CVD researchers to use minimally invasive tissue sampling to identify cause of child mortality

University of Maryland School of MedicineJul 1 2016

The Center for Vaccine Development (CVD) has been awarded a large grant for research that will help determine why so many children under five are dying in the world's poorest countries. The grant will fund use of an innovative alternative to traditional autopsy known as minimally invasive tissue sampling. The technique, which involves the collection of tissue samples with fine needles, allows researchers to quickly identify the cause of death, and help illuminate ways to save lives and improve the health of children in these vulnerable areas.

The grant will support work at CVD's center in Bamako, Mali. It is one of the first three sites to be chosen, joining Soweto, South Africa and Manhiça, Mozambique. CVD is part of the University of Maryland School of Medicine (UM SOM).

The work is part of a larger effort led by Emory University and funded by the Bill & Melinda Gates Foundation to create a network of up to 25 disease surveillance sites known as the Child Health and Mortality Prevention Surveillance network (CHAMPS). The Gates Foundation has committed up to $75 million overall to establish the first six surveillance sites in south Asia and sub-Saharan Africa over the next three years. The program is a long-term project, and is expected to last for 20 years.

The lead researchers on the grant are Karen Kotloff, head of the Division of Infectious Disease and Tropical Pediatrics at UM SOM and Samba Sow, director general of CVD-Mali.

The problem of child mortality is enormous. In 2015, nearly 6 million children died before reaching their fifth birthday--16,000 every day, most in the poorest countries of the world.

A key part of the CHAMPS project is the minimally invasive tissue sampling, which can serve as a substitute for autopsy. When a child dies in the developing world, performing a traditional autopsy is difficult. Often patients die far from a hospital, where there is a shortage of equipment and trained personnel. More importantly, in many cultures autopsies are not accepted, particularly for children, and parents and relatives are not comfortable having them done.

Minimally invasive tissue sampling addresses these limitations and concerns. Such sampling is easier to perform, less expensive, and more acceptable culturally: fine needles are inserted into the body, retrieving small amounts of organ tissue, including lung, liver, heart and brain. This tissue is then examined to pinpoint potential causes of death. By establishing cause of death, researchers can better understand which knowledge gaps most need to be addressed, which interventions will save the most lives, and which diseases require a novel approach to prevention and cure.

"We are very excited to be part of this important project," said Kotloff. "We think this can really help us understand the causes of child mortality. CVD-Mali has an outstanding track record conducting infectious disease research that directly benefits the health and well-being of Malian citizens. The tremendous support of the Malian government has made this possible. It is our hope that CHAMPS data will facilitate efforts to diminish the unacceptably high child mortality rates in Mali."

Kotloff also said that training local medical personnel in Mali and elsewhere will build a medical research infrastructure able to support not only the goals of the CHAMPS study, but also the needs of local health agencies.

CVD-Mali is part of the Malian Ministry of Health, and the data from CHAMPS will help the country, Dr. Sow said. "CHAMPS gives us an unprecedented opportunity to uncover information about life-threatening childhood illnesses that can lead to better recognition, prevention, and treatment," he said.