India Declared Free of Trachoma, a Leading Cause of Blindness

Trachoma, a highly contagious bacterial infection, has been a leading cause of preventable blindness worldwide. According to WHO estimates, trachoma affects 150 million people globally, with 6 million either blind or at risk of severe visual impairment. Children are often the most vulnerable to its infectious stages.

In a major public health accomplishment, India has now been officially declared free from trachoma by the World Health Organization (WHO). This achievement follows years of sustained efforts by the government to safeguard the vision of millions, and underscores the critical role of maintaining healthy eyesight for all.

What is Trachoma?

Trachoma is a serious eye disease caused by infection with the bacterium Chlamydia trachomatis.

It spreads primarily through eye secretions from infected individuals and can be transmitted in several ways, including close physical contact, particularly between mothers and children, sharing personal items like towels or pillows, exposure to houseflies that carry the infection, and through coughing or sneezing.

Environmental factors that contribute to the transmission of trachoma include poor hygiene, overcrowded living conditions, water scarcity, and inadequate sanitation facilities. Addressing these risk factors is essential to breaking the cycle of transmission and preventing the further spread of the disease.

Children are particularly vulnerable to trachoma. With repeated infections, scarring can develop on the inner surface of their upper eyelids, leading to a painful condition known as trachomatous trichiasis, where the eyelid turns inward, causing the eyelashes to rub against the eyeball.

If left untreated, this can result in vision loss. Research suggests that more than 150 infections over a lifetime may be needed for severe complications associated with blinding trachoma to occur.

India’s Triumph Over Trachoma

In the 1950s and 1960s, trachoma was a widespread public health issue in India, severely affecting states like Gujarat, Rajasthan, Punjab, Haryana, Uttar Pradesh, and the Nicobar Islands.

During this time, over 50% of these populations were affected, and by 1971, trachoma accounted for 5% of all blindness cases in India. In response, the country initiated various strategies to address and eliminate the disease.

Key Measures to Fight Trachoma

Recognizing the urgency of the situation, India launched several interventions under the National Programme for Control of Blindness and Visual Impairment (NPCBVI). A critical step in these efforts was the adoption of the WHO SAFE strategy, which aimed to treat current cases while preventing future infections through improved hygiene. Over time, India took significant measures, such as:

1. Launch of the National Trachoma Control Program (1963): Supported by WHO and UNICEF, this program laid the foundation for comprehensive trachoma management, focusing on:

   • Surgical Treatment for trachomatous trichiasis.
   • Antibiotic Distribution to clear active infections.
   • Promoting Facial Cleanliness to reduce transmission.
   • Environmental Improvements to increase access to water and sanitation.

2. Integration into National Programs (1976): Trachoma control efforts were incorporated into the broader NPCBVI framework, ensuring ongoing focus and resources for elimination activities.

3. Notable Progress: In 2005, trachoma still accounted for 4% of blindness cases in India, but by 2018, this figure had dropped to just 0.008%. A series of assessments, including pre-validation and trichiasis-only surveys, confirmed that elimination targets were met in previously endemic areas.

Through these sustained efforts, India made significant progress toward eliminating trachoma. By 2017, the country was officially declared free from infective trachoma. This announcement coincided with the release of the National Trachoma Survey Report (2014-17) by the then Union Minister of Health, J.P. Nadda, which confirmed that active trachoma infections were eliminated in children across all surveyed districts, with an overall prevalence of just 0.7%, far below the WHO's elimination threshold of 5%.

Despite this success, India’s public health commitment did not waver. From 2019 to 2024, continuous surveillance across all districts ensured that the infection did not resurface. This vigilance is key to maintaining India's hard-won trachoma-free status, demonstrating the nation's dedication to protecting the eye health of its citizens and preventing avoidable blindness.

Recognition from the WHO

The World Health Organization recognized India's comprehensive efforts to eliminate trachoma, with Director-General Dr Tedros Adhanom Ghebreyesus highlighting the collaboration between the government, healthcare workers, and international partners that made this achievement possible.

India now joins 21 other countries, including Nepal and Myanmar, that have successfully eradicated trachoma as a public health issue. However, the disease still affects 39 other nations, where approximately 1.9 million people remain at risk of blindness.

Conclusion

India’s journey to becoming trachoma-free illustrates the power of coordinated public health efforts and community support. By implementing the WHO SAFE strategy, the country has dramatically reduced the prevalence of this serious eye disease.

The success is a testament to the cooperation between government agencies, healthcare workers, and international partners. As India continues to safeguard its citizens’ vision, the achievement underscores the importance of maintaining consistent public health programs to ensure that future generations remain free from preventable blindness.