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Dr. Alfred Sommer, 2001 Awardee
Dr. Alfred Sommer was born in the United States. He serves as the dean of the School of Hygiene & Public Health at Johns Hopkins University (USA) and professor of Epidemiology, International Health and Ophthalmology at the university. Dr. Sommer received his medical degree from Harvard Medical School, conducting his medical internship and residency at Harvard University's Beth Israel Hospital, his fellowship in epidemiology at Johns Hopkins, and his residency and fellowship in ophthalmology at the Johns Hopkins Wilmer Eye Institute.
Since 1969, Dr. Sommer and his family have traveled and lived extensively in developing countries, pursuing research related to blindness prevention and child survival. As a founding member of the International Vitamin A Consultative Group (IVACG), he has advanced global policy and programmatic initiatives for the control of micronutrient deficiencies.
Dr. Sommer has authored five books and more than 250 scientific articles. He has chaired advisory committees for numerous organizations, including WHO, UNICEF and the National Institutes of Health (U.S.), and is an elected member of the U.S. National Academy of Sciences, Institute of Medicine, serving on its Food and Nutrition Board.
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RESEARCH WORK
SELECTED BIBLIOGRAPHY
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Research Work
Dr. Alfred Sommer's contributions to our understanding of epidemiology and consequences of malnutrition are marked by innovation and persistence. The first, soon after completing his basic medical education, was the pioneering demonstration that simple anthropometrical measurements were closely associated with subsequent childhood death. These and other indices are now routinely employed in nutritional screening, measurement, and surveillance programs.
Dr. Sommer's major, long-term continuing research interest involves the cause, magnitude, consequences, and control of vitamin A deficiency, and most recently, those of related micronutrients. These investigations began in earnest in the mid 1970s with a complex series of intervention trials that Dr. Sommer conducted in Indonesia (1976-1980). In addition to revealing the epidemiologic characteristics and determinants of deficiency among young children, Dr. Sommer documented the complete clinical spectrum of xerophthalmia, from mild nightblindness, retinal depigmentation and corneal punctate keratopathy, through blinding keratomalacia. He uses clinical-pathologic correlations and randomized trials to demonstrate that corneal ulceration and blindness was entirely related to vitamin A deficiency. Parallel studies he organized with colleagues in Africa demonstrated that most measles-associated pediatric blindness was related to acute decompensation of vitamin A status.
Dr. Alfred Sommer's contributions to our understanding of epidemiology and consequences of malnutrition are marked by innovation and persistence. The first, soon after completing his basic medical education, was the pioneering demonstration that simple anthropometrical measurements were closely associated with subsequent childhood death. These and other indices are now routinely employed in nutritional screening, measurement, and surveillance programs.
Dr. Sommer's major, long-term continuing research interest involves the cause, magnitude, consequences, and control of vitamin A deficiency, and most recently, those of related micronutrients. These investigations began in earnest in the mid 1970s with a complex series of intervention trials that Dr. Sommer conducted in Indonesia (1976-1980). In addition to revealing the epidemiologic characteristics and determinants of deficiency among young children, Dr. Sommer documented the complete clinical spectrum of xerophthalmia, from mild nightblindness, retinal depigmentation and corneal punctate keratopathy, through blinding keratomalacia. He uses clinical-pathologic correlations and randomized trials to demonstrate that corneal ulceration and blindness was entirely related to vitamin A deficiency. Parallel studies he organized with colleagues in Africa demonstrated that most measles-associated pediatric blindness was related to acute decompensation of vitamin A status.
Dr. Sommer's most important insight, and initially the most controversial, was his recognition that mild vitamin A deficiency dramatically increases childhood death, particularly from reduced resistance to infections diseases (primarily measles and diarrhea). It took Dr. Sommer and his growing team of colleagues a number of large-scale, community-based randomized trials, from 1983 through 1992, to finally convince the broad scientific community and major policy makers of the validity of their observations and potential impact. As a result, control of vitamin A deficiency was included in the Declaration of the Rights of Children, as well as the Plan of Action of the World Food Congress.
Upon discovering that vitamin A deficiency was far more common than previously recognized, Dr. Sommer's remarkable ability to move from science to practice is marked by his demonstration that the debilitating consequences of deficiency could be effectively, and far more urgently and cheaply treated with oral high-dose vitamin A supplementation and did not require sterile injectable preparation. As a result, the World Development Report (World Bank) declared vitamin A supplementation one of the most cost-effective of all health interventions.
Ongoing Research
Presently, Dr. Sommer and his colleagues continue to unravel the physiologic consequences of vitamin A deficiency and potential impact of alternative intervention schemes, using vitamin A alone and in combination with other micronutrients. A recently published series of papers demonstrates, for the first time, that supplementing women of childbearing age with either vitamin A or beta-carotene dramatically reduces mortality (on average, by almost 45%). As one would expect, most of the benefit occurs among those women who were most deficient to begin with. These dramatic results are now being tested in a new, equally large randomized controlled field trial in Bangladesh, where, in addition, the potential benefits of simultaneous supplementation with other micronutrients (zinc, folate, iron, B-complex) is being determined.
An earlier study by Dr. Sommer and colleagues suggested that providing an infant with a large vitamin A dose at birth (50,000 IU) dramatically reduced subsequent mortality. This finding is at odds with inferential data Dr. Sommer and others collected from other studies. Two new trials are directly addressing this issue in enhanced fashion in India and Zimbabwe.
The fourth major field investigation about to be launched by Dr. Sommer and his research team is a multi-armed trial of alternative combinations of micronutrients on the subsequent health and survival of young Nepalese children. Similar protocols will subsequently pursue this important issue in Bangladesh and Zanzibar.
Selected Bibliography
Sommer A, Muhilal, Tarwotjo I, Djunaedi E, Glover J. Oral versus intramuscular vitamin A in the treatment of xerophthalmia. Lancet 1980;1:557-559
Sommer A, Tarwotjo I, Hussaini G. Incidence, prevalence and scale of blinding malnutrition. Lancet 1981;1:1407-1408.
Sommer A, Tarwotjo I, Hussaini G, Susanto D. Increased mortality in children with mild vitamin A deficiency. Lancet 1983;2:585-588.
Sommer A, Katz J, Tarwotjo I. Increased risk of respiratory disease and diarrhea in children with preexisting mild vitamin A deficiency. Am J Clin Nutr 1984;40:1090-1095.
Sommer A, Tarwotjo I, Djunaedi E, West KP, Loedin AA, Tilden R, Mele L, and the Aceh Study Group. Impact of vitamin A supplementation on childhood mortality: a randomized controlled community trial. Lancet 1986;1:1169-1173.
Barclay AJG, Foster A, Sommer A. Vitamin A supplements and mortality related to measles: a randomized clinical trial. Br Med J 1987:294:294-296.
West KP Jr, Pokhrel RP, Katz J, LeClerq SC, Khatry SK, Shrestha SR, Pradhan EK, Tielsch JM, Pandey MR, Sommer A. Efficacy of vitamin A in reducing preschool child mortality. Lancet 1991;338:67-71.
Sommer A. Uses and misuses of vitamin A. Current issues in Public Health. 1996;2:161-164.
West KP Jr, LeClerq SC, Shrestha SR, Wu LS-F, Pradhan EK, Khatry Sk, Katz J, Adhikari R, Sommer A. Effects of vitamin A on growth of vitamin A-deficient children: field studies in Nepal. J Nutr 1997;127:1957-1965.
West KP Jr, Katz J, Khatry SK, LeClerq SC, Pradhan EK, Shrestha SR, Connor PB, Dali SM, Christian P, Pokhrel RP, Sommer A. Double blind, cluster randomized trial of low dose supplementation with vitamin A of beta-carotene on morality related to pregnancy in Nepal. Br Med J 1999;318:570-575.
Katz J, West KP Jr, Khatry SK, Pradhan EK, LeClerq Sc, Christian P, Wu LSF, Adhikari RK, Shrestha SR, Sommer A, and NNIPS-2 Study Group. Maternal low-dose vitamin A or beta-carotene supplementation has no effect on fetal loss and early infant mortality: a randomized cluster trial in Nepal. Am J Clin Nutr 2000;71:1570-1576.
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Dr. Sommer is Dean of the Johns Hopkins School of Hygiene and Public Health and Professor of Ophthalmology, Epidemiology and International Health.
Sommer received his M.D. from Harvard Medical School (1967) and his Master of Health Science in Epidemiology from the Johns Hopkins School of Public Health (1973).
Sommer's research interests include outcomes assessment; blindness prevention strategies; child survival; and the growing interface between medicine and public health.
Sommer has published 5 books and over 300 scientific articles and has chaired scientific and advisory committees of the National Institutes of Health, the World Health Organization, UNICEF, the International Vitamin A Consultative Group (IVACG), the Edna McConnell Clark Foundation and the American Academy of Ophthalmology.
He has received numerous awards, including the Albert Lasker Award for Clinical Research; the Helmut Horten Medical Research Award; the Charles A. Dana Award for Pioneering Achievements in Health; the Prince Mahidol Award (from His Majesty the King of Thailand); the Joseph E. Smadel Award of the Infectious Diseases Society of America; and the Duke Elder International Gold Medal for Contributions to Ophthalmology.
He has delivered over 30 named lectureships, including the Jackson Memorial Lecture (American Academy of Ophthalmology), Duke Elder Oration (Royal College of Ophthalmologists), De Schweinitz Lecture (College of Physicians, Philadelphia), Dohlman Lecture (Harvard Medical School), Doyne Lecture (Oxford Ophthalmologic Congress), and the Kimura Lecture (University of California, San Francisco), among others.
Sommer is a member of both the National Academy of Sciences and its Institute of Medicine; immediate Past President of the Association of Schools of Public Health; and holds the 19th Chair of the Academia Ophthalmologica Internationalis.
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