Your Guide to
Neglected Tropical Diseases

Trachoma, a contagious bacterial eye infection, is the world’s leading infectious cause of blindness. An individual’s immune system can clear a single infection, but in endemic areas, repeated infections occur frequently over many years. After years of repeated infections, the inside of the eyelid becomes severely scarred, turning the eyelid inward and resulting in the eyelashes rubbing against the eyeball with each blink (a condition called trachomatous trichiasis). This causes constant pain, light sensitivity, and corneal damage. Without treatment, trachoma leads to the formation of irreversible corneal opacities and blindness.

Trachoma spreads through personal contact via hands, clothes, bedding, or hard surfaces contaminated with eye and nose discharge from infected individuals. Eye-seeking flies, which breed in human feces exposed on soil, also transmit the bacteria. Young children are most commonly infected, with peak prevalence in children aged 3-5 years. The infection is usually acquired from household contacts, when an individual with active disease lives in close proximity with other family members. Disease transmission occurs primarily between children and women who care for them. Environmental factors that increase transmission include lack of access to clean water, absence of toilets or latrines, crowded living conditions, close proximity to cattle, and poor personal hygiene.

Geographic scope:

• Trachoma remains a public health problem in about 30 countries, down from more than 50 countries in previous decades.
• Around 90 million people live in areas where trachoma is common and are at risk of blindness; these primarily include the poorest and most rural areas of Africa, Central and South America, Asia, Australia, and the Middle East.
• Africa is the most affected continent, accounting for about 90% of the global burden.
• About 1.9 million people are currently blind or visually impaired from trachoma.

Population affected:

• Active infection is most common in preschool children aged 3-5 years, who spread the disease to family members and caregivers.
• The blinding stage typically appears in adulthood, most commonly in middle-aged individuals.
• Women are blinded 2-4 times more often than men, likely due to their greater contact with infected children through caregiving roles.
• Tens of thousands of people receive surgical treatment annually, and tens of millions receive antibiotic treatment each year.The majority of patients who receive surgery to treat the advanced blinding stage of the disease are female.
• The number of people at risk of blindness who require surgical treatment has decreased by more than 80% since the early 2000s, showing significant progress toward elimination.

WHO recommends the SAFE strategy for trachoma elimination: Surgery for trachomatous trichiasis, Antibiotics to clear infection, Facial cleanliness, and Environmental improvement. Surgery involves a simple procedure to correct the inward-turning eyelid and prevent further corneal damage. Environmental improvement focuses on increasing access to clean water, sanitation facilities, and waste management to reduce fly populations and disease transmission. The number of people living in trachoma-endemic areas decreased by approximately 94% from 1.5 billion to 97 million between 2002 and 2025. WHO aims to eliminate the disease as a global public health problem by 2030.