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submitted by Dr. Rajiv Tandon
03/28/2016 at 10:43

On March 26, 2016, India joined the growing number of countries that have introduced rotavirus vaccine into their national immunization programs. The Indian Minister for Health and Family Welfare, Mr. JP Nadda, launched the rotavirus vaccine through the Universal Immunisation Programme (UIP) in Bhubaneswar, Odisha. Mr. Nadda called it a "historic" moment and an "exemplary" step in India’s immunization programme as well as an essential investment in children, the future of the country. Union Minister of State Dharmendra Pradhan, and Atanu Sabyasachi Nayak, Minister of Health and Family Welfare (MoHFW) in Odisha, were also in attendance at the launch event.

In the first phase of the roll-out in the UIP, besides the eastern state of Odisha, the vaccine also will be provided to children in the southern state of Andhra Pradesh and the two northern states of Haryana and Himachal Pradesh. Later, the roll-out will be expanded across the country. The vaccine, called ROTAVAC®, is an indigenously developed vaccine that was licensed by the Drugs Controller General of India in 2014.

Rotavirus accounts for approximately one-third of the nearly 600,000 global child deaths attributable to diarrhea. Ninety-five percent of these deaths occur in developingcountries.  The impact of rotavirus vaccines on the burden of diarrhea has been dramatic in countries that have introduced the vaccine.

India continues to have one of the highest rates of diarrhea in the world. Along with pneumonia, it is one of the leading causes of child illness and death, and rotavirus is the most common cause of severe diarrhea. In India, an estimated 11.37 million episodes of rotavirus gastroenteritis occur each year, with 78,000 cases resulting in death.  Rotavirus is responsible for almost 40 percent of diarrhea-related hospitalizations in India. That is a total of 291,756 hospitalizations each year. 

At the launch, Dr. CK Mishra, Additional Secretary and Mission Director National Health Mission, MoHFW, stressed that the introduction of the rotavirus vaccine in the UIP had strengthened health systems and this would faciliate faster introduction of other new vaccines like the pneumococcal vaccine.  Dr. Bhanu Pratap Sharma, secretary health, MoHFW emphasized that the cost effective vaccine would not only reduce under-five mortality but pave the way for achieving the Sustainable Development Goals.

While rotavirus diarrhea can be treated, the urgent medical care needed is not always accessible to many children, especially among poor populations in India. Vaccination is, thus, the best way to prevent death of infants from severe diarrhea caused by rotavirus.

And, now India has just joined the ranks of 80 other countries around the globe who are helping to save the lives of their children from this terrible disease.


Photo credit: Dr. Rajiv Tandon.

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submitted by DefeatDD
03/18/2016 at 16:05

World Water Day revelers all over the globe are going #Blue4Water to bring attention to the many stresses on the world’s water resources and to underscore how greater investments in water and sanitation will help achieve nearly all of the Sustainable Development Goals (SDGs, also known as Global Goals).

Once you start paying attention to all the ways water flows through our lives, finding inspiration isn’t too difficult. Post your own #Blue4Water selfie and tell us where YOU see blue.


Access to safe drinking water and sanitation triggers a "wave" of positive health outcomes!

I see blue when I go to the loo.

No, this isn’t a portal to a mystical fairy land. It’s the toilet that came with my new house. It may not be a rabbit hole to Wonderland, but I have to admit, it does give going a sense of wonder. Every night, a timer turns this typical toilet into a sapphire throne—proudly emitting a royal hue that says, “I dare you to miss.” Truly, I have to hand it to this cobalt commode for seizing its opportunity to shine. Frills or no frills, toilets deserve all the credit they can get for doing our dirty work. Without them, clean water and sanitation would be mere fantasies. Let’s make sure that everyone has access to these powerful tools—every day, not once in a blue moon.

-          Lauren Newhouse


I see blue in blueberries.

Let’s hear it for blueberries! Trying to get vitamins and vegetables into my finicky toddler is tough, but these super(food) little gems very often save our day… or dinner. Regardless of where she sets her table, each mother (father, too) knows that healthy food is essential to a healthy, happy kid. But in some countries, nutritious foods at the table are not enough. Where clean water and sanitation aren’t available, microscopic threats in their environments relentlessly attack kids. These bugs often infect through the gut, causing chronic inflammation that disrupts nutrient absorption and weakens immune protection from further infections. Sure, blueberries aren’t all it will take to give my girl a healthy start. Her plate needs plenty other key foods, too, integrated for an optimal diet. And kids who are especially vulnerable need integration, too: programs that coordinate nutrition and WASH interventions to give them the healthiest possible start. 

-          Deborah Kidd


Where do I see blue?  Among other places: the ocean. 

The calm that settles in when I finally sit and relax, reading a book and listening to the waves, maybe catching a sunset.  I am always reminded of the ocean’s beauty, the life sustaining resources, and the potential for destruction. The calm reminds me to be grateful, to be thoughtful, and on this World Water Day, to not forget that our push for universal access to clean water and improved sanitation is not over. 

-          Ashley Latimer


I see blue in an umbrella: as in, an umbrella approach to protect and save lives.

Thanks to El Niño, we recently had a downpour in San Francisco, which led me to dust off a white and blue umbrella that hasn’t seen much action in recent years. The rain was a bit novel for me and my sidekick Bogie (who, in case you missed it, has been featured on DefeatDD before—in the 2016 #TravelingPoo calendar!).

Even though in this scenario the umbrella was providing protection against the cold and wet, I think it’s also a great symbol for the work it will take to protect health in areas where lack of access to clean water and sanitation puts children at risk for virulent infectious diseases like diarrhea. It will take a combination of tools—under one umbrella—to save lives and promote good health for children everywhere. (See Erika’s entire post on the PATH Drug Development blog.)

-          Erika Amaya



World Water Day, March 22, is particularly special to me because, well, it’s my birthday! Birthdays have always been a big cause for celebration in my family—no matter the age—and that’s the way I think it should be. Birthdays are a celebration of life! For the 663 million people around the world without access to clean water or the 2.4 billion people without access to a proper toilet, children’s birthdays cannot be taken for granted. Every day, 1,000 children under five years of age die from diseases caused by unsafe water or inadequate sanitation. By working to improve access to safe water and sanitation, we can help ensure that all children not only get to celebrate their fifth birthday, but also live long and healthy lives full of birthdays, family, friends, adventures, love, and celebrations.

-          Laura Edison


I see blue in precious gems: sapphire and water!

Sapphires are one of Earth’s precious gems, though their deep blues remind me of something even more precious – water! Safe drinking water is something that many of us take for granted, yet more than 780 million people do not have access to it. Not only is it a key resource to support life, it is critical for preventing diarrheal disease and pneumonia, the two leading causes of death in children under five years of age. This World Water Day, I’m going #Blue4Water to work toward a world where people everywhere have access to this truly precious gem.

-          Elayna Salak


I see blue in a lifesaving chain reaction.

Thank you, Taylor and Reese (ages 7 and 6, respectively), for giving blue shirts to the children in this #SaveMomsAndKids paper chain on the Reach Act: the perfect #Blue4Water accessory to adorn my desk for World Water Day 2016.

The bipartisan Reach Every Mother and Child Act calls for the scaling up of cost-effective, high-impact solutions – like safe drinking water and sanitation – and for a coordinated, streamlined strategy to end preventable maternal, newborn, and child deaths by 2035. Passage of this legislation would be a great US contribution to Sustainable Development Goal #6 for safe drinking water and sanitation, and I proudly support it! Not just because it’s the right thing to do, but because it is so practical.

Research shows that water and sanitation rank as among the highest global development priorities among American citizens, and I count myself among them. We can’t live without water, and we can’t live well without clean water. I believe global health efforts must address this foundational basic need, which by its very nature will produce a ripple effect of growth for families, communities, and nations.

-          Hope Randall

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submitted by Mathu Santosham
03/15/2016 at 10:44

An infant being immunized at a child welfare clinic at the Elmina Urban Health Center in the Central Region of Ghana. Photo by: UNICEF.

This post originally appeared on Devex.

This month, hundreds of thousands of children will get access to rotavirus vaccines in India with the start of a national introduction that marks Asia’s largest to date. But over 90 million children around the world still lack access.

Despite the fact that it can be prevented and treated, diarrhea continues to take its devastating toll on children around the world. It is a leading cause of child death, and is responsible for hospitalizing millions of children.

Rotavirus, the most common cause of severe, deadly diarrhea, claims the lives of more than 200,000 children each year, and hospitalizes hundreds of thousands more. This one virus is responsible for nearly 40 percent of all diarrhea hospitalizations. And a recent multicountry study showed that children who developed moderate to severe diarrhea had an eight-and-a-half times higher risk of dying in the subsequent two months compared to children who did not suffer from diarrhea.

The health — and economic — consequences of rotavirus ripple across families, communities and countries. Children with rotavirus diarrhea are more susceptible to the next illness that strikes. They cannot absorb nutrients as well, which can slow their growth during crucial stages of development. Weakened, malnourished children have less energy for school, and tend to grow up to learn less and earn less. Parents who must take time off work to care for a sick child lose income, which can plunge a family into poverty. Multiplied by thousands of children and families, these effects hobble entire economies.

Yet it’s all entirely preventable. We know how to stop rotavirus illnesses and deaths, and we have the tools today to do it.

Global health experts recommend a comprehensive approach focused on preventing illness in the first place and treating children if they do become sick. Mild to moderate cases of diarrhea can be treated with oral rehydration solution — a simple mixture containing sugar, salt and safe water — and zinc supplements. More severe cases require intravenous fluids and urgent medical care.

But though inexpensive and effective, ORS coverage is only about 30 percent in many of the places where the most diarrhea deaths occur. Hospitalization, too, is often out of reach. And while improvements in hygiene, sanitation and drinking water are important to prevent diarrhea in general, they cannot stop the spread of rotavirus. That’s why preventing rotavirus infections is essential.

Vaccination is the best tool available today to protect children from rotavirus. These vaccines are improving health, reducing health care costs and saving lives today in countries where they are in use.

The World Health Organization has recommended that every country introduce rotavirus vaccines into national immunization programs. So far, 80 countries have introduced the vaccines, but not enough countries in Asia or Africa have taken action — the regions where burden is highest.

The ROTA Council, a global body of scientific experts on rotavirus, strongly agrees with the WHO recommendation. In addition, to accelerate the introduction of lifesaving, health-improving rotavirus vaccines, the ROTA Council recommends that key stakeholders in countries where these vaccines have not yet been introduced take action in the following areas:

1. Take a comprehensive approach to diarrheal disease control.

In conjunction with the introduction of rotavirus vaccine, countries should work with WHO, UNICEF and other partners working on diarrheal disease to plan and implement a comprehensive set of interventions to reduce illnesses and deaths caused by diarrheal disease, consistent with the Global Action Plan for the Prevention and Control of Pneumonia and Diarrhea, or GAPPD.

2. Apply for Gavi support.

Eligible countries that have not yet introduced rotavirus vaccines should apply to Gavi, the Vaccine Alliance for new vaccine support for rotavirus vaccines as soon as possible.

3. Develop new, low-cost vaccines.

National governments and funding agencies should continue to support the research and development of new, low-cost rotavirus vaccines. Manufacturers in low- and middle-income countries have demonstrated the ability to develop and license low-cost rotavirus vaccines, such as Rotavin in Vietnam and ROTAVAC in India, with technology partnerships and public funding.

Global funding agencies should also support the development of parenteral rotavirus vaccines, which are likely to be more efficacious than the currently available oral vaccines.

4. Make sure vaccine prices are fair.

Global health entities — including UNICEF, WHO and Gavi — and nongovernmental organizations influential in vaccine programs — including Médecins Sans Frontières and Save the Children — should focus on efforts to ensure prices paid for rotavirus vaccines reflect true manufacturing costs, provide reasonable returns on manufacturers’ investment and take into account an individual country’s ability to pay.

Additional mechanisms may be required to provide innovative funding options for low-middle income, non-Gavi eligible countries.

5. Address vaccine program implementation challenges.

National governments, global health entities, funding agencies, manufacturers and other stakeholders should facilitate the development of new, live oral rotavirus vaccines that address supply shortages in Gavi-eligible and low- and middle-income countries. These new vaccines should also address implementation challenges such as cold chain capacity, volume of administration and storage, delivery systems, safety concerns and cultural sensitivity. And of course, all new vaccines must be safe, efficacious and available at low cost.

In 2016, it’s unconscionable that children are still suffering from diseases we have the knowledge and tools to prevent. It’s time to protect all children, everywhere, from the scourge of rotavirus.

Eighty countries, including India, have taken laudable steps to introduce and scale up the use of rotavirus vaccines. But millions more children await. It’s time to take action.

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submitted by DefeatDD
03/08/2016 at 15:04

Children need a nutritious diet to grow healthy and strong. If children don’t get key nutrients during these critical early years, the impact can be far-reaching.

Malnutrition and diarrheal disease feed off each other in a relentless loop to keep children sick and vulnerable to infections. But if we assume the effects wear off when the symptoms disappear, we’re missing a huge part of the story: Chronic diarrhea and malnutrition can stunt physical growth and impact cognitive development, keeping children and their communities from reaching their fullest potential.  

Researchers are beginning to uncover the implications of malnutrition on cognitive development, and study findings reinforce that an integrated approach to prevent and treat diarrheal disease (WASH, vaccines, exclusive breastfeeding, nutrition, and ORS/zinc) is the only way to comprehensively address the vicious cycle of diarrhea and malnutrition and the long-term damage it can cause.


 We asked a few experts to weigh in:


“The leaky, chronically inflamed and poorly functioning gut of children exposed to unsanitary living conditions and repeated bouts of infection, including diarrheal disease, has been called ‘environmental enteropathy’ or EE . . . EE is associated with malnutrition, failure of the polio and rotavirus vaccines, and poor language and cognitive development . . . Understanding the problem is the first step to a solution.”

-          William A. Petri, Jr., MD, PhD, Chief, Division of Infectious Diseases & International Health; University of Virginia. Learn more here.



"A child’s organ systems are trying to develop and get to their maximum potential, and that happens very, very quickly. The competition for nutrition is very high. Unfortunately, this is the time children in the developing world get afflicted with diarrhea and other infectious diseases. With a bout of diarrhea, it’s very easy for a child to tip off into malnutrition. When their brains are supposed to be developing, when their organs are supposed to be developing, they are completely depleted of these nutrients that they need. Once a child developmentally misses an opportunity to grow, you can never fix that."

-          Dr. Roma Chilengi, Chief Medical Officer, Centre for Infectious Disease Research, Zambia.



“The link between malnutrition and cognitive development is powerful and far-reaching. Its effects span not only the lifespan of the individual affected, but also cross generations and can affect the earning potential of individuals and populations.  For example, a baby born small for its age is less likely to achieve his or her academic and intellectual potential at school, and in their 50’s, 60’s, and 70’s has a higher risk of developing problems such as high blood pressure, diabetes, and high cholesterol.

Malnourished children often become malnourished parents and the vicious cycle is repeated. Now more than ever before, as the entire global community extends its survival focus to include to include thriving, we all need to work harder and closer together to ensure that every baby, every child, every woman and every man eats a well-balanced meal and is optimally nourished.”

-          Dr. Cyril Engmann, Director of Maternal, Newborn and Child Health and Nutrition, PATH. Click here to learn more.


Photo credit: PATH.

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submitted by Nancy Goh
03/01/2016 at 19:35

A mother in Uganda gives her 3 year old daughter, Naume, ORS and zinc for her diarrhea and she recovers quickly. She is well again and loves playing with her two older sisters. Photo credit: Melinda Stanley, Clinton Health Access Initiative, Inc.


In 2004, UNICEF and WHO updated their guidance for the treatment of acute diarrhea by recommending a combination of zinc supplementation and oral rehydration salts (ORS). Where have we come since then?

Significant global and political attention has raised the profile of this simple, highly-effective, and affordable solution and its potential to save the lives of children. For example, the UN Commission on Life-Saving Commodities for Women and Children named zinc and ORS as two of 13 essential commodities. The Integrated Global Action Plan for Pneumonia and Diarrhea (GAPPD), accompanied by a Lancet Series, updated and provided the evidence-base for an integrated framework of interventions for pneumonia and diarrhea, including zinc and ORS. Partner networks representing the NGO, donor, academic, and private sectors—including the Zinc Task Force and the Diarrhea & Pneumonia Working Group, among others—have come together to address global and regional barriers to access.

Most importantly, governments and local partners have demonstrated unprecedented leadership and commitment to reducing child mortality in their countries by increasing access to and use of zinc and ORS. A review of progress across the 10 focal countries of the Diarrhea & Pneumonia Working Group have shown notable improvements in treatment coverage, national policies, and care-seeking behavior compared to other countries. In spite of this progress, there is much work that remains in order to further reduce child deaths.

So, what can we learn from the high-performing countries?

Progress over a Decade of Zinc and ORS Scale-up: Best Practices and Lessons Learned, a new report published by the members of the Diarrhea & Pneumonia Working Group chaired by the Clinton Health Access Initiative, Inc. (CHAI) and UNICEF, attempts to answer this question, drawing from the past decade of experiences from a range of countries, child health partners, and other experts involved in large-scale efforts. Four key success factors were established (see figure below):  


1.       Securing a strong enabling environment: A national scale-up plan—in line with GAPPD and other global frameworks—helps to align government and partners around a common framework and a government-led national coordinating mechanism can drive its implementation. Achieving over-the-counter status for zinc is also needed to ensure the products can be widely distributed and marketed to consumers.

2.       Improving availability of supply: The local market for high-quality, affordable, and optimal zinc and ORS products has improved dramatically, particularly in sub-Saharan Africa, with the introduction of new suppliers. In the public sector, robust forecasting, procurement, supply chain, and distribution practices help to ensure a consistent supply for health facilities and community health workers. In the private sector, partnerships with actors along the supply chain expand the reach of products to rural areas where most children die from diarrhea.

3.       Generating demand among caregivers: A strategy informed by the latest market evidence and tailored to address local barriers has the greatest potential for improving awareness and usage of recommended products. Updating product packaging and presentations also has a strong influence on consumer appeal and adherence. 

4.       Improving knowledge and skills of providers: Frontline workers (both public and private sector) —often the first and only point of care for child diarrhea in remote areas—should be adequately equipped with the knowledge, skills, and motivation needed to manage and treat diarrhea.


Bangladesh has demonstrated that this ‘four-pronged approach’ works. Today, an increased number of children with diarrhea are receiving the correct treatment, with 77% receiving ORS and 44% receiving zinc.

Each year, over 500,000 children still die unnecessarily from diarrhea and governments, donors, and partners have invested significant time and resources to tackling this problem since 2004. More is needed to achieve high coverage levels. We have a responsibility to focus our next investments on what works (and learning from what doesn’t work) to continue to drive large-scale change and ensure children with diarrhea receive the correct treatment. 

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