Trachoma

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21-May-2018: Nepal: first country in South-East Asia validated for eliminating trachoma

The World Health Organization (WHO) has validated Nepal for having eliminated trachoma as a public health problem – a milestone, as the country becomes the first in WHO’s South-East Asia Region to defeat the world’s leading infectious cause of blindness.

Nepal’s achievement is commendable and results from strong political commitment, intense community engagement and impressive leadership demonstrated by civil society.

Trachoma was the second leading cause of preventable blindness in Nepal in the 1980s. In 2002, the Government of Nepal stepped up efforts to eliminate the disease with the establishment of a national trachoma programme. From 2002 to 2005, following the implementation of sustained control activities, the prevalence of active (inflammatory) trachoma fell by 40%.

The Government of Nepal, through the Ministry of Water Supply and Sanitation, provided incentives to local communities and districts to build and maintain latrines – measures that were crucial to improving sanitation and reducing disease-carrying flies.

To increase awareness, the national trachoma programme collaborated with the Ministry of Education to include a module on trachoma in the school curriculum.

Approximately 30 000 operations were provided to manage trichiasis, and almost 15 million doses of azithromycin were distributed. Between 2002 and 2014, eye hospitals and dozens of eye centres and clinics with trained staff were established across Nepal.

Azithromycin is donated by the pharmaceutical company Pfizer through the International Trachoma Initiative and was delivered in Nepal by NNJS with support from the United States Agency for International Development-funded ENVISION project, implemented by RTI International.

A series of surveys conducted progressively from 2005 to 2015 showed that active trachoma in children had been brought below the elimination prevalence threshold. Low prevalence was maintained after mass antibiotic treatment was discontinued.

Several criteria are used to assess a country’s claim for having eliminated trachoma as a public health problem. These include:

  • less than 5% of children aged 1–9 years have signs of active trachoma (trachomatous inflammation–follicular), which can be treated with antibiotics, in each previously-endemic district;
  • less than 0.2% of people aged 15 years and older have trachomatous trichiasis, which requires eyelid surgery, in each previously-endemic district; and
  • a health system which can identify and manage new cases of trachomatous trichiasis.

Trachoma, an eye disease caused by infection with the bacterium Chlamydia trachomatis, is spread through contact with infective eye or nose discharges. Infection is particularly common in young children.

Ocular or nasal discharge can be transmitted directly from person to person, or be mediated by flies which have been in contact with the eyes and noses of infected people. Transmission is associated with poor sanitation and hygiene, which increase the availability of eye discharges and encourage the breeding of flies.

Trachoma puts more than 190 million people at risk of blindness in 41 countries. It is responsible for the blindness or visual impairment of around 1.9 million people worldwide.

Pin It
Whatsapp

21-May-2018: Nepal: first country in South-East Asia validated for eliminating trachoma

The World Health Organization (WHO) has validated Nepal for having eliminated trachoma as a public health problem – a milestone, as the country becomes the first in WHO’s South-East Asia Region to defeat the world’s leading infectious cause of blindness.

Nepal’s achievement is commendable and results from strong political commitment, intense community engagement and impressive leadership demonstrated by civil society.

Trachoma was the second leading cause of preventable blindness in Nepal in the 1980s. In 2002, the Government of Nepal stepped up efforts to eliminate the disease with the establishment of a national trachoma programme. From 2002 to 2005, following the implementation of sustained control activities, the prevalence of active (inflammatory) trachoma fell by 40%.

The Government of Nepal, through the Ministry of Water Supply and Sanitation, provided incentives to local communities and districts to build and maintain latrines – measures that were crucial to improving sanitation and reducing disease-carrying flies.

To increase awareness, the national trachoma programme collaborated with the Ministry of Education to include a module on trachoma in the school curriculum.

Approximately 30 000 operations were provided to manage trichiasis, and almost 15 million doses of azithromycin were distributed. Between 2002 and 2014, eye hospitals and dozens of eye centres and clinics with trained staff were established across Nepal.

Azithromycin is donated by the pharmaceutical company Pfizer through the International Trachoma Initiative and was delivered in Nepal by NNJS with support from the United States Agency for International Development-funded ENVISION project, implemented by RTI International.

A series of surveys conducted progressively from 2005 to 2015 showed that active trachoma in children had been brought below the elimination prevalence threshold. Low prevalence was maintained after mass antibiotic treatment was discontinued.

Several criteria are used to assess a country’s claim for having eliminated trachoma as a public health problem. These include:

  • less than 5% of children aged 1–9 years have signs of active trachoma (trachomatous inflammation–follicular), which can be treated with antibiotics, in each previously-endemic district;
  • less than 0.2% of people aged 15 years and older have trachomatous trichiasis, which requires eyelid surgery, in each previously-endemic district; and
  • a health system which can identify and manage new cases of trachomatous trichiasis.

Trachoma, an eye disease caused by infection with the bacterium Chlamydia trachomatis, is spread through contact with infective eye or nose discharges. Infection is particularly common in young children.

Ocular or nasal discharge can be transmitted directly from person to person, or be mediated by flies which have been in contact with the eyes and noses of infected people. Transmission is associated with poor sanitation and hygiene, which increase the availability of eye discharges and encourage the breeding of flies.

Trachoma puts more than 190 million people at risk of blindness in 41 countries. It is responsible for the blindness or visual impairment of around 1.9 million people worldwide.

2017

8-Dec-2017: India now free of ‘infective trachoma’

Union Minister of Health and Family Welfare released the National Trachoma Survey Report (2014-17). He declared that India is now free from ‘infective trachoma’, and termed this as a momentous achievement. The survey findings indicate that the active trachoma infection has been eliminated among children in all the survey districts with overall prevalence of only 0.7%. This is much below the elimination criteria of infective trachoma as defined by the WHO- active trachoma is considered eliminated if the prevalence of active infection among children below 10 years is less than 5%.

The Survey results indicate that active trachoma is no longer a public health problem in India. We have met the goal of trachoma elimination as specified by the WHO under its GET2020 program. This has been possible due to decades of inter-sectoral interventions and efforts that included provision of antibiotic eye drops, personal hygiene, availability of safe water, improved environmental sanitation, availability of surgical facilities for chronic trachoma, and a general improvement in the socio economic status in the country. Still, there should be a constant surveillance by the states to report any fresh cases of trachoma and trachoma sequelae(TT cases) and to treat them promptly to finally be completely free of trachoma.

States which still report cases of active trachoma need to develop a strategy for community-based case finding of patients of trachomatous trichiasis (TT). These cases must be provided free entropion surgery/ treatment in local hospitals. A careful record of each case identified and its management status must be maintained as per the WHO Guidelines. Also, adequate surveillance of the disease must be done all over the country in order to certify India as trachoma free (eliminated). Monthly data on indicators of trachoma surveillance as per WHO guidelines must be regularly sent to the NPCB.

Background: Trachoma is a chronic infective disease of the eye and is the leading cause of infective blindness globally. Trachoma is a disease of poor environmental and personal hygiene and inadequate access to water and sanitation. It affects the conjunctiva under the eyelids. Repeated infections cause scarring leading to in-turning of the eyelashes and eyelids. This further causes damage to the cornea and blindness. It is found affecting the population in certain pockets of the States of North India like Gujarat, Rajasthan, Punjab, Haryana, Uttar Pradesh and Nicobar Islands. Trachoma infection of the eyes was the most important cause of blindness in India in 1950s and over 50% population was affected in Gujarat, Rajasthan, Punjab, and Uttar Pradesh. It was the most important cause of corneal blindness in India, affecting young children.

The National Trachoma Prevalence Surveys and the Trachoma Rapid Assessment Surveys were conducted by Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi in collaboration with National Program for Control of Blindness & Visual Impairment, Union Ministry of Health and Family Welfare from 2014 to 2017. This was conducted in 27 high-risk districts across 23 states and union territories. Trachoma Prevalence Surveys were done in 10 districts selected from the previously hyper-endemic states. Under the survey, 19662 children in 1-9 year age group were examined by trained ophthalmologists. As many as 44135 persons were examined among the 15yr+ age group. The Trachoma Rapid Assessment Surveys (TRA) was done in 17 other districts from other parts of the country in places where trachoma cases have been reported, which were not previously hyper-endemic.