The Wire Staff 
New Delhi: India joined 19 other countries in having eliminated trachoma, an eye disease caused by a bacterial infection, the WHO said on Tuesday (October 8).
In doing so India has come a long way ever since the elimination programme for the disease was launched in the country in 1964.
Elimination refers to the near-zero incidence of a disease in a particular geographic location – in this case India – and the continuation of efforts to see to it that the infection does not come back. It is different from eradication in that sense, because the latter would mean zero prevalence of the disease across the world.
So far, only smallpox has been eradicated from the world.
Although Indian authorities had claimed that India had become free of trachoma in 2017, the WHO granted elimination status in 2024 after a continued surveillance to see that the infection had not resurfaced. This is standard WHO procedure before granting elimination status for any disease to any country.
The bacterium Chlamydia trachomatis is responsible for causing this eye infection. According to the WHO, the infection spreads from contaminated fingers, fomites and flies that have come into contact with discharge from the eyes or nose of an infected person.
The disease commonly infects younger children. Repeated bouts of infection can lead to a condition in which the inside of the eyelid can become scarred to the extent that the eyelid turns inwards and the eyelashes start rubbing against the eyeball. This can result in constant eye pain and lead to blindness.
The first stage of trachoma is trachomatous inflammation-follicular (TF). This is when the infection is just beginning and may not be particularly irritable. Antibiotics are usually started at this stage.
In the second stage, the infection can become intense and start causing pain. In the third stage, the scarring of the eyelids starts.
The fourth stage is when the eyelids start turning inwards and rubbing against the eyeball. Eyelid surgery is usually recommended at this stage, which is known as trachomatous trichiasis (TT). If left untreated, in the fifth stage, the disease leads to blindness.
The WHO passed a resolution in 1998 to target trachoma elimination by the year 2020.
India’s journey to elimination
According to a paper published in 1964 in the Indian Journal of Ophthalmology, the time around which the national elimination programme was launched, trachoma and associated infections made 3.9 million people visually impaired, including 570,000 ‘economically blind’ (a condition in which one is unable to do any work).
“Although it [trachoma] is a preventable condition, the task of eradication of trachoma in India which is still a developing country with low standards of living of the masses, is faced with problems peculiar to itself,” it had said.
“Environmental sanitation, personal hygiene, educational standards are yet to be raised. Age-old beliefs, superstitions and taboos, quacks and charlatans have still their place among the people,” it elaborated.
In the last few years, cases of trachoma were mainly confined to Delhi, Rajasthan, Haryana, Punjab, Gujarat, Uttarakhand and the Andaman and Nicobar Islands.
The WHO in its statement on Tuesday giving India the status of ‘elimination’ said the dreaded infection was responsible for 4% of all cases of blindness in India till 2005.
By 2008, the proportion had significantly come down to 0.008%.
In a survey conducted in 2022 in ten endemic districts (the districts in which the disease had been widespread), it was found that TF was not a ‘public health’ problem by then. Therefore, the study recommended that the mass administration of antibiotics, like azithromycin, be stopped.
However, it also said TT was found in over 0.2% of adults in four districts. It recommended surgical interventions at a wider level as part of an elimination strategy.
Regional director of WHO for the South-East Asia Region, Saima Wazed, credited the governments, ophthalmologists (eye specialists) and other healthcare workers for the success.
“They worked together with partners to ensure effective surveillance, diagnosis and management of active trachoma, provision of surgical services for trichiasis, and promotion of water, sanitation and hygiene, particularly facial cleanliness, among communities to ensure people of all ages can now look towards a trachoma free future,” she said in a statement.
Though the elimination of the disease has been achieved, policymakers would have to ensure continuous surveillance to ensure that the bacteria does not circulate in the community again. They also would need to continue the provision of trichiasis surgery, should there be a case again; and ensure awareness among vulnerable populations regarding facial hygiene and cleanliness.
India joins 19 other nations – Benin, Cambodia, China, Gambia, Ghana, Iran, Iraq, Lao, Malawi, Mali, Mexico, Morocco, Myanmar, Nepal, Oman, Pakistan, Saudi Arabia, Togo and Vanuatu – in achieving trachoma elimination.
“Trachoma is hyperendemic [mostly prevalent] in many of the poorest and most rural areas of Africa, Central and South America, Asia, Australia and the Middle East,” the WHO also said, adding that overall, “Africa remains the most affected continent and the one with the most intensive control efforts.”