RotaFlash, April 2016
In 1982, I remember how a mother with two children with measles helped save many others.
Sadly, she lost one of the ailing children to a subsequent bout of pneumonia and mentioned to me that her children were not the only ones suffering. A visit to her village saved 18 children whose families believed that measles was a “divine curse,” that there was no cure, and that therefore, it was not worth bringing the children to the hospital! When these children recovered after visiting the hospital, it established the community’s confidence in measles treatment.
This incident happened when I first began working at the Mahatma Gandhi Institute of Medical Sciences (MGIMS) in Sewagram, , which has great engagement with communities. I realized then that apart from treatment, it is important to reach out to communities to help them prevent diseases. To minimize the disease burden on children, immunization is one of the most cost effective methods, but this requires educating community members first. MGIMS doctors would set up temporary health camps to treat community members, they also increased awareness about prevention of disease, and immunization and hygiene were important topics. MGIMS adopted one village every year and medical students educated many families this way.
Infant mortality in India is down to 39 per 1,000 and neonatal mortality, too, is on the decline. In spite of the progress in immunization in the past four decades – notably 80 percent coverage –infectious diseases like respiratory, diarrheal diseases, and tuberculosis continue to cause major challenges, especially in underprivileged communities. In comparison to neighboring Sri Lanka – which has been able to bring its infant mortality rate to single digits – India, by far a much larger country with nuanced complexities, continues to struggle with the burden of infectious diseases. A case in point is that we continue to have outbreaks of measles, which for a long time in most advanced countries has not been heard of.
Today as I work within a Government hospital in New Delhi, ensuring treatment for children on a variety of ailments, I also teach young doctors about prevention and treatment of childhood diseases. In my lifetime, I have seen the decline of diseases like tetanus, cholera, and Indian childhood cirrhosis. With the introduction of diarrhea management guidelines and ORS, there has been a reduction in diarrheal diseases too, especially if you look at morbidity and mortality.
As part of the Government of India’s National Adverse Events Following Immunization (AEFI) Committee, the National Technical Advisory Group on Immunization (NTAGI), the pulse polio program, and various other programs, I advocate for immunization to save children from preventable diseases. I was the convener of the Indian Academy of Pediatrics (IAP) committee on immunization, which reviewed immunization practices, incorporated new evidence in support of immunization, and made guidelines that are now used by most pediatricians in the country. I was also part of the committee that advocated for the introduction of the new vaccines in the Universal Immunization .
I am a vaccine advocate because it is important to have greater communication around this and it is critical for the media to address this issue. In India, public awareness about immunization still lacks. Greater awareness will help increase immunization coverage. India can succeed in eliminating vaccine-preventable diseases.
Photo credit: PATH.
In observance of Earth Day, we examine how climate change poses both threats and opportunities for the future of human sanitation, nutrition, and diarrheal disease. Photo: PATH/Patrick McKern.
Here at DefeatDD, we love our home planet. We love its mountains, trees, oceans, rivers, flowers, and the beautiful diversity of animals and humans that inhabit it. But on Earth Day and every day, we’re thinking about poop.
Everyone poops, and humans have learned throughout history how to develop a variety of sanitation systems that ensure poop and its diarrheal disease-causing germs stay away from our food and our mouths. In the process, we’ve learned that sanitation actually protects the environment and helps us live in greater harmony with our surroundings. By pumping waste into treatment facilities instead of dumping it into streams, rivers, and oceans, we clean up our water, prevent illness, and help plants and animals thrive. And in turn, these thriving plants and animals help feed and support people in a sustainable way.
However, climate change is threatening to change our relationship with our planet in an unprecedented way, and we have work to do. Melting ice, hotter temperatures, rising sea levels, and more extreme weather events such as floods, droughts, hurricanes, and tsunamis will alter natural habitats, put agriculture at risk, and damage vital infrastructure—such as our sanitation systems. In a natural disaster, sanitation systems can be destroyed, damaged, or flooded, causing waste water to contaminate food and drinking water sources with deadly pathogens, which can continue to prey on their victims long after the storms have passed. In fact, it is estimated that diarrheal diseases cause over 40 percent of the deaths in disaster and refugee camp settings.
For example, the 2010 earthquake in Haiti was followed by one of the worst epidemics of cholera in recent history due to water and sewage treatment failures. The outbreak is ongoing, with over 770,000 cases and over 9,200 deaths attributable to dehydrating diarrhea caused by Vibrio cholerae bacteria so far. Diarrheal diseases pose an even greater risk to communities without strong sanitation systems already in place—particularly in refugee camps and crowded megacities in the developing world.
Indeed, the most dangerous storms spread not only wind or water—but also waste.
The good news, however, is that climate change is also an opportunity. By adapting to climate change, we could promote significant health and development benefits now and in the future, much like sanitation systems have done throughout history. Climate change is just one more reason why we need to act to improve water and sanitation systems now. Adaptation measures that protect us from climate variability can also create resilience to storms and floods and enhance water security, directly contributing to health and development.
Community members use the SE200 to treat borehole water in rural Zimbabwe. Photo credit: PATH.
In order to adapt, we need innovative technological practices and implementation strategies. The MSR SE200™ Community Chlorine Maker, co-developed by PATH and Mountain Safety Research® Global Health, is one such technological innovation with potential to improve access to clean water and sanitation and, in doing so, help prevent future diarrheal disease outbreaks. Chlorine is an effective method for destroying pathogenic microorganisms in water and has been shown to reduce the threat of waterborne disease and infection. Using just salt, water, and electricity to produce enough chlorine in five minutes to treat up to 55 gallons of water, the MSR SE200™ became available on the commercial market in 2015. A new, larger version that produces enough chlorine to treat 4000 gallons of water per hour—or enough for 1000 people—is currently being field tested in refugee camps in Kenya and Rwanda. Once finalized and launched, the new device will be poised for adoption by ministries of health and aid organizations for use in rural health care settings, refugee camps, or during disaster response efforts.
Our home planet sure is beautiful, and it’s the only home we’ve got. By prioritizing, investing in, and accelerating innovations and improvements in water and sanitation systems, we can protect Planet Earth, the plants and animals we share it with, and—ultimately—ourselves.Read more
Cholera is an acute diarrheal disease that can lead to rapid dehydration and death if not immediately and correctly treated. While the global burden of cholera is not precisely known, estimates showthat there are more than 2 million cases per year leading to about 95,000 deaths annually. Cholera occurs mainly in areas with poor water and sanitation conditions and is transmitted through the ingestion of contaminated food or water. Therefore, efforts to prevent cholera often involve improving water, sanitation and hygiene (WASH) conditions and the promotion of healthy behaviors. Oral cholera vaccine (OCV), while perhaps less known, is also an essential component for cholera prevention. OCV can decrease the severity of an outbreak, reduce rates of disease in endemic settings, and prevent cholera from occurring in times of humanitarian crisis or emergencies.
OCV has been used sporadically since 1997, but it was not until it was prequalified by the WHO in 2011 that its use has become more widespread. To date, over 30 million doses of vaccine have been administered in various countries and settings. The cholera vaccine most used currently is Shanchol, since it is available through the global stockpile. Shanchol can be administered to anyone over the age of one year, generally given in two doses, the second occurring two to four weeks after the first. Trials have shownan efficacy of 65% over a period of five years. For this reason, it is important to provide information to vaccine recipients about healthy behaviors such as drinking safe water, practicing good food hygiene, washing hands at key moments, using latrines, and maintaining clean latrines. The vaccine has also been shown to provide indirect (herd) protection to communities, lowering the risk of contracting cholera even among those who have not been vaccinated. OCV is not an alternative to safe water, but should be used in conjunction with improving water and sanitation.
Recognizing both the benefits of the vaccine and its underutilization, in 2013, the World Health Organization (WHO) established a stockpile of OCV with an annual two million doses. Initially, the stockpile was intended for use during outbreaks and humanitarian crisis settings and was accessible through an application submitted via the OCV international coordinating group. In January 2016, with the addition of another vaccine manufacturer, the WHO announcedthat the available supply will increase significantly and that the vaccine may also be used for high- risk areas as a preventive measure. With increased availability of OCV and potential higher demand, it’s essential that policy makers understand when and where the vaccine should be used and that health workers have the information to effectively implement vaccination campaigns and administer the vaccine.
In an effort to provide the necessary information for those implementing vaccine campaigns, administering the vaccine, or making decisions regarding its use, we have created the StopCholera Toolkit. The Toolkit is a series of four modules that help decide if, when, where, and how to use OCV to reduce mortality, prevent cases, and halt outbreaks. The Manual for OCV Campaigns: For adaptation by program managers for training health care workersprovides a comprehensive overview on cholera, the vaccine, and the steps involved in conducting a vaccination campaign, including important key WASH messages to prevent cholera.
I am personally looking forward to hearing how the additional vaccine supply is used. I invite you to share your experiences implementing OCV campaigns with us at: Info@stopchol.org.
Jon Lascher, Partners In Health, 2012.
Louise Annaud, Médecins Sans Frontières, 2015
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.Read more
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
I see blue in: BIRTHDAY PRESENTS!
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 RandallRead more