Australian Trachoma Surveillance Report 2016

New South Wales

In 2014, NSW Health expanded the trachoma screening project to include a further nine potentially at-risk communities in north western and far western NSW. Repeat screening was also undertaken in the one affected community that was identified in 2013. Screening was conducted by the Bathurst Population Health Unit with support from NSW Ministry of Health. No trichiasis screening was undertaken in NSW.

Queensland

The Communicable Diseases Branch within the Queensland Department of Health coordinates trachoma prevention and control activities across Queensland in collaboration with Hospital and Health Services. The trachoma team consists of an ophthalmologist, a public health clinical nurse consultant, and an ophthalmology clinical nurse consultant.
In 2016 the trachoma team undertook a mapping exercise in three communities in the Torres Strait. This consisted of examining and classifying eyes according to the WHO simplified grading scale. The ophthalmologist performing the screen also examined each child for corneal pannus, Herbert’s pits, and inflammatory thickening of the upper tarsal conjunctiva. Conjunctival swabs for chlamydia PCR testing were collected from each child found to have five or more follicles consistent with the WHO criteria for TF.

The optometrist who services the Torres Strait visits most communities twice a year performing a comprehensive eye exam on residents of the Torres Strait. Communities of the Torres Strait have had an uninterrupted specialist ophthalmic service for the last 30 years.

Data analysis

For the purpose of this report, a community is defined as a geographic location where people reside and where there is at least one school. Community coverage is defined as the number of communities screened for trachoma as a proportion of those that were identified as at risk. Individual screening coverage is the proportion of resident children in the target age group who were screened.
Data on resident population numbers were derived by each jurisdiction using enrolment lists from schools and health clinics and from local advice. This method has been used since 2012. For 2007 to 2011 estimates were projected from the 2006 Australian census using Australian Bureau of Statistics (ABS) standard estimates of population increase (1.6%, 1.8% and 2.1% in the NT, WA and SA, respectively). The prevalence of active trachoma was calculated using the number of children screened as the denominator.
Trachoma data were analysed in the age groups 1-4, 5-9 and 10-14 years. Comparisons over time were limited to the group aged 5-9 years. Data from 2006 were excluded from assessment of time trends as collection methods in this first year differed substantially from those subsequently adopted.

Calculations for trachoma prevalence

Three distinct methods were used to calculate trachoma prevalence. The observed prevalence of active trachoma was calculated using only the data from screening activities undertaken during the reporting year. Since implementation of the 2014 National Guidelines, at-risk communities have not been required to undertake annual screening for trachoma. Therefore, for communities not screened in 2016 an estimated prevalence of active trachoma was calculated by carrying forward the most recent prevalence data, following a method endorsed by the NTSCRG. This method is likely to result in an over-estimate of current prevalence, particularly for communities in which antibiotic distribution has been taking place. Finally, the overall prevalence of active trachoma was calculated by combining data from at-risk communities screened during 2016, the most recent prevalence from at-risk communities that did not screen in 2016 and the most recent prevalence carried forward from communities that were judged by jurisdictions to have eliminated trachoma and were therefore removed from the at-risk register. Community specific data for communities amalgamated for reporting purposes were used or carried forward until the year of amalgamation.

National results 2016

Figures and Tables

Figure 1.1 Trachoma prevalence in children aged 5-9 years in all at-risk communities by region, Australia 2016*

*Most recent estimates carried forward in communities that did not screen in 2016

Figure 1.2 Number of communities designated to be at risk by jurisdiction, Australia 2007 – 2016

* In 2012 and 2016 QLD communities and in 2013 & 2014 NSW communities were designated as “potentially at-risk” for the purposes of prevalence surveys

Figure 1.3 Number of at-risk communities according to trachoma control strategy implemented by jurisdiction, Australia 2016

Figure 1.4 Population screening coverage in children aged 5-9 years in communities that were screened for trachoma by jurisdiction, Australia 2016

Figure 1.5 Proportion of screened children aged 5-9 years who had a clean face by jurisdiction, Australia 2007-2016.

Figure 1.6 a Observed prevalence of active trachoma among screened children aged 5-9 years by jurisdiction, Australia 2007-2016

Figure 1.6 b Estimated prevalence of active trachoma among children aged 5-9 years by jurisdiction, Australia* 2007-2016.

* Most recent estimates carried forward in at-risk communities that did not screen in 2016

Figure 1.6 c Overall prevalence of active trachoma among children aged 5-9 years by jurisdiction, Australia* 2007-2016.

* Most recent estimates carried forward in all communities that were considered at risk at some time since 2007

Figure 1.7 Number of at-risk communities* according to level of trachoma prevalence in children aged 5-9 years by jurisdiction, Australia 2016

* Including at-risk communities that did and did not screen in 2016

Figure 1.8 Proportion of communities with zero prevalence of trachoma by jurisdiction, Australia 2007-2016

Figure 1.9 Proportion of communities with endemic (>5%) levels of trachoma by jurisdiction, Australia 2007-2016

Figure 1.10 Number of doses of azithromycin administered for the treatment of trachoma by jurisdiction, Australia 2007-2016

Table 1.1 Trachoma control delivery in at-risk^* communities by jurisdiction, Australia 2016

Number of communities	Northern Territory	South Australia	Western Australia	Queensland	Total
At risk * (A)	77	19	51	3	150
Requiring screening for trachoma (B)	52	19	37	3	111
Screened for trachoma (C)	47‡	19	37	3	106
Requiring treatment without screening † (D)	12	0	13	0	25
Received treatment without screening † (E)	8‡	0	13	0	21
Screened and/or treated for trachoma (F = C+E)	55	19	50	3	127
Requiring neither screening or treatment for trachoma (G=A-B-D)	13	0	1	0	14

* As defined by each jurisdiction

† As per Guidelines

‡ See Table 2.4

Table 1.2 Trachoma screening coverage, trachoma prevalence and clean face prevalence in children aged 5-9 years by jurisdiction, Australia 2016

	Northern Territory	South Australia	Western Australia	Queensland	Total
Number of communities screened	47	19	37	3	106
Age group (years)	5-9	5-9	5-9	5-9	5-9
Children examined for clean face	1689	637	890	153	3369
Children with clean face	1179	480	659	141	2459
Clean face prevalence (%)	70	75	74	92	73
Estimated number* of Indigenous children in communities^†	1774	706	781	165	3426
Children screened for trachoma	1628	637	725	153	3143
Trachoma screening coverage (%)	92	90	93	93	92
Children with active trachoma	130	29	16	0	175
Observed prevalence of active trachoma (%)	8.0	4.6	2.2	0	5.6
Estimated prevalence of active trachoma (%)	6.5	4.5	5.7	0	6.6
Overall prevalence of active trachoma (%)	6.1	2.8	3.5	0	4.7

* Jurisdictional estimate

† Communities that were screened for trachoma in 2016

‡ Methods of calculating prevalence rates on page 16

§ 14 children in QLD were identified with follicles meeting WHO simplified grading scheme for TF. Ophthalmologist review identified no corneal pannus or Herbert’s pits. These children were assessed as not having active trachoma

Table 1.3 Number and proportion * of at-risk communities according to level of trachoma prevalence in children aged 5-9 years, Australia 2007-2016

	2007		2008		2009		2010		2011		2012		2013		2014		2015		2016
Communities at-risk †	229		233		232		244		203		196		183		177		157		150
Communities not screened ‡	102		107		116		89		53		9		20		0		8		8
Number of communities §	123		121		116		152		152		187		163		177		149		142
≥20%	32	26%	54	45%	26	22%	44	29%	21	14%	15	8%	14	9%	17	10%	16	11%	15	11%
≥10% but <20%	22	18%	14	12%	13	11%	23	15%	20	13%	13	7%	20	12%	36	20%	27	18%	29	20%
≥5% but <10%	11	9%	14	12%	12	10%	15	10%	20	13%	20	11%	21	13%	12	7%	16	11%	12	8%
>0% but <5%	7	6%	12	10%	24	21%	16	11%	19	13%	24	13%	17	10%	13	7%	16	11%	21	15%
0%	51	41%	27	22%	41	35%	54	36%	72	47%	115	61%	91	56%	99	56%	74	50%	65	46%

* Based on current or most recent year

† As defined annually by each jurisdiction

‡ Or treated as required per Guidelines

§ Screened or receiving ongoing annual treatment as per Guidelines

Table 1.4 Treatment strategies by jurisdiction, Australia 2016

Number of communities	Northern Territory	South Australia	Western Australia	Queensland	Total
Required treatment for trachoma	40	15	22	3	80
Treated for trachoma	36	15	22	3	76
Screened and treated	28	15	8	3	54
Received treatment without screening	8	0	13	0	21
Received 6-monthly treatment	9	1	1	0	11
Did not require treatment	43	4	29	0	76
Treated active cases and households	10	14	6	3	33
Treated the whole of community	26	1	16	0	43
Not treated according to CDNA guidelines	4	0	0	0	4

* Four communities not treated according to Guidelines due to road conditions, cultural ceremonies and contracted local service program disruption in one region

† While no children in QLD were identified as having active trachoma, children and their contacts were treated based on WHO simplified grading scheme and CDNA National guidelines for the public health management of trachoma

Table 1.5 Trachoma treatment coverage, Australia 2016

	Northern Territory					South Australia					Western Australia					Queensland †					Total
Age group (years)	0-4	5-9	10-14	15+	All	0-4	5-9	10-14	15+	All	0-4	5-9	10-14	15+	All	0-4	5-9	10-14	15+	All	0-4	5-9	10-14	15+	All
Requiring treatment for active trachoma	10	130	11	N/A	151	3	29	8	N/A	40	1	16	4	N/A	21	0	14	1	N/A	15	14	189	24	N/A	227
Received treatment for active trachoma	10	128	11	N/A	149	3	28	8	N/A	39	1	15	4	N/A	20	0	14	1	N/A	15	14	185	24	N/A	223
Received treatment for active trachoma (%)	100	99	100	N/A	99	100	97	100	N/A	98	100	94	100	N/A	95	N/A	100	100	N/A	100	100	98	100	N/A	98
Estimated community members* requiring treatment	1053	1309	1108	6677	10147	43	55	53	259	410	269	329	324	1717	2639	10	21	11	34	76	1375	1714	1496	8687	13272
Number of community members* who received treatment	906	1196	966	5449	8517	42	53	50	241	386	253	298	299	1619	2469	10	21	11	34	76	1211	1568	1326	7343	11448
Estimated community members who received treatment (%)	86	91	87	82	84	98	96	94	93	94	94	91	92	94	94	100	100	100	100	100	88	91	89	85	86
Total number of doses of azithromycin delivered	916	1324	977	5449	8666	45	81	58	241	425	254	313	303	1619	2489	10	35	12	34	91	1225	1753	1350	7343	11671
Doses administered in communities that were treated without screening*	255	347	297	1640	2539	0	0	0	0	0	217	246	254	1430	2147	0	0	0	0	0	472	593	551	3070	4686
Doses administered six-monthly*	381	486	378	2427	3672	26	23	18	86	153	39	69	80	229	417	0	0	0	0	0	446	578	476	2742	4242
Estimated overall treatment coverage (%)	86	92	87	82	84	98	98	95	93	95	94	91	92	94	94	100	100	100	100	100	88	92	89	85	86

* As per Guidelines

† While no children in QLD were identified as having active trachoma, children and their contacts were treated based on WHO simplified grading scheme and CDNA National guidelines for the public health management of trachoma

Table 1.6 Trichiasis screening coverage, prevalence and treatment among Indigenous adults, Australia 2016

	Northern Territory		South Australia		Western Australia		Total
Number of communities screened for trichiasis	76		19		51		146
Age group	15-39	40+	15-39	40+	15-39	40+	15-39	40+	15+
Estimated population in region	16548	9481	2983	2001	5340	3158	24871	14640	39511
Adults examined	3459	3056	645	1174	440	1544	4544	5774	10318
With trichiasis	3	37	0	7	0	18	3	62	65
With trichiasis (%)	0.1	1.2	0.0	0.6	0.0	1.2	0.1	1.1	0.6
Offered ophthalmic consultation	1	22	0	7	0	16	1	45	46
Declined ophthalmic consultation	0	0	0	0	0	8	0	8	8
Surgery in past 12 months	5	5	0	4	0	3	5	12	17

* Population estimate limited to trachoma endemic regions and does not take into account changing endemic regions over time and transiency between regions

† Number of adults examined limited to numbers reported. This number may not account for adults who have been examined in routine adult health checks, and may also include multiple screening