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The Lancet Breastfeeding Series

The Lancet Breastfeeding SeriesWith a substantial development of research and findings for breastfeeding over the past three decades, we are now able to expand on the health benefits for both women and children across the globe. The two papers in this Series will describe past and current global trends of breastfeeding, its short and long-term health consequences for the mother and child, the impact of investment in breastfeeding, and the determinants of breastfeeding and the effectiveness of promotion interventions.

New Research Shows That Breastfeeding Matters Everywhere and Could Save Millions of Lives and Dollars

"Political commitment and investment in breastfeeding by governments, donors, employers and civil society is urgently needed to ensure the health of women and children and to shape a more sustainable future for all. UNICEF and the World Health Organization, in partnership with close to 20 organizations, are leading the charge to mobilize global action to raise political and financial investment to support breastfeeding. Together, we are working to remove barriers to breastfeeding and to give women the tools they need to make informed decisions to ensure their health and the health of their children for generations come."
Werner Schultink, Chief of Nutrition at UNICEF - Breastfeeding saves lives and it’s time for action

Clinical Evaluation of Ultrasonic Hydration Monitor for Infants

Clinical Evaluation of Ultrasonic Hydration Monitor for InfantsStudy of Ultrasonic Hydration Monitor for Neonatology and Pediatric Children and Infants and/or Children up to Age 3 Years Old With Diarrhea

Study will verify ability of infant Hydration Monitor (IHM) to assess changes of hydration status in newborns and infants by means of ultrasound velocity measurements through muscle tissues. Changes of tissue hydration will be followed during first days of life in newborns and in acute diarrhea in small children during re-hydration therapy. Weighting and clinical dehydration symptoms will be used as controls.

Handheld device to diagnose newborn dehydration

Noune Sarvazyan and her team at Artann Laboratories in the U.S. are developing a hand-held ultrasonic device to measure water content in the soft tissue of newborns and diagnose dehydration, one of the leading causes of infant morbidity and mortality in the developing world.

Infant Feeding Support for Refugee Children – #SafelyFed   Infant Feeding Support for Refugee Children

Infant Feeding Support for Refugee Children
Infant Feeding Support for Refugee Children is a group of mothers and other interested people, working as volunteers, to gather and co-ordinate support for the infants (newborns to age two years old and beyond) fleeing war and thus caught in the refugee crisis.  As a group we support the WHO recommendations on Infant Feeding whereby milk, preferably mother’s milk, should be the only food given for the first six months and milk feed should be offered freely for a minimum of two years.

  • support mother & infant
  • educate, train & support volunteers
  • educate public
  • support IYCF-E aligned groups to fundraise

GEMS study pinpoints main causes of childhood diarrheal diseases, suggests effective solutions

GEMS study pinpoints main causes of childhood diarrheal diseases, suggests effective solutions

The Global Enteric Multicenter Study (GEMS) is the largest, most comprehensive study of childhood diarrheal diseases ever conducted in developing country settings. Globally, diarrheal diseases are the second leading cause of death among children under five, despite the existence of effective interventions, such as oral rehydration solutions (ORS) and zinc supplements as general treatments. Many different bacteria, viruses and other pathogens can cause diarrheal disease. However, it has been difficult to prioritize and target interventions because previous studies cannot be easily compared or combined due to differences and limitations in the methods used. By studying more than 22,000 children (9,439 cases and 13,129 controls) across two continents with consistent methods, GEMS provides important, new data that will help researchers, policymakers, donors and advocates make evidence-based decisions to help to reduce the global burden of diarrheal diseases.

News Release Fact Sheet | Country Specific-Fact Sheets | Infographic |Clinical Infectious Diseases Supplement

Treatment of diarrhea in young children: results from surveys on the perception and use of oral rehydration solutions, antibiotics, and other therapies in India and Kenya

Journal of Global Health - 2013 June; 3(1): 010403. - doi: 10.7189/jogh.03.010403
Diarrheal disease is a leading cause of morbidity and mortality among children under five. Although oral rehydration solution (ORS) has tremendous therapeutic benefits, coverage of and demand for this product have remained low in many developing countries. This study surveyed caregivers and health care providers in India and Kenya to gather information about perceptions and use of various diarrhea treatments, assess reasons for low ORS use, and identify opportunities for expanding ORS use.

"Children are dying for lack of basic healthcare knowledge among citizens and health workers, and this is especially true of children with diarrhoea. Previous studies have shown that only 1 in 10 children with diarrhoea in India receive increased fluids to prevent death from dehydration, contributing to more than a million deaths every year. Almost 4 in 10 receive less to drink than normal, thereby tragically *increasing* their risk of death as compared with carrying on as normal. By contrast, more than 1 in 3 are inappropriately given antibiotics, which are not generally recommended for childhood diarrhoea.

A thousand children die needlessly from diarrhoea every day in India alone, due to basic errors in care from parents and health workers.
See: This new paper from India and Kenya provides further cause for concern... More than 90% of all diarrhea deaths could potentially be avoided with universal coverage of ORS - A million children are dying unnecessarily from diarrhoea every year because of lack of basic healthcare knowledge... How can we do better to improve the knowledge of citizens and health workers to manage child diarrhoea more effectively?" Join HIFA2015 and Discuss - It's Free!

Dr. Mathuram Santosham Receives 2014 Albert B. Sabin Gold Medal Award
April 29, 2014 - The Sabin Vaccine Institute today will present its annual Albert B. Sabin Gold Medal Award to Dr. Mathuram Santosham for his pioneering role in the prevention of deadly H. influenzae type b (Hib) diseases, including pediatric bacterial meningitis and pneumonia. Dr. Santosham's leadership in conducting groundbreaking research, vaccine efficacy trials and advocacy to prioritize Hib vaccines spans more than 40 years and has saved millions of children's lives worldwide.

Largest ever diarrhea study highlights solutions

Findings published in The Lancet can guide prevention, treatment and research on diarrheal diseases, which claim the lives of 800,000 children annually

15 MAY 2013 — WHO - A new study published in The Lancet has pinpointed the primary causes and impact of diarrheal diseases—a leading cause of deaths among children globally—and has revealed new opportunities for intervention. The Global Enteric Multicenter Study (GEMS) is the largest study ever conducted on diarrheal diseases in developing countries, enrolling more than 20,000 children from seven sites across Asia and Africa.

GEMS, coordinated by the University of Maryland School of Medicine’s Center for Vaccine Development, confirmed rotavirus – for which a vaccine already exists – as the leading cause of diarrheal diseases among infants and identified other top causes for which additional research is urgently needed. GEMS found that approximately one in five children under the age of two suffer from moderate-to-severe diarrhea (MSD) each year, which increased children’s risk of death 8.5-fold and led to stunted growth over a two-month follow-up period.

Related links and documents

Global Enteric Multicenter Study (GEMS): Article in The Lancet - 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 - GEMS factsheet - GEMS website More information on ending preventable child deaths from diarrhoea
Integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD)
PMNCH Knowledge Summary #25: Integrating immunization and other services for women and children
UNICEF report on pneumonia and diarrhoea

Childhood Pneumonia and Diarrhoea

Childhood Pneumonia and Diarrhoea - 2 Diseases, Many Solutions; 1 Global Action PlanExecutive summary - Published April 12, 2013 - Click here, for a comprehensive suite of resources and materials

The Lancet Series on Childhood Pneumonia and Diarrhoea, led by Aga Khan University, Pakistan, provides evidence for integrated control efforts for childhood pneumonia and diarrhoea. The first paper assesses the global burden of these two illnesses, comparing and contrasting them, and includes new estimates of severe disease and updated mortality estimates for 2011.

Findings from the second paper show that a set of highly cost-effective interventions can prevent most diarrhoea deaths and nearly two thirds of pneumonia deaths by 2025, if delivered at scale. Furthermore, the paper estimates what the cost of scale up will be.

The third paper presents the results of consultations with several hundred frontline workers in high-burden countries and explores the barriers and enablers they face in dealing with these two diseases and potential ways forward.

The final paper represents a call to action and discusses the global and country-level remedies needed to eliminate preventable deaths from these illnesses by 2025.

Integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD), a new global plan from UNICEF and WHO, represents the first-ever simultaneous effort to protect children from pneumonia and diarrhoea, the two leading killer diseases of children less than five years old.

Mind the GAPPD — A Pivotal New Resource Offers Global and Local Strategies to Overcome Leading Child Killers
11 April 2013 - This week, we celebrate integration. Though it is intrinsically at the heart of what we and our partners do in addressing myriad global health challenges through thoughtful, efficient strategies, today integration is particularly at the fore. For the very first time, there is a global plan to simultaneously take on the two diseases killing more than 2 million young children each year: pneumonia and diarrhea.


Continuing the child survival revival
Richard Horton, Udani Samarasekera
Full Text | PDF

Integrated action for the prevention and control of pneumonia and diarrhoea
Margaret Chan, Anthony Lake
Full Text | PDF

Playing our part to save children's lives
Jakaya Kikwete, Kevin Jenkins, Jasmine Whitbread
Full Text | PDF
Series Papers
Global burden of childhood diarrhoea and pneumonia
Christa L Fischer Walker, Igor Rudan, Li Liu, Harish Nair, Evropi Theodoratou, Zulfiqar A Bhutta, Katherine L O'Brien, Harry Campbell, Robert E Black
Full Text | PDF

Interventions to address deaths from childhood diarrhoea and pneumonia equitably: what works and at what cost?
Zulfiqar A Bhutta, Jai K Das, Neff Walker, Arjumand Rizvi, Harry Campbell, Igor Rudan, Robert E Black, for The Lancet Diarrhoea and Pneumonia Interventions Study Group
Full Text | PDF

Bottlenecks, barriers, and solutions: results from multi-country consultations focused on reduction of childhood diarrhoea and pneumonia deaths
Christopher J Gill, Mark Young, Kate Schroder, Liliana Carvajal-Velez, Marion McNabb, Samira Aboubaker, Shamim Qazi, Zulfiqar A Bhutta
Full Text | PDF

Ending of preventable deaths from pneumonia and diarrhoea: an achievable goal
Mickey Chopra, Elizabeth Mason, John Borrazzo, Harry Campbell, Igor Rudan, Li Liu, Robert E Black, Zulfiqar A Bhutta
Full Text | PDF

The biggest scandal in global health today: Why are 2 million children dying from pneumonia and diarrhea every year?

29 October 2012 – If you don’t work in global health you might be surprised to learn that fighting the leading killers of children has not been a global priority. You might also be surprised to learn exactly what the leading killers of children under 5 are – two diseases, pneumonia and diarrhea. These two kill more children under 5 than AIDS, malaria and measles combined. They cause 2 million children to die every year and account for a massive 30% of all under 5 deaths. And yet they attract less than 5% of global health funding.

To add insult to injury we have very cost effective vaccines, antibiotics and other treatments like oral rehydration salts and zinc that can prevent and treat the leading causes of pneumonia and diarrhea. If we made them widely available, pneumonia and diarrhea would kill a fraction of the children that they do now. Vaccines alone have the power to prevent almost 1 million child deaths from pneumonia and diarrhea every year. When you add in antibiotics, oral rehydration salts, zinc and vitamin A supplements – each of which cost cents per dose – you can probably double that figure and wipe out almost all deaths.

International Society for Social Pediatrics and Child Health (ISSOP) Position Statement on sponsorship of paediatricians/paediatric societies by the Baby Feeding Industry

Infant and young child feeding is central to child health and, after birth, breastfeeding is the first act of provision by a mother for her child. For most of history no other third party was required to support infant feeding other than the mother and the surrounding family. It is only since the commercial development of breast milk substitutes in the nineteenth century that health professionals have become involved in their prescription.

ISSOP "In recent years, the commercialisation of infant feeding has impacted on professional practice through the development of sponsorship by the Baby Feeding Industry of medical conferences and meetings, along with gifts to health workers.

It is the view of ISSOP that this sponsorship is damaging to the reputation of paediatricians, to the health of mothers and infants, and to the status of breastfeeding and this statement explains the reasons why we believe that such sponsorship should be terminated."

>> Download ISSOP Position Statement

ISSOP is hopeful that the Position Statement will be used with paediatric societies and associations around the world to ensure that paediatricians and other health professionals avoid conflicts of interest, and protect breastfeeding as one of the most health promoting measures in the field of child health.

*The term Baby Feeding Industry refers to all commercial companies which market infant formula or other infant feeding products.

Pneumonia and diarrhoea: Tackling the deadliest diseases for the world’s poorest children

Pneumonia and diarrhoea: Tackling the deadliest diseases for the world’s poorest children8 June 2012 – Preventing and treating pneumonia and diarrhoea – the two leading causes of death among children under five – can help save the lives of more than two million children, according to a report released today by the United Nations Children’s Fund (UNICEF).

“We know what works against pneumonia and diarrhoea – the two illnesses that hit the poorest hardest,” UNICEF’s Executive Director, Anthony Lake, said in a news release. “Scaling up simple interventions could overcome two of the biggest obstacles to increasing child survival, help give every child a fair chance to grow and thrive.”

Pneumonia and diarrhoea account for nearly one-third of the deaths among children under five globally – or more than 2 million lives each year. Nearly 90 per cent of deaths from pneumonia and diarrhoea occur in sub-Saharan Africa and South Asia.

The prevention and treatments for both diseases often overlap, and include such basic steps as: increasing vaccine coverage; encouraging breastfeeding and hand-washing with soap; expanding access to safe drinking water and sanitation; and disseminating oral rehydration salts to children with diarrhoea and antibiotics to children with bacterial pneumonia. Download pdf report

Towards ending preventable child deaths

Margaret Chan, Director-General of WHO and Anthony Lake, Executive Director of UNICEF "'We, as the leaders of WHO and UNICEF, are personally committed to the achievement of MDG 4 and new targets introduced through A Call to Action and A Promise Renewed. The two agencies will work in an even closer collaboration to support countries to achieve universal coverage of effective interventions - and effectively put an end to preventable child deaths."

Thanks in large part to the increased attention to maternal and child survival brought about by the Millennium Development Goals (MDGs), the world has made substantial progress in reducing child mortality over the past two decades. The number of deaths among children younger than 5 years has declined from more than 12 million in 1990 to 7·6 million in 2010. The mortality rate in children under 5 years has dropped from 88 deaths per 1000 livebirths in 1990 to 57 in 2010—a 35% reduction. The rate of decline in the under 5 mortality rate has accelerated from 1·9% a year from 1990 to 2000 to 2·5% a year from 2000 to 2010. The rate of reduction has doubled in sub-Saharan Africa. These gains underline the importance of having clearly defined targets, especially when they are combined with mechanisms for monitoring progress, ensuring equity, and promoting accountability.

Researchers Outline Plan to End Preventable Child Deaths in a Generation
From Johns Hopkins Bloomberg School of Public Health
Preventable childhood deaths caused by illnesses such as pneumonia and diarrhea can be nearly eliminated in 10 years according to researchers from the Johns Hopkins Bloomberg School of Public Health and the National Institutes of Health. In a new commentary featured in the June issue of the Journal of the American Medical Association, researchers outline a strategy and benchmarks for curbing childhood preventable deaths and recommend a new common vision for a global commitment to end all preventable child deaths. Read more.

Declaration on Scaling up Treatment for Diarrhea and Pneumonia - 2 page .pdf
PATH joined the US Agency for International Development, the Clinton Health Access Initiative, the Micronutrient Initiative, and others in raising a collective voice to call for investments to scale-up the use of proven tools, particularly oral rehydration solution, zinc, and amoxicillin with the Declaration on Scaling up Treatment for Diarrhea and Pneumonia. The Declaration represents an unprecedented commitment to the leading killers of children.

May 2012 DefeatDD and partners made a splash on World Water Day by sharing success stories with policymakers on Capitol Hill, promoting a social media voice donation campaign, and raising our glasses at the “Drink to the World” event, where we celebrated the good work that is saving lives in the field. On defeatDD.org, PATH’s Vice President of Field Programs, Ayo Ajayi, blogged about his experience seeing the effects of waterborne illness first-hand as a doctor in Nigeria, a sober yet inspiring reminder of how WASH is foundational to community health and well-being. We had even more to celebrate when Secretary of State Hillary Clinton spoke at the State Department ceremony, where she signed a U.S. Water Partnership that will mobilize US-based knowledge, expertise, and resources to improve water security around the world – particularly in countries most in need. Cheers to our partners for another great World Water Day!

May 2012 The Sanitation and Water for All Partnership (SWA), a group focused on promoting access to WASH in the settings where it is needed most, convened its second annual High Level Meeting on April 20, garnering participation from more than 140 Ministers of WASH and Finance from 50 countries. Among the many encouraging outcomes of the meeting, the U.S. government officially joined SWA. For those of you who tweet, help us show some love to Raj Shah, USAID Administrator, for demonstrating US leadership for WASH.

May 2012 We’ve said it before, and we’ll say it again: we need more talk about diarrhea! With our new report, co-authored with our friends at Tearfund, we’re taking the conversation to Africa. “Diarrhoea Dialogues: From Policies to Progress” looks at the policy landscape and opportunities and obstacles for diarrheal disease control in Ethiopia, Mali, and Zambia. The recommendations in the report target national governments, donors, and multilaterals. We hope you’ll share it with your networks and continue the dialogue! To request hard copies, contact Hope Randall.

May 2012 Simple solutions should be at hand for every mom, and this belief inspired our video, "The Extraordinary Healing Power of Mom.” Watch and share it to honor moms everywhere, and thank your mom for all she did to keep you healthy! “Sound Solutions,” our newest video, lets simplicity speak for itself. Slow down and listen to the ways we can save millions of lives from diarrheal disease. And in case you missed it, the Chronicle of Philanthropy recently featured “No Bleep” in an article about the use of humor in nonprofit advocacy efforts. Check out the article!

May 2012 This year, 7 million children will die before their 5th birthday from largely preventable illnesses like pneumonia and diarrhea. The good news: we can change this! DefeatDD is a proud partner of USAID’s Every Child Deserves a 5th Birthday campaign. You can support the effort by uploading your 5th birthday photo on the campaign website and by liking their page on Facebook. Read our take on the launch event and join the nostalgic defeatDD team for a trip down memory lane as we revisit our five-year old selves.

May 2012 By integrating education and clinical care in a new national policy on the control of diarrhea and pneumonia, PATH and the Government of Cambodia are placing a broad spectrum of tools in the hands of health workers, volunteers, and families to make a major impact. Learn more about the project by reading our project summary or browsing our photo album.

May 2012 Two weeks ago, Ghana made history by becoming the first African nation to simultaneously introduce vaccines against pneumonia and diarrhea, the leading killers of children. At PATH, it was a time not just to celebrate but to reflect on the hard and rewarding effort that made rotavirus vaccine introduction possible. Ghana’s successful introduction came directly on the heels of a new Vaccine journal supplement that features an incredible finding: rotavirus vaccines are projected to save 2.4 million lives by 2030. We’re thrilled that Ghana’s children will be among them!

May 2012 A new publication in the Lancet presents encouraging news on the continued decrease in global child deaths. From 2000-2010, deaths among children under five dropped from 9.6 to 7.6 million per year, according to data gathered by the Child Health Epidemiology Reference Group of the World Health Organization and UNICEF. Despite these gains, childhood diarrhea and pneumonia still claim a combined 2 million lives annually. The good news of decreases in child deaths are also coupled with an alarm that millions of children remain vulnerable despite proven and available interventions. A coordinated approach to diarrhea and pneumonia control in the hardest-hit countries, along with increased commitments to protect all children, offer the most promise for helping global child deaths decrease even further.

May 2012 When it comes to pregnancy and childbirth, good information and support make all the difference. So what happens when the support’s not there and the information is more dangerous than helpful? PATH’s Sure Start website introduces community members in India who are using simple objects – like piggy banks, childhood games, and personal letters – to ensure new moms and babies get the care and support that all of us needed when we first came into the world. We hope you’ll draw on these stories for inspiration and then share your own. Who kept you healthy when you came into the world? Who did you keep healthy? Join the conversation on Facebook and Twitter, using the hashtag #PATHSureStart.

May 2012 Do you have a great idea for increasing awareness about the leading killers of children in low resource settings? Building on the success of last year’s events, the World Pneumonia Day coalition is currently accepting applications for the 2012 Small Grants Advocacy Program. A small grant supports activities and events aimed at increasing awareness, urgency, and action on childhood pneumonia and related child killers, like diarrhea, on or around World Pneumonia Day (November 12, 2012) and throughout the year. To learn more, visit the World Pneumonia Day website.

Ghana takes on top two child killers simultaneously

Ghana takes on top two child killers simultaneouslyHistoric dual rollout of rotavirus and pneumococcal vaccines—a first for Africa

April 26, 2012—Today, Ghana made history. It became the first African country to simultaneously introduce vaccines against the primary causes of the two leading childhood killers worldwide—diarrhea and pneumonia. In Ghana, these killer diseases together account for approximately 20 percent of the country’s mortality in children under five years of age. The Expanded Program on Immunization Manager, Dr. K.O. Antwi-Agyei, decided that Ghana’s children could wait no longer for lifesaving vaccines and made the unprecedented decision to introduce both vaccines at once. "We could not introduce one vaccine and then wait—while our children were dying—to introduce the other. We have the systems and we have carefully planned the introduction process," said Dr. Anti-Agyei.

Preparations for the dual introduction were heroic and successful:
• Expansion of the cold chain to keep the vaccines cool in a tropic nation where electricity in rural areas is unreliable.

• Completion of training programs for tens of thousands of healthcare workers.
• Far-reaching public awareness campaigns taken to outreach centers in rural villages.
• Reissuance of millions of upgraded child health immunization cards.

Ghana has identified rotavirus vaccines as an essential and lifesaving intervention in its comprehensive diarrhea control strategy, thereby facilitating achievement of Millennium Development Goal 4—reduction of child mortality.

A lifeline for children across the African continent and beyond
27 September, 2011
GAVI approves rotavirus vaccine funding for 16 new countries, 12 in Africa Until today, life-saving rotavirus vaccines were not accessible for most children in Africa, the continent with a staggering burden of rotavirus disease and where vaccines are desperately needed to prevent severe rotavirus diarrhea and save children’s lives: • Where nearly a quarter of a million children die of rotavirus disease each year.
• Where roughly 40% of children hospitalized for severe diarrhea have rotavirus.
• Where urgent care and treatment for severe rotavirus diarrhea is often limited or unavailable. Now there is a new story of hope and promise to tell about Africa—a story of a future where children who need the vaccine most will have a chance at a healthy and happy life, free from the threat of severe rotavirus disease. Today the GAVI Alliance approved rotavirus vaccine funding for 16 new countries, 12 in Africa, including Angola, Burundi, Cameroon, Congo DR, Djibouti, Ethiopia, Ghana, Madagascar, Malawi, Niger, Rwanda, and Tanzania—and four other countries, including Armenia, Georgia, Moldova, and Yemen. On July 17, 2011, Sudan became the first African country to introduce rotavirus vaccines with GAVI Alliance funding—just two years after the World Health Organization recommended all countries introduce the vaccine into their national immunization programs. People have heard about Sudan’s introduction and have seen the news around the world that vaccines against rotavirus are saving lives in countries where children have access to them. They eagerly await the vaccine's arrival.

GAVI’s historic rollout of rotavirus vaccines in Africa begins today!
July 17, 2011

This morning, hundreds of infants in Khartoum, Sudan received their first doses of vaccine that will help prevent severe rotavirus and the deadly dehydrating diarrhea it causes. Today marks a milestone in global health—the first nationwide introduction of rotavirus vaccines by a GAVI-eligible African country. “We finally have the vaccine in our hands; it is a great and exciting day in our lives and we are happy that this is a reality now,” said Dr. Amani Abdelmoniem Mustafa, the manager of the Expanded Programme on Immunization (EPI). “We share our joy with our supportive partners at GAVI, WHO, UNICEF, and PATH who are part of this victory over childhood diarrhea in Sudan.” Until today, life-saving rotavirus vaccines were out of reach of most children in Africa. South Africa (which is not GAVI-eligible due to its higher income level) introduced rotavirus vaccines in 2008 and 2009, and there are plans for many other GAVI-eligible African countries to roll out rotavirus vaccines in the next few years. GAVI’s commitment to support the introduction of rotavirus vaccines in more than 40 countries by 2015, many in Africa, will reverse the tragic story by preventing hundreds of thousands of unnecessary child deaths from diarrhea across the African continent. Please click here for GAVI’s statement supporting the African introduction of rotavirus vaccines.

March 2011 - Scaling Up Diarrhea Prevention and Treatment Interventions: A Lives Saved Tool Analysis - Research Article Diarrhea remains a leading cause of mortality among young children in low- and middle-income countries. Although the evidence for individual diarrhea prevention and treatment interventions is solid, the effect a comprehensive scale-up effort would have on diarrhea mortality has not been estimated. Using currently available interventions, we demonstrate that with improved coverage, diarrheal deaths can be drastically reduced. If delivery strategy bottlenecks can be overcome and the international community can collectively deliver on the key strategies outlined in these scenarios, we will be one step closer to achieving success for the United Nations' Millennium Development Goal 4 (MDG4) by 2015. more >>

January 2011 - The Pediatric Infectious Disease Journal special issue shows that rotavirus vaccines are improving the health and well-being of children by substantially reducing severe and fatal diarrhea. Real World Impact of Rotavirus Vaccination, a special supplement to the January 2011 edition of The Pediatric Infectious Disease Journal, demonstrates the dramatic impact of rotavirus vaccines on children's health in both developed and developing countries. Studies in the supplement show that in the two to three years following the roll-out of rotavirus vaccines in national immunization programs, countries experienced striking and swift reductions in the number of children under five years of age hospitalized due to acute diarrhea caused by rotavirus. more >>

Disparities in the Treatment of Childhood Diarrhoea in India
Nisha Malhotra and Nicholas Choy
August 2010 download pdf19 pages - 246 kb

Despite the severe impact of diarrhoea on children's health and mortality in India, recent surveys show that only half of all children suffering from diarrhoea receive treatment or medical advice, and more than two-thirds receive no Oral Rehydration Therapy (ORT). An understanding of the socio-demographic determinants for appropriate treatment of the disease will be critical for improving these figures. This analysis is based on the most recent National Family Health Survey (NFHS3), which shows that children are more likely to receive ORT if they are treated in a public health facility, rather than in a private health facility. Households with mothers belonging to the youngest age group, lowest educational attainment, and poorest wealth index are the least likely groups to properly treat their children suffering from diarrhoea. A significant gender bias also exists as parents show a preferential treatment of male children and delay seeking treatment for their female children. The low usage of ORT can also be attributed to a combination of low health knowledge among the aforementioned groups, and low use of public health facilities.

List of supporting organizationsCall to Action on diarrhoeal disease

Answering nature's call with man-made solutions
Seattle PI, November 2009
After co-hosting the panel "Toilet Talk" for the occasion of World Toilet Day, Glenn Austin, director of Safe Water Projects at PATH, and Dr. David Winder, acting CEO of WaterAid America, partner to co-author this letter to the editor. It traces how important sanitation systems were, and are, essential to sustain the health of populations in industrialized countries, and notes the tremendous burden that a large percentage of the developing world still faces because they lack this crucial solution.

AIDS, malaria eclipse the biggest child-killers
Associated Press, November 2009
In this article, Margie Mason notes the disconnect between the diseases that make headlines and the diseases that are the largest childhood killers. She quotes Dr. John Wecker, director of the Vaccine Access and Delivery Global Program at PATH, who asserts that we have the tools that we need, so there is no reason why pneumonia and diarrhea should not be top priorities.

New Vaccine special edition on rotavirus burden data chronicles a decade of rotavirus surveillance in Asia
PATH, November 2009
This special edition of the journal Vaccine focuses on the rotavirus burden in Asia, where the disease is responsible for almost half of acute diarrhea hospitalizations among Asian children under 5. The edition goes on to encourage scientists to become advocates for the life-saving rotavirus vaccine.

Rotavirus -- the most common and lethal form of diarrhea -- deadly for children
IH - Blog, November 2009
While rotavirus itself is democratic, infecting nearly every child in the world by age 3, treatment options for those in the developing world remain elusive. Dr. John Wecker, director of the Vaccine Access and Delivery Global Program at PATH, says that his global health crisis is one that can be solved. He includes links to several resources - including a special edition on rotavirus in the Journal of Infectious Diseases - that are working to increase the awareness and political will necessary to defeat this deadly childhood killer.

New Journal of Infectious Diseases special edition outlines compelling rotavirus burden data and critical need for access to vaccines in high-burden regions
PATH, November 2009
"The Journal of Infectious Diseases has released a special edition, Global Rotavirus Surveillance: Preparing for the Introduction of Rotavirus Vaccines. This special edition provides a significant contribution to the understanding of rotavirus disease burden and the impact of rotavirus vaccines, which have the potential to save an estimated 228,000 lives annually."

As Donors Focus on AIDS, Child Illnesses Languish
New York Times, October 2009
In this article, Celia Dugger draws attention to the fact that the leading killers of children - pneumonia and diarrhea - receive little attention and funding when compared with more "glamorous" global health issues. She shows that the time is right to scale up US investment in these mundane, but deadly diseases.

Linking Water, Sanitation, and Health Sector
ONE, October 2009
This blog summarizes and links to a paper recently published by the Center for Strategies and International Studies (CSIS) Global Health Policy Center: "Enhancing U.S. Leadership on Drinking Water and Sanitation -- Opportunities within Global Health Programs." The author of the report, Katherine E. Bliss, makes the argument that water and sanitation issues need to be included in health sector discussions. Water-borne diseases like diarrhea account for a large percentage of the global disease burden.

Celebrating handwashing with soap in Zimbabwe
UNICEF, October 2009
Several countries around the world conducted activities for Global Handwashing Day. In Zimbabwe, hundreds of community volunteers participated in a campaign that focused on school children as agents of this life-saving behavior change.

Wash your hands and sing the Happy Birthday song
ONE, October 2009
"Today is Global Handwashing Day. So, when you put down this paper, don’t forget to wash your hands. Oh sure, if you forget, you’ll survive. But remember others – especially children – around the world aren’t so lucky. Their well-being deserves our continued attention because all children deserve to celebrate their next birthday."

1.5 Million Children Die a Year From Diarrhea - Unsafe Drinking Water, Lack of Handwashing to Blame
Treehugger, October 2009
Written for the occasion of Global Handwashing Day, Matthew McDermott draws a direct connection between the global diarrheal disease burden and climate change.

Easy as Water and Soap: Clean Hands Save Lives
The World Bank, October 2009
This article summarizes the importance of proper handwashing as a public health intervention and includes a video clip about Global Handwashing Day.

Handwashing Saves Lives, and Not Simply from Swine Flu
Huffington Post, October 2009
While handwashing is on the minds of the American public this flu season, Richard Chin, CEO of OneWorld Health, points out that this simple act should be global priority all year round for its capacity to save lives from diarrhea, the second leading killer of children worldwide. In this article, chin applauds efforts like Global Handwashing Day, the UNICEF/WHO report Diarrhoea: Why Children are Still Dying and What Can Be Done, and the Call to Action against diarrheal disease.

How Do You Solve a Problem Like Diarrhea? Poop Jokes May Save Millions of Kids a Year
Newsweek, October 2009
"There are two ways to try to draw attention to the oft-ignored issue of diarrhea in the Third World. You can point out that it’s literally a dead serious thing, an ailment that kills more than a million children under age 5 every year. Or you can use comedy in the service of tragedy─i.e., you can make jokes about poop."

UNICEF and WHO issue report on dangers of diarrhoea
United Nations Radio, October 2009
"It's a tragedy that diarrhoea, which is little more than an inconvenience in the developed world, kills an estimated 1.5 million children each year says UNICEF Executive Director, Ann Veneman. She says inexpensive and effective treatments for diarrhoea exist, but in developing countries only 39 per cent of children with the disease receive the recommended treatment."

India has largest number of people that defecate in open, says United Nations
The Times of India, October 2009
The new report launched by UNICEF and WHO, Diarrhoea: Why children are still dying and what can be done, presents some sobering statistics on the diarrheal disease burden, especially for India. Thankfully, it also outlines simple treatment and prevention plans, showing that diarrheal disease control can be within reach for all countries.

UNICEF and WHO Launch Strategy to Prevent and Treat Diarrhea -- the Second Biggest Killer of Children
Collection Development Blog, October 2009
This article outlines the findings of the new UNICEF/WHO report, Diarrhoea: Why Children Are Still Dying and What Can Be Done, including the seven-point prevention and treatment strategy. Several effective, low cost interventions show that no child should die from diarrhea and that now is the time to implement this strategy.

New UNICEF/WHO report focuses attention on diarrheal disease -- the second leading killer of children under 5 -- and outlines 7-point plan to control this preventable and treatable illness
PATH, October 2009
PATH and a coalition of partners issued this press release to spotlight the new UNICEF/WHO report, Diarrhoea: Why Children Are Still Dying and What Can Be Done.The release also highlights Global Handwashing Day, which was celebrated worldwide the day after the report launch (October 15) as a timely reminder of one of the most effective and low cost ways to prevent diarrheal disease.

Diarrhoea: Why Children Are Still Dying and What Can Be Done
UNICEF, October 2009
This press release on the UNICEF website gives an overview of the recently launched report by WHO and UNICEF, DiarrhoeaL Why Children Are Still Dying and What Can Be Done. It outlines the topics covered in the report, including promising treatments, an emphasis on prevention, rotavirus vaccine, and the need to expand access.

In India, new seat of power for women
Washington Post, October 2009
Proper sanitation habits had been a hard sell in India until the "No Toilet, No Bride" campaign. The success of this marketing strategy is evidence of changing attitudes, both for personal hygiene and for women's empowerment.

India's dying children
Guardian, October 2009
Though global child mortality rates have seen improvement, child mortality rates in India's slums have doubled. This short video tells the story of Surma, a mother who lost her four year old son, Parmesh, to diarrhea.

We have changed the history of my country
ONE, October 2009
Dr. Amador, Director of Health Systems and Technology in Nicaragua at PATH, blogs about the incredible strides his country has made in the fight against diarrheal disease, thanks to PATH's partnership to provide the rotavirus vaccine and other lifesaving interventions. A short video and slideshow are included.

Gates Foundation Grant Supports Testing of Treatment for Diarrhea
Media Newswire, September 2009
The Gates Foundation is providing a two year grant to the Yale School of Medicine as a team of scientists conduct clinical trials for a new and improved oral rehydration solution.

Living Proof Project: A Rotavirus Vaccine's Remarkable Impact
Bill and Melinda Gates Foundation, September 2009
The Bill and Melinda Gates Foundation's Living Proof Project seeks to show Americans that U.S. investment in global health is working. This four minute video spotlights the impact of rotavirus vaccine in Nicaragua.

Guest Blog: Evan Simpson, MPH, Enhanced Diarrhoeal Disease Control Initiative, PATH
Stories on Malawi, September 2009
PATH's Evan Simpson writes about the importance of an integrated approach in the fight against diarrheal disease. He highlights momentum already happening in Malawi specifically, having just spoken at the annual Commonwealth Association of Paediatric Gastroenterology and Nutrition Conference on Diarrhoea and Malnutrition.

Soap That Saves
Hotel Interactive, September 2009
Clean the World is partnering with hotels to recycle used soap for distribution among those in need, offering a creative, environmentally friendly way to fight diarrheal disease.

Child Mortality Rate Declines Globally
New York Times, September 2009
Simple solutions like exclusive breastfeeding and the commitment of community health workers have helped drive down child deaths in the developing world, according to new data from UNICEF. But to reach the Millennium Development Goal of cutting under-five deaths by two-thirds by 2015, attention must remain focused on diarrhea and pneumonia, the two most common but still neglected causes of child mortality.

Diarrhea: The Great Zinc Breakthrough

Diarrhea: The Great Zinc Breakthrough - 17 August, 2009

Can One Pill Tame the Illness
No One Wants to Talk About?

17 August, 2009 - It is hard to grasp the impact diarrhea has on people's lives across Africa and Asia. The disease kills more children than either malaria or AIDS, stunts growth, and forces millions — adults and children alike — to spend weeks at a time off work or school, which hits both a country's economy and its citizens' chances of a better future.

Taming a Devastating Illness with a Simple Pill See pictures of of how zinc is saving lives in Mali.
Zinc tablets help African communities fight diarrhea, a scourge that claims the lives of an astonishing 1.6 million children every year

Healing: The Unexpected Properties of Zinc

Scaling up oral rehydration salts and zinc for the treatment of diarrhoea

Scaling up the provision of zinc and ORS could rapidly reduce child mortality for four reasons.

Firstly, although it has been almost eight years since the World Health Organization recommended combination treatment with zinc and ORS, few countries have implemented basic interventions to increase the currently low use of adjunctive zinc. Such interventions would include marketing zinc to caregivers and distributing it in large volumes through both public and private facilities. Even limited additional investment in such interventions could have a large effect.

Secondly, children with diarrhoea can be reached and given appropriate treatment easily. Most children currently obtain some form of treatment for diarrhoea, but most of them receive inappropriate treatments such as antibiotics and antidiarrhoeal agents. Merely switching the treatments children receive, which is less challenging than trying to change caregivers' treatment seeking behaviour, could therefore drive substantial increases in ORS and zinc coverage.

Thirdly, and in contrast to treatments for malaria or pneumonia, effective treatment of diarrhoea does not need to be carefully targeted to selected children in whom a definitive diagnosis is made. A strategy of "flooding the market" with ORS and zinc­ distributing them through all outlets where caregivers seek treatment ­could be pursued safely, with no threat of drug resistance, for example.

Lastly, a full course of zinc and ORS treatment costs less than $0.50 (£0.3; €0.38), and the marketing, training, and distribution necessary to drive product uptake could also be implemented at comparatively modest cost. Moreover, public funding for procurement of zinc and ORS in many countries would be further moderated by the fact that most treatment for diarrhoea is delivered through the private sector and paid for out of pocket. >> more

Zinc and low osmolarity ORS for diarrhoea: a renewed call to action
Bulletin of the World Health Organization, August 2009
This paper highlights the need to revitalize diarrhoea management with treatment strategies like zinc and ORS (oral rehydration solution).

Hilton Humanitarian Prize Awarded to PATH
PNN Online, August 2009
PATH has been selected to receive the 2009 Conrad N. Hilton Humanitarian Prize of $1.5 million: the world's largest humanitarian prize. This article spotlights the integrated diarrheal disease control initiative as an example of PATH's innovative approach to finding health solutions.

Diarrhea: The Great Zinc Breakthrough
Time Magazine, August 2009
Vivienne Walt spotlights the tragic neglect of diarrheal disease while nodding at the "quiet revolution" of aid organizations and governments that are making an impact to defeat this global killer. Though the article centers on the success of zinc treatment, it also discusses oral rehydration therapy, rotavirus vaccine, and water/sanitation.

Rotavirus vaccine shows early impact
6 Minutes, August 2009
"The first Australian evidence has emerged to show that rotavirus vaccine has resulted in a substantial reduction in rotavirus disease activity since routine infant immunisation began in July 2007."

Water, Hygiene Related Illnesses
The News, July 2009
The Ministry of Environment in Pakistan, in collaboration with UNICEF and USAID, hosted a workshop entitled "National Behavioural Change Communication Strategy for Drinking Water Supply and Sanitation Sector." The workshop underscores the importance of simple behavior changes as a crucial element in alleviating the disease burden.

Fighting an Epidemic Without Medicine
Republica, July 2009
Kalendra Sejuwal outlines the tragic consequences for residents in rural areas of Africa, who cannot gain access to medicine to treat diarrheal disease. Though health clinics and medical deliveries from the government reach more populated areas, villagers often cannot reach or afford these lifesaving treatments.

Shreveport Teen Starts Nonprofit
Shreveport Times, July 2009
Nineteen year old Will Webb started a nonprofit, Operation Rehydration, to help children in Lesotho, Africa, who are suffering from diarrheal disease.

Watching Children's Health When Diarrhea, Dehydration Occur
The Jakarta Post, July 2009
The author of this article outlines the most frequent causes of diarrhea in developing countries, warning signs for parents of sick children, and the "dos and don'ts" of treatment options.

Discovery of New Transmission Patterns May Help Prevent Rotavirus Epidemics
Science Daily, July 2009
"New vaccines have the potential to prevent or temper epidemics of the childhood diarrhea-causing disease rotavirus, protect the unvaccinated and raise the age at which the infection first appears in children, federal researchers report in a new study."

Institute for OneWorldHealth and Novartis Launch Innovative Collaboration to Discover and Develop Novel Therapy to Combat Diarrheal Disease
Institute for OneWorld Health, July 2009
The Institute for OneWorld Health, the US-based non-profit pharmaceutical company, and Novartis, a global pharmaceutical leader, have announced a a three year partnership to discover and develop a new drug to treat secretory diarrhea.

Comprehensive Global Health Strategy
The Huffington Post, July 2009
"While memories of President Obama speech in Ghana promising a 'comprehensive, global health strategy' are fresh, we hope he, Ghanian President John Atta-Mills and other world leaders do not miss an opportunity to address the neglected disease that's one of the world's most pervasive killers of children worldwide -- childhood diarrheal disease," writes Richard Chin.

USAID Commemorates Day of the African Child; Launches Two Decades Report on Child Survival and Maternal Health
Fox Business, June 2009
Statistics show that global child deaths have fallen over the past two decades, and it is necessary to build upon these successes by delivering “low-cost, high-impact interventions to prevent or treat the leading killers of mothers, newborns and children under five.” Oral rehydration solution and exclusive breastfeeding are cited here as components of this approach.

Countering Diarrheal Disease
Monday Developments, June 2009
Glenn Austin, Director of PATH Safe Water Project, and Dr. John Wecker, Global Program Leader of Immunization Solutions, make an appeal for renewed political will and funding for diarrheal disease control. They show that we are in a better position now more than ever to tackle the problem and emphasize an integrated approach of proven, cost effective solutions and new medical technologies.

Pulitzer Center Reports from the World Water Forum
The World Water Forum, the world’s largest water policy event, held its fifth session last March in Istanbul, Turkey. "[There were] 40 journalists who attended the Forum under the auspices of Media21, a Geneva-based non-profit that also organized follow-on field reporting trips to India and Ethiopia. Their dispatches are assembled here, along with links to short videos that highlight key aspects of the water challenge."

Toilets become Nairobi's hottest social spots
UPI, June 2009
Through the company he founded, Ecotact, Kenyan architect David Kuria is addressing the cultural barriers against sanitation. With the creation of “toilet malls,” families have access to shower and toilet facilities, as well as classes on sanitation and hygiene.

What Are We Worst at Covering?
New York Times, June 2009
The news media is worst at covering public health because it is "unglamorous and overwhelming," asserts Nicholas Kristof in his blog. He cites the WHO universal recommendation of the rotavirus vaccine as an example of an important topic deserving greater media attention.

How Bill Gates caught the global health bug
Crosscut, June 2009
"It was when he read about rotavirus, a cause of widespread death of children from diarrhea. A decade later, Gates Foundation's efforts have brought about WHO approval of a rotavirus vaccine."

WHO recommends global use of rotavirus vaccines
PATH, June 2009
In a landmark decision, the World Health Organization’s Strategic Advisory Group of Experts (SAGE) gave a universal recommendation for the introduction of rotavirus vaccines in all national immunization programs. This decision will help to protect poor countries against the most deadly form of diarrheal disease. The press release was issued by WHO, PATH, and the GAVI Alliance.

Breaking the Cycle of Malnutrition and Diarrhea
Bread for the World Institute, June 2009
Highlighting the personal stories of two mothers from Kenya, Janie Hayes from PATH and Altrena Mukuria from the Infant and Young Child Nutrition Project illustrate the “vicious cycle” of malnutrition and diarrheal disease. They outline proven, cost effective solutions as well as advocacy efforts that are currently underway to address these problems.

NGOs Try Power in Numbers Approach in Call to Action against Diarrheal Disease
Center for Global Development, May 2009
Scott Kniaz, program coordinator on the Global Health Team at the Center for Global Development, discusses the comprehensive advocacy approach embodied in the recently launched Call to Action against diarrheal disease: “Understanding that the causes and effects of this disease are widespread, its civil society supporters must also be drawn from many corners.”

Diarrheal disease: the long-ignored killer of millions
IPIU, May 2009

Shanely Knox highlights the preventable nature of diarrheal disease and makes a case for simple solutions that deserve more attention, using stories from the field and input from experts.

Sanitation vs. vaccination in cholera control
IRIN, May 2009
International Vaccine Institute director John Clemens argues for a coordinated effort against diarrheal diseases. “It is a false dichotomy to pit sanitation against vaccination,” he asserts. “Progressively, people are thinking about how water sanitation and vaccinations can work together.”

Two new reports highlight stalled progress against diarrheal disease
PATH, May 2009
PATH and WaterAid America released two new reports that show that the international aid community and developing-country governments are not responding to clear evidence on child mortality by targeting resources where the disease burden is greatest.

Diarrhoea - second biggest killer of under-fives being ignored
Medical News Today, May 2009
"The international health agenda is failing to save the lives of millions of children by not responding appropriately to causes of child deaths, according to development organisation WaterAid in a new report released today."

The possibility of a pandemic and the reality of diseases that kill
The Huffington Post, May 2009
Author Richard Chin advocates for action against diarrheal disease--the second leading cause of death in children--and urges readers to join the fight against this "senseless killer."

The Politics of Toilets
The Washington Post's Post Global, April 2009
Rose George, author of The Big Necessity: The Unmentionable World of Human Waste and Why It Matters, reminds us of the deadly consequences of lack of sanitation and unsafe water. According to George, "Diarrhea is world's most effective weapon of mass destruction."

It's 2009. Do you know where your soul is?
New York Times, April 2009
An op-ed column by Bono, co-founder of the advocacy group ONE, highlights rotavirus as a "killer pest" that our aid money would be well spent on. "It's not charity, it's justice."

Transparency: Drinking Water
GOOD, March 2009
This brief video presents statistics on the dangers of contaminated drinking water and outlines affordable sanitation solutions.

Water deserves higher priority on development agenda
United Nations, March 2009
"Chronic underinvestment and poor governance in many parts of the world has left hundreds of millions of people deprived of their right to safe water and basic sanitation, vulnerable to disease and extreme hunger," stated the Director-General of the UN Educational, Scientific and Cultural Organization (UNESCO) at the opening of the 2009 World Water Forum.

Neglected disease research and development: how much are we really spending?
The George Institute for International Health, February 2009
The first survey of global public and private investment in research and development of products for neglected diseases found that almost 80 percent of funding was directed to HIV/AIDS, TB, and malaria interventions, while major childhood killers including diarrheal disease and pneumonia received less than 6 percent.

Zimbabwe cholera tied to crumbling infrastructure
National Public Radio, December 2008
Zimbabwe faces a crisis as a severe cholera outbreak grips the country, attributed to failures of water and sanitation systems.

Prepare for bout of "winter" diarrhoea
Vietnam News, December 2008
More children are admitted for diarrhea during winter months, but Vietnamese health officials urge use of oral rehydration solution and hygienic practices.

… Now we can seriously discuss sanitation
Scientific American, October 2008
An interview with Rose George, author of The Big Necessity: The Unmentionable World of Human Waste and Why It Matters.

Millions lather up to save lives as UN observes Global Handwashing Day
UNICEF, October 2008
In more than 70 countries around the world, children, teachers, and parents joined celebrities, officials, civil society, and the private sector to raise awareness about handwashing with soap.

RotaTeq® receives WHO pre-qualification—Significant step in Merck's efforts to expand global access to rotavirus vaccine
Medical News Today, October 2008
WHO prequalification is an important milestone for making new rotavirus vaccines available for procurement by UNICEF and the GAVI Alliance, increasing access for the developing world.

A simple solution
Time, October 2006
An article on the history and potential of oral rehydration solution.

Rotavirus Update - News from the PATH Rotavirus Vaccine Program

Global advisory group notes efficacy of RotarixTM in Africa

Upon its review of the latest data on rotavirus vaccines, including preliminary immunogenicity and clinical efficacy results from a Phase III study of the RotarixTM vaccine in Africa, the World Health Organization’s Strategic Advisory Group of Experts (SAGE) noted that RotarixTM significantly reduced serious rotavirus gastroenteritis in challenging settings. The study, which PATH is conducting in collaboration with the vaccine’s manufacturer, GlaxoSmithKline (GSK), and investigators in South Africa and Malawi, has been recently completed. Full results will be presented to SAGE at its April 2009 meeting, at which time SAGE will consider whether the results warrant establishing a global recommendation for the use of rotavirus vaccines.

Along with trials in Ghana, Kenya, Mali, Bangladesh, and Vietnam to evaluate the clinical efficacy of RotaTeq® by Merck & Co., Inc., the GSK study speaks to an earlier SAGE recommendation that called for the generation of safety and efficacy data on the vaccines’ use in developing countries of Africa and Asia. Both rotavirus vaccines currently are prequalified by WHO for use in developing countries of Latin America and Europe, where previous clinical trials demonstrated their safety and efficacy. In November 2006, the GAVI Alliance pledged to provide financial support for the use of rotavirus vaccines by developing countries in these regions as well.

WHO convenes experts to provide guidance on extrapolating clinical trial data on rotavirus vaccines

The October 24, 2008, issue of the Weekly Epidemiological Record (WER), published by the World Health Organization (WHO), features a report on the outcome of a meeting of global, regional, and country-level rotavirus experts and immunization opinion leaders who gathered to provide guidance on evaluating and extrapolating clinical trial data on rotavirus vaccines.

Participants agreed that even vaccines with moderate efficacy would bring about substantial public health benefits in developing countries in Africa and Asia, where most rotavirus deaths occur, and would be cost effective for saving children’s lives. The experts noted that criteria such as the WHO mortality strata and local epidemiology of rotavirus infection are useful for extrapolating clinical trial data to other regions and countries. The meeting participants also deliberated about the research agenda for candidate rotavirus vaccines under development.

The PATH Rotavirus Vaccine Program is collaborating with GlaxoSmithKline and Merck & Co., Inc., to generate important efficacy data through clinical trials in Bangladesh, Ghana, Kenya, Malawi, Mali, South Africa, and Vietnam. Interim results from the South Africa trial are positive and underscore the potential of rotavirus vaccines to have significant public health impact in low-resource countries. Additional data will be available soon, and results from all of the clinical studies in progress will be available in 2009.

The WER article, “Evaluating clinical trial data and guiding future research for rotavirus vaccines,” may be read in full at http://www.who.int/wer/2008/wer8343.pdf.

Major surveillance study shows worldwide need for rotavirus vaccines

Findings from a global surveillance network measuring the burden of rotavirus disease were published this week in the Morbidity and Mortality Weekly Report (MMWR) of the US Centers for Disease Control and Prevention and in the Weekly Epidemiologic Record (WER) of the World Health Organization. The hospital-based surveillance findings indicate that, during 2001 to 2008, rotavirus accounted for approximately 40 percent of hospitalizations for diarrhea among children under five years of age worldwide. To read the full reports, please visit MMWR November 21, 2008 / Vol. 57 / No. 46 (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5746a3.htm) and WER 21 November 2008/ Vol. 83/ No. 47 (http://www.who.int/wer/en/).

The data in this study were collected as part of a collaboration, beginning in 2001, of the World Health Organization, international partners, and networks of hospital-based sentinel surveillance sites for detection of rotavirus diarrhea and characterization of rotavirus strains. The data were collected in sentinel hospital–based sites in 35 countries from each region of the world.

The study demonstrates the substantial burden of rotavirus diarrhea worldwide and highlights the potential health impact of vaccination. According to the authors of the MMWR, “The substantial health burden of rotavirus diarrhea in the world underscores the need for effective interventions (e.g., vaccines) for the control of this disease as part of a comprehensive approach for prevention and control of diarrhea.”

The PATH Rotavirus Vaccine Program is collaborating with GlaxoSmithKline Biologicals and Merck & Co to generate important efficacy and safety data through clinical trials in Bangladesh, Ghana, Kenya, Malawi, Mali, South Africa, and Vietnam. Data from clinical studies currently in progress will become available in 2009. Results from these trials will provide important information for WHO’s consideration of these vaccines for global use.

New studies show rotavirus vaccines have led to dramatic reduction in US severe rotavirus disease

The use of rotavirus vaccines in the United States has reduced hospitalizations for severe diarrhea by 70 to 80 percent and may have prevented illness in unvaccinated children by limiting the number of circulating infections. Several studies documenting these results will be presented this week in Washington, DC, at a joint meeting of the Infectious Disease Society of America (ISDA) and the Interscience Conference on Antimicrobial Agents and Chemotherapy.

Before rotavirus vaccines were approved for use in the United States in 2006, rotavirus caused 200,000 emergency room visits and 55,000 hospitalizations in the United States each year. Worldwide, rotavirus is responsible for 2 million hospitalizations and more than 500,000 deaths annually in children aged five years or younger. Nearly all rotavirus deaths occur in the poorest parts of the world, and the dramatic impact of rotavirus vaccines in the United States is a strong signal of their potential in saving lives globally.

Typically, it can take more than ten years for new vaccines to reach the developing world, but rotavirus vaccines are rapidly overcoming this barrier. Low- and middle-income countries in Latin America and Eastern Europe have introduced or are considering introduction of rotavirus vaccines, with subsidized support from the GAVI Alliance. Clinical trials among impoverished populations in Africa and Asia also are evaluating the vaccines’ performance in these environments. Results expected in 2009 will inform decision-making by both the World Health Organization and the GAVI Alliance.

For more information, see the news coverage by the Associated Press or the ISDA Abstract Search Page (use “rotavirus” as your keyword).

Merck’s RotaTeq® vaccine earns WHO prequalification

WHO has placed RotaTeq®, the rotavirus vaccine manufactured by Merck & Co., on its list of prequalified vaccines for purchase by UN agencies as of October 2008. WHO’s prequalification of RotaTeq® is a major step in accelerating the availability of rotavirus vaccines in the developing world. The Rotarix® vaccine manufactured by GlaxoSmithKline (GSK) achieved prequalification in January 2007.

“Vaccines are the best hope for preventing severe rotavirus disease,” said John Wecker, PhD, Director of the PATH Rotavirus Vaccine Program (RVP). “WHO’s prequalification of RotaTeq® is an important milestone towards ensuring that rotavirus vaccines are accessible to children worldwide.”

RVP is collaborating with Merck and GSK to generate important efficacy and safety data through clinical trials in South Africa, Malawi, Ghana, Mali, and Kenya in Africa, and Bangladesh and Vietnam in Asia. Data from clinical studies currently in progress will become available in 2009.

New data show substantial progress against rotavirus in the United States

New data, published today in the US Centers for Disease Control and Prevention’s (CDC) Morbidity and Mortality Weekly Report (MMWR), indicate a dramatic reduction in seasonal incidence of rotavirus coinciding with increased use of rotavirus vaccine, which was recommended for US infants in February 2006. CDC surveillance data indicate that seasonal incidence of rotavirus dropped more than 50 percent during 2007-2008 in the US, and that the current rotavirus season began two to four months later than usual. During the first 18 weeks of 2008, only six percent of samples tested positive for rotavirus, compared to 51 percent in 2006 and 54 percent in 2007 over the same 18-week period. Both the drop in magnitude and delay in seasonal onset coincide with increasing use of rotavirus vaccines in the US.

The most common form of severe diarrhea in children, rotavirus accounts for over 50,000 hospitalizations, more than 200,000 emergency department visits, and 410,000 physician office visits in the US annually. Readily accessible medical care means that children in the US rarely die from the disease; however, rotavirus is estimated to take the lives of more then 500,000 children around the world each year, nearly all in low-income countries.

PATH’s Rotavirus Vaccine Program (RVP) is a partnership with the World Health Organization and the US CDC, funded by the GAVI Alliance. By collaborating closely with the vaccine industry, public health organizations, donors, and governments, RVP is working to make rotavirus vaccines accessible to children worldwide.

Read the full MMWR report here.

Rotarix® rotavirus vaccine receives US FDA approval

On April 3, 2008, the US Food and Drug Administration (FDA) approved GlaxoSmithKline’s (GSK’s) Rotarix® vaccine for prevention of rotavirus in infants, providing an additional option for protecting American children against this severe diarrheal disease. Data from large-scale clinical trials conducted in the US, Europe, and Latin America informed the FDA’s decision. Another rotavirus vaccine, RotaTeq®, manufactured by Merck & Co., Inc., received FDA approval in 2006.

Rotavirus causes more than half a million childhood deaths every year, but fatalities are rare in the US and other industrialized countries, where acute medical care is readily accessible. The developing world, however, carries a far greater burden of disease. Nearly 90 percent of all rotavirus-related deaths occur in the world’s poorest countries, making rotavirus vaccination an imperative public health intervention.

PATH’s Rotavirus Vaccine Program is working in partnership with GSK and Merck on clinical trials of their respective vaccines in Africa and Asia. These trials will generate valuable data for developing countries considering the use of vaccines to reduce rotavirus mortality. They are a pivotal element of a broad range of activities that PATH and its partners are conducting to lay the foundation for accelerated introduction of rotavirus vaccines in the developing world.

Click here to read the FDA announcement.

New resource to assist countries applying for GAVI support of rotavirus vaccines

A new publication, Introduction of rotavirus vaccine with support from the GAVI Alliance: Information to assist the national decision-making and application process, is now available. Developed by PATH in partnership with the GAVI Alliance and the World Health Organization (WHO), this new resource summarizes the scientific evidence and operational guidelines that countries need to consider in preparation for introducing rotavirus vaccines. Along with data on the burden of rotavirus disease and the efficacy, safety, and cost-effectiveness of the two currently available rotavirus vaccines, the information pack addresses eligibility criteria, application procedures, co-financing requirements, and health system considerations for new vaccine introduction.

Intended as a supplement to GAVI’s detailed guidelines, the document aims to support decision-making by GAVI-eligible countries in the WHO European region, and it is also available in Russian. Updates will be posted on GAVI’s website as new information becomes available and in accordance with GAVI decisions on eligibility in other WHO regions.

Promising trial results add to evidence on rotavirus vaccination in Asia
Results released this week from a clinical trial of GlaxoSmithKline’s Rotarix™ revealed significant immune responses among Bangladeshi infants given the vaccine. In a study conducted at the International Center for Diarrheal Disease Research, Bangladesh (ICDDR,B), and supported by PATH, 57 to 67 percent of participants receiving the live, oral vaccine developed an immune response, providing critical evidence of the potential impact of rotavirus vaccine introduction in the region. The Phase 2, double-blind, randomized, placebo-controlled study of 300 children was conducted from June 2005 through January 2006.

In addition to testing the immunogenicity of Rotarix™ in this setting, investigators at ICDDR,B also evaluated the co-administration of the vaccine with oral polio vaccine (OPV) and found that coadministration did not lower the polio immune response and that Rotarix™ may be administered concomitantly with OPV. Because the performance of oral vaccines can vary in different regions, WHO’s Strategic Advisory Group of Experts (SAGE) has called for appropriately designed clinical trials of rotavirus vaccines among infants in Asia and Africa as a prerequisite to recommending global use.

To learn more about additional clinical studies PATH is supporting in Africa and Asia, please see the summary below. Click here to read PATH’s press release on the new study results.

WHO releases updated estimates of global rotavirus disease burden
WHO recently announced updated estimates on the number of child deaths worldwide in 2004 that were associated with rotavirus infection:

  • 527,000 children under five years old died due to rotavirus infection, comprising 29 percent of all diarrhea-related mortality in this age group.
  • Nearly 85 percent of child rotavirus deaths occurred in Africa and Asia.
  • 23 percent of all rotavirus deaths under five years of age occurred in India; six countries (India, Nigeria, Democratic Republic of the Congo, Ethiopia, China, and Pakistan) accounted for more than half of under-five rotavirus deaths.

An extended summary of the new estimates is available on the WHO website. Check back for future updates to this web page, including country-specific estimates of rotavirus disease burden.

Update on clinical trials in Africa and Asia
PATH is working in partnership with Merck & Co., Inc. and GlaxoSmithKline to evaluate the safety and efficacy of their respective rotavirus vaccines in developing countries of Africa and Asia. A Phase 3 study of Merck’s RotaTeq® vaccine began in Bangladesh in early April, with enrollment of the study’s first infant at ICDDR,B. Additional trials with RotaTeq® will begin later this year in Mali, Ghana, Kenya, and Vietnam.

A Phase 3 trial of GSK’s Rotarix™ vaccine is ongoing in South Africa and Malawi. At the end of March, investigators in Malawi enrolled the one-thousandth child, bringing the total number of children enrolled at all sites in both countries to more than 4,000. Full participation is anticipated to top 5,000 by the time enrollment is completed on June 30, 2007.

European network established with surveillance initiated in four countries
The CDC’s latest issue of Rotavirus Surveillance News outlines activities of the European regional surveillance network. Data on the burden of rotavirus in Eastern Europe is particularly important, as the region includes several countries that may be early introducers of rotavirus vaccines subsidized by the GAVI Alliance. With technical assistance from CDC and PATH, surveillance began in December 2006 in Azerbaijan, Georgia, Tajikistan, and Ukraine. Activities in these countries enabled the establishment of a regional network that also incorporates data collected in Kyrgyzstan and Uzbekistan, which had previously initiated rotavirus surveillance. To read more about the European regional rotavirus surveillance network, click here.

Learn more about advisory committee review of RotaTeq® vaccine safety in US

Presentations from February’s meeting of the CDC’s Advisory Committee on Immunization Practice are now available online. The committee reviewed post-marketing safety surveillance data on RotaTeq®, the rotavirus vaccine by Merck & Co., Inc. Because of a suspected association between intussusception and the RotaShield® vaccine that was withdrawn from the US market in 1999, the CDC is taking particular care to monitor adverse event reports associated with RotaTeq®. The data reveal that cases of intussusception reported since its introduction in early 2006 did not exceed the expected background rate. For a detailed report of the meeting and the committee’s data review, please see the March 16 issue of the Morbidity and Mortality Weekly Report.

GlaxoSmithKline’s Rotarix® vaccine earns WHO prequalification
On January 30, 2007, WHO announced prequalification of the Rotarix® vaccine manufactured by GlaxoSmithKline (GSK), marking the first time in history that a rotavirus vaccine has been prequalified. This designation of “acceptability in principle” will allow for purchase of the vaccine by United Nations agencies and is a significant advance in the accessibility of rotavirus vaccine for developing countries that depend on agencies like UNICEF for drug procurement.

In issuing its decision, WHO noted the need for data on the vaccine’s safety and efficacy in Africa and Asia before the product will be prequalified for use in these regions. GSK is partnering with PATH to generate important clinical data in trials conducted in Bangladesh, Malawi, and South Africa.

For further details, including provisions on Rotarix® packaging and presentation, please see the notes on Rotarix® within WHO’s list of prequalified vaccines.

FDA updates prescribing information on RotaTeq® vaccine
In a public health notification issued February 13, the US Food and Drug Administration (FDA) provided updated prescribing information for the RotaTeq® vaccine manufactured by Merck & Co., Inc. The update noted 28 reported cases of intussusception identified through the US Vaccine Adverse Event Reporting System, but clarified that “the number of intussusception cases reported to date after RotaTeq administration does not exceed expected background rates among unvaccinated children of the same age.”

In an update to its website posted February 14, the US CDC affirmed its continued support for use of the vaccine: “This notice does not mean there is a problem with the RotaTeq® vaccine. CDC is not changing its policy at this time. CDC continues to support the Advisory Committee on Immunization Practices’ [ACIP] recommendation for routine immunization of all U.S. infants with three doses of RotaTeq® administered orally at ages 2, 4 and 6 months.” The ACIP will conduct a regularly-scheduled review of the safety tracking data during its upcoming meeting on February 21, and the CDC stated that it will continue to monitor reports of possible adverse effects of the vaccine in partnership with the FDA.

Media reports of the FDA notice implied a link between the vaccine and intussusception that is not supported by the current data. To avoid further misperceptions, PATH is reaching out to key audiences, including the investigators with whom we are collaborating to conduct clinical trials of RotaTeq® in Africa and Asia, as well as our partners in the global health community.

Innovative investment accelerates global access to pneumococcal vaccines
The governments of Italy, Canada, Russia, the United Kingdom, and Norway; and the Bill & Melinda Gates Foundation recently announced their decision to financially support an Advance Market Commitment (AMC) for the purchase of pneumococcal vaccines for developing countries. Pneumococcus, a bacterium that is one of the most common causes of pneumonia, kills about one million children under age five each year. By creating incentives for companies to invest in vaccines for diseases that disproportionately affect developing countries, an AMC can help create more predictable markets and accelerate research and development. Click here to learn more.

Investigators’ meeting in London kicks off key clinical trials
At an investigators’ meeting in London last month, PATH and partners met to finalize plans to launch Phase 3 clinical trials of RotaTeq, the rotavirus vaccine manufactured by Merck & Co., Inc. PATH and Merck are partnering with leading researchers in Asia and Africa to conduct efficacy trials in five countries: Bangladesh, Vietnam, Kenya, Ghana, and Mali. Enrollment at some study sites will be initiated as early as this month, and results are anticipated by mid-2009. Meeting participants, including leading rotavirus experts from NIH and WHO, reviewed the study protocol for the study to ensure adherence, scientific rigor, and regulatory compliance.

Update on rotavirus surveillance
Routine surveillance is revealing significant rates of rotavirus among children suffering from diarrheal disease in Pakistan, where two sites recorded rates of 20 and 38 percent, respectively. The data were generated through hospital-based rotavirus surveillance supported by the WHO Eastern Mediterranean Regional Office and were presented at the Third Annual Symposium on Neonatal and Child Health organized by the country’s National Insititute of Child Health.

Sentinel hospital-based surveillance supported by PATH, CDC, and WHO recently begun in several countries of the European (EURO) and African (AFRO) WHO regions. In EURO, surveillance was initiated in December 2006 at six hospitals in Azerbaijan, Republic of Georgia, Tajikistan, and Ukraine. AFRO surveillance is ongoing at six hospitals in Cameroon, Ghana, Kenya, Uganda, and Zambia. Both networks are coordinated by the respective regional WHO offices and follow WHO protocol.

With the launch of these new networks, global rotavirus surveillance is ongoing in a total of 40 countries in all five WHO regions. These surveillance activities will provide valuable data to inform decisions regarding the introduction of rotavirus vaccines. Click here for additional information on the regional rotavirus surveillance networks supported by PATH’s Rotavirus Vaccine Program.

Vaccination may be factor in reduced seasonal rotavirus incidence in El Salvador
The current rotavirus season in El Salvador is providing insight into the real-world impact of vaccine introduction as well as the disease’s epidemiology in the country. Often mislabeled in the local media as a result of “outbreaks,” cases of rotavirus routinely increase in the region during the winter months due to natural epidemiological patterns. But vaccination against rotavirus, initiated in El Salvador last October, is already helping to reduce this burden.

To date, more than 20,000 infants in El Salvador have been fully immunized, and an impact can be seen in the latest surveillance figures. In January 2006, 164 cases including 15 deaths were confirmed among children between 7 and 14 months of age. By comparison, 114 rotavirus cases and four deaths were confirmed among unvaccinated children during the same period this year, and no reports of rotavirus have been recorded among vaccinated children.

El Salvador is one of several countries in Latin America that report monthly rotavirus surveillance data to the Pan American Health Organization. Click here for further details on PAHO’s support of these activities.

PATH featured in BBC series on vaccine innovations and challenges
A new four-part documentary series by the BBC looks at the scientific advances and real-world challenges of delivering life-saving vaccines to children in the developing world. From the hunt within research labs to harness new technologies to the clinics in remote villages where the vaccines are given to children, the series looks at the promise of and the progress on making vaccines affordable and accessible to the countries where they are needed most. PATH’s work on the development of new vaccines and helping to accelerate the use of rotavirus vaccines are featured in this compelling narrative.

BBC World programs may be viewed in more than 200 countries, but do not air in the US or UK. The “Vaccine Hunters” series began airing February 4, 2007, over the BBC World Service; see http://www.bbcworld.com/ for viewing times.

Developing country officials weigh in on GAVI support for rotavirus vaccines
The GAVI Alliance Board’s unanimous decision last month to subsidize funding for rotavirus and pneumococcal vaccines will have a significant impact on the health of children in developing countries, beginning as soon as 2008. Officials in these countries shared their reactions to this landmark advancement:

“The Health Ministry of Uzbekistan applauds GAVI’s funding for the vaccines against rotavirus and pneumococcal diseases. These much needed vaccines will protect our children and allow us to reduce [our country’s] mortality rate.” — Mr. B.I. Niyazmatov, Deputy Minister of Health, Republic of Uzbekistan

“Guyana is determined to introduce these new vaccines into our routine program, and we are grateful that GAVI has included the two vaccines for funding. With GAVI's continued support, further inroads in infant morbidity and mortality can be achieved. Guyana looks forwards to being a pioneer country in this respect.” — Dr. Leslie Ramsammy, Minister of Health, Guyana

“The decision of GAVI to fund rotavirus and pneumococcal vaccines for our country will help to protect Ukrainian children and give them new life.” — Dr. Lyudmila Mukharskaya, Deputy Chief Sanitary Doctor, Ukraine

Click here to learn more about this landmark decision.

New support from GAVI enables RVP to gather critical evidence in Africa and Asia
Earlier this year, the GAVI Alliance awarded $15 million to the Rotavirus Vaccine Program (RVP) to advance the clinical trials agenda for rotavirus vaccines produced by GlaxoSmithKline (GSK) and Merck & Co, Inc. Ongoing trials and upcoming studies, conducted in collaboration with GSK and Merck, will evaluate the vaccines’ efficacy and safety among pediatric populations in Africa and Asia and will provide fundamental information regarding the value of rotavirus vaccines in these settings.

Spotlight on reference centers to support global rotavirus surveillance
The latest issue of Rotavirus Surveillance News, published by the US CDC, provides an overview of the Rotavirus Collaborating Centers and Reference Centers supported by RVP. These essential resources provide consultation and training on strain characterization, laboratory diagnostics, and other standard procedures for scientists conducting active rotavirus surveillance around the world. To date, laboratory personnel from more than 35 countries have received training and other support from the five centers. Center directors are also finalizing a unified laboratory manual for use in the field. To learn more, read the latest issue online.

Enrollment begins in trial to determine Rotarix® efficacy and safety in Africa
On October 17, 2006, investigators in Malawi initiated enrollment for a clinical trial supported by RVP and GSK to determine the safety and efficacy of Rotarix®. As part of the same clinical trial, enrollment in South Africa was reinitiated in November 2006, where more than 1,800 infants have been enrolled to date.

Rotarix® is orally administered and, historically, these types of vaccines have performed differently in different regions of the world. Large-scale trials of Rotarix® in North and South America affirmed their safety and efficacy among these populations. However, the WHO’s Strategic Advisory Group of Experts recommended that new rotavirus vaccines should also be studied among infants in Asia and Africa, where the burden of rotavirus disease is very high.

Bond sales to accelerate support for new vaccines and system strengthening
The International Finance Facility for Immunisation (IFFIm) issued its inaugural bonds last month, kicking off an innovative scheme to accelerate funding for vaccination programs in the world’s poorest countries. IFFIm is the latest in groundbreaking strategies spearheaded by the GAVI Alliance to accelerate delivery of lifesaving interventions to benefit the world’s children. Through this new initiative, immediate financing for national immunization programs in developing countries will be raised by selling bonds in the international capital markets, based on legally-binding long term commitments from donors—including the governments of Britain, France, Italy, Norway, Spain, and Sweden. Click here to learn more.

Review of surveillance data in US confirms safety profile of Merck’s rotavirus vaccine
During their meeting on October 25 and 26, 2006, the US Advisory Committee on Immunization Practices reviewed early surveillance data on the safety of RotaTeq®. As of September 30, 2006, nearly 1.8 million doses of the vaccine had been distributed, and the estimated incidence of intussusception (six reported cases total) was lower than the expected background rate, even after accounting for underreporting. CDC will continue to collect data on intussusception and other adverse events through its Vaccine Safety Datalink and Vaccine Adverse Event Reporting System. Click here to view a presentation of surveillance data provided by Penina Haber, epidemiologist of the CDC’s Immunization Safety Office.
Nicaragua demonstration program garners international attention
The landmark collaboration between the Government of Nicaragua and Merck to provide rotavirus vaccines to children reached by the public health system was warmly welcomed in international media. The demonstration program will provide free doses of ROTATEQ®, Merck’s three-dose oral rotavirus vaccine, to all infants in Nicaragua for the next three years.

As Dr. Julian Lob-Levyt, executive secretary of the GAVI Alliance, noted, “This demonstration project is a significant step toward global use of rotavirus vaccines, which have the potential to save hundreds of thousands of lives and help the world achieve the Millennium Development Goals. It is also a good illustration of what can be achieved by combining and integrating political will with private resources and partner support to deliver the outcomes needed to reach the health MDGs.”

The demonstration project announced by the Government of Nicaragua and Merck is an important milestone toward accelerating rotavirus vaccine introduction in GAVI-eligible countries. It will provide valuable lessons as RVP and partners seek to build awareness and replicate such progress in the region and throughout the developing world. In addition to its potential to save thousands of lives, Nicaragua’s experience will help illuminate the benefits and challenges of integrating rotavirus vaccines into routine immunization programs in resource-limited settings. Merck donating vaccine against diarrheal illness to Nicaragua for 3 years, International Herald Tribune/Associated Press

Merck to donate rotavirus vaccine in Nicaragua, Reuters

Merck and Nicaragua unveil new rotavirus vaccine demonstration project at Clinton Global Initiative, Medical News Today

Rotavirus vaccine demonstration to help accelerate progress against a leading killer of children, GAVI Alliance and PATH

UNICEF cites diarrheal disease control as key element in reducing mortality
The Lancet recently highlighted the role of diarrheal disease control as part of an integrated approach to child survival. Interventions including low-osmolarity oral rehydration solution (ORS), zinc treatment, and promotion of breastfeeding were among five indicators used to define a comprehensive child health policy. The article reviewed the adoption of such interventions by WHO member states as measures of progress toward achieving Millennium Development Goal #4 (to reduce mortality of children under five by two-thirds). Investigators found that, while some countries have successfully implemented the use of low-osmolarity ORS and zinc treatment, many countries reported low rates of diarrheal disease management. This finding emphasizes the urgency of disseminating relevant data among country-level public health officials so that they may make informed decisions on diarrheal disease control measures, including rotavirus vaccines.

A renewed focus on diarrheal disease control has emerged as a priority in global public health, and surveys conducted by RVP among officials and clinicians in developing countries found similar gaps in awareness and implementation. The development and availability of new rotavirus vaccines offers an opportunity to invigorate broader diarrheal disease control efforts. Learn more about what RVP is doing in this arena by visiting our online Enhanced Diarrheal Disease Control Resource Center.

The Lancet article was part of a special issue published to coincide with the Symposium on Child Survival held last month in New York. In outreach regarding the symposium, UNICEF listed rotavirus vaccines among new tools that hold potential in reducing under-five mortality. Click here to learn more.

TIME highlights advances in diarrheal disease control
A feature article in TIME magazine (October 8, Europe edition) provides a comprehensive update on the current use of ORS to treat severe diarrhea, along with other promising interventions including rotavirus vaccines. The article highlights treatment and research efforts of the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), the Ethiopian Ministry of Health’s sanitation interventions, and the mission of RVP and partners to accelerate rotavirus vaccine availability in developing countries. Click here to read the complete article.

Shaping new guidelines for evaluating vaccine cost-effectiveness
The WHO’s Weekly Epidemiologic Record (September 15) featured recommendations on assessing the cost-effectiveness of rotavirus vaccines. A March 2006 meeting was convened by WHO, the US CDC, and PATH as a forum for participants to review country-level data as well as global guidelines and a standard protocol for future costing studies. These recommendations are an important component of the evidence that decision-makers will weigh in considering potential rotavirus vaccine introduction.

In an encouraging twist, the meeting’s recommendations to decision-makers in developing countries are providing important guidance to the evaluation of vaccine introduction in the industrialized world. The US Advisory Committee on Immunization Practices (ACIP) looks to follow the lead of RVP and partners in developing standardized methodology for measuring the cost-effectiveness of vaccines. According to Dr. Jean Clare Smith, CDC medical officer and assistant to the director for immunization policy, “Although the focus of the meeting was international, the discussions and recommendations parallel work being done at CDC to develop a standardized approach to economic analyses of vaccines being considered by the ACIP for introduction in the US.”

Lancet article provides update on current rotavirus vaccines
Our CDC partners continue to strengthen the evidence base through surveillance of rotavirus morbidity and mortality and training initiatives. In a recent Lancet review article (July 22), CDC experts detailed the status of rotavirus vaccines and the urgency to make them accessible in the developing world. “Rotavirus vaccines: current prospects and future challenges” provides background on rotavirus disease, historic milestones in vaccine development, and a summary of the obstacles to overcome in accelerating their introduction.

Calendar of events
Upcoming international conferences will offer a forum for discussion of the potential benefits of rotavirus vaccines, as well as broader initiatives for controlling diarrheal disease. Click on the links below for details on registration, abstract submission guidelines, and general information.

Vaccines for Enteric Diseases
April 25 – 27, 2007; Lisbon, Portugal
Sponsored by several vaccine manufacturers, this event will feature discussion of diarrheal disease burden in industrialized and developing countries, as well as updates and research on promising vaccine candidates to protect against enteric infections.

11th Annual Scientific Congress of the International Centre for Diarrhoeal Disease Research, Bangladesh
March 4 – 6, 2007; Dhaka, Bangladesh
The theme of this year’s conference is “Partnership in achieving the Millennium Development Goals.”

Online resources

PATH rotavirus resource library

Enhanced Diarrheal Disease Control Resource Center

Presentations from the 7th International Rotavirus Symposium

Journal of Infectious Diseases special supplement: Rotavirus in Asia

PubMed preformatted rotavirus search

PubMed preformatted rotavirus vaccine search

PATHKey Facts About Rotavirus Disease and Vaccines
Recent studies demonstrate that crucial gaps exist in the awareness of rotavirus disease among public health providers in developing countries. Yet this missing information is key to designing effective rotavirus control strategies. Here is a summary of the most important facts about rotavirus disease and vaccines.

TIME Europe Magazine Oct. 16, 2006 | Vol. 168, No. 17
TIME Europe
16 October 2006

Diarrhea kills more young children around the world than malaria, AIDS and TB combined. Yet a simple and inexpensive treatment can prevent many of those deaths. Why isn't it more widely used?

A Simple Solution
In the West, it's an inconvenience, but, in the developing world, it can be a death sentence. It kills millions of children every year, yet the treatment is a simple mixture of salt, sugar and water. So why isn't more being done to fight diarrhea? Most deaths from diarrhea can be prevented by giving the victim oral rehydration. A guide to how it works Surviving Diarrhea
Most deaths from diarrhea can be prevented by giving the victim oral rehydration. A guide to how it works

Dr. David Nalin receiving the Mahidol Medal from His Royal Highness the King of Thailand
click to enlarge

Prince Mahidol Award Foundation under the Royal Patronage Dr. David Nalin receiving the Mahidol Medal from His Royal Highness the King of Thailand at the 2006 Prince Mahidol Award presentation ceremony, Chakri Throne Hall, Bangkok, Thailand, January 31, 2007. Co-awardees included Dr. Richard A. Cash and Dr. Dilip Mahalanabis (Award for Public Health) and Dr. Stanley Schultz (Award for Medicine). His Majesty King Bhumibol Adulyadej graciously granted permission for the establishment of the “Prince Mahidol Award” in commemoration of the centenary of the Birthday Anniversary of His Royal Highness Prince Mahidol of Songkla on January 1st, 1992. The Award is administered by the Prince Mahidol Award Foundation under the Royal Patronage of which Her Royal Highness Princess Maha Chakri Sirindhorn is the President. The Foundation confers two international awards each year—one for the exemplary contributions in the field of medicine and the other in the field of public health.
In 2006, there are a total of 59 nominations from 29 countries around the world. The Scientific Advisory Committee carefully screened and submitted the short list to the International Award Committee who scrutinized and made a recommendation for the Award laureates to the Board of Trustees. H.R.H. Princess Maha Chakri Sirindhorn presided over the meeting of the Board of Trustees in which the final decision on the Award laureates was made. On November 1st, 2006, the Board of Trustees made a unanimous decision to confer the Prince Mahidol Award for 2006 to a group of medical professionals who, during the 1960s and the 1970s, had dedicated their lives to the discovery, the introduction, and the widespread use of “Oral Rehydration Solution (ORS) or Oral Rehydration Therapy (ORT).” This simple, inexpensive, but effective treatment of severe diarrhea can be practiced by patients and their household members themselves. The treatment has been used worldwide, both in the developed and in the developing countries alike. It is estimated that the introduction of the ORT has saved more than 40 million lives in the past 30 years. The discovery and introduction of Oral Rehydration Therapy is a major achievement in the human health service by applying “appropriate technology” based on scientifically-proven clinical research. The Lancet, a very prestigious medical journal, has recognized the ORT as “the most important medical discovery of the 20th century”. Four of the most distinguished scholars and scientists are conferred the Prince Mahidol Awards for 2006: In the Field of Medicine:

Professor Stanley G. Schultz, MD. is the former Dean of the University of Texas Medical School at Houston in Texas, USA. He is now Professor of the Department of Integrative Biology Pharmacology, University of Texas Medical School at Houston, Texas, U.S.A. In the 1960s, Dr. Schultz and his team demonstrated that glucose and sodium absorption in the small intestine was intimately coupled, and glucose could facilitate the absorption of sodium and water. This pioneering work provided the scientific foundation for the use of the oral rehydration solution consisting of salt, sugar and water in the treatment of dehydration in diarrhea patients. Since the early 1970s, the ORT has continuously benefited the lives of millions of children each year all over the world. Dr. Schultz is also known to be a great teacher, receiving several teaching awards including Teacher of the Year award from the American Physiological Society. In the Field of Public Health:

David R. Nalin, MD. Is the former Director of Vaccine Scientific Affairs. Merck Vaccine Division, Merck&Co. Inc., West Point, Pennsylvania, U.S.A. Dr. David R. Nalin, was assigned, in the 1960s, to the Pakistan-SEATO Cholera Research Laboratory (CRL) in Dhaka, East Pakistan (presently, the capital city of Bangladesh) as a research associate at the US National Institutes of Health (NIH). Dr Nalin, Dr Richard Cash, and their colleagues successfully tested the efficacy of an oral glucose-electrolyte solution, later known as oral rehydration therapy (ORT), to be used instead of intravenous fluid for the treatment of patients with severe cholera. This new treatment was tested in Matlab and then used by the Johns Hopkins University International Center for Medical Research and Training (ICMRT) in Calcutta in the refugee camps during the Liberation War of Bangladesh in 1971. Later as a WHO consultant, Dr Nalin has helped establish a number of highly successful national programs on the oral rehydration therapy for diarrhea diseases in Costa Rica, Jamaica, Jordan, and Pakistan. Richard A. Cash, MD, MPH. is Senior Lecturer on International Health at the Department of Population and International Health, Harvard University School of Public Health, Boston, U.S.A. As a young clinician, right after finishing his internship in New York City, working at the Pakistan-SEATO Cholera Research Laboratory (CRL) in Dhaka in 1960s, Dr Cash had been involved in the first scientifically-proven successful clinical trial of testing the oral rehydration therapy on severe diarrhea patients. The trial has become a landmark for subsequently applying this treatment around the world. Dilip Mahalanabis, MD. is the Director of the Society for Applied Studies, a non-governmental research organization, in Kolkata, India. Dr. Dilip Mahalanabis started his work on oral rehydration therapy in 1966 as a research investigator for Johns Hopkins University International Center for Medical Research and Training in Calcutta. During the Liberation War of Bangladesh in 1971, Dr. Mahalanabis used the ORT in the refugee camps which accommodated 350,000 refugees, in West Bengal. Dr. Dilip Mahalanabis instructed his staff to distribute the ORT for the treatment of over 3,000 patients. With the ORT, the death rate dropped to only 3% in comparison with 20 – 30% using only intravenous fluid therapy. This was the first large – scale use of oral rehydration solution in a disaster situation. As a result, it gained the International health Organizations’ recognition and its application was spread worldwide. The research works conducted by Dr. David R. Nalin, Dr. Richard A. Cash, and Dr. Dilip Mahalanabis have sequentially contributed to the application of the oral rehydration solution in the treatment of severe diarrhea worldwide, including Thailand. It is estimated that each year around 500 million packs of the oral rehydration solution is used in more than 60 developing countries, saving millions of lives around the world. Supat Vanichakarn MD., Worawut Smuthkalin, Ph.D.

Progress For Children: A Child Survival Report Card (Volume 1, 2004)

Progress For Children: A Child Survival Report Card (Volume 1, 2004)
Download the full publication Progress For Children: A Child Survival Report Card (Volume 1, 2004)pdf 1.2 mb This first issue of Progress For Children addresses the child survival Millennium Development Goal, graphically depicting the world's advances in the lead up to 2015. Despite global gains in child survival since 1990, 11 million children still die needlessly each year. By ensuring access to basic services and continued use of simple, cost-effective interventions, these deaths can be averted and the goal of a two-thirds reduction in under-five mortality from 1990 to 2015 achieved. World Falling Short on Promise to Reduce Child Deaths
Video [Real format] - Low bandwidth - View clip | High bandwidth - View clip

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News Archives

Off-Site Links

Indian scientists develop anti-diarrhoea vaccine
Indo-Asian News Service - New Delhi
November 5, 2004 The first Indian vaccine to prevent a virulent form of diarrhoea that kills hundreds of children every year is ready for clinical trial. Developed over 10 years by researchers at the All India Institute of Medical Sciences here and the Indian Institute of Science in Bangalore, the vaccine, isolated from the bodies of newborn babies, has passed laboratory tests and will now be tested on humans. "If all goes well, the vaccine will be available in the markets in two to three years," M.K. Bhan, secretary of the Department of Science and Technology, told IANS.

Diarrhoea vaccine 'a step closer'
Children in the developing world are particularly vulnerable

26 August, 2004

Scientists have discovered how the virus that causes most cases of diarrhoea invades cells. The Boston Children's Medical School team say the finding could help develop an vaccine to combat the rotavirus. The virus, the most common cause of severe, dehydrating diarrhoea, kills around 440,000 children a year, mainly in developing countries. Writing in Nature, the researchers say understanding more about the virus will help them fight it successfully. The researchers say their work shows how vaccine development can be made "smarter" by looking at the physical make-up of viruses and finding the minimum parts needed to prime the immune system, without having to use a whole virus to make a vaccine. Almost all children are infected with the rotavirus as toddlers. It can cause gastroenteritis that is sometimes severe enough to require hospital care. Breaking into cells Scientists have been working to develop a vaccine which will be effective against the virus for some time. Two vaccine have been licensed. One was used in the US, but was withdrawn after it was linked to a condition which causes bowel obstruction. The second has only been licensed for use in China. The researchers in this study examined the geometric structure and behaviour of one of the rotavirus's surface proteins, called VP4, which plays a key role in binding on to the surface of a target cell, and breaking through its membrane. The key finding for vaccine development is that the "head" and "body" portions of the VP4 protein contain many of the targets that the immune system recognises when it attacks the virus and protects against infection, they say. "The work is a clear example of the way in which structural studies can contribute to new good ideas about strategies for vaccines," said Dr Stephen Harrison, head of the Children's Medical Hospital Laboratory of Molecular Medicine.

Meeting the MDG Drinking Water and Sanitation Target:
A mid-term assessment of progress

26 August, 2004

In adopting the Millennium Development Goals that address the most pressing development issues, countries pledged to halve the proportion of people without access to safe drinking water and basic sanitation. Yet, more than 1 billion people today lack safe drinking water, and some 2.6 billion - half of the developing world - lack improved sanitation. This publication reports on our progress towards the MDG goal of ensuring environmental sustainability. It seeks to encourage countries slow to meet the target to accelerate action, and highlights areas where efforts need to be strengthened in order to meet the goal. UN Water Report Meeting the MDG Drinking Water and Sanitation Target
Meeting the MDG Drinking Water and Sanitation Target More information: Why world's taps are running dry Water Facts: The Big Picture
Water Facts - The Big picture A statistical view of the world's water - BBC News Water Facts - The Big picture World's water hot spots
From disappearing lakes and dwindling rivers to military threats over shared resources, water is a cause for deep concern in many parts of the world. Supplies are threatened by overuse, bad management and changing weather patterns. The pressure will only increase as populations grow. more info

Handwashing Program Dramatically Cuts Childhood Diarrhea in Pakistan

1 June, 2004 A household handwashing program in Pakistan substantially reduced the occurrence of diarrhea among children living in a high-risk situation, according to a report in this week's Journal of the American Medical Association. The results come from a study of more than 4500 children living in 36 low-income neighborhoods in Karachi. In 25 of the neighborhoods, handwashing was promoted to encourage the use of plain or antibacterial soap after defecation, food preparation, eating, and child feeding. The other 11 neighborhoods served as the control group. In their report, Dr. Stephen P. Luby, from the Centers for Disease Control and Prevention in Atlanta, and colleagues write: "In these communities in which diarrhea is the leading cause of childhood death, wash water was heavily contaminated with human fecal organisms, and no provisions were made for clean drying of hands, handwashing promotion with soap halved the burden of diarrheal disease." Compared with children from control neighborhoods, those from a neighborhood encouraging plain soap use had a 53 percent lower rate of diarrhea. In addition, the plain soap intervention was tied to a 39 percent reduction in the number of days with diarrhea. No apparent advantage was seen for using antibacterial soap rather than plain soap, since the antibacterial agent has no effect on many organisms that cause diarrhea. "Although visiting households weekly to provide free soap and encourage handwashing was effective in reducing diarrhea, this approach is prohibitively expensive for widespread implementation," the authors point out. Therefore, less costly approaches are needed to reach the millions of children living in at-risk households. SOURCE: Journal of the American Medical Association.

The Rotavirus Vaccine Program
Evan Simpson, Program for Appropriate Technology in Health (PATH),
[email protected] PATH's Rotavirus Vaccine Program was created in 2003 to reduce child morbidity and mortality from childhood diarrhoeal disease by accelerating the availability of rotavirus vaccines appropriate for use in developing countries. Strategies include:

  • Vaccine demand: providing potential vaccine purchasers at global, national, and local levels with information about disease burden estimates, safety and efficacy; financing and economic data; and immunisation policy analysis.
  • Vaccine supply: collecting data needed to conduct demand forecasts and market surveys, and information related to international supply requirements. "The aim is to overcome demand uncertainty, which has been a significant barrier to ensuring vaccine availability in developing countries."

more info

NIH Attempts To Revive Diarrhea Vaccine

5 May, 2004
Washington (AP) -- The National Institutes of Health is attempting to revive an anti-diarrhea vaccine that was pulled off the market five years ago after a life-threatening side effect struck some babies. At issue is rotavirus, an intestinal infection that kills 600,000 children worldwide each year. In the United States, 3 million children get rotavirus annually, but good medical care ensures only about 40 of them die. In developing countries, however, about one child in every 250 dies of rotavirus. more info

Resource Centre Manual: How to set up and manage a resource centre How to Set Up and Manage a Resource Centre
download pdf

This manual is designed for health and disability workers planning to set up and develop a resource centre within resource-poor communities around the world, and is aimed toward people operating on a limited budget. Healthlink Worldwide uses this manual to support its workshops for organisations setting up resource centres in developing countries. Written in English with illustrations and diagrams, the manual provides readers with tried-and-tested tips, examples, checklists and resource lists. According to Healthlink Worldwide, it can be used for reference, training or to aid the development of information services, and is presented in a ring-binder for ease of reference and updating. In this second edition, key areas have been updated and extended to include computers and electronic communication, reviews of database software packages, lists of electronic information sources and further reading, and lists of resource suppliers and distributors.

Child survival: a global health challenge - A series of papers - THE LANCET

26 July, 2003

Where and why are 10 million children dying every year?
How many child deaths can we prevent this year?
Reducing child mortality: can public health deliver?
Applying an equity lens to child health and mortality: more of the same is not enough

The series of papers on child survival that have appeared in The Lancet describes a major public health challenge: more than 10 million children dying each year because they have not been reached by known and effective interventions.1 Children are dying because of the neglect of common and preventable childhood illnesses, of health problems in newborn babies, and of the measures needed to protect mothers and infants during pregnancy and childbirth. The child survival series was written by technical experts who recognised a set of problems, reviewed the evidence, and challenged WHO, UNICEF, other UN agencies, multilateral and bilateral agencies, non-governmental organisations, and health professionals to take appropriate action. Now it is time for policy makers and public-health leaders to respond, and to transform this knowledge into action. Three commitments must be pursued urgently and unremittingly. Where and why are 10 million children dying every year?
The first paper in this series on child survival presented an unacceptable picture: more than 10 million children dying every year, almost all in low-income countries or poor areas of middle-income countries. 90% of these deaths occurred in just 42 countries, most from one of a short list of causes: diarrhoea, pneumonia, measles, malaria, HIV/AIDS, and the underlying cause of undernutrition for deaths among children younger than 5 years, and asphyxia, preterm delivery, sepsis, and tetanus for deaths among neonates. The assessment of deaths by cause provides a useful starting point for a stocktaking of available child survival interventions. http://www.thelancet.com/

Rotavirus Vaccines, Take Two 19 August, 2002
Renewed immunization efforts look to avoid pitfalls of failed predecessor | By Bob Beale

excerpts The optimism however, has reemerged with new vaccines that are in the pipeline. And perhaps within the next five years, the battle against rotavirus can be rejoined. Although public awareness is low, rotavirus is one of the world's worst infectious disease agents, killing up to 2,000 children a day. "We now have the potential for several other vaccines becoming available in developing nations, made by national producers in China, India, and Indonesia, and by multinational producers within the next three to five years. As a result, we may even achieve our goals faster than we would have before with just one product and one company." The Scientist | Volume 16 | Issue 16 | 34

New Rehydration Formula to Save Millions of Lives 10 May, 2002 The World Health Organization, released a new improved formula of Oral Rehydration Salts (ORS) on Wednesday that would save millions of lives and reduce the severity of illness of those suffering from acute diarrhoea, WHO reported. ORS is a sodium and glucose solution used to treat children with acute diarrhoea. WHO said the new formula would reduce the severity of diarrhoea and vomiting, the number of hospitalisations, the need for costly intravenous fluid treatment and the length of illness. Use of the new ORS formula would begin later this year in India, WHO said. more info

Facts for Life Lifesaving UNICEF Health Guide Gets New Web Site One of the world's most widely-read books, Facts for Life (FFL), itself gained new life recently with its first major revision in a decade and new PDF and website versions.

More than 15 million copies of earlier versions of the book are in use, and it has been translated into 215 languages. FFL is a joint effort of UNICEF, WHO, UNESCO, UNFPA, UNDP, UNAIDS, WFP and the World Bank to provide families and communities around the world with essential information on low-cost ways to help prevent child deaths and diseases and to protect women during pregnancy and childbirth. Everyone has the right to know this life-saving information. more info

Hypo-Osmolar Oral Rehydration Solution Advantageous In Treating Pediatric Diarrhea 5 October, 2001 DELHI (Reuters Health) - A modified oral rehydration solution reduces the severity of diarrhea in malnourished children compared with the standard solution currently recommended by the World Health Organization, researchers reported at the recently concluded 9th Asian Conference on Diarrheal Diseases and Nutrition here.

.... the dialogue continues.
The international newsletter on the control of diarrhoeal diseases Dialogue on Diarrhoea offers clear, practical advice on preventing and treating diarrhoeal diseases. Regular features include guidelines on diagnosis and treatment, training tips, information on rational drug use, research updates and feedback from the field. In addition to information on clinical management, the newsletter addresses issues which affect health workers' and families' abilities for care for children, such as communication skills, organisation of health centres and hospitals, health education and training.

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ORS Day in India 29, July, 2001

Over Eight Hundred Thousand people unite on July 29, 2001 - ORS Day
to spread the message "ORS Saves Lives"

Indian Academy of Pediatrics, IAP, and Partners Intensify Promotion of ORS to Prevent Childhood Diarrhea Deaths in India

July 29, 2001 declared as ORS Day by the Indian Academy of Pediatrics, is part of a major effort, aimed at reducing childhood diarrhea deaths. - more info

Maryland Rice-Based ORS Product
Clinically Superior to Glucose-Based Oral Rehydration Salts

July 2001
STUDY IN SWEDISH PEDIATRIC JOURNAL ACTA PAEDIATRICA Cost effective - decreased doses compared to World Health Organization ORS A study of 167 boys with cholera compared the safety and efficacy of CeraLyte, a rice-based oral rehydration solution (ORS) to the standard "World Health Organization formula" glucose ORS, concluding that the CeraLyte ORS, as in other studies with long-chain rice carbohydrate, is more effective than glucose ORS. The boys, ages 5 to 15 years, suffered severe dehydrating diarrhea, with losses equivalent to about 30% of their body weight while hospitalized. On average, these boys were admitted 14 hours after their illness began, by which time they had already lost 14% of their body weight to dehydration. Thus, total average volume lost during illness was about 44%. - more info

New Oral Rehydration Solution More Effective for Children with Diarrhea;

2 April, 2001
WHO Plans to Make Changes Based on New Research Findings Multicenter, Randomized, Double-Blind Clinical Trial to Evaluate the Efficacy and Safety of a Reduced Osmolarity Oral Rehydration Salts Solution in Children With Acute Watery Diarrhea Children who receive a less concentrated (reduced osmolarity) oral rehydration solution for the treatment of dehydration and diarrhea are significantly less likely to need costly intravenous (IV) fluid treatment compared to children treated with the current solution used by the World Health Organization (WHO), according to a new study conducted by the Johns Hopkins School of Public Health and five other institutions around the world. Based on the latest research findings, the WHO plans to conduct a meeting of experts to revise its recommendations on oral rehydration solution formulation for treatment of children with diarrhea. The study is published in April 2001 edition of Pediatrics. "More than 200,000 children are hospitalized and nearly 300 die from severe diarrhea in the U.S. each year and the problem is worse in other countries. The reduced osmolarity, or less concentrated, oral rehydration solution is a very effective treatment and it will be extremely beneficial to children in developing countries who might not have access to IV's and advanced medical care," says co-author Mathuram Santosham, MD, MPH, professor of international health at the Johns Hopkins School of Public Health. Since its development in the 1960s, oral rehydration solution has been credited with saving the lives of millions of children throughout the world who suffer from dehydration caused by severe diarrhea. The solution is a mixture of water, glucose, sodium, potassium, and electrolytes, which help children recover and retain vital fluids and nutrients. The United Nations Children's Fund (UNICEF) distributes oral rehydration solution worldwide. Similar solutions are sold in U.S. supermarkets under different brand names such as Pedialyte and Infanlyte. The new reduced osmolarity solution is a less concentrated formula and contains less sodium than the current WHO solution. The lower osmolarity helps the body absorb water more quickly and reduces the risk of hypernatraemia, which is a rare but deadly disorder caused by too much salt in the body. For the double-blind study, researchers randomly selected 675 children from health centers in five developing countries who suffered from diarrhea. All of the children selected for the study were between one and 24 months of age. Half of the group was treated with the current rehydration solution while the other half was treated with the new reduced osmolarity solution. "We found that the children who received the reduced osmolarity solution were 33 percent less likely to need IV treatment when compared to the children treated with the current WHO formula. Also, the new formula was equally effective at reducing diarrhea and vomiting," explains Dr. Santosham.
The study was funded by grants from the World Health Organization (WHO), Division of Child Health and Development, Applied Research on Child Health Project of the Harvard Institute for International Development, and the United Nations Children's Fund (UNICEF).

WHO: Soda Bottles, Sunlight Can Save Millions Of Lives A Year 21 March, 2001 GENEVA (AP) - A do-it-yourself technique of disinfecting water with sunlight and soft-drink bottles could save up to 2.5 million lives a year, the World Health Organization said Thursday. In a campaign to reduce water-related deaths in developing countries, the United Nations health agency is promoting Solar Water Disinfection or SODIS. Martin Wegelin, a researcher at the Swiss Institute for Environmental Science and Technology, said when transparent bottles are filled with water and placed horizontally on a flat surface for about five hours, the heat and ultraviolet rays of the sun kill illness-causing microorganisms in polluted water. The method is even more effective when the bottom half of the bottle is painted black or placed on black-painted corrugated iron or plastic sheets, he said. More than one billion people drink unsafe water, WHO said in a report on water and sanitation released to mark World Water Day. Some 3.4 billion people, mostly children, die every year from water-related diseases, which include malaria, diarrhea and guinea worm. WHO urged the use of SODIS, chlorination and better hygiene as immediate means of improving people's water supply in developing countries. Chlorination is another simple method that costs just a few cents a day, WHO said. "Even in conditions of very poor sanitation and hygiene, where people are collecting whatever water is available for their household supply, if the water is chlorinated (it) is improved," said Mark Sobsey, professor of environmental microbiology at the University of North Carolina in Chapel Hill. "And you can find statistically significant decreases in diarrhea disease." WHO said chlorine could be added to both home and city reservoirs and was essential in refugee camps. The International Federation of the Red Cross and Red Crescent said it was redoubling its efforts to provide disaster victims with access to clean water and sanitation. It has been deploying emergency water purification units to relief camps and provides 20 million liters (5.3 million gallons) of water per day to one million people, spending 50 million Swiss francs dlrs 30 million) a year. JOHNS HOPKINS SCHOOL OF PUBLIC HEALTH
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Synthetic Vaccine Against Infant Diarrhoea for Angola

22 February, 2001

Panafrican News Agency (Dakar)
Luanda, Angola A synthetic vaccine against infant diarrhoea will be tested in Angola this week, US scientist John Robbins announced during a visit to the Americo Boa Vida hospital in Luanda. Robbins, accompanied by his colleague Rachel Schnerson, has been in Angola since 18 February at the invitation of the health ministry, to study the causes of diarrhoea among Angolan children. While the test results are awaited, there are negotiations between the inventors of the vaccine (Robbins and Schnerson) and Angolan specialists in paediatrics since the product essentially concerns children. The American researchers, whose visit will end Saturday, will publish other discoveries, particularly those regarding infections in children, in order to national hospitals to detect the microbes that cause some of those diseases. Robbins explained that his team had developed a product called "Aemofilos tipo-B", which effectively fights bacterial meningitis in children and has been found very useful in many countries, notably in the US. He also announced the manufacture of other medicines against convulsive cough, as well as the conclusion of a study on the fight against typhoid fever. He said the eradication of typhoid fever was 92 percent efficient. Robbins is current head of the Molecular Development and Immunity Department at the US-based National Institute of Health.

Poorer Half Of The World Can Expect Better Health And Prosperity In The Next Decade

World Bank
2 January, 2001

Washington A new report jointly issued today by five United Nations agencies and the World Bank claims that worsening AIDS, TB and malaria epidemics are not inevitable and shows numerous strategies deployed by several developing countries to successfully fight these diseases, and prevent the deaths they cause. The targets for reducing the toll of these illnesses, set by the world's leaders at successive summits over the last year, remain feasible. What is needed are the funds and systems that will enable widespread implementation of actions that have shown to be effective, the report says. The report contains success stories from 20 different countries, encompassing the widest variety of economic, social and geographic conditions. It shows, for example, how countries like Senegal, Uganda and Thailand have developed strategies that successfully can reduce HIV infection rates, how Azerbaijan and Vietnam have cut in half the number of deaths from malaria, how China, India and Peru have cut TB deaths by half, and how Sri Lanka has drastically reduced maternal mortality. The report Health, a key to Prosperity: Success Stories in Developing Countries the World Health Organization (WHO), the United Nations Children's Fund (UNICEF), the United Nations Educational, Scientific and Cultural Organization (UNESCO), the Joint United Nations Program on HIV/AIDS (UNAIDS), the United Nations Population Fund (UNFPA) and the World Bank outline key factors for combating AIDS, tuberculosis, malaria, childhood diseases and maternal and prenatal conditions, even in resource-poor settings. more

Zinc Supplements Important in Combating Diarrhea

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27 November, 2000


Researchers at the Johns Hopkins School of Public Health have found that zinc supplements help children suffering from acute and persistent diarrhea significantly reduce the duration of their symptoms. The study can be found in the December 2000 issue of the American Journal of Clinical Nutrition. "Diarrhea is a very serious public health problem in developing countries, resulting in millions of deaths each year. Those who survive are often left with malnutrition. This study was important because it measures the effect of supplemental zinc given in conjunction with oral rehydration therapy during the recovery from acute or persistent diarrhea," said study co-coordinator Robert Black, MD, MPH, professor and chair, International Health, Johns Hopkins School of Public Health. The researchers analyzed ten randomized, controlled studies that had assessed the therapeutic benefit of zinc supplements in children under age five. In the case of the acute-diarrhea trials, diarrhea was defined as three or four loose stools in a 24-hour period. For persistent diarrhea, the original trials' definitions for diarrhea and recovery were retained. All trials used the standard World Health Organization recommendations for fluid and dietary case management of diarrhea. The researchers divided the participants of all the reviewed studies into subgroups according to sex, age, weight-for-height, and initial plasma zinc concentration, and then evaluated the overall effect of zinc on each group. Results of the study showed that the children who were given a zinc supplement during the acute-diarrhea trials were 15 percent less likely than controls to still have diarrhea by a given day; children in the persistent-diarrhea trials had a 24 percent lower risk of the diarrhea continuing. The authors said their meta-analysis showed that zinc apparently offers comparable benefits to all subgroups, a finding that indicates the nutrient needn't be aimed only at certain narrow populations but is feasible for wide use in the developing world. Although future studies are still needed to examine the effect of zinc supplementation on other measures of severity, such as diarrheal output, occurrence of dehydration, treatment failure, or death, the researchers believe attention should now focus on the best means of providing zinc during diarrhea, as well as on other ways to increase the zinc intake of children in developing countries. This study was supported by the Johns Hopkins Family Health and Child Survival Cooperative Agreement with the U.S. Agency for International Development, by the World Health Organization's Division of Child Health and Development, and by the Rockefeller Foundation's Bellagio Study and Conference Center.

Johns Hopkins Health Information

Novel Approaches To Treating Diarrhea Show Promise

21 March, 2000

HONG KONG (Reuters Health) - Enkephalinase inhibitors and other antisecretory agents are gaining recognition as effective treatment methods for diarrhea, according to researchers who are studying the pathogenic mechanisms that lead to the condition.

El Nino Increases Diarrheal Disease Incidence By 200 Percent 4 February, 2000

BALTIMORE (Johns Hopkins) — The El Nino phenomenon, the warming of the equatorial Pacific ocean that occurs every two to seven years, has been linked to outbreaks of dengue, malaria and cholera. Now, researchers from the Johns Hopkins School of Public Health, A.B. Prisma, and the Instituto Nacional de Salud in Lima, Peru, have found that the 1997-1998 El Niño season increased hospitalizations for diarrheal disease by 200 percent. Click here for a PowerPoint slide show on Effects of the El Nino phenomenon and ambient temperature on hospital admissions for diarrheal disease

Wyeth Lederle Withdraws Rotavirus Vaccine From Market 18 October, 1999 WESTPORT, (Reuters Health) - The Wyeth Lederle Vaccines unit of American Home Products said on Friday that it has voluntarily withdrawn its RotaShield rotavirus vaccine from the market and has requested an immediate return of all vaccine doses. The withdrawal follows a temporary suspension of distribution and administration of the vaccine that was announced on July 16. As Reuters Health reported at the time, the US Centers for Disease Control and Prevention requested that healthcare providers and parents postpone use of RotaShield in infants until November, following reports of intussusception in some infants who received the vaccine.

Rotavirus Vaccine May Be Linked To More Cases Of Bowel Disorder

Bethesda, MD (Reuters Health) — The Food and Drug Administration (FDA) has received reports of 99 cases of intussusception that may be related to Wyeth-Ayerst's RotaShield rotavirus vaccine, an FDA medical officer said Tuesday. The number is a huge jump from the previously noted 15 cases, reported as of July 7.

Johns Hopkins Health Information

CDC: Cease Use Of Diarrhea Vaccine
16 July, 1999

ATLANTA (AP), The government is recommending that doctors temporarily stop giving children a diarrhea vaccine because at least 20 infants have developed a bowel obstruction after getting their shot.

First Do No Harm:
Making Oral Rehydration Solution (ORS) Safer In A Cholera Epidemic

Oral rehydration solution (ORS) is lifesaving therapy for cholera and pediatric diarrhea. During a cholera epidemic in Guinea-Bissau, we evaluated the microbiologic quality of ORS prepared at a hospital and tested a simple intervention using special vessels for disinfecting tap water with bleach and for preparing, storing, and dispensing ORS. Few coliform bacteria and Escherichia coli were recovered from tap water; however, pre-intervention ORS contained numerous bacteria including E. coli and toxigenic Vibrio cholerae O1. In contrast, ORS samples from intervention vessels had few or no coliform bacteria, no E. coli, and no V. cholerae. Mean pre-intervention counts of coliform bacteria (3.4 × 107 colony-forming units [cfu]/100 ml) and E. coli (6.2 × 103 cfu) decreased significantly during the intervention period to 3.6 × 102 cfu and 0 cfu, respectively (P < 0.001). This simple system using bleach disinfectant and special storage vessels prevents bacterial contamination of ORS and reduces the risk of nosocomial transmission of cholera and other enteric pathogens.

Excerpt from

The American Journal of Tropical Medicine & Hygiene
Vol. 60, No. 6, pp. 1051–1055

updated: 23 August, 2019