Trachoma is the world’s leading infectious cause of blindness
According to the latest WHO data, 182 million people are at risk of Trachoma blindness, 1.2 million people are irreversibly blind, 2.2 million have impaired vision, and 3.2 million need surgery to avoid blindness from the advanced stages of disease.
Trachoma, a disease of poverty and one of the WHO-defined neglected tropical diseases (NTDs), is caused by a contagious bacterial infection of the eye spread from person to person through contact with contaminated hands, clothing and eye-seeking flies. It often begins in early childhood, and is worsened by episodes of reinfection. This causes inflammation and scarring of the inner eyelid. The eyelashes touch and scratch the surface of the eyeball and, considering we blink an estimated 19,000 times each day, this repeated action leads to horrific pain and irreversible blindness.
Trachoma is found in populations with poor personal and community hygiene. Factors associated with elevated individual risk of repeat infections include lack of adequate water supply, absence of basic sanitation facilities, living with an infected person, crowding and poverty in general. A high-risk factor seems to be the presence of children with dirty faces in the proximal environment: the presence of infectious ocular and nasal discharges facilitates transmission.
Priorities for implementing
the SAFE strategy
for people at immediate
risk of blindness
• Addressing the backlog of 3.2 million people needing surgery to avoid blindness
• High-quality surgeries being performed close to the communities to ensure access for all
• Incorporation of surgical training aids like ‘HEAD START’ into all national programmes
to clear infection
• 182 million people still require annual antibiotic treatment using Zithromax ®, generously donated by Pfizer
• Strengthening country supply chains
• Ensuring all districts that need to implement SAFE apply for donated antibiotics
to reduce transmission
• Promoting behaviours that help to interrupt the transmission of Trachoma
• Co-ordinated planning and implementation with WASH partners for integrated programme delivery
• Incorporating hygiene messages into school curricula and community-led initiatives
to make facial cleanliness more achievable and
reduce transmission by eye-seeking flies
• Effective collaboration with WASH and development agencies to establish and sustain water and sanitation services
The number of people at risk of Trachoma blindness has fallen from 325 million in 2011 to 182 million in 2017
The human impact…
people in need of antibiotics
to clear the infection
more Trichiasis in women
than in men
people need surgery to avoid blindness –
22% live in Ethiopia
At what cost…
estimated annual lost productivity
estimated global cost of SAFE
implementation to achieve GET2020
estimated additional investments needed
from the WASH sectors for
Trachoma CAN be eliminated
Forty two countries are known to require interventions to eliminate Trachoma as a public health problem. In 2017, Mexico joined Oman and Morocco as the third country to be validated by WHO as having eliminated Trachoma, and an additional seven countries have reported achievement of the elimination targets. The status of 12 countries is uncertain, because of a lack of recent local data.
Among the WHO regions, the European region is the only one where Trachoma is no longer present. Africa is the most severely affected, with 26 countries known to require intervention to achieve elimination; and the region where the greatest efforts to intervene are underway.
At the end of 2016, 34 countries were actively implementing an integrated package of interventions called the ‘SAFE strategy’ to eliminate Trachoma (see Priorities for Implementing the SAFE Strategy above). Through (i) integration and co-ordination with other NTD elimination and eye care programmes, and (ii) inter-sectoral collaboration with WASH (Water, Sanitation and Hygiene), education and community development, Trachoma can be eliminated.
There is an urgent need to implement ‘SAFE’ in all endemic countries at the scale needed to reduce the prevalence below elimination thresholds. As of July 2017, 41 districts (containing more than 4.9 million residents) in seven countries had an active Trachoma prevalence which exceeded these thresholds but weren’t yet programming for mass distribution of antibiotics.
Status of elimination of Trachoma as a public health problem, 2017
need SAFE interventions
to eliminate Trachoma
of the people at risk of Trachoma live in Ethiopia
Oman, Morocco and Mexico, validated
as having eliminated Trachoma
people at risk in Ethiopia,
the world’s most affected country
claim to have
Alliance for good
The WHO Alliance for the Global Elimination of Trachoma by the year 2020 (GET2020) was established by WHO in 1996. The Alliance fosters co-operation within its world-wide partnership of member states, non-governmental organisations, academic institutions and the private sector to realize the GET2020 goals.
The contributions of these partners, sharing a common vision which targets elimination, has increased year upon year. In recent years Alliance partners have:
- Celebrated Pfizer’s donation of more than 658 million antibiotic treatments since 1999 and its ongoing commitment to the donation for GET2020
- Completed the ambitious Global Trachoma Mapping Project, screening 2.6 million people in 29 countries in three years
- Provided more than US$200 million in funding for elimination efforts
- Presented clear economic arguments that investments in the elimination of Trachoma are public health ‘best buys’. The investments represent <0.003% of global expenditure on health for 0.01% of the global burden of disease, and would avert estimated annual losses in productivity of between US$2.9-5.3 billion (increasing to US$8 billion when Trachomatous Trichiasis is included)
- Created regional alliances to support national implementation and scale-up of SAFE and a network of WHO Collaborating Centres to address research questions of critical importance to the quality and sustainability of GET2020
- Sought opportunities to co-ordinate efforts with other NTDs, particularly the preventative chemotherapy diseases including Onchocerciasis (River Blindness)
- Harnessed technology to streamline implementation of disease mapping and monitoring initiatives, generate and store reliable programme data, and produce cost efficiencies through standardisation
- Produced a range of technical guidelines, a process for generating national Trachoma Action Plans, preferred practices and training tools/resources derived from field experiences, and a standard equipment list to build capacity and support SAFE implementation in endemic countries
of the global surgical backlog exists in just
with 16 million residents in 16 countries
require urgent interventions
Through a better understanding of the disease and these direct efforts to tackle it head on, the number of people at risk of Trachoma blindness has fallen from 325 million in 2011 to 182 million in 2017. Visit trachomaatlas.org and who.int/gho for the current disease estimates.
The potential to eliminate blindness and visual impairment from Trachoma is within reach. Alliance partners know how and what needs to be done to achieve GET2020. They urgently need the funds and cross-sector collaborations to do so.
Disease mapping successes so far, and the 2020 target
million people screened
countries over three years
One person examined every
surveys required in the next four years in districts already
participating in the donation programme (as of July 2017)
It is estimated that
is needed to eliminate Trachoma
The target is to