company pfizer has agreed to donate azithromycin until 2025, if necessary, for elimination of the disease. the campaign unexpectedly found distribution of azithromycin to very poor children reduced their early death rate by up to 25%. history the disease is one of the earliest known eye afflictions, having been identified in egypt as early as 15 bc. its presence was also recorded in ancient china and mesopotamia. trachoma became a problem as people moved into crowded settlements or towns where hygiene was poor. it became a particular problem in europe in the 19th century. after the egyptian campaign (1798–1802) and the napoleonic wars (1798–1815), trachoma was rampant in the army barracks of europe and spread to those living in towns as troops returned home. stringent control measures were introduced, and by the early 20th century, trachoma was essentially controlled in europe, although cases were reported until the 1950s. today, most victims of trachoma live in underdeveloped and poverty-stricken countries in africa, the middle east, and asia. in the united states, the centers for disease control says, "no national or international surveillance exists. blindness due to trachoma has been eliminated from the united states. the last cases were found among native american populations and in appalachia, and those in the boxing, wrestling, and sawmill industries (prolonged exposure to combinations of sweat and sawdust often led to the disease). in the late 19th and early 20th centuries, trachoma was the main reason for an immigrant coming through ellis island to be deported." in 1913, president woodrow wilson signed an act designating funds for the eradication of the disease. immigrants who attempted to enter the u.s. through ellis island, new york, had to be checked for trachoma. during this time, treatment for the disease was by topical application of copper sulfate. by the late 1930s, a number of ophthalmologists reported success in treating trachoma with sulfonamide antibiotics. in 1948, vincent tabone (who was later to become the president of malta) was entrusted with the supervision of a campaign in malta to treat trachoma using sulfonamide tablets and drops. due to improved sanitation and overall living conditions, trachoma virtually disappeared from the industrialized world by the 1950s, though it continues to plague the developing world to this day. epidemiological studies were conducted in 1956–1963 by the trachoma control pilot project in india under the indian council for medical research. this potentially blinding disease remains endemic in the poorest regions of africa, asia, and the middle east and in some parts of latin america and australia. currently, 8 million people are visually impaired as a result of trachoma, and 41 million have an active infection. of the 54 countries that the who cited as still having blinding trachoma occurring, australia is the only developed country—australian aboriginal people who live in remote communities with inadequate sanitation are still blinded by this infectious eye disease. india's health and family welfare minister jp nadda declared india free of infective trachoma in 2017. etymology the term is derived from neo-latin trāchōma, from greek τράχωμα trākhōma, from τραχύς trākhus "rough". economics the economic burden of trachoma is huge, particularly with regard to covering treatment costs and productivity losses as a result of increased visual impairment, and in some cases, permanent blindness. the global estimated cost of trachoma is reported between $us2.9 and 5.3 billion each year. by including the cost for trichiasis treatment, the estimated overall cost for the disease increases to about $us 8 billion.