In settings where medical care can be difficult to access, prevention through vaccination is the best way to protect children against the leading causes of severe diarrhea. Vaccines against rotavirus are already making a significant impact: vaccines against ETEC and Shigella, the leading causes of bacterial diarrhea, are currently in development.
Rotavirus vaccines protect against the leading cause of severe childhood diarrhea, and the World Health Organization recommends their introduction in all countries.1
Rotavirus causes about one-third of child deaths due to diarrhea. Worldwide, 215,000 rotavirus deaths were recorded in 2013, and the vast majority of these occurred in developing countries of Africa and Asia.2 Nearly every child in the world is at risk, regardless of hygiene, sanitation, or access to clean water. Rotavirus infections cannot be treated with antibiotics or other drugs. Mild rotavirus infections can be treated effectively with oral rehydration therapy until the disease runs its course, but children with severe rotavirus diarrhea urgently need intravenous fluids or they risk dying from dehydration. In low-income countries, this type of urgent health care is often inaccessible or unavailable, making rotavirus prevention through vaccination critical to saving children’s lives.
Vaccines are the best way to protect children from rotavirus and the dehydrating diarrhea that it can cause. Two globally available rotavirus vaccines are dramatically improving the health and well-being of children around the world by substantially reducing severe diarrhea. Many of the countries that have introduced rotavirus vaccines into their national immunization programs have observed swift and significant declines in hospitalizations and deaths due to rotavirus and other causes of diarrhea.3 The vaccines also are indirectly protecting those who are too young or too old to receive vaccination, through herd immunity.4 Rotavirus vaccines are cost-effective and not only improve child health, but also save lives.
PATH is working with Gavi, the Vaccine Alliance and other partners to ensure that all children have access to rotavirus vaccines, no matter where they live. We also are collaborating with manufacturers to accelerate the development of new vaccines against rotavirus, as well as other causes of severe diarrhea. As part of an integrated package of interventions that includes ORS, zinc, breastfeeding, nutrition, and sanitation/hygiene, rotavirus vaccination is one of the best ways to prevent death from diarrhea.
For country rotavirus vaccine introduction maps, fact sheets, and other helpful materials, visit our compilation of rotavirus advocacy resources.
ETEC and Shigella
Enterotoxigenic Escherichia coli (ETEC) and Shigella, leading causes of bacterial diarrhea, are among the top five pathogens causing moderate-to-severe diarrhea among children in Africa and South Asia.5 Vaccines to protect against ETEC and Shigella are currently under development.
Infections from Shigella, which causes dysentery, and ETEC are typically caused by contaminated food or water. Illness can lead to dehydration and malnutrition, as well as impaired physical and cognitive development in young children.6 In low-resource countries, where access to medical care is often limited and inappropriate use of antibiotics is strengthening bacterial pathogens, vaccines to prevent ETEC and Shigella hold dramatic potential.7
PATH is collaborating with private- and public-sector partners to advance safe, effective, and affordable vaccines against ETEC and Shigella. We’re pursuing a wide range of approaches to bring at least one vaccine candidate for each pathogen to late-stage development. We have also identified a highly promising vaccine component that we plan to test with several vaccine candidates. Finally, to ensure that ETEC and Shigella vaccines reach all children who need them, we are assessing manufacturing partners, mostly in emerging countries, to take on the eventual manufacture and distribution of these vaccines.
1 WHO. Rotavirus vaccines: WHO Position Paper – January 2013.Weekly Epidemiological Record. 2013;88(5):49-64.
2 Jacqueline E. Tate, Anthony H. Burton, Cynthia Boschi-Pinto, and Umesh D. Parashar. Global, Regional, and National Estimates of Rotavirus Mortality in Children <5 Years of Age, 2000–2013. Clinical Infectious Diseases. 2016;62(suppl 2):S96-S105.
3 Patel MM, Parashar US, eds. Real World Impact of Rotavirus Vaccination. Journal of Infectious Diseases. 2011;30(1).
4 Anderson E, Shippee D, Weinrobe M, et al. Indirect Protection of Adults From Rotavirus by Pediatric Rotavirus Vaccination. Clinical Infectious Diseases. 2013;56(6):755–760.
5 Kotloff KL, Nataro JP, Blackwelder WC, et al. Burden and aetiology of diarrhoeal disease in infants and young children in developing countries (the Global Enteric Multicenter Study, GEMS): a prospective, case-control study. The Lancet. 2013;382(9888):209–222.
6 Niehaus MD, Moore SR, Patrick PD, et al. Early childhood diarrhea is associated with diminished cognitive function 4 to 7 years later in children in a northeast Brazilian shantytown. American Journal of Tropical Medicine and Hygiene. 2002;66(5):590–593.
7 Walker RI, Van De Verg LL, Hall RH, Schmitt CK, Woo K, Hale V. Enteric vaccines for pediatric use. Workshop summary. Vaccine. 2005;23(46-47):5432–5439.
Photo credits: PATH.