Trachoma Research Projects
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 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 Management
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 five 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 and the use of postoperative doxycycline.
Oral doxycycline after surgery for trachomatous trichiasis in Ethiopia: a randomised, double-blind, placebo-controlled trial.
E.Habtamu, T.Wondie, S.Aweke, Z.Tadesse, M.Zerihun, B.Gashaw, C.h.Roberts, A.B.Kello, D.C.W.Mabey, S.N.Rajak, E.K.Callahan, D.Macleod, H.A.Weiss and M.J.Burton
Lancet Global Health, 2018, 6:e579-e592
Posterior versus bilamellar tarsal rotation surgery for trachomatous trichiasis in Ethiopia: a randomised controlled trial
E.Habtamu, T.Wondie, S.Aweke, Z.Tadesse, M.Zerihun, Z.Zewudie, A.B.Kello, C.h.Roberts, P.M.Emerson, R.L.Bailey, D.C.W.Mabey, S.N.Rajak, K.Callahan, H.A.Weiss and M.J.Burton
Lancet Global Health, 2016, 4(3): e175-184
Absorbable versus silk sutures for surgical treatment of trachomatous trichiasis in Ethiopia: A randomised controlled trial
S.N.Rajak, E.Habtamu, H.A.Weiss, A.B.Kello, T.Gebre, A.Genet, R.L.Bailey, D.C.W.Mabey, P.T.Khaw, C.E.Gilbert, P.M.Emerson and M.J.Burton
PLoS Medicine, 2011; 8(12): e1001137
Surgery versus epilation for the treatment of minor trichiasis in Ethiopia: a randomised controlled non-inferiority trial
S.N.Rajak, E.Habtamu, H.A.Weiss, A.B.Kello, T.Gebre, A.Genet, R.L.Bailey, D.C.W.Mabey, P.T.Khaw, C.E.Gilbert, P.M.Emerson and M.J.Burton
PLoS Medicine, 2011; 8(12): e1001136
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
Effect of repeated epilation for minor trachomatous trichiasis on lash burden, phenotype, and surgical management willingness: a cohort study.
Esmael Habtamu, Tariku Wondie, Wubshet Gobezie, Zerihun Tadesse, Bizuayehu Gashaw, Abebaw Gebeyehu, Chrissy h Roberts, E. Kelly Callahan, David Macleod, and Matthew J. Burton
PLOS Neglected Tropical Diseases, 2020, In Pressv
Posterior lamellar versus bilamellar tarsal rotation surgery for trachomatous trichiasis: long-term outcomes from a randomised controlled trial.
E.Habtamu, T.Wondie, Z.Tadesse, B.Atinafu, B.Gashaw, A.Gebeyehu, E.K.Callahan, D.Macleod, and M.J.Burton
EClinicalMedicine, 2019, In Press.
Pre-operative Trichiatic Eyelash Pattern Predicts Post-operative Trachomatous Trichiasis
E.W.Gower, B.Munoz, S.Rajak, E.Habtamu, S.K.West, S.L.Merbs, E.K.Callahan and M.J.Burton
PLOS Neglected Tropical Diseases, 2019, 13(10):e0007637
Impact of trichiasis surgery on daily living: A longitudinal study in Ethiopia
E.Habtamu, T.Wondie, S.Aweke, Z.Tadesse, M.Zerihun, B.Melak, B.Gashaw, K.Callahan, P.M.Emerson, R.L.Bailey, D.C.W.Mabey, S.N.Rajak, H.Kuper, S.Polack, D.Macleod, H.A.Weiss and M.J.Burton
Wellcome Open Research, 2017, 2:69
Predictors of Trachomatous Trichiasis Surgery Outcome
E.Habtamu, T.Wondie, S.Aweke, Z.Tadesse, M.Zerihun, B.Gashaw, G.S.Wondimagegn, H.D.Mengistie, S. N.Rajak, K.Callahan, H.A.Weiss, and M.J.Burton
Ophthalmology, 2017, 114(8):1143-1155
Impact of Trichiasis Surgery on Quality of Life: a longitudinal study in Ethiopia
E.Habtamu, T.Wondie, S.Aweke, Z.Tadesse, M.Zerihun, Z.Zewdie, K.Callahan, P.M.Emerson, H.Kuper, R.L.Bailey, D.C.W.Mabey, S.N.Rajak, S.Polack, H.A.Weiss and M.J.Burton
PLOS Neglected Tropical Diseases, 2016, 10(4):e0004627
The impact of Trachomatous Trichiasis on Quality of Life: a case-control study
E.Habtamu, T.Wondie, S.Aweke, Z.Tadesse, M.Zerihun, Z.Zewdie, K.Callahan, P.M.Emerson, H.Kuper, R.L.Bailey, D.C.W.Mabey, S.N.Rajak, S.Polack, H.A.Weiss and M.J.Burton
PLOS Neglected Tropical Diseases, 2015, 9(11):e0004254
Trachoma and Relative Poverty: a case-control study
E.Habtamu, T.Wondie, S.Aweke, Z.Tadesse, M.Zerihun, Z.Zewdie, K.Callahan, P.M.Emerson, H.Kuper, R.L.Bailey, D.C.W.Mabey, S.N.Rajak, S.Polack, H.A.Weiss and M.J.Burton
PLOS Neglected Tropical Diseases, 2015, 9(11):e0004228
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; 13;9(3):e0003558
Trachomatous trichiasis and its management in endemic countries
S.N.Rajak, J.R.O.Collin and M.J.Burton
Survey of Ophthalmology, 2012; 57(2):105-35
Antibiotics for Trachoma Control
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. Currently, we are conducting a large cluster randomised controlled trial in Ethiopia to examine the potential impact of using a second dose of azithromycin antibiotic, two weeks after the first in mass drug administration programmes.
Enhanced antibiotic distribution strategies and the potential impact of Facial cleanliness and Environmental improvements for the sustained control of trachoma: a modelling study
A.Pinsent, M.J.Burton and M.Gambhir
BMC Medicine, 2016, 14(1):71
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
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 and controlling transmission – F & E
We are seeking to better understand the routes and mechanisms of ocular Chlamydia trachomatis transmission between people living in trachoma endemic communities in Ethiopia. This is informing the development and testing of new approaches to interrupting transmission.
Viability PCR shows that non-ocular surfaces could contribute to transmission of Chlamydia trachomatis infection in trachoma.
Bart Versteeg, Hristina Vasileva, Joanna Houghton, Anna Last, Oumer Shafi Abdurahman, Virginia Sarah, David Macleod, Anthony W. Solomon, Martin J. Holland, Nicholas Thomson, Matthew J. Burton
PLOS Neglected Tropical Diseases, 2020, In Press
Detecting extra-ocular Chlamydia trachomatis in a trachoma-endemic community in Ethiopia: identifying potential routes of transmission
A.Last, B.Versteeg, O.S.Abdurahman, A.Robinson, G.Dumessa, M.A.Aga, G.S.Bejiga, N.Negussu, K.Greenland, A.Czerniewska, N.Thomson, S.Cairncross, V.Sarah, D.Macleod, A.W.Solomon, J.Logan, M.J.Burton
PLOS Neglected Tropical Diseases, 2020, In Press
Comparison of face washing and face wiping methods for trachoma control: a pilot study
A.Czerniewska, A.Versteeg, O.Shafi, G.Dumessa, M.Aga, A.Last, D.MacLeod, V.Sarah, S.Dodson, N.Negussu, B.K.Sori, M.Kirumba, A.Biran, S.Cairncross, M.J.Burton, K.Greenland
American Journal of Tropical Medicine & Hygiene, 2020, 102(4): 740-43
Selecting behaviour change priorities for trachoma ‘F’ and ‘E’ interventions: a formative research study in Oromia, Ethiopia
Katie Greenland, Sian White, Katina Sommers, Adam Biran, Matthew Burton, Virginia Sarah, Wondu Alemayehu
PLOS Neglected Tropical Diseases, 2019, 13(10):e0007784
Responses of the putative trachoma vector, Musca sorbens, to volatile semiochemicals from human faeces.
A.Robinson, J.Bristow, M.V.Holl, R.L.Bailey, D.McLeod, M.A.Birkett, J.C.Caulfield, V.Sarah, J.A.Pickett, S.Dewhirst, V.Chen-Hussey, C.M.Woodcock, U.D’Alessandro, M.J.Burton, A.Last, S.W.Lindsay, J.G.Logan
PLOS Neglected Tropical Diseases, 2020, In Press
Understanding trachoma
In trachoma, the 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. We have conducted large scale cohort studies in Tanzania and Ethiopia that have regularly assessed people for disease and infection and corelated this with a number of immunological responses.
DjinniChip: Evaluation of a novel molecular rapid diagnostic device for the detection of Chlamydia trachomatis in trachoma-endemic areas
Tamsyn R Derrick, Natalia Sandetskaya, Harry Pickering, Andreas Kölsch, Athumani Ramadhani, Elias Mafuru, Patrick Massae, Aiweda Malisa, Tara Mtuy, Matthew J Burton, Martin J Holland, Dirk Kuhlmeier
Parasites & Vectors, 2020, In Press
The conjunctival transcriptome in Ethiopians after trichiasis surgery: associations with the development of eyelid contour abnormalities and the effect of oral doxycycline treatment
Tamsyn Derrick, Esmael Habtamu, Zerihun Tadesse, E. Kelly Callahan, Abebaw Worku, Bizuayehu Gashaw, David Macleod, David C.W. Mabey, Martin J. Holland, Matthew J Burton
Wellcome Open Research, 2019, 4:130
Progression of scarring trachoma in Tanzanian children: a four-year cohort study
A.M.Ramadhani, T.Derrick, D.Macleod, P.Massae, E.Mafuru, A.Malisa, K.Mbuya, C.h.Roberts, W.Makupa, T.Mtuy, R.L.Bailey, D.C.W.Mabey, M.J.Holland and M.J.Burton
PLOS Neglected Tropical Diseases, 2019, 13(8):e0007638
Ocular Immune Responses, Chlamydia trachomatis infection and Clinical Signs of Trachoma Before and After Azithromycin Mass Drug Administration in a Treatment Naïve Trachoma-Endemic Tanzanian Community
A.M.Ramadhani, T.Derrick, D.Macleod, P.Massae, A.Malisa, K.Mbuya, T.Mtuy, W.Makupa, C.Roberts, R.L.Bailey, D.C.W.Mabey, M.J.Holland and Matthew J. Burton
PLOS Neglected Tropical Diseases, 2019, 13(7):e0007559
Evaluation of a Chlamydia trachomatis specific, commercial, real-time PCR for use with ocular swabs
H.Pickering, M.J.Holland, A. R.Last, M.J.Burton and S.E.Burr
Parasites & Vectors, 2018, 11:102
Clinical signs of trachoma are prevalent among Solomon Islanders who have no persistent markers of prior infection with Chlamydia trachomatis.
R.Butcher, O.Sokana, K.Jack, L.Sui, C.Russell, A.Last, D.L.Martin, M.J.Burton, A.W.Solomon, D.C.W.Mabey, C.h.Roberts
Wellcome Open Research, 2018, 3:14
Immunofibrogenic Gene Expression Patterns in Tanzanian Children with Ocular Chlamydia trachomatis Infection, Active Trachoma and Scarring: Baseline Results of a Four-Year Longitudinal Study
A.Ramadhani, T.Derrick, D.Macleod, P.Massae, T.Mtuy, D.Jeffries, C.h.Roberts, R.L.Bailey, D.W.C.Mabey, M.J.Holland, M.J.Burton
Frontiers in Cellular and Infection Microbiology, 2017, 7:406
miRNAs that associate with conjunctival inflammation and ocular Chlamydia trachomatis infection do not predict progressive disease.
T.Derrick, A.Ramadhani, K.Mtengai, P.Massae, M.J.Burton and M.J.Holland
Pathogens and Disease, 2017, 72(2):ftx016
The relationship between Active Trachoma and ocular Chlamydia trachomatis infection before and after mass antibiotic treatment
A.Ramadhani, T.Derrick, D.Macleod, M.J.Holland and M.J.Burton
PLOS Neglected Tropical Diseases, 2016, 10 (10):e0005080
Fibroblasts profiling in scarring trachoma identifies IL6 as a functional component of a fibroblast-macrophage pro-fibrotic and pro-inflammatory feedback loop
Z.Kechagia, D.Ezra, M.J.Burton and M.Bailly
Scientific Reports, 2016, 6:28261
Increased epithelial expression of CTGF and S100A7 with elevated subepithelial expression of IL-1β in trachomatous trichiasis.
T.Derrick P.Luthert, H.Jama, V.H.Hu, P.Massae, D.Essex, M.J.Holland and M.J.Burton
PLOS Neglected Tropical Diseases, 2016, 10(6):e0004752
Immunohistochemical analysis of scarring trachoma indicates infiltration by Natural Killer and undefined CD45 negative cells.
V.H.Hu, P.Luthert, T.Derrick, J.Pullin, H.A.Weiss, P.Massae, T.Mtuy, W.Makupa, D.Essex, D.C.W.Mabey, R.L.Bailey, M.J.Holland and M.J.Burton
PLOS Neglected Tropical Diseases, 2016, 10(5):e0004734
Pathogenesis of Progressive Scarring Trachoma in Ethiopia and Tanzania and its Implications for Disease Control: Two Cohort Studies
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
PLOS Neglected Tropical Diseases, 2015; 13;9(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; 22(6): 394-402
Trachoma
H.R.Taylor, M.J.Burton, D.Haddad, S.K.West and H.Wright
Lancet, 2014; 384(9960):2142-52
Trachoma: protective and pathogenic ocular immune responses to Chlamydia trachomatis
V.H.Hu, M.J.Holland and M.J.Burton
PLOS Neglected Tropical Diseases, 2013; 7(3):e2020