Why is it in the news?

• On October 8, 2024, India marked a significant milestone in public health by eliminating trachoma as a public health problem. Although this achievement may not have been widely celebrated, its economic and health implications are substantial.

Understanding Trachoma

• Trachoma is a chronic eye infection caused by the bacterium Chlamydia trachomatis, primarily linked to poor hygiene and sanitation. The disease is particularly detrimental to children and women in areas with limited access to clean water, resulting in blindness and visual impairment.
• Economically, it incurs an estimated loss of $2.9 to $5.3 billion annually due to decreased productivity.
• Trachoma spreads through contact with infected eye secretions or contaminated items, and it is exacerbated by overcrowded living conditions. Untreated, it can lead to scarring of the inner eyelid and eventual blindness.

Global and National Context

• The World Health Organization (WHO) classifies trachoma as a neglected tropical disease (NTD), with a target for elimination by 2030.
• NTDs predominantly affect impoverished communities, making their elimination a priority under the United Nations Sustainable Development Goal 3 (Target 3.3).
• Despite facing significant challenges, India successfully reduced trachoma prevalence to 0.7%, largely through the implementation of the WHO’s SAFE strategy that includes surgery, antibiotics, promoting facial cleanliness, and improving sanitation.

Criteria for Elimination

• According to WHO guidelines, trachoma is considered eliminated as a public health issue when the prevalence of trachomatous trichiasis falls below 0.2% in individuals aged 15 and above, and when the prevalence of active trachoma in children aged 1 to 9 years is below 5%.
• While India has made significant strides—reducing trachoma’s contribution to blindness from 4% in 2005 to just 0.008% by 2018—sporadic cases still exist.

The Path Forward

• The term “elimination as a public health problem” indicates a major reduction in disease prevalence, but not complete eradication. This distinction is crucial; elimination refers to the significant reduction of public health threats, whereas eradication signifies the halting of all transmission.
• India’s current achievement marks an important first step, but ongoing efforts are essential to maintain this progress and prevent a resurgence of trachoma.
• Historically, countries that successfully eliminated trachoma in the 1950s did so through continuous improvements in sanitation and health education.
• India must adopt a similar approach, focusing on preventing disease transmission through better access to clean water, hygiene practices, and continued vigilance.

Surveillance and Future Efforts

• The WHO has not established an eradication target for trachoma, acknowledging the complexity of controlling this disease.
• To maintain its status, India’s National Programme for Control of Blindness and Visual Impairment (NPCBVI) must conduct regular surveys to detect new cases and ensure that trachoma remains a negligible public health threat.
• This achievement demonstrates that coordinated public health efforts can yield significant results, even under challenging conditions.
• India’s success against trachoma can serve as an inspiration for tackling other health challenges, such as kala-azar and tuberculosis, illustrating that determined efforts can lead to lasting change.