Trachoma

A trachoma patient recruitment and treatment campaign. ETHIOPIA. ICEH/LSHTM
Caption: A trachoma patient recruitment and treatment campaign. ETHIOPIA. ICEH /LSHTM

 

Trachoma is the leading infectious cause of blindness. It is a disease of poverty afflicting some of the world’s poorest people, particularly in Africa. Trachoma has disastrous consequences for affected individuals and communities, frequently compounding health problems and poverty. Prevention of blindness from trachoma is a major public health priority internationally.

Trachoma begins in early childhood with repeated infection by the bacterium Chlamydia trachomatis, which causes conjunctival inflammation, referred to as active trachoma. This leads to progressive scarring and in-turning of the eyelashes (trichiasis), so that they now scratch the surface of the cornea. The cornea becomes irreversibly scarred leading to visual impairment and blindness.

To control trachoma and prevent blindness endemic countries are implementing the SAFE Strategy: Surgery for trichiasis, Antibiotic to treat infection and promotion of Facial cleanliness and Environmental improvements to supress transmission of infection.

Our research, within the LSHTM Trachoma Research Group, focuses on aspects of the SAFE strategy, including clinical trials to improve the management of trichiasis and antibiotic treatment, the immunopathogenesis of the disease process, and its socioeconomic impact. Our research is done with partners in several countries including Ethiopia, Tanzania and The Gambia.

Trachomatous Trichiasis – Disease and treatment

We have been working on several aspects of the management of trichiasis: improving the long-term outcome of eyelid surgery, the optimal treatment for the earlier stages of the disease and detailed studies on the clinical features of the disease. This has included several large clinical trials that have explored the use of postoperative azithromycin, alternative suture materials, the role of epilation in mild disease and a comparison of different operation types.

Trachomatous trichiasis surgery training DVD

Trachomatous trichiasis surgery training DVD

This training DVD has step-by-step teaching videos on both the bilamellar tarsal rotation (BLTR) and posterior lamellar tarsal rotation (PLTR) procedures.  In addition, there is extensive supporting material, such as the assessment and counselling of patients, setting up an operating theatre, sterilising instruments and post-operative care. Watch the DVD online or order copies for distribution in low and middle-income countries.

Antibiotics for Trachoma

Antibiotics are used by trachoma control programmes to treat Chlamydia trachomatis infection. Our work has focused on the rational use of the antibiotic azithromycin; addressing questions such as who should be given the antibiotic? How frequently should they receive it? How many years should the antibiotic be given for? This work has contributed to an understanding of the major reservoirs of infection within endemic communities and to the current approaches for the use of antibiotics.

Understanding trachoma

In trachoma infection triggers a poorly understood inflammatory response, which leads to conjunctival scarring and blinding complications. We are studying the way that the human immune system reacts to chlamydial infection in order to define biomarkers for progressive disease and to identify potential therapeutic targets for progressive scarring.

Climate and Trachoma

Evidence indicates that climate change will contribute to the global burden of disease through a variety of different mechanisms, including both direct and indirect effects of global warming and more extreme weather conditions. It is possible that the prevalence of trachoma will be significantly affected by changes in the environment as these may alter specific risk factors such as the availability of water and fly populations. This work is reviewing the available data in this area.

“F” and “E” elements of the SAFE strategy

A mixed methods study was undertaken in Turkana and Marsabit, two districts in northern Kenya where trachoma is highly endemic. The study explored the availability of water and sanitation, and behaviours in relation to hand washing and the use of water and sanitation with a view to improving interventions to reduce the transmission of trachoma. Report: Trachoma Turkana report FINAL (PDF)

Acknowledgements

We gratefully acknowledge the support of the research funders:

  • The Wellcome Trust
  • Band Aid Foundations
  • British Council for the Prevention of Blindness
  • SightSavers

Publications

Trachomatous Trichiasis – Disease and treatment

Epilation for minor trachomatous trichiasis: four-year results of a randomised controlled trial

  • E.Habtamu, S.N.Rajak, Z.Tadesse, T.Wondie, M.Zerihun, B.Guadie, T.Gebre, A.B.Kello, K.Callahan, D.C.W.Mabey, P.T.Khaw, C.E.Gilbert, H.A.Weiss, P.M.Emerson and M.J.Burton. PLOS Neglected Tropical Diseases, 2015; In Press
  • Rajak SN, Habtamu E, Weiss HA, Kello AB, Abera B, Zerihun M, Gebre T, Gilbert CE, Khaw PT, Emerson PM, Burton MJ. The outcome of trachomatous trichiasis surgery in Ethiopia: risk factors for recurrence. PLoS Negl Trop Dis. 2013 Aug 22;7(8):e2392. Article
  • Rajak SN, Habtamu E, Weiss HA, Bedri A, Zerihun M, Gebre T, Gilbert CE, Emerson PM, Burton MJ. Why do people not attend for treatment for trachomatous trichiasis in Ethiopia? A study of barriers to surgery PLoS Negl Trop Dis. 2012 Aug;6(8):e1766. Article 
  • Rajak SN, Collin JR, Burton MJ. Trachomatous trichiasis and its management in endemic countries. Surv Ophthalmol. 2012 Mar-Apr;57(2):105-35. Article
  • Rajak SN, Habtamu E, Weiss HA, Bedri A, Gebre T, Genet A, Khaw PT, Bailey RL, Mabey DC, Gilbert CE, Emerson PM, Burton MJ. Epilation for trachomatous trichiasis and the risk of corneal opacification. Ophthalmology. 2012 Jan;119(1):84-9. Abstract
  • Rajak SN, Habtamu E, Weiss HA, Kello AB, Gebre T, Genet A, Bailey RL, Mabey DC, Khaw PT, Gilbert CE, Emerson PM, Burton MJ. Absorbable versus silk sutures for surgical treatment of trachomatous trichiasis in Ethiopia: a randomised controlled trial. PLoS Med. 2011 Dec;8(12):e1001137. 13. Article 
  • Rajak SN, Habtamu E, Weiss HA, Kello AB, Gebre T, Genet A, Bailey RL, Mabey DC, Khaw PT, Gilbert CE, Emerson PM, Burton MJ. Surgery versus epilation for the treatment of minor trichiasis in Ethiopia: a randomised controlled noninferiority trial. PLoS Med. 2011 Dec;8(12):e1001136. Article
  • Rajak SN, Habtamu E, Weiss HA, Bedri A, Gebre T, Bailey RL, Mabey DC, Khaw PT, Gilbert CE, Emerson PM, Burton MJ. The clinical phenotype of trachomatous trichiasis in Ethiopia: not all trichiasis is due to entropion. Invest Ophthalmol Vis Sci. 2011 Oct 10;52(11):7974-80. Print 2011. Abstract
  • Habtamu E, Rajak SN, Gebre T, Zerihun M, Genet A, Emerson PM, Burton MJ. Clearing the backlog: trichiasis surgeon retention and productivity in Northern Ethiopia. PLoS Negl Trop Dis. 2011 Apr 5;5(4):e1014. Article

Trichiasis surgery in The Gambia: a four year prospective study. 

  • S.N.Rajak, P.Makalo, A.Sillah, M.J.Holland, D.C.W.Mabey, R.L.Bailey and M.J.Burton. Investigative Ophthalmology & Visual Science, 2010; 51(10): 4996-5001

The long-term natural history of trachomatous trichiasis in The Gambia.

  • M.J.Burton, R.J.C.Bowman, H.Faal, E.A.N.Aryee, U.N.Ikumapayi, N.D.E.Alexander, R.A.Adegbola, D.C.W.Mabey, A.Foster, G.J.Johnson and R.L.Bailey. Investigative Ophthalmology & Visual Science, 2006; 47(3): 847-852

A randomised controlled trial of azithromycin following surgery for trachomatous trichiasis in The Gambia. 

  • M.J.Burton, F.Kinteh, O.Jallow, A.Sillah, M.Bah, M.Faye, E.A.N.Aryee, U.N.Ikumapayi, N.D.E.Alexander, R.A.Adegbola, H.Faal, D.C.W.Mabey, A.Foster, G.J.Johnson and R.L.Bailey. British Journal of Ophthalmology, 2005; 89: 1282-1288

Long term outcome of trichiasis surgery in The Gambia. 

  • M.J.Burton, R.J.C.Bowman, H.Faal, E.A.N.Aryee, U.N.Ikumapayi, N.D.E.Alexander, R.A.Adegbola, S.K.West, D.C.W.Mabey, A.Foster, G.J.Johnson and R.L.Bailey. British Journal of Ophthalmology, 2005; 89: 575-579

Antibiotics for Trachoma

  • Profound and sustained reduction in Chlamydia trachomatis in The Gambia: a five-year longitudinal study of trachoma endemic communities. M.J.Burton, M.J.Holland, P.Makalo, E.A.N.Aryee, A.Sillah, S.Cohuet, A.Natividad, N.D.E.Alexander, D.C.W.Mabey and R.L.Bailey. PLOS Neglected Tropical Diseases, 2010; 4 (10): e835
  • The development of an age-structured model for trachoma transmission dynamics, pathogenesis and control. M.Gambhir, M.G.Basáñez, M.J.Burton, A.W.Solomon, R.L.Bailey, M.J.Holland, I.M.Blake, C.Donnelly, I.Jabr, D.C.W.Mabey and N.C.Grassly. PLOS Neglected Tropical Diseases, 2009; 3(6): e462
  • Estimating household and community transmission of ocular Chlamydia trachomatis. I.M.Blake, M.J.Burton, R.L.Bailey, A.W.Solomon, S.K.West, B.Muñoz, D.C.W.Mabey, M.Gambhir, M.G.Basáñez and N.C.Grassly. PLOS Neglected Tropical Diseases, 2009; 3(3): e401
  • Re-emergence of Chlamydia trachomatis infection after mass antibiotic treatment of a trachoma endemic Gambian community. M.J.Burton, M.J.Holland, P.Makalo, E.A.N.Aryee, N.D.E.Alexander, A.Sillah, H.Faal, S.K.West, A.Foster, G.J.Johnson, D.C.W.Mabey and R.L.Bailey.Lancet, 2005; 365: 1321-28
  • Which members of a community need antibiotics to control trachoma? Conjunctival Chlamydia trachomatis infection load in endemic Gambian villages.M.J.Burton, M.J.Holland, N.Faal, E.A.N.Aryee, N.D.E.Alexander, M.Bah, H.Faal, S.K.West, A.Foster, G.J.Johnson, D.C.W.Mabey and R.L.Bailey. Investigative Ophthalmology & Visual Science, 2003; 44(10): 4215-422
  • Strategies for control of trachoma: observational study with quantitative PCR. A.W.Solomon, M.J.Holland, M.J.Burton, S.K.West, N.D.E.Alexander, A.Aguirre, P.A.Massae, H.Mkocha, B.Munoz, G.J.Johnson, R.W.Peeling, R.L.Bailey, A.Foster, D.C.W.Mabey.Lancet, 2003; 362: 198-204

Understanding Trachoma

  • M.J.Burton, S.N.Rajak, V.H.Hu, A.Ramadhani, E.Habtamu, P.Massae, Z.Tadesse, K.Callahan, P.M.Emerson, P.T.Khaw, D.Jeffries, D.C.W.Mabey, R.L.Bailey, H.A.Weiss and M.J.Holland.
  • Pathogenesis of Progressive Scarring Trachoma in Ethiopia and Tanzania and its Implications for Disease Control: Two Cohort Studies. PLOS Neglected Tropical Diseases, 2015 May9(5): e0003763

Estimating the future impact of a multi-pronged intervention strategy on the ocular disease sequelae caused by trachoma: a modelling study 

  • M.Gambhir, N.C.Grassly, M.J.Burton, A.W.Solomon, H.R.Taylor, D.C.Mabey, I.M.Blake and, M.G.Basáñez. Ophthalmic Epidemiology, 2015; In Press

The conjunctival microbiome in health and trachomatous disease

  • Y.Zhou, M.J.Holland, P.Makalo, H.Joof, C.H.Roberts, D.C.W.Mabey, R.L.Bailey, M.J.Burton, G.M.Weinstock and S.E.Burr. Genome Medicine, 2014; 6(11):99
  • Mabey DC, Hu V, Bailey RL, Burton MJ, Holland MJ. Towards a safe and effective chlamydial vaccine: lessons from the eye.  Vaccine. 2014 Mar 20;32(14):1572-8.  Article
  • Nguena MB, van den Tweel JG, Makupa W, Hu VH, Weiss HA, Gichuhi S, Burton MJ. Diagnosing ocular surface squamous neoplasia in East Africa: case-control study of clinical and in vivo confocal microscopy assessment. Ophthalmology. 2014 Feb;121(2):484-91.
  • Hu VH, Holland MJ, Cree IA, Pullin J, Weiss HA, Massae P, Makupa W, Mabey DC, Bailey RL, Burton MJ, Luthert P. In vivo confocal microscopy and histopathology of the conjunctiva in trachomatous scarring and normal tissue: a systematic comparison. Br J Ophthalmol. 2013 October; 97(10): 1333–1337. Article
  • Hu VH, Holland MJ, Burton MJ. Trachoma: Protective and Pathogenic Ocular Immune Responses to Chlamydia trachomatis. PLoS Negl Trop Dis. 2013 Feb;7(2):e2020. Article
  • Burton MJ, Rajak SN, Ramadhani A, Weiss HA, Habtamu E, Abera B, Emerson PM, Khaw PT, Mabey DCW, Holland MJ, Bailey RL. Post-operative recurrent trachomatous trichiasis is associated with increased conjunctival expression of S100A7 (Psoriasin). PLoS Negl Trop Dis. 2012 December; 6(12): e1985. Article
  • Hu VH, Weiss HA, Ramadhani AM, Tolbert SB, Massae P, Mabey DC, Holland MJ, Bailey RL, Burton MJ. Innate immune responses and modified extracellular matrix regulation characterize bacterial infection and cellular/connective tissue changes in scarring trachoma. Infect Immun. 2012 Jan;80(1):121-30. Article
  • Hu VH, Weiss HA, Massae P, Courtright P, Makupa W, Mabey DC, Bailey RL, Burton MJ. In vivo confocal microscopy in scarring trachoma. Ophthalmology. 2011 Nov;118(11):2138-46. Epub 2011 Sep 13. Article
  • Burton MJ, Hu VH, Massae P, Burr SE, Chevallier C, Afwamba IA, Courtright P, Weiss HA, Mabey DC, Bailey RL. What is causing active trachoma? The role of non-chlamydial bacterial pathogens in a low prevalence setting. Invest Ophthalmol Vis Sci. 2011 Jul 29;52(8):6012-7. Article
  • Hu VH, Massae P, Weiss HA, Chevallier C, Onyango JJ, Afwamba IA, Mabey DC, Bailey RL, Burton MJ. Bacterial infection in scarring trachoma. Invest Ophthalmol Vis Sci. 2011 April; 52(5): 2181–2186. Article
  • Burton MJ, Rajak SN, Bauer J, Weiss HA, Tolbert SB, Shoo A, Habtamu E, Manjurano A, Emerson PM, Mabey DC, Holland MJ, Bailey RL. The conjunctival transcriptome in scarring trachoma. Infect Immun. 2011 Jan;79(1):499-511. Article
  • Hu VH, Massae P, Weiss HA, Cree IA, Courtright P, Mabey DC, Bailey RL, Burton MJ. In vivo confocal microscopy of trachoma in relation to normal tarsal conjunctiva. Ophthalmology. 2011 Apr;118(4):747-54. Article
  • Hu VH, Harding-Esch EM, Burton MJ, Bailey RL, Kadimpeul J, Mabey DC. Epidemiology and control of trachoma: systematic review Trop Med Int Health. 2010 Jun;15(6):673-91. Abstract
  • Anita Ramesh, Sari Kovats, Dominic Haslam, Elena Schmidt and Clare E Gilbert. The impact of climatic risk factors on the prevalence, distribution, and severity of acute and chronic trachoma. PLoS Negl Trop Dis. 2013 Nov 7;7(11):e2513.  Article

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