Wednesday, November 13, 2019

Posted at: Dec 11, 2017, 1:24 AM; last updated: Dec 11, 2017, 9:21 AM (IST)

India free from active trachoma in children

Trachoma sequelae still prevalent in country, Punjab among most endemic states

Aditi Tandon

Tribune News Service

New Delhi, December 10

The country yesterday declared the elimination of active trachoma, a disease seen among children, marking an important milestone in the fight against the debilitating bacterial disease, which happens to be the most common infectious cause of blindness worldwide.

The World Health Organisation (WHO) defines elimination of active trachoma as less than 5 per cent prevalence in the population under study. A Health Ministry commissioned survey conducted by AIIMS experts between 2014 and 2017 has shown active trachoma prevalence of only 0.7 per cent in children aged one to nine years, who were examined. “We have eliminated active trachoma as a public health problem and will seek WHO certification for this. This is a step forward after polio and yaws elimination,” Health Minister JP Nadda said.

Trachoma has two forms —active and sequelae. While active trachoma is seen among children, sequelae is seen among adults and leads to blindness if untreated. The latter is still prevalent in India, the survey says.

The rate of trachoma sequelae in India is 3.5 per 1,000 persons aged 15 years and above — higher than WHO’s standard of elimination which is less than two cases per 1,000 people. Punjab has reported the second highest burden of trachoma sequelae, also called trachomatous trichiasis. Punjab’s district under study, Hoshiarpur, revealed trichiasis prevalence in 6.6 persons per 1,000. This is second only to Car Nicobar islands, where the prevalence is 24 per 1,000.

Led by Dr Praveen Vashisht of AIIMS, the experts conducted trachoma prevalence survey in 10 districts of India’s seven most trachoma endemic states. These districts were Mahendragarh, Mewat, Tonk, Dholpur, Bikaner, Pauri Garhwal, East Delhi, Hoshiarpur, Banaskantha and Nicobar. “This success is commendable considering in 1960s the prevalence in Punjab, UP, Bihar, Rajasthan and Gujarat ranged from 79 per cent to 48 per cent,” Health Secretary Preeti Sudan said.

India has signed WHO’s Global Elimination of Trachoma by 2020 Plan but acknowledges it needs to do more to eliminate the disease in all forms. While active trachoma can be treated with one dose of erythromycin, trichiasis requires corrective surgery depending on the damage caused to the eye.

“Trachoma is a disease of the poor and unhygienic environments. It begins with irritation and redness and overtime, in the absence of treatment, can cause the eyelid to roll inwards scarring the cornea and causing blindness. It’s infectious. And, blindness from trachoma is irreversible,” Dr Vashisht said.

India was the first country to start an anti-trachoma national plan in 1963 which was merged with the National Programme for Control of Blindness. Experts called for state-specific sentinel surveillance to detect and treat trachoma trichiasis. They said identifying patients for surgery is critical to elimination of trachoma trichiasis, which can damage the cornea so much that sometimes corneal donation is needed to avert permanent blindness.

Bacterial disease

Trachoma has two forms — active and sequelae. While active trachoma is seen among children, sequelae is seen among adults and leads to blindness if untreated. The latter is still prevalent in India, the survey says.


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