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WHO reports good progress in eliminating trachoma

Trachoma remains endemic in 44 countries and has blinded or visually impaired about 1.9 million people worldwide.

12 Jul 2019

The number of people at risk of trachoma globally has fallen from 1.5 billion in 2002 to just over 142 million in 2019, a reduction of 91 per cent, according to a recent report from the World Health Organisation.

Trachoma is the world’s leading infectious cause of blindness.

New data presented at the 22nd meeting of the WHO Alliance for the Global Elimination of Trachoma by 2020 (GET2020), held at Mozambique in June, also showed that the number of people requiring surgery for trachomatous trichiasis – the late, blinding stage of trachoma – has dropped from 7.6 million in 2002 to 2.5 million in 2019, a reduction of 68 per cent.

Trachoma remains endemic in 44 countries and has blinded or visually impaired about 1.9 million people worldwide. Mapping of trachoma has been completed to identify its distribution and target control measures through the SAFE strategy.

SAFE is an acronym for Surgery for trachomatous trichiasis; Antibiotics to clear ocular C. trachomatis infection; Facial cleanliness to reduce transmission of ocular C. trachomatis; and Environmental improvement, particularly improved access to water and sanitation.

“Eliminating trachoma contributes to the ocular health and quality of life of the poorest,  most disadvantaged people worldwide and thereby moves us a step closer to achieving universal health coverage,” said Dr Mwelecele Ntuli Malecela, Director of WHO Department of Control of Neglected Tropical Diseases.

“Ridding the world of this painful, debilitating disease is being made possible through generous donations of the antibiotic azithromycin, sustained contributions from a network of dedicated funding agencies and partners, and the efforts of hundreds of thousands of front-line workers who work tirelessly to engage communities and deliver interventions.”

Scott McPherson, Chair of the International Coalition for Trachoma Control said:  “Eliminating trachoma has immediate benefit in preserving vision for people at risk. But work against trachoma has required the creation of innovative partnerships, which will help ensure that the most remote and marginalised people are not left behind as more comprehensive health services are strengthened.” 

In 2018 alone, 146,112 cases of trichiasis were managed and almost 90 million people were treated with antibiotics for trachoma in 782 districts worldwide.

Since 2011, eight countries have been validated by WHO as having eliminated trachoma as a public health problem. At least one country in every trachoma-endemic WHO Region has now achieved this milestone, demonstrating the effectiveness of the SAFE strategy in different settings.

The significant reduction in the global prevalence of trachoma has resulted from increased political will in endemic countries, expansion of control measures and generation of high-quality data. The global program has been supported by the world’s largest infectious disease mapping effort – the Global Trachoma Mapping Project (2012–2016) – and, since 2016, by Tropical Data, which has assisted health ministries to complete more than 1500 internationally-standardised, quality-assured and quality-controlled prevalence surveys.

In 1996, WHO launched GET2020, and with other partners in the Alliance, supports country implementation of the SAFE strategy and strengthening of national capacity for epidemiological assessment, monitoring, surveillance, project evaluation and resource mobilisation. Elimination of trachoma is inexpensive, simple and highly cost–effective, yielding a high rate of net economic return.

Trachoma is a disease of the eye caused by infection with the bacterium Chlamydia trachomatis. Transmission occurs through contact with infective discharges from the eyes and nose, particularly in young children who harbour the main reservoir of infection. It is also spread by flies which have been in contact with the eyes and noses of infected people.

The immune system can clear a single episode of infection, but in endemic communities the organism is frequently reacquired. After years of repeated infection, the inside of the eyelid can become so severely scarred (trachomatous conjunctival scarring) that it turns inwards and causes the eyelashes to rub against the eyeball (trachomatous trichiasis), resulting in constant pain and light intolerance. This and other alterations of the eye can lead to scarring of the cornea. Left untreated, this condition leads to the formation of irreversible opacities, with resulting visual impairment or blindness.

 


Published: 12 Jul 2019