World Health Organization Validates El Salvador as Trachoma-Free Country

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The World Health Organization (WHO) has officially validated El Salvador as having eliminated trachoma as a public health problem, marking a significant milestone in global infectious disease control. The country is the first in Central America and the second in the Americas to reach this status, following three years of rigorous epidemiological assessments conducted between 2023 and 2026.

• El Salvador achieved WHO validation by demonstrating a prevalence of trachomatous trichiasis (TT) below 0.2% in adults and trachomatous inflammation (TF) below 5% in children.
• Elimination was confirmed through targeted, community-based surveillance and the implementation of robust, integrated primary health care services.
• Ongoing systemic surveillance and access to quality eye care remain mandatory to prevent the re-emergence of Chlamydia trachomatis, the pathogen responsible for the disease.

Epidemiological Pathogenesis and Surveillance

Trachoma is caused by the bacterium Chlamydia trachomatis, which is transmitted through direct contact with ocular or nasal secretions from infected individuals. The disease process is characterized by chronic inflammation of the conjunctiva, known as follicular trachoma (TF). Repeated cycles of infection lead to subconjunctival scarring, which eventually causes the eyelid to contract inward—a condition termed trachomatous trichiasis (TT). When the eyelashes abrade the cornea, it results in profound and irreversible visual impairment.

The validation process in El Salvador was predicated on strict clinical thresholds established by the WHO Road Map for Neglected Tropical Diseases 2021–2030. According to the official assessment data, researchers found no evidence of active infection in pediatric populations and no advanced cases of trichiasis that were previously unknown to the national health system. This evidence was secured through a multisectoral strategy that improved water, sanitation, and hygiene (WASH) infrastructure while simultaneously expanding visual acuity screening in remote, vulnerable populations.

Infrastructure and Sustained Clinical Oversight

The success of the initiative is largely attributed to the Pan American Health Organization (PAHO) and the Initiative for the Elimination of Trachoma in the Americas, which received funding and strategic support from the Government of Canada. This partnership allowed for the integration of trachoma screening into existing primary care frameworks, rather than relying on vertical, disease-specific programs. By training local health personnel to identify and manage incident cases of TT, the national health system has built a sustainable “safety net” to prevent the disease from regaining a foothold.

For healthcare systems operating in regions where neglected tropical diseases remain endemic, the El Salvador model underscores the necessity of integrating surveillance with broader social development.

Regional Context and Global Targets

While El Salvador has successfully met the criteria, trachoma remains a public health concern in other parts of the Americas, including parts of Brazil, Colombia, Guatemala, and Peru. The regional strategy remains focused on defining the epidemiological status of suspected cases in countries such as Bolivia, Ecuador, and Venezuela. The global goal, supported by the WHO Alliance for the Global Elimination of Trachoma by 2020 (GET2020), is to achieve total worldwide elimination by 2030.

The transition from an endemic state to a validated elimination status requires consistent, long-term commitment to health equity. As Dr. Tedros Adhanom Ghebreyesus, WHO Director-General, noted, this milestone is a “testament to the power of political commitment, strategic investment, and community engagement.” For clinicians working in ophthalmology or infectious disease control, the current priority is maintaining high-sensitivity surveillance systems.

The path forward for nations still grappling with endemic trachoma involves a parallel focus on basic sanitation and the scaling of surgical services for existing trichiasis cases. As international partners continue to monitor progress, the focus will shift from initial eradication to the maintenance of public health systems capable of immediate response to any imported or latent cases.