Feb 13, 2017


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, which have been globally available since 2009, are making a significant impact. Vaccines against ETEC and Shigella, the leading causes of bacterial diarrhea, are currently in development.

An infant receives an oral rotavirus vaccine.
Rotavirus vaccination is essential for preventing childhood diarrhea deaths.



Rotavirus vaccines protect against the leading cause of severe childhood diarrhea, and the World Health Organization recommends their introduction in all countries. As part of an integrated package of interventions that includes ORS, zinc, breastfeeding, nutrition, and water, sanitation, and hygiene, rotavirus vaccination is one of the best ways to prevent death from diarrhea.

Rotavirus causes about one-third of child deaths due to diarrhea. Worldwide, around 200,000 deaths due to rotavirus occur in children under 5 years of age every year, and the vast majority of these occur in low-income countries in Africa and Asia. 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.   

World map of global rotavirus deaths in 2013
Rotavirus infections occur everywhere, but most deaths happen in low-income countries in Africa and Asia where access to treatment is limited.


Vaccines are the best way to protect children from rotavirus and the dehydrating diarrhea that it can cause. 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. The vaccines also indirectly protect those who are too young or too old to receive vaccination through herd immunity. Amidst several recent changes in the rotavirus vaccine market, rotavirus vaccines remain cost-effective and not only improve child health, but also save lives.

PATH works to ensure that all children have access to rotavirus vaccines, no matter where they live. We work with countries to help decision-makers assess, evaluate, and prepare for rotavirus vaccine introduction and costs. Simultaneously, we’ve also been supporting the development and licensure of new vaccine options. For example, PATH supported the development of two Indian-made vaccines: ROTAVAC®, which is just US$1 per dose, and ROTASIIL®, which is heat-resistant. Both achieved WHO's stamp of approval in 2018. Finally, we also collaborate with manufacturers to accelerate the development of next-generation vaccines against rotavirus

By helping make more rotavirus vaccines available for countries to choose from, we can increase access, improve supply, reduce costs, and ultimately save more lives from this preventable disease.

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. Vaccines to protect against ETEC and Shigella are currently under development.

Cascading impact diagram
ETEC and Shigella vaccines could protect from the cascading disease burden of diarrhea’s leading bacterial causes.

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, causing a cascading disease burden with long-term consequences. 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.

PATH is collaborating with private- and public-sector partners to advance safe, effective, and affordable vaccines against ETEC and Shigella, pursuing a range of approaches for each pathogen. We have brought one vaccine candidate for ETEC to late-stage development, and several promising candidates for Shigella are making progress. 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.


Illustrated vaccine image.
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Photo credits: PATH.