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Laboratory Tests in the Fight to Save Sight

Posted on by Diana Martin, PhD (Microbiologist, Division of Parasitic Diseases and Malaria)
Laboratory technicians at the Hospital San Antonio in Mitu, Colombia, prepare samples to be run on the trachoma ELISA in June 2016. They will test 3,000 samples collected as part of a survey to determine the impact of mass treatment in the Amazonian district of Vaupes.
Laboratory technicians at the Hospital San Antonio in Mitu, Colombia, prepare samples to be run on the trachoma ELISA in June 2016. They will test 3,000 samples collected as part of a survey to determine the impact of mass treatment in the Amazonian district of Vaupes.

Trachoma, a disease of the eye caused by a bacteria called Chlamydia trachomatis, is the leading infectious cause of blindness worldwide. Repeated infections cause the eyelid to turn inward, at which point the eyelashes scrape and permanently scar the cornea. At one time, trachoma was endemic in parts of Europe and the United States. Trachoma exams—flipping the eyelids and looking for the characteristics spots (or follicles) —were conducted on European immigrants passing through Ellis Island and other facilities in the early 20th century. With development came improved sanitation, leading to the disappearance of the disease in the United States and Europe in the mid-20th century.

Still, today, 540 million people are at risk in 55 countries, and 84 million people are already infected.

In 1997 the Global Elimination of Trachoma by 2020—GET2020—was established. Successes toward the elimination of trachoma achieved thus far can be credited to proven strategies like surgery to correct advanced disease and antibiotics donated by Pfizer to treat active infection, with over 550 million doses of the donated drug given to date. Facial cleanliness and environmental improvement campaigns are also critical to reduce disease transmission. Knowing where interventions are needed the most has been accomplished through the efforts of the Global Trachoma Mapping Project, the largest disease mapping project ever undertaken. And USAID, now celebrating the 10th anniversary of work in Neglected Tropical Diseases (NTDs), has been a major funding partner for these programs.

While trachoma elimination is still a few years off, it is time to begin anticipating what is needed to ensure sustained elimination. There’s no doubt that new lab tools will be a key element.

A laboratory technician at the Hospital San Antonio in Mitu, Colombia, stops the ELISA reaction (blue to yellow color change) to read on the ELISA plate reader. They will test 3,000 samples collected as part of a survey to determine the impact of mass treatment in the Amazonian district of Vaupes.
A laboratory technician at the Hospital San Antonio in Mitu, Colombia, stops the ELISA reaction (blue to yellow color change) to read on the ELISA plate reader. They will test 3,000 samples collected as part of a survey to determine the impact of mass treatment in the Amazonian district of Vaupes.

Moving forward it will be critical to develop surveillance systems that identify re-emergence or re-introduction of trachoma into communities. The 2020 target for trachoma elimination is four years off, but sustaining the gains of the trachoma elimination program requires developing the information and laboratory monitoring systems now. It takes time to develop and test the laboratory tools that are needed for monitoring the success of trachoma programs. After that, these tools will need to be tested in the field before public health officials can rely on the data to detect re-emergence of disease transmission. These concerns prove to be a challenge for global health programs when prioritizing resources and in the face of more immediate needs for getting sight-saving treatment to communities.

With the support of USAID investments, scientists in CDC’s Division of Parasitic Diseases and Malaria have turned to the blood as a way to develop tools to determine how much trachoma is in a community. The scientific rationale is that when kids get infected, they should develop an antibody response. And if they get infected again, and again, and again, each of those infections should act as a sort of booster to the previous infection. When there is a lot of trachoma in a community, there should be a lot of kids with a lot of antibody, and when there is little or no trachoma in a community, the kids should have no antibodies.

So far that is exactly what we have found. The proportion of kids with antibodies to the bacteria that causes trachoma decreases as the amount of trachoma in the community decreases. And in communities where trachoma has been eliminated, the percent of kids with antibody responses is virtually zero. This laboratory tool makes it possible to monitor the impact of trachoma elimination programs and identify infections early if trachoma returns.

Using USAID funding, we developed antibody tests for trachoma surveillance at CDC and rapidly transferred the tools for use in endemic countries. CDC staff have since trained laboratory scientists in Ghana, Malawi, and Colombia to use ELISA methods for antibody testing, and we have partnered with these countries to continue testing the tool so that it will be ready for surveillance as countries move toward elimination of trachoma. We have also developed a rapid, hand-held version of the test and recently field-tested it in Nepal. Ethiopia—the country with the heaviest trachoma burden—is set to validate the new handheld test this summer.

The 2020 target for global trachoma elimination is fast approaching. CDC and our partners are committed to providing countries with the right tools to guarantee the continued control and eventual elimination of trachoma and the blindness that it may cause, continuing in our fight to save sight.

The field team takes a break while village children look on, Kahe Mpya, Rombo District, Tanzania, June 2012. This was the first study looking at trachoma antibodies in a village in which trachoma had been eliminated.
The field team takes a break while village children look on, Kahe Mpya, Rombo District, Tanzania, June 2012. This was the first study looking at trachoma antibodies in a village in which trachoma had been eliminated.
Children in Kahe Mypa, Rombo District, Tanzania, pose for a picture after having trachoma exams conducted and a small amount of blood taken by finger prick.
Children in Kahe Mypa, Rombo District, Tanzania, pose for a picture after having trachoma exams conducted and a small amount of blood taken by finger prick.
Children in Kahe Mypa, Rombo District, Tanzania, pose for a picture after having trachoma exams conducted and a small amount of blood taken by finger prick.
Children in Kahe Mypa, Rombo District, Tanzania, pose for a picture after having trachoma exams conducted and a small amount of blood taken by finger prick.
Village leaders meet with the field team to discuss the study, Kahe Mpya, Rombo District, Tanzania, June 2012. Community engagement is critical to successful field studies.
Village leaders meet with the field team to discuss the study, Kahe Mpya, Rombo District, Tanzania, June 2012. Community engagement is critical to successful field studies.
Posted on by Diana Martin, PhD (Microbiologist, Division of Parasitic Diseases and Malaria)Leave a comment

Saving Lives with Hand Hygiene in Sierra Leone

Float parade celebrating World Hand Hygiene Day at Pujehun, Sierra Leone

“See what is in your hands“ – Nanah Sesay Kamara, National IPC Coordinator, Sierra Leone Hundreds of millions of patients worldwide are affected by unsafe healthcare each year, and the burden is significantly higher in countries where resources are limited. Hand hygiene is one inexpensive and effective strategy to help ensure safe care. Clean hands Read More >

Posted on by Dr. Benjamin Park, Chief, International Infection Control ProgramLeave a commentTags , , ,

World No Tobacco Day – Tobacco Surveillance in Barangay Looc, Province of Zambales, Philippines; Reflections on GTCB’s Worldwide Impact

Global Adult Tobacco Survey pretest surveillance team, barangay Looc.

As an IT Specialist working for the CDC Foundation and assigned to the Office on Smoking and Health’s Global Tobacco Control Branch (GTCB), I have had the opportunity to travel to many places around the world.  We conduct several surveys and I mainly work with the Global Adult Tobacco Survey (GATS).  I provide technical support Read More >

Posted on by Edward Rainey, IT Specialist and Public Health Analyst with the CDC Foundation, assigned to GTCB.Leave a commentTags , , ,

Vietnam: Increased Surveillance Leads to Detection of Zika Virus

Vietnam EOC gathered for a briefing about the Zika virus.

Vietnam EOC gathered for a briefing about the Zika virus. Along with WHO, CDC experts Anthony Mounts, Trang Do, Michael Johansson, and Leisha Nolen provided consultation during the meeting. CDC Vietnam will enhance surveillance and temperature monitoring at border control areas and alert pregnant women to be aware and report any signs and symptoms. The Read More >

Posted on by Niki Pham, MSc.Leave a commentTags , ,

Vietnam: Empowering Communities to Detect Potential Outbreaks Early

Diseases may start in local communities before they spread and become widespread outbreaks. Vietnam is harnessing the power of community members to identify potential outbreaks earlier to shorten response times and avert epidemics. A parent hears rumors from other parents about several children bitten by a rabid dog. A teacher sees an unusually high number Read More >

Posted on by Niki Pham, MSc.Leave a commentTags , ,

A Ray of Hope for a Better-Prepared Ethiopia

Working alongside an EIS officer and an FETP resident on an investigation in Konso, Ethiopia, 2015.

I have called Ethiopia home for the past five years – it is a country that is very close to my heart. I was moved to humanitarian work by images of the famine when I was in college and subsequently adopted my daughter from here. As we face our worst drought in 50 years, I Read More >

Posted on by Lucy Boulanger, DGHP Program Director, EthiopiaLeave a commentTags ,

When It Was Even Scarier

Dr. Anne Schuchat with her mother Molly G Schuchat

This blog originally appeared on The Huffington Post on April 29, 2016 Four score and seven years ago, my mother was born into an America swarming with pathogens. Many were simply known as diseases of childhood; not all children survived them. My mother remembers how her family suffered when a cousin died during infancy from Read More >

Posted on by Anne Schuchat, MDLeave a commentTags , , , ,

Global Immunization: 50 Years of Work, Humanity, and Success

With her head tilted back, the picture depicts a young Nigerian girl, as she was holding her mouth wide open in order to receive her dose of orally-administered polio vaccine. This activity was taking place during Nigeria’s National - Stop Transmission of Polio Program (N-STOP), which is a refined and specialized offspring of two larger programs that train disease detectives: the (international) STOP program, and the Nigeria Field Epidemiology and Laboratory Training Program. N-STOP is a key element in Nigeria’s effort to rid the country of this crippling disease.

This blog was originally posted on MyAJC.com on April 26, 2016. Government is a creature of numbers and statistics, a generator of such vast quantities of data and reports that it’s hard to appreciate sometimes the full human dimension of what it takes to protect everyone from vaccine-preventable diseases. That reality comes to mind as Read More >

Posted on by Rebecca Martin, PhD, Director of the U.S. Centers for Disease Control and Prevention’s Center for Global HealthLeave a commentTags , , ,

The “Ride” To Eliminating Malaria In Haiti

Malaria Zero has one bold goal: to eliminate malaria from the island of Hispaniola, which includes Haiti and the Dominican Republic, by 2020.

CDC works with Haiti and the Dominican Republic to eliminate malaria by 2020. #endmalaria #WMD2016 Tweet This The town of Dame Marie on the southwestern tip of Haiti, is 225 miles from the country’s teeming, chaotic capital Port-au-Prince. But getting there by car—on a good day—can easily take eight hard-fought, kidney-bashing, hairpin-turning hours. That may Read More >

Posted on by Michelle Chang, MD, Medical Epidemiologist/Director of Malaria ZeroLeave a commentTags , , , , ,

World TB Day 2016

TB meeting in country

This blog was originally posted on Huffington Post on March 24, 2016. Today on World TB Day – more than a century after the scientific discovery of the bacteria that causes tuberculosis (TB), TB continues to be one of the world’s most deadly infectious diseases and among the leading causes of death worldwide. That TB Read More >

Posted on by Dr. Shannon Hader, Director, Division of Global HIV & TB, CDCLeave a commentTags
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