Health experts hope the release of data showing the success of rotavirus vaccine will help compel policymakers to ensure all children will be immunized.
Rotavirus – the top cause of severe and often fatal diarrhoea and dehydration in children – kills some 527,000 children a year globally, nearly half of them in sub-Saharan Africa.
“It is our hope that these data will catalyze action so that one day we can live in a world where no child dies from diarrhoea,” Kathy Neuzil, senior clinical advisor for vaccines at the international health non-profit PATH, said in a 27 January statement.
Published on 27 January 2010 in the New England Journal of Medicine, results from first-ever clinical trials in South Africa and Malawi show that a live, oral rotavirus vaccine significantly reduces the episodes of severe rotavirus gastroenteritis in African children during the first year of life.
The data “provide policymakers with the critical information they need to make decisions about rotavirus vaccine introduction,” George Armah, professor and rotavirus expert at Ghana’s Noguchi Memorial Institute for Medical Research, said.
The trial results led the World Health Organization in June 2009 to recommend global use of the vaccine.
The Africa trials focused on the vaccine’s performance in high mortality, low-income settings, according to a 27 January 2010 communiqué by PATH and GAVI Alliance.
Health experts point out that while rotavirus infection in treatable, it has devastating and deadly impact in rural and poor areas where people cannot access medical care. “Vaccines represent the best hope for preventing the severe consequences of rotavirus infection,” Nigel Culiffe of University of Liverpool said in statement.
The trials were coordinated and co-funded through a partnership between GlaxoSmithKline Biologicals and the GAVI Alliance-funded Rotavirus Vaccine Trials Partnership – PATH, WHO and the US Centers for Disease Control and Prevention.
Despite the existence of inexpensive and efficient means of treatment, diarrhoea kills more children than AIDS, malaria and measles combined, according to a report issued today by UNICEF and the World Health Organization (WHO).
The report, titled Diarrhoea: Why Children Are Still Dying and What Can Be Done (PDF), includes information on the causes of diarrhoea, data on access to means of prevention and treatment, and a seven-point plan to reduce diarrhoea deaths. “It is a tragedy that diarrhoea, which is little more than an inconvenience in the developed world, kills an estimated 1.5 million children each year,” said UNICEF Executive Director, Ann M. Veneman.
“Inexpensive and effective treatments for diarrhoea exist, but in developing countries only 39 per cent of children with diarrhoea receive the recommended treatment.” Dr Margaret Chan, Director-General of WHO, said: “We know where children are dying of diarrhoea. We know what must be done to prevent those deaths. We must work with governments and partners to put this seven-point plan into action.” Diarrhoea is a common symptom of gastrointestinal infection, which can have a variety of sources.
However just a handful of organisms are responsible for most acute cases of diarrhoea and one, Rotavirus, is responsible for more than 40 per cent of all diarrhoea-related hospital admissions of children under five. A new vaccine for Rotavirus has been found to be safe and effective but is still largely unavailable in most developing countries. Though most episodes of childhood diarrhoea are mild, acute cases can lead to significant fluid loss and dehydration. This dehydration can lead to death unless fluids are quickly replaced. Oral rehydration therapy is the cornerstone of fluid replacement and the new low-osmolarity formula of oral rehydration salts (ORS) is a simple, inexpensive and life-saving remedy that prevents dehydration in children suffering diarrhoea.
Some 88 percent of diarrhoeal deaths worldwide are attributable to unsafe water, inadequate sanitation and poor hygiene. As of 2006, an estimated 2.5 billion people around the world were not using adequate sanitation facilities, and about 1 in 4 people in developing countries practiced open defecation. Access to clean water and good hygiene practices are extremely effective in preventing childhood diarrhoea. Hand washing with soap has been shown to reduce the incidence of diarrhoeal disease by over 40 per cent, making it one of the most cost-effective interventions for reducing child deaths caused by this neglected killer.
October 15 is annual Global Handwashing Day when millions of children and adults in over 80 countries will take part in activities to highlight this key intervention. The overall health and nutrition of children is also critical to their susceptibility to diarrhoea and the damage it can cause. Undernourished children are at higher risk of suffering more frequent, severe and prolonged episodes of diarrhoea, and repeated bouts of diarrhoea also place children at greater risk of worsening nutritional status.
The seven point plan to save the lives of children stricken by diarrhoea includes two treatment and five prevention elements.
The two treatment elements are:
fluid replacement to prevent dehydration; and
zinc treatments, which decrease the severity and duration of the attack.
The five prevention elements are:
immunization against rotavirus and measles;
early and exclusive breastfeeding and vitamin A supplementation;
handwashing with soap;
improved water supply quantity and quality; and
promoting community-wide sanitation.
Campaigns targeting childhood diarrhoea in the 1970s and 1980s achieved success by educating caregivers and scaling up oral rehydration therapy to prevent dehydration. The campaigns delivered promising results but following that success, focus shifted to other health problems. There is now an urgent need to shift attention and resources back to treating and preventing diarrhoea.
Johansson, E.M. … [et al.] (2009). Diarrhoea : why children are still dying and what can be done. New York, NY, USA, UNICEF and Geneva, Switzerland, World Health Organization. v, 58 p. ISBN 978-92-806-4462-3 (UNICEF). ISBN 978-92-4-159841-5 (WHO). Full report
There is also an online version of the report on 7pointplan.org
The World Health Organization has paved the way for children in Africa and Asia to be vaccinated against a diarrhoea-causing virus that kills some 500,000 children annually worldwide – 85 percent of them in African and Asian developing countries. WHO has recommended that the vaccine for rotavirus – the leading cause of severe and often fatal diarrhoea and dehydration in under-five children – be included in national immunization programmes worldwide.
As of 2007 the organization had said more research was needed on the vaccine’s efficacy in developing countries with high child mortality; new data from clinical trials has led WHO to recommend global use of the vaccine, according to a 5 June communiqué. The decision means poor countries in Asia and Africa can now apply for funding to include rotavirus vaccines in their national immunization programmes.
“This [vaccine] will significantly reduce mortality and morbidity of rotavirus disease,” Samba Ousmane Sow, associate professor of medicine at University of Maryland and coordinator of the Centre for Vaccine Development in Mali, told IRIN. “For rotavirus, as with many infectious diseases, mortality is often a question of geography,” he said. “For the many people in rural Africa who cannot easily access medical care, the best and most practical solution [against this lethal illness] is to bring the vaccine to them.”
A child with rotavirus disease – which causes fever, vomiting and diarrhoea – can rapidly become dehydrated. Death from rotavirus is most common where there is no quick access to medical care, so vaccination is the most effective way to prevent severe cases and deaths, experts say.
Transmitted primarily by the faecal-oral route, the virus affects the vast majority of children globally before age three, according to WHO. The virus attacks the villi – tiny projections on the wall of the small intestine. Destruction of the affected cells reduces digestion and absorption of nutrients, resulting in diarrhoea with a loss of fluids.
The virus is resilient and traditional hygiene measures that might prevent other sanitation-related illnesses are not sufficient to limit its impact, according to PATH, an international health non-profit and one of the organizations conducting vaccine trials with WHO and the Global Alliance for Vaccines and Immunization (GAVI). But given that there are many causes of diarrhoeal disease, the rotavirus vaccine must be part of a comprehensive control strategy, including improving water quality, hygiene and sanitation and providing oral rehydration solution and zinc supplements, WHO says in its communiqué.
[N]ow governments will have to prepare an investment plan for including rotavirus vaccine in their immunization programmes. The GAVI Alliance uses a co-financing approach, in which countries procure some vaccines with non-GAVI funds; the intention is for countries to gradually increase their share of vaccines’ cost, making immunization programmes sustainable. The GAVI Alliance board is expected to decide at its November 2009 meeting whether all 72 GAVI-eligible countries will now become eligible to apply for funding to include the rotavirus vaccine in their immunization programmes, GAVI’s Ariane Leroy told IRIN.
Clinical trials of the vaccine are ongoing in Asia and sub-Saharan Africa, but WHO’s Strategic Advisory Group of Experts has recommended the vaccine for all populations given available evidence, WHO says.
Pneumonia and diarrhea, which kill one in three children around the world, are emerging as key concerns in disease prevention, a public-private partnership said.
In the coming year, more progress in getting vaccination against the two diseases would reach more countries, said the GAVI Alliance, which is a grouping of governments, philanthropists, vaccine industry players and international organizations such as the World Health Organization.
“Of prime concern are pneumonia and diarrhoea which together account for 36 percent of global child deaths. Progress in preventing these diseases is crucial to achieving the Millennium Development Goals,”" said the alliance in its annual report.
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GAVI said it had adopted a two-phase strategy for rotavirus vaccine, with the first phase to make vaccines support available to Latin American [Bolivia, Guyana and Honduras were the first to apply] and European countries where the vaccine was already licensed for use.
“”Roll-out in Africa and Asia awaits the results of large-scale safety and efficacy trials,”" it said.
Pneumonia and diarrhea, which kill one in three children around the world, are emerging as key concerns in disease prevention, a public-private partnership said.
