Success Story of Trachoma Elimination in India

Trachoma, a neglected tropical disease, is one of the leading causes of blindness worldwide.[1] 0.1% of blindness and visual impairment in India were due to trachoma.[2] In 2016, over 260,000 individuals received corrective surgery for trachoma, and 85 million people in endemic areas were treated with antibiotics to combat the disease.[3] In 2005, 4% of blindness cases were due to trachoma in India. However, the prevalence had decreased significantly to 0.008% in 2018. In 2024, a survey on trichiasis was conducted across 200 endemic districts, confirming that all evaluation units (EUs) had met their elimination targets. The SAFE strategy recommended by the World Health Organization (WHO) – comprising Surgery, Antibiotics, Facial cleanliness, and Environmental improvements – along with national initiatives such as the Swachh Bharat and Jal Jeevan Mission, facilitated this achievement.[4] India’s efforts to control trachoma began in 1963, with the launch of the National Trachoma Control Program, supported by WHO and UNICEF. The SAFE strategy was adopted to curb the disease, and by 1976, Trachoma Control Program was merged into the National Program for Control of Blindness and Visual Impairment. In 2017, India was declared free of infective trachoma. The National Trachoma Survey Report (2014–2017) highlighted that children in all surveyed districts were free of trachoma infection and the prevalence was just 0.7%, which was below WHO’s threshold of 5% for elimination.[5] Sociodevelopmental progress, combined with the implementation of the SAFE interventions, decreased the active trachoma and trichiasis cases confirmed by Trachoma Rapid Assessments conducted during 2006–2007 in the North-Western region.[6] WHO has stipulated that trachomatous inflammation–follicular (TF) should be below 5% among 1–9 years children, and the prevalence of trachomatous trichiasis (TT) should be below 2 per 1000 among 15+ years adults in any previously endemic EU to meet elimination criteria.[7] A notable success in trachoma control is the case of Car Nicobar Island. In 2010, a Trachoma Rapid Assessment Survey revealed that 49% of children on the island had TF. As a response, azithromycin was given as mass drug administration yearly from 2010 to 2012 to all residents of the island. Follow-up surveys in 2013 and 2017 confirmed that TF prevalence was reduced from 6.8% to 1.6% in 1–9-year children.[8] However, in four districts – Car Nicobar, Hoshiarpur, Dholpur, and Tonk, the incidence of TT in 15 years above adults was 0.2%, necessitating trichiasis surgery, although TF was no longer a public health concern. It was also confirmed that there was no need for mass drug administration, but trichiasis surgery was still required to meet elimination goals due to the elevated TT levels. Environmental hygiene challenges persisted in these EUs.[9] The National TT-only Survey was conducted across 200 endemic districts under the NPCBVI from 2021 to 2024, in alignment with WHO’s mandate for India to be officially declare trachoma eliminated. It was in accordance with the socioeconomic development of the country. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.