Eyes Wide Open in Guinea Bissau

Dr Anna Last, a Wellcome Trust Clinical PhD fellow in the School’s Faculty of Infectious and Tropical Diseases, won a Young Investigator Award at the 63rd Annual Meeting of the American Society for Tropical Medicine and Hygiene in New Orleans last month, for her work on pathogen diversity in ocular Chlamydia trachomatis which causes blinding trachoma.

Anna has been working in the remote Bijagos Archipelago in Guinea Bissau, where she learned to speak Portuguese Creole and assembled a team of nurses and community health workers to study trachoma, an important cause of blindness on the islands. In collaboration with the Sanger Institute, she has put together the largest collections of chlamydial genome sequences ever assembled, and identified a new virulence gene in C. trachomatis through a genome-wide association study.

Here, Anna reflects on conducting research in a unique setting:

Trachoma, the leading infectious cause of blindness globally, is a significant public health problem on the remote Bijagos Archipelago of Guinea Bissau in West Africa. The archipelago is comprised of approximately 20 inhabited isolated ethnically and culturally distinct islands, whose population has limited access to basic amenities and health care.

I joined the School in 2010, and was given the opportunity to set up a new study site and undertake research into the pathogenicity of ocular Chlamydial infection on these islands. In 2011 I obtained a Wellcome Trust Clinical PhD Fellowship to conduct this research, the first project of its kind on the islands.

I enjoyed the challenges of working on the islands, ranging from conducting field studies and observing the disease in these communities, learning the local language, to developing infrastructure and being able to conduct cutting edge research in this environment.

Through this research, in collaboration with the Wellcome Trust Sanger Institute, we now have a large population-based collection of Chlamydial whole genome sequence data. These data are important in the study of the pathogenesis of chlamydial infection, and through pathogen genome-wide sequence analysis, we have identified genes and loci associated with Chlamydial virulence, allowing directed future research into potential vaccine candidates for this globally important infection.

Additionally we have worked closely with the Programa Nacional de Saude de Visao to build capacity and to administer the first rounds of community mass treatment with azithromycin, in line with WHO policy to eliminate blinding trachoma, to previously treatment-naïve populations on the islands, significantly reducing the prevalence of trachoma in children at follow-up one year after a single round of treatment.

Other Studies

Since starting my PhD research with a single field research team, we have now expanded our infrastructure to six teams, comprised of trained community nurses and local field assistants trained in study methodology. This will allow us to conduct further studies, which to date include an operational treatment trial and a case-control study. We have also been able to offer projects to undergraduate medical students intercalating in International Health from Birmingham University and our own Master’s students. I look forward to continuing with this research when I return to the School in 2015 as a Clinical Lecturer funded by the National Institute for Health Research.



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