Historical Aspects of Endemic Trachoma in Peru: 1895–2000

Trachoma, a chronic keratoconjunctivitis caused by the intracellular bacterium Chlamydia trachomatis, is the leading infectious cause of blindness and affects the most underprivileged populations worldwide. An estimated 1.3 million people have been blinded, and there are more than 50 trachoma-endemic countries, mainly in Africa, the Middle East, and Asia [1,2]. In Latin America, countries such as Brazil, Guatemala, and Mexico have targeted the areas where trachoma has been identified, according to the Report on the Sixteenth Meeting of World Health Organization (WHO) Alliance for the Global Elimination of Trachoma by 2020 (GET 2020) [3]. Recently, Colombia has reported pockets of trachoma among indigenous populations in Vaupés, [4] San Joaquín, and Santa Catalina, and it is identifying additional areas for completeness of the data [5]. Other countries, such as Peru, Bolivia, and Venezuela, which are likely to be endemic, according to these sources, have not reported population-based estimates. This lack of trachoma assessment at the population level was noted and put on the agenda of the WHO GET 2020, a target that could not be reached without recent and welldesigned studies in suspected countries. Regarding Peru, the current status of trachoma is unknown. A search of the two main elibraries, the Medical Literature Analysis and Retrieval System Online (MEDLINE) and the Scientific Electronic Library Online (ScIELO), using keywords such as trachoma, trichiasis, and Peru, produced no articles. Only one database considered as gray literature, the Latin American Literature in the Health Sciences (Literatura Latinoamericana en Ciencias de la Salud, or LILACS), produced seven articles, all in Spanish and not referenced in any large recent reviews on blindness, trachoma, or other neglected tropical diseases in Latin America and the Caribbean. Moreover, the full versions of these articles were not available, even after institutional request. To fill this gap, we have conducted an extensive and critical historical review of the local literature and have searched all available sources of early written documentation and pictorial evidence of trachoma in Peru.