$10 million to fight eye illness

December 29, 2007|By David Kohn | David Kohn,Sun reporter

The Johns Hopkins University has received $10 million from the Bill & Melinda Gates Foundation to lead a landmark study on trachoma, a bacterial eye disease that afflicts 84 million people around the world every year and blinds about 4 million.

The award is one of the largest ever to support trachoma research.

"This will be a huge help for understanding how to get rid of trachoma," said Dr. Sheila West, an ophthalmologist and professor at Hopkins' Wilmer Eye Institute. "This disease shouldn't exist at all. The fact that it's still around is frustrating."

West will lead the study, which includes researchers at Hopkins, the London School of Hygiene and Tropical Medicine, the University of California at San Francisco, the World Health Organization and the Ministries of Health in Tanzania, Ethiopia and The Gambia. The group's official name is the Partnership for Rapid Elimination of Trachoma (PRET).

Trachoma is caused by the chlamydia bacterium and is spread by everyday contact in unsanitary conditions, particularly by children.

In the developed world, chlamydia is spread by sexual contact, and can damage the reproductive system. But in poor countries, a different strain of the bug affects the eye and can cause symptoms similar to pinkeye.

Repeated infections over years can scar the eyelid and cause the eyelashes to turn in, damaging the cornea and ultimately causing blindness.

The disease was eliminated from much of the world, including the U.S., in the early 20th century. But trachoma still exists in 48 countries, mostly in Africa and the Middle East. In some parts of Ethiopia, almost every child is infected.

Because trachoma affects mainly people in poor countries, researchers say it has been largely ignored by Western medical establishments. "It hasn't gotten the attention it deserves," said Dr. Thomas Quinn, director of the Hopkins Center for Global Health, which also will work on the project.

Quinn, an infectious disease expert on the faculties of the public health and medical school, has worked in Africa, Asia and Latin America for the past 20 years.

Experts say women develop blindness from trachoma at a rate two to three times that of men.

In the developing world, the condition creates significant economic problems, public health experts say. Causing almost 4 million cases of blindness and more than 5 million cases of reduced vision, trachoma diminishes productivity by $3 billion a year, according to a 2003 study.

Health officials say there are three basic ways to control trachoma: surgery to repair scarred eyelids, antibiotics to kill the bacterium and improved sanitation and hygiene to stop its spread and ultimately wipe it out.

West said the PRET team will look at two potential solutions: a new surgical technique and identification of the best way to deliver antibiotics.

Often, those who undergo eye surgery in poor countries develop the disease again in a year or two. It's not clear why, although many researchers suspect that doctors might not be performing the surgery properly. The researchers will test a new procedure that might simplify the operation.

But most of the $10 million will go to develop strategies to use antibiotics -- particularly azithromycin -- to wipe out trachoma in large communities.

Focusing on Tanzania, Ethiopia and The Gambia, researchers will enroll between 32,000 and 64,000 people in a randomized, controlled trial to see how often people in a village must be dosed with antibiotics in order to wipe out the disease.

The pharmaceutical company Pfizer has pledged to donate as much medicine to the program as needed.

"If you can mass-treat communities, you can reduce transmission and it would literally die out," West said. The study will begin next year, and end in 2010.

West has spent two decades researching trachoma, and she has high hopes that the project will help provide key answers to eliminating it. "I'm excited. I want to retire and know that trachoma is not a problem," she said.

The Gates Foundation has given away billions of dollars in recent years to improve health in the developing world.

Much of the money has gone to HIV/AIDS programs, although the organization has also given money to programs involving malaria, tuberculosis and maternal and child health. Some critics have said the foundation has focused too much on HIV.

"This [grant] shows they're making an effort not only on AIDS, but in other diseases as well," Quinn said.


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