the disease during the second half of the 20th Century. Disease prevalence had been as high as 60 percent in 1960, but by the mid-1990s, trachoma prevalence had been brought to much lower levels, with active trachoma cases confined to clusters within the population and advanced cases — known as trichiasis.
National surveys in the 1990’s determined the pockets of disease distribution mostly in rural areas, ranging between 10-27%. An estimated 11 million people remain in need of antibiotic treatment, and the backlog of trichiasis cases needing surgery is approximately 300,000.
It is estimated that 1700 Vietnamese communes have active trachoma prevalence of over 5 percent, and of these at least 630 have prevalence rates of over 10 percent.
The 2000-2004 period of the Vietnam/ITI partnership introduced the SAFE strategy, including the donation of 1.3 million doses of Pfizer's Zithromax. Almost 47,000 trichiasis surgeries were performed during this initial, two-year phase of the program.
557 communes in 24 districts in 15 provinces were included in the MOH/ITI trachoma control program period 2000-2004. These districts are found largely in the Northern Highlands, Central Coastal, and Red River Delta provinces. During the course of this phase, the program has covered an estimated one-third of the remaining trachoma-endemic districts in Vietnam.
Since inception, the prevalence of disease in children was reduced by 50%-75% and the backlog of surgeries by 13.5%. The program’s face washing and trachoma awareness messages reached thousands of villagers during the last five years, and water and sanitation projects have brought safe water sources and latrines to many communities in trachoma-endemic areas.
An Effective Partnership
An important key to the Vietnam program's success has been the work of local health providers and educators. With the technical support from the National Institute of Ophthalmology (NIO), Provincial eye centers organized mobile teams to conduct eyelid surgeries at commune health centers. Provincial eye centers also trained community health workers and nurses to distribute Zithromax annually, fulfilling the "S" and "A" components of the SAFE strategy.
The General Department of Preventive Medicine and HIV-AIDS control (GDPMAC), plays a crucial coordination role among the partners, emphasizing the "F" and "E" components of the strategy in Vietnam. The GDPMAC works closely with the Ministry of Education and Training (MOET), the Ministry of Agriculture and Rural Development (MARD), International Development Enterprise (IDE), UNICEF, and other partners involved in trachoma control to support a multi-pronged approach in health education and health promotion throughout the 15 provinces that have been targeted in the period 2000-2004. Part of this effort includes an expansion of a private-sector rainwater-harvesting program, especially in the more arid areas of the country. IDE stimulates market demand for improved water supplies through a comprehensive social marketing campaign.
More than 3,000 health workers and some 10,000 schoolteachers and women promoters have been trained on trachoma prevention and on communication skills in Vietnam as a result of this partnership.
These elements of the partnership have reached more than two million people in the project areas through direct (meetings/home visits) and indirect (materials/messages) contacts. The project has also supported the installation of 90 water tanks in program area schools.
2005-2010: The Road Ahead
In 2004, the Ministry of Health organized the Strategic Planning Workshop to develop the National Program for Elimination of Blinding Trachoma by 2010. The workshop brought together all stakeholders to identify strategies to meet the 2010 goal. A comprehensive strategic plan was developed and endorsed by the Ministry of Health at the end of the workshop. The goal of eliminating blinding trachoma in Vietnam by 2010 has been included as one of the objectives in the Vietnam national plan for preventive medicine - 2010-2020.
The strategic plan will be implemented in 1700 communes in Northern and Central Provinces. Using a streamlined process, the next stage of the program will be much more ambitious than the first five years. It will include more than 11 million Zithromax treatments and approximately 300,000 surgeries for advanced trachoma cases by 2010.
The next phase will also increase water and latrine coverage in trachoma endemic areas from 54% to 80% and from 40% to 60%, respectively. To accomplish this, an estimated 638,444 new water sources and 491,111 new latrines must be constructed. Also, water and sanitation facilities are to be constructed in 1,080 primary schools in the program area, as well as in an equal number of commune health stations. Trachoma prevention lessons are to be taught in all primary schools in the program areas. End.