Eliminating Trachoma in El Salvador: A Major Health Milestone

The World Health Organization (WHO) has validated El Salvador as having eliminated trachoma as a public health problem, marking a significant milestone in global efforts to combat the leading infectious cause of blindness. This achievement positions El Salvador as the first Central American nation and the second in the Americas to reach this goal, joining 64 countries worldwide recognized by WHO for eliminating at least one neglected tropical disease.

“I congratulate El Salvador on this remarkable achievement. It is a testament to the power of political commitment, strategic investment, and community engagement,” said Dr. Tedros Adhanom Ghebreyesus, WHO Director-General. “El Salvador’s success is a vital step towards our global target of eliminating trachoma worldwide by 2030 and a clear signal that a healthier, more equitable future is within reach.”

The validation process involved targeted assessments conducted between 2023 and 2026 in communities prioritized based on environmental and social risk factors. These assessments found no evidence of active trachoma transmission, with no signs of the disease detected in children and no advanced cases capable of causing blindness in adults. The findings confirmed that trachoma no longer constitutes a public health problem in the country.

“This validation reflects El Salvador’s commitment to reaching populations in the most vulnerable conditions and generating solid evidence to demonstrate that trachoma is not endemic in the country,” said Dr. Jarbas Barbosa, Director of the Pan American Health Organization (PAHO). “It is the result of sustained efforts to reach communities, identify potential cases, and ensure no one was left behind.”

El Salvador’s progress was driven by a multisectoral approach, including strengthened primary health care services, improvements in water, sanitation, and hygiene (WASH), and expanded eye health services such as visual acuity screening in adults. Collaboration among government sectors, communities, and international partners, including PAHO and the Government of Canada, played a critical role. The country also established systems to sustain this achievement, including trained health personnel, integrated surveillance mechanisms, and the capacity to detect and manage trichiasis cases—advanced-stage trachoma where eyelashes turn inward and can lead to blindness.

“El Salvador has reached a major health milestone by achieving certification as a country free of trachoma, the result of sustained national efforts, with the support of PAHO and the Embassy of Canada,” said El Salvador’s Minister of Health, Francisco Alabi. “We are proud to have reached this achievement in just three years, positioning the country in the region and improving the visual health of our population.”

Trachoma, caused by the bacterium *Chlamydia trachomatis*, spreads through contact with eye and nasal discharge from infected individuals. Repeated infections can lead to scarring of the inner eyelid, causing trichiasis and potentially blindness. The disease is strongly associated with poverty and inequities in access to basic services like WASH and health care. In the Americas, trachoma remains a public health problem in rural and remote areas of Brazil, Colombia, Guatemala, and Peru, with regional efforts expanding to define its epidemiological status in other countries.

WHO recommends that countries that have achieved elimination maintain surveillance systems and ensure continued access to quality eye care services to prevent re-emergence. The organization’s 2021–2030 Road Map for Neglected Tropical Diseases outlines targets for controlling, eliminating, or eradicating over 30 conditions. Trachoma is one of the diseases targeted under PAHO’s Disease Elimination Initiative, aiming for elimination in the Americas by 2030.

Elimination of trachoma as a public health problem is defined by three criteria: a prevalence of trachomatous trichiasis (TT) “unknown to the health system” of less than 0.2% in people aged 15 and older; a prevalence of trachomatous inflammation–follicular (TF) in children aged 1–9 years of less than 5% in each formerly endemic district; and the existence of a system to identify and manage incident TT cases.

El Salvador’s validation adds to a growing list of countries that have eliminated trachoma, including Algeria, Australia, Benin, Burundi, Cambodia, China, Egypt, Fiji, Gambia, Ghana, India, Iraq, Iran, Lao PDR, Libya, Malawi, Mali, Mauritania, Mexico, Morocco, Myanmar, Nepal, Oman, Pakistan, Papua New Guinea, Saudi Arabia, Senegal, Togo, Tunisia, Vanuatu, and Vietnam.