Trachoma is the world’s leading infectious cause of blindness

According to the latest WHO data published in June 2018, 157.7 million people are at risk of Trachoma and 2.8 million people need surgery to end pain and stop further vision loss from the advanced stages of disease.

Trachoma is the world’s leading infectious cause of blindness, a disease of poverty it is one of 20 neglected tropical diseases (NTDs) as defined by the WHO. This debilitating disease 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

va-safe-1Surgery
for people at immediate
risk of blindness


SCALE-UP PRIORITIES
• Providing surgery to 2.8 million people with trachomatous trichiasis, the late blinding stage of Trachoma
• High-quality surgeries performed close to communities to ensure access for all
• Incorporation of surgical training aids like ‘HEAD START’ into all national programmes

va-safe-2Antibiotics
to clear infection


SCALE-UP PRIORITIES
• 157.7 million people are at risk of trachoma and require annual antibiotic treatment
• Ensuring all districts that need to implement SAFE apply for donated antibiotics
• Full utilisation of Tropical Data to conduct surveys to determine populations that require treatment and when treatment can stop

va-safe-3Facial Cleanliness
to reduce transmission


SCALE-UP PRIORITIES
• Promoting behaviours that help to interrupt the transmission of Trachoma
• Co-ordinated planning and implementation with WASH partners for integrated programme delivery guided by the WASH/NTD toolkit developed by WHO and the NTD NGO Network (NNN)
• Incorporating hygiene messages into school curricula and community-led initiatives

va-safe-4Environmental Improvements
to make facial cleanliness more achievable and
reduce transmission by eye-seeking flies


SCALE-UP PRIORITIES
• Effective collaboration with WASH and development agencies to achieve universal access to water and sanitation services

The number of people at risk of Trachoma blindness has fallen from 325 million in 2011 to 157.7 million in 2018

The human impact…

157.7
million

people in need of antibiotics
to clear the infection

Up to
4x

more Trichiasis in women
than in men

2.8
million

people need surgery need surgery to end pain and stop further vision loss

Progress since 2011

51%
decrease

in number of people at risk from infectious Trachoma

450
million +

doses of antibiotics have been distributed

1.3
million

surgeries to treat trachomatous trichiasis

Trachoma CAN be eliminated

43 countries are known to require interventions to eliminate trachoma as a public health problem. As of September 2018, eight countries – Cambodia, Ghana, the Islamic Republic of Iran, Lao People’s Democratic Republic, Mexico, Morocco, Nepal and Oman – had been validated by WHO as having eliminated trachoma as a public health problem, and an additional 4 countries have reported achievement of the elimination targets. The status of 9 countries is uncertain, because of a lack of recent local data.

Among the WHO regions, the European region is the only region where trachoma is not present. As of 2018, all other WHO regions now include at least one country that has eliminated trachoma as a public health problem. Africa is the most severely affected, with 29 countries known to require interventions to achieve elimination; and the region where the greatest efforts to intervene are underway.

As of July 2018, 38 countries are 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.

In 2017, 83.5 million people were treated with antibiotics. For the first time, the global-level of antibiotic coverage exceeded 50%. In order to sustain progress towards elimination, there is an urgent need to implement the SAFE strategy in all endemic countries at the scale needed to reduce the prevalence below elimination thresholds.

As of October 2018, 34 districts (containing more than 2.4 million residents) in five countries require urgent intervention because trachoma prevalence is over 5% but no programming for mass distribution of antibiotics has yet commenced . This does not include the 201 districts (with 27.7 million residents) in this same prevalence bracket which have planned to commence MDA in 2018.

Status of elimination of Trachoma as a public health problem, 2018

43

countries

need SAFE interventions
to eliminate Trachoma

Over

55%

of the people at risk of Trachoma live in Ethiopia and Nigeria

8

countries

Cambodia, Ghana, the Islamic Republic of Iran, Lao People’s Democratic Republic, Mexico, Morocco, Nepal and Oman – have been validated by WHO as having eliminated Trachoma as a public health problem since 2012

38

countries

actively implementing
SAFE strategy

70

million

people at risk in Ethiopia,
the world’s most affected country

4

countries

China, The Gambia, Iraq and Myanmar claim to have
eliminated Trachoma (not validated by WHO)

Trachoma-map-v3

Encourage regular face washing © The Carter Center Published in: Community Eye Health Journal Vol. 25 No. 79.80 2012

va-trends-trachoma-2

Alliance for good

WHO leads an international alliance of interested parties to work for the global elimination of trachoma, the WHO Alliance for Global Elimination of Trachoma by the year 2020 (GET2020), established in 1996. The Alliance fosters co-operation within its world-wide partnership of governments of endemic countries, donors, 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:

  • Supported and collaborated with WHO in carrying out essential activities such as epidemiological assessment, including baseline mapping, project implementation, coordination, monitoring, surveillance and project evaluation
  • Completed the ambitious Global Trachoma Mapping Project (2012-2016), screening 2.6 million people in 29 countries and supported the launch of Tropical Data which has now conducted 985 surveys in 33 countries.
  • Collaborated to mobilize political will through the 2018 Commonwealth Heads of Government Meeting summit to commit to the elimination of Trachoma , and new financial resources through the launch of The Commonwealth Fund , the Audacious Project, Big Ideas and the USAID CEP-NTD Element One . Together these new resources will accelerate progress towards elimination by 2020.
  • Celebrated Pfizer’s donation of more than 765 million antibiotic treatments since 1999 and its ongoing commitment to treatment donation for GET2020
  • Provided more than US$ 300 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 technical guidelines, 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
  • Collaborated to produce tools to support the transition of trachoma elimination programs to routine public services, thereby strengthening health systems and the eye health care sector post validation of elimination as a public health problem.
  • Contributed annual updates on the global trachoma program by the GET2020 Alliance in the WHO Weekly Epidemiological Record, in order to share progress and highlight key challenges with the global health community.
  • In recent years WHO has convened an annual GET2020 meeting to bring ministries of health together with WHO and implementing partners to identify challenges, share best practices and set priorities for work to eliminate trachoma as a public health problem. Discussions focus on strategy implementation and a detailed review of regional and specific country situations.

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 157.7 million at of April 2018.

Visit trachomaatlas.org and the Global Health Observatory for 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 from the Global Trachoma Mapping Project

2.6
million

million people screened

Across
29

countries over three years
One person examined every

40
seconds

Trachoma mapping

The Global Trachoma Mapping Project 2012 – 2016 is the largest infectious disease survey ever undertaken, helping to pinpoint accurately the world’s trachoma-endemic areas. 2.6 million people in 29 countries were examined using Android smartphones. On average one person was examined every 40 seconds. This groundbreaking collaboration was a partnership of more than 53 organisations, including 30 ministries of health.

In 2016, a WHO-led initiative launched Tropical Data to provide an end-to-end epidemiological survey support service, from planning and protocol development to training, data processing, health ministry review and approval, and through to application of the survey outputs. Since 2016, Tropical Data has supported 985 surveys in 33 countries, examining nearly 3 million people. While its initial focus is on Trachoma, Tropical Data is also being used to support other NTDs including remapping Lymphatic Filariasis in Guyana and verification of elimination of Schistosomiasis in the Dominican Republic.

It is estimated that
157.7 million
people are at risk of Trachoma

The target is to
eliminate Trachoma
by 2020

Total doses of Zithromax® shipped to trachoma elimination programmes, 1999 – 2018
For 2017-2018: This figure is comprised of 81 million treatments shipped in calendar year 2017 and 110 million treatments planned for 2018, of which 35 million have been shipped to date.

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