India eliminates trachoma as a public health problem – What lies ahead?
Year: 2024
Type: article
Abstract: Trachoma, caused by the bacterium Chlamydia trachomatis, is a significant infectious eye disease responsible for preventable blindness. Recurrent childhood infections with Chlamydia trachomatis result in severe conjunctival inflammation, scarring, and an increased risk of corneal blindness due to trichiatic lashes or entropion in later life. The epidemiology and pathophysiology of this disease have been extensively studied and documented in ophthalmic literature, with many studies identifying integrated ocular health programs as key to implement the SAFE Strategy of surgery for trichiasis, mass antibiotics distribution for treatment, promotion of facial cleanliness, and environmental improvement. Trachoma remains a public health concern in 39 nations, causing visual impairment or blindness in approximately 1.9 million people.[1] As of April 2024, approximately 103 million people live in trachoma-endemic regions,[1] primarily in the most rural areas of Africa, Central and South America, Asia, Australia and the Middle East. Poor ocular hygiene, overcrowding, and unhealthy living conditions—coupled with limited access to water and sanitation facilities —have compounded the challenge of eradicating trachoma in these hyperendemic regions. Results from the National Trachoma Prevalence Survey[2] and National Trachoma Rapid Assessment Survey 2014-17[3] outlined the current status of trachoma control in India. India now joins the list of 20 trachoma-free nations, along with 19 other countries that have been declared “Trachoma-Free” by the WHO: Benin, Cambodia, China, The Gambia, the Islamic Republic of Iran, the Lao People’s Democratic Republic, Ghana, Iraq, Malawi, Mali, Mexico, Morocco, Myanmar, Nepal, Oman, Pakistan, Saudi Arabia, Togo and Vanuatu, all of which have been validated by the WHO as having eliminated trachoma as a public health problem. Trachoma monitoring involves the scrutiny of two related but morphologically different clinical presentations: (i) the active infectious form of trachoma (TI) and (ii) trachomatous trichiasis (TT), the progression of the disease. The control and elimination of trachoma as a public health problem in India is a commendable success story in the field of Indian Public Health. The WHO definition of trachoma elimination as a public health problem[1] is as follows: A trachomatous trichiasis (TT) prevalence of “unknown to the health system” at less than 0.2% in adults aged ≥15 years (approximately 1 case per 1000 total population) and A trachomatous inflammation-follicular (TF) prevalence in children aged 1–9 years of < 5%, sustained for at least two years without any mass antibiotic treatment programs, in each formerly endemic district; and The presence of a health system that can recognize and treat incident TT cases, adopting the defined strategies, along with evidence of sufficient financial resources to implement these strategies. Corporate health initiatives, such as the International Trachoma Initiative (ITI), an antibiotic donation program, and several others, have contributed to the elimination of trachoma—once the most neglected of all the neglected tropical diseases (NTD)—by promoting the SAFE strategy. Trachoma control and prevention programs must continue post-validation epidemiological surveillance for identifying active cases and implementing the SAFE strategy in formerly endemic regions, to prevent the emergence of new cases in alarming proportions. Current practices in trachoma management face challenges in trachoma trichiasis surgery due to progressive tarso-conjunctival scarring in trachoma and increased recurrence rates following tarsal rotation procedures.[4] A retrospective analysis of national survey and implementation data from all countries previously endemic for trachoma, including data collated up until November 10 2021, for 38 countries representing 2097 ever-endemic implementation units, highlighted the challenges in achieving global trachoma elimination as a public health problem by 2020.[5] However, the progress attained till date should not to be undermined by the delay in reaching global elimination, as ongoing implementation initiatives and programs now reflect a renewed commitment to achieve global elimination by 2030. Although trachoma causes more cases of preventable blindness than any other infectious disease, a combination of strategies is currently underway to reduce its global prevalence. A recent comprehensive summary of trachoma-related events vividly describes the ongoing efforts, challenges faced, and future prospects, as we await to see if this is the last decade of global trachoma’s existence.[6] As clinical and community ophthalmologists in a nation that has moved beyond trachoma elimination, we still have the responsibility of performing trachoma impact surveys to assess the need to continue or discontinue preventative interventions, as well as trachoma surveillance surveys to continually assess the prevalence of active trachoma and identify any resurgence following the discontinuation of trachoma interventions. With global experts continuing their efforts, we remain optimistic about overcoming the remaining challenges in in the path to achieving global trachoma elimination and transitioning to a trachoma-free world.
Source: Indian Journal of Ophthalmology
Author: Murugesan Vanathi
Institution: All India Institute of Medical Sciences
Language: English
Subfield: Ophthalmology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4403850393