Studies of trachoma in families on Taiwan.

This study was undertaken to clarify the natural history and pathogenesis of trachoma. A group of families who live in a formerly trachoma hyperendemic area of Southern Taiwan were placed under continuous surveillance. The development in recent years of the micro immunofluorescence test for trachoma antibody, along with improved cell culture isolation methods, have allowed this surveillance to include repeated effective laboratory studies in addition to clinical observations. After four years' study of one group of families and three years of another, a number of interesting findings have been obtained. Evidence is presented supporting our hypothesis that trachoma is a disease of immumopathology and results from repeated reinfections with the trachoma organisms. The clinical findings of papillae, especially those of an acute nature, has been the clinical finding most closely associated with the isolation of the organism and the demonstration of antibody. Evidence is presented that transmission of the organism is usually within the family group. Although only trachoma immunotypes B and C previously had been associated with trachoma infection on Taiwan, data is presented from one family in which type D infections occurred. While a series of new and reinfections with trachoma organisms were demonstrated in some of the families under observation, the majority of the families not only showed no new infections but showed spontaneous healing or disappearance of clinical and laboratory evidence of trachoma infection. This tendency of active trachoma infection to disappear from a family in the absence of transmission of the organism parallels the rapid fall and prevalence of active trachoma on Taiwan during the past decade.