Context: Recently, the World Health Organization (WHO) has officially recognized that India has eliminated trachoma as a public health issue. 

Key highlights

• India is now the third country in the WHO Southeast Asia Region to achieve this significant public health milestone.

• India – India has successfully eliminated trachoma, a bacterial infection that affects the eyes, as a public health problem.

• India’s success is due to the strong leadership of its Government and the commitment of ophthalmologists and other cadres of health-care workers.

• Impacts – The economic cost in terms of lost productivity from blindness and visual impairment is estimated at USD 2.9–5.3 billion annually, increasing to USD 8 billion when trichiasis is included.

• As of June 2022, 125 million people live in trachoma endemic areas and are at risk of trachoma blindness.

About Trachoma

• About: It is the leading infectious cause of blindness globally.

• Caused by: It is caused by Chlamydia trachomatis, an obligate intracellular bacterium.

• It occurs via direct or indirect contact with eye or nose discharges from infected individuals, particularly young children who are the main reservoir. Certain fly species can also spread the infection.

Environmental risk factors that promote the transmission of trachoma include:

1. Poor hygiene practices.
2. Overcrowded living conditions.
3. Water scarcity.
4. Inadequate latrines and sanitation facilities.

• Prevalence: In endemic areas, active trachoma is common among preschool children, with prevalence rates reaching up to 60-90%.

• Public health concern – It is a public health problem in 42 countries and is responsible for the blindness or visual impairment of about 1.9 million people.

• Transmission: It is primarily transmitted within households; close contact with infected individuals increases risk. Although an individual’s immune system can clear single infections, frequent re-infections are common in endemic areas.

• Disease Progression: Repeated infections lead to scarring inside the eyelid (trachomatous conjunctival scarring), which can cause the eyelashes to turn inward (trachomatous trichiasis). This results in pain, light intolerance, and potential corneal scarring, eventually leading to irreversible blindness if untreated.

• Impact on Women: Women are blinded up to four times more often than men, likely due to frequent close contact with infected children.

• Environmental Factors Influencing Transmission: Inadequate hygiene practices, Overcrowded living conditions, Limited access to water and Insufficient sanitation facilities.

• Geographic Distribution: Hyperendemic in rural, impoverished areas across Africa, Central and South America, Asia, Australia, and the Middle East. Responsible for blindness or visual impairment in approximately 1.9 million people, accounting for 1.4% of global blindness. Africa is the most affected continent with significant control efforts underway.

• Countries Eliminating Trachoma: As of October 2022, 15 countries, including Cambodia, China, Gambia, and others, have been validated by WHO as having eliminated trachoma as a public health problem.

• Prevention and control – Elimination programmes in endemic countries are being implemented using the WHO-recommended SAFE strategy. This consists of:

1. Surgery to treat the blinding stage (trachomatous trichiasis),

2. Antibiotics to clear infection, particularly mass drug administration of the antibiotic azithromycin, which is donated by the manufacturer to elimination programmes, through the International Trachoma Initiative,

3. Facial cleanliness and

4. Environmental improvement, particularly improving access to water and sanitation.