The World Health Organization (WHO) has validated El Salvador as having eliminated trachoma as a public health problem. This milestone makes El Salvador the first Central American nation to achieve this status, following a rigorous process (2023–2026) that confirmed no active transmission of the disease in prioritized communities.
This isn’t just a victory for one country; it’s a blueprint for global health equity. Trachoma is a neglected tropical disease (NTD) that is strongly associated with poverty and inequities in access to basic services. By eliminating this infectious cause of blindness, El Salvador has demonstrated that a multisectoral approach, including strengthened primary health care services, improvements in water, sanitation, and hygiene (WASH), and collaboration among government sectors, communities, and international partners can achieve results.
In Plain English: The Clinical Takeaway
- What happened: El Salvador has eliminated trachoma as a public health problem.
- Why it matters: Trachoma can lead to blindness; its elimination is a vital step towards the global target of eliminating trachoma worldwide by 2030.
- The secret sauce: Success came from a “multisectoral” approach—including strengthened primary health care services, improvements in water, sanitation, and hygiene (WASH), eye health services, and collaboration among government sectors, communities, and international partners.
The Pathophysiology of Trachoma
To understand this achievement, we must look at the mechanism of action of the disease. Trachoma is caused by the bacterium Chlamydia trachomatis. It is spread through contact with eye and nasal discharge from infected individuals.
The danger lies in repeated infections. Repeated infections can lead to scarring of the inner eyelid, causing the eyelashes to turn inward (trichiasis), which can ultimately result in blindness. To manage the disease, the country has established systems including trained health personnel, integrated surveillance mechanisms, and the capacity to detect and manage trichiasis cases within the national health system.
Epidemiological Benchmarks: How Elimination is Measured
Elimination of trachoma as a public health problem is defined as: (i) a prevalence of trachomatous trichiasis (TT) “unknown to the health system” of < 0.2% in ≥15-year-olds; and (ii) a prevalence of trachomatous inflammation – follicular (TF) in children aged 1–9 years of < 5%, in each formerly endemic district; plus (iii) the existence of a system to identify and manage incident cases of TT.
| Metric | Clinical Threshold for Elimination | Target Population |
|---|---|---|
| Trachomatous Trichiasis (TT) | < 0.2% prevalence (unknown to health system) | Adults ≥ 15 years |
| Trachomatous Inflammation—Follicular (TF) | < 5% prevalence | Children aged 1–9 years |
| Health System Capacity | Existence of a system to identify and manage incident cases of TT | National Health System |
Between 2023 and 2026, El Salvador conducted targeted assessments in communities prioritized based on environmental and social risk factors. These assessments found no evidence of active transmission of trachoma.
Regional Impact and the 2030 Global Target
El Salvador is the first country in Central America and the second in the Americas to achieve this milestone. Trachoma remains a public health problem in rural and remote areas of Brazil, Colombia, Guatemala, and Peru. Regional efforts to investigate and better define the epidemiological status of trachoma have also been expanded in countries where the disease has been suspected, including the Plurinational State of Bolivia, Ecuador, Guyana, Panama, Paraguay, and the Bolivarian Republic of Venezuela.
PAHO supported the country’s efforts through the Initiative for the Elimination of Trachoma in the Americas, in collaboration with the Government of Canada.
The broader goal is the road map for neglected tropical diseases 2021–2030. WHO continues to support endemic countries to accelerate progress towards the global target of eliminating trachoma as a public health problem worldwide by 2030.
The Path Forward: Sustaining the Milestone
WHO recommends that countries that have achieved elimination maintain surveillance systems and ensure continued access to quality eye care services to prevent the re-emergence of the disease. This means health personnel must remain trained to detect incident cases of trichiasis and ensure the capacity to manage them within the national health system.
The success of El Salvador serves as a testament to the power of political commitment, strategic investment, and community engagement. As we move toward 2030, the focus remains on the global target of eliminating trachoma worldwide.
