Distribution and Incidence

Trachoma remains widespread in the twentieth century. Two estimates place the number of victims worldwide at 400 million to 500 million, with millions suffering from sight defects and perhaps 2 million totally blinded (Bietti and Werner 1967; Rodger 1981).

In 1935 Adalbert Fuchs found that the greatest frequency of the disease was in Egypt, "where 98 percent of schoolchildren in the fourth grade are afflicted by trachoma" (Fuchs 1962). In the 1960s,

Egypt still led the list of areas where a majority of the population was affected. Because a dry climate seems to affect incidence, among the highest rates of infection are the countries of North Africa and the Muslim Middle East-that is, from Morocco to Egypt and the Sudan in North Africa, and from the Red Sea to Turkey and Iran in the Middle East. It is also widespread in Asia, with 20 to 50 percent of the population infected in Burma, Pakistan, India, China, Southwest Asia, Indonesia, and Borneo. These rates also occur in Africa south of the Sahara, except for West Africa, where the incidence falls below 20 percent. Similar trachoma rates continue along the Mediterranean coast of Europe, in Eastern Europe, parts of Russia, Korea, Japan, Australia, New Zealand (among the Maoris), and the Pacific Islands. In the Western Hemisphere, Brazil and Mexico have the highest incidences, but trachoma also infects Indians and Mexican-Americans in the southwestern United States. Sporadic cases appear in parts of Europe, the Philippines, and some Central and South American countries. The disease is practically extinct in Canada, Switzerland, Austria, and northern Europe - that is, in the countries with the highest standards of living and sanitary conditions and without pockets of extreme poverty. Where living conditions have improved, trachoma has declined or disappeared (Bietti and Werner, 1967). It is, however, a disease that still afflicts the impoverished who live in crowded conditions in the desert and tropical regions of Africa, the Middle East, Asia, and Latin America (Bietti and Werner 1967; Rodger 1981).

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