The number of people at risk from trachoma, the world's leading infectious cause of blindness, has reduced by 91% from 1.5 billion in 2002 to 142.2 million in March 2019, the World Health Organization (WHO) has reported in its Weekly Epidemiological Record (WER).

The record summarizes applications of the SAFE strategy against trachoma during 2018. It also contains estimates of the global population at risk of trachoma blindness based on district-by-district data submitted to WHO from national health ministries.

Since the last Weekly Epidemiological Record trachoma update in June 2018, the Islamic Republic of Iran, has been  validated by WHO for eliminating trachoma as a public health problem, bringing the total number of countries to achieve this milestone to eight (Cambodia, Ghana, Islamic Republic of Iran, Lao People’s Democratic Republic, Mexico, Morocco, Nepal and Oman).

The record shows that health ministries are continuing to achieve historically high levels of antibiotic distribution, with 89.1 million people receiving antibiotics for trachoma in 2018 compared to 83.5 million in 2017. Antibiotics, largely donated to health ministries by Pfizer Inc through the International Trachoma Initiative, were distributed in 782 of the 1475 districts that are known to require antibiotic interventions, representing 53% global coverage. Approximately 70% of all antibiotics were distributed in Ethiopia, which has the largest number of people living in endemic areas and represents 44% of the global trachoma burden.

The number of people managed for trachomatous trichiasis (TT), the late blinding stage of trachoma, reduced from 231,447 in 2017 to 145,287 in 2018. However, the number of people requiring management for TT has reduced from 7.6 million in 2002 to 2.5 million in 2019, a 68% reduction. Over 62% of TT surgeries conducted in 2018 were performed in Ethiopia. Of the 35 countries that reported TT surgery in 2018, 26 reported gender-disaggregated data, covering 92% of individuals operated on for TT. 70% of cases managed in these countries were females, demonstrating that the trachoma community is achieving equity for TT management, as women are approximately twice as likely to develop TT than men.

Facial cleanliness and environmental changes (F&E) were noted as being delivered by wash, hygiene and sanitation interventions through cross - sectoral collaborations across education, water and sanitation or rural development, supported by intra government agencies.

"The association between the effectiveness of the SAFE strategy, it’s scale up and subsequent reduction in global trachoma prevalence is clear and a 91% reduction since 2002 is something to be very optimistic about", said Scott McPherson, Chair of the International Coalition for Trachoma Control. "There is a great opportunity to eliminate this painful and disabling disease in the coming years and to ensure investments through the global trachoma program strengthen health systems. As an increasing number of districts reach elimination thresholds, we must also look to ensure no one is left behind and continue to identify remaining gaps in the global program and target interventions to include hard to reach populations. Eliminating trachoma will significantly improve the lives of the world’s most marginalised people and is a necessary step to achieve the 2030 Sustainable Development Goals." 

Read Weekly Epidemiological Record 19 July 2019, vol.94, 29 (pp317-328) here.