Huffington Post, March 2014
"Along with the global effort to scale up...
The leading bacterial causes of diarrhea are enterotoxigenic Escherichia coli (ETEC) and Shigella, and vaccines against these pathogens could save the lives of up to a half-million children each year. PATH’s enteric vaccine project is working to accelerate the development of several promising vaccine candidates. We are also looking at innovative ways to make these vaccines as effective, practical, and affordable as possible so they can be easily implemented in the developing world.
Adjuvants, ingredients that may enhance the effectiveness of some vaccines, are one important area of focus. PATH is currently involved in research on a highly promising new adjuvant, the double-mutant heat-labile toxin (dmLT), which could open more doors to achieving immunity in the intestine. The dmLT is actually an ETEC antigen (a substance that causes the immune system to produce antibodies against it), so it may offer protection against both diarrhea and intestinal infection when used in conjunction with vaccines that are targeted to mucosal surfaces like the intestine. We aren’t exactly sure why, but children in resource-poor countries often have a lower response rate to mucosal vaccines. A wide range of factors may contribute to this issue, such as the influence of breastfeeding and maternal antibodies, poor nutrition, or increased exposure to intestinal pathogens. An adjuvant like the dmLT may help to bridge this gap in effectiveness.
Right now, we’re working with the National Institutes of Health’s (NIH) Division of Microbiology and Infectious Diseases on a Phase 1 clinical trial using oral doses of dmLT (not in conjunction with a vaccine) in healthy adults. We will have complete results later this year, but the preliminary data are quite promising. Meanwhile, we are about to launch our first Phase 1 trial of the dmLT combined with one of our oral ETEC vaccine candidates.
In addition, we plan to start another Phase 1 trial to test the dmLT intradermally (through the skin), and we would also like to study its use sublingually (under the tongue), to see if these alternative delivery routes can achieve an immune response in the intestine. If preclinical studies accurately predict what will be seen in humans, delivering dmLT in these ways could open up a whole range of possibilities for developing more effective and practical vaccines.
This type of innovative research is critical to moving forward the field of vaccines to address diarrheal disease, and support from the NIH and other partners is critical to this effort. As the dmLT and other promising vaccine technologies progress in their development, we know we are getting ever closer to expanding and improving the arsenal of tools to use in the fight against this major killer of children.
-- Dick Walker, director of the Enteric Vaccine Initative at PATH's Vaccine Development Program
For more information:
-- Escherichia coli (ETEC) and Shigella are major culprits of bacterial diarrheal disease. Learn how PATH is working with public and private sector partners to bring affordable vaccines to the children who need them most.Read more
I am a Program Assistant. For most, understandably, this job title does not conjure a vivid illustration of the role. As I describe it to interested family and friends, my day-to-day entails assembling proposals, reports, and presentations, setting up timelines and schedules for activities, assisting with meetings, and otherwise supporting the activities of my team. Still not very illustrative.
Where I go from there is what people–myself included–get excited about. I describe to them that I work at PATH—an international nongovernmental organization working toward equal health for all—within the Water and Sanitation Group–a team focused on reducing diarrheal disease-related deaths.
From here listeners pose questions and thoughts about global development, health, aid, etc., and fascinating conversations ensue. Oddly enough, however, almost every chat somehow winds around to the same question. And surprisingly it’s not about what PATH does or about our work in increasing access to water and sanitation, but:
“Do you get to travel a lot for work?”
Until now, the answer has always been “no.” And because of this, talks have trailed onto other topics—something that has perplexed and even disturbed me in the past since I’ve assumed that departure from our conversation was due to my lack of titillating travel adventure stories.
Two weeks ago I returned from my first work-related travel experience where I had an eye-opening opportunity to assist in facilitating an evaluation of one of my team’s most successful pilot projects in Kampong Speu Province, Cambodia. In the pilot project, rural households were offered small loans to purchase water filters which had been designed based on local needs and aesthetics. By increasing access through financing options, and by offering a culturally appropriate treatment option, PATH and its partners encouraged many households in the pilot group to acquire this water filter. My mentor and I arrived in Kampong Speu about six to twelve months after families had started using their new filters, to administer surveys about experiences with the filter, experiences with the loan process, and perceived changes in health since beginning to use this water treatment method.
Final results are not yet available for this evaluation, so my travel stories cannot include those details. But, I can tell you that I now understand the high interest in that aforementioned, popular question.
Prior to my travel, I could have rattled off PATH’s upcoming publications about water, updated you on our newest proposal endeavors, and informed you of our latest project ideas in an effort to describe our work—all fascinating, conversation-enhancing topics, but I could not have recalled to you this:
At every single household I visited while assisting with the evaluation in Kampong Speu, I watched kids interrupt their play to run for a drink of water. And in the middle of remote, rural villages served only by contaminated streams and ponds they were able to turn a tap, fill a cup, quench their thirst, and return to their play, never having ingested deadly diarrheal disease-causing bacteria.
These are the “results,” “successes,” “travel stories” that drive our interest in global health. These are what people were seeking when they pose their work-travel inquiries. These are what keep our conversations going.
-- Anna Larsen, Program Assistant for Technology Solutions at PATH
For more information:
-- Anna got people to talk about diarrhea at a cocktail party, then wrote about it.
-- PATH's Vice President knows a thing or two about work-related travel -- and about the importance of safe drinking water.
-- Learn more about PATH's Safe Water Project.Read more
Diarrhea is a scourge that has affected humanity throughout history. Battles have been lost by armies because of epidemics of diarrhea. Until recently there were no treatments available for diarrhea except intravenous fluids to correct dehydration. In the past 3 decades, oral rehydration solutions (ORS) have been available. ORS has been distributed around the world in dry powder form in packets that cost a few cents. In the past 3 decades, ORS is credited with saving over 60 million lives! However, 800,000 children continue to die unnecessarily from diarrhea and dehydration each year.
Why should so many children die of diarrhea when we have such a simple solution to the problem? Unfortunately, the majority of diarrheal deaths occur in the poorest countries in Africa and Asia. The global coverage of ORS has been stagnant at about 30% for the past decade. In the poorest regions of the world, the ORS coverage is as low as 15%.
There are various reasons for the poor ORS coverage. In 1978, the Control of Diarrheal Diseases (CDD) Program was announced by the World Health Organization (WHO). By the early 1980’s, most developing countries had their own National Control of Diarrheal Diseases (NCDD) programs. The NCDD Programs had their own dedicated funding, staff and monitoring system. In the 1990’s, NCDD programs were merged into Integrated Management Neonatal and Childhood Illness (IMNCI) Programs. With this merger, diarrheal disease programs lost their focus. The IMNCI programs did not have dedicated funding or staff or a monitoring and evaluation system. The program still does not have a seat at the table for resources.
I have had the joy of watching children in remote parts of Africa and Asia recover from severe dehydration within a couple of hours with use of oral rehydration therapy when they were at death’s door. I have also watched the tragedy of children dying from dehydration because they did not have access to ORS. I distinctly remember arriving at a remote village in Nigeria where I went as a WHO consultant in 1988 to conduct a training program on ORS. A teenage mother ran into the clinic with her baby of about 8 months age, screaming for help because her child had bad diarrhea. I examined the child with my stethoscope and my heart sank – the baby had just died from dehydration. I could not believe that I actually had ORS packets in my pocket to train the local workers. If only we could have made a packet of ORS available at the child’s home the child would have lived. The mother stared at me and said in her language, “You are a big doctor from America. Please help my baby.” From that day, I determined to do whatever I can to avert such tragedy.
We have come a long way in the last 30 years. In 1980 when I began my work on diarrhea there were almost 5 million deaths a year. Today, there are less than a million deaths. This is a remarkable achievement. However, there are still far too many unnecessary deaths. If we can all work together and mobilize the necessary political and financial resources there should be no need for any child to die from diarrhea. In the words of Pandit Jawaharlal Nehru, the first Prime Minister of India who on the occasion of the celebration of India’s independence in the 1950’s said, “We have done a lot in the past few years but there is still a lot more to do.”
-- Dr. Mathu Santosham is a global expert on prevention and control of diarrheal diseases. At Johns Hopkins Bloomberg School of Public Health, Dr. Santosham serves as the Director of the Center for American Indian Health, and Professor of International Health and Pediatrics . He has served as consultant to various international organizations and countries on issues related to child survival.
For more information:
-- Photos: Restoring ORT corners in Kenya
-- Video: Sometimes saving a life is as simple as combining sugar, water, and salt.
Photo credit: PATH/Hope RandallRead more
I didn’t notice Savita Rai at first. I was too busy watching the mothers’ group. I was in her Indian village to see how PATH’s Sure Start project was transforming a devastating situation—high rates of maternal and newborn deaths—into one of hope, and the mothers’ group was where the action was.
A PATH-trained health worker was telling the circle of mothers a lively story embedded with information on best practices for pregnancy, childbirth, and infant care. Savita Rai squatted just outside the circle, not talking, her grandson playing between her knees. But when I asked her why she was at the meeting, she surprised me. She stood right up and spoke in a voice that was both commanding and wracked by grief.
She brought her two daughters-in-law to the mothers’ group meetings, she said, so they could get the information she didn’t have when her baby died. Her son’s death could have been caused by one of many childrearing practices still used today. “We gave the babies cow’s milk,” Savita Rai said. “We thought it was god’s milk. I didn’t know about covering the child to keep it warm. I didn’t know about giving birth at the health center or vaccinations. I didn’t know about any of it.”
PATH’s Sure Start project is changing these often dangerous traditions by bringing lifesaving information to millions of families in India and providing the support they need to act on it. Now mothers, fathers, village leaders, and grandparents like Savita Rai can say, “I’ve learned how to take care of the mother and child.” And she has: she’s making sure all her grandchildren are delivered safely in health centers, breastfed to protect them from infection and diarrhea, kept warm and dry to keep pneumonia at bay, and vaccinated against a range of diseases.
Savita Rai’s story is one of many shared on a new interactive website about Sure Start. Visit the website, click on any one of the images and explore the stories of people whose lives have been changed. You’ll also discover ingenious tools used to create community-wide transformation in birthing practices and infant care.
Throughout May, PATH is also inviting people to share their stories on its Facebook page and on Twitter by using the hashtag #PATHSureStart. Who couldn’t you live without when you were pregnant? How did you prepare for your baby’s arrival? What was the economic impact of having a baby for your family? Visit and share the new website, and join the conversation on Facebook and Twitter!
-- Lesley Reed, PATH
For more information:
-- Video: Miracles happen when moms have access to simple solutions. Watch "The Extraordinary Healing Power of Mom."
-- Photos: Knowledge is power. Just look at the impact of village health volunteers in Cambodia.
Photo credit: PATH/Gabe BienczyckiRead more
Do you know that feeling when someone tells you good news but you have to keep it a secret? We might be bursting to share our excitement, but we have to stay quiet.
This happened to me last week when I was at a scientific session on diarrheal disease and heard that the number of child deaths continues to decrease. I am really excited, that today, with the publication of the data in The Lancet, we can spread the good news.
Child mortality fell from 9.6 to 7.6 million deaths per year over the last decade, according to the updated analysis of annual trends in causes of child mortality from years 2000-2010 by the Child Health Epidemiology Reference Group (CHERG) of the World Health Organization and UNICEF.
The collective efforts of the global health community to save children’s lives are working. The decline in child mortality is proof positive that when we invest in prevention and treatment, we see the results in lives saved.
The overall trend also masks some challenges. Diarrheal disease and pneumonia continue to be the two diseases that are the leading killers of children. While the absolute numbers of deaths from diarrhea and pneumonia declined, the proportion of the mortality pneumonia causes remains about the same and the share from diarrhea fell only slightly. And, we have made little headway in reducing the overall burden of illness from diarrheal disease; the incidence of diarrhea has fallen very little. Finally the averages don’t do justice to the stark disparities. In the highest-burden countries, the death and disease toll is far worse than the averages show.
How do we double down? The other big topic at the meeting last week is the work underway on national strategies in the 10 highest burden countries and on a Global Action Plan for Diarrhea (D-GAP).
The national strategies focus on the increasing access to the lifesaving treatments for childhood illness. These strategies focus on increasing supply and improving access to zinc, ORS, and the key treatments for pneumonia and malaria. By funding these governments’ scale-up plans, donor countries can make a down payment to jump start progress.
For the D-GAP, WHO and UNICEF will be spearheading a series of consultations in countries and regions to agree on the full range of solutions: water, sanitation, and hygiene; vaccines; feeding and nutrition; and treatment. The result will be a new global norm that can guide country strategies and inform donor investments. Look for the launch of the D-GAP in March of next year.
Both the national strategies and the D-GAP will define concrete ways to further drive down the rates of sickness and death from diarrhea. Because after we pause to savor the impressive progress and the decisive return on our investments, it is time to redouble our efforts.
Eileen Quinn is director of communications for PATH's Vaccine Development Program and fearless leader of defeatDD's Poo Crew.
For more information:
- Diarrhoea Dialogues explores the opportunities in select countries for doubling down on diarrhea control.Read more