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Diarrheal Disease: The Unfinished Agenda

This post originally appeared in Impatient Optimists on November 9, 2015.

By Dr. Mathuram Santosham

In 1980, the first summer I worked on the White Mountain Apache reservation, a community of fewer than 10,000 people in Arizona, so many babies were dying of diarrhea that we buried one every week.

To combat this major problem, we trained community outreach workers to give oral rehydration solution (ORS)—a mixture of sugar, salt and safe water—to babies and young children sick with severe, dehydrating diarrhea. Over time the practice spread and diarrhea deaths in the community dropped to nearly zero.

Proven solutions like ORS, vaccines and better sanitation and hygiene have dramatically reduced childhood diarrhea deaths around the world—from 5 million deaths in 1980 to 600,000 today.

But it’s not just deaths we have to worry about. Illnesses are a major issue too. As the rate of diarrhea deaths have dramatically come down, incidence has barely decreased at all. Children continue to experience an average of three episodes of diarrhea each year. A case of severe diarrhea, especially during important development stages in a child’s life, can have a lasting impact on physical and cognitive growth. Diarrhea can also make children more susceptible to death from other causes like pneumonia.

Recently, at TropMed in Philadelphia, recent progress in global efforts to protect children from diarrhea was hailed and the unfinished agenda highlighted.

Here are four critical things we need to do to protect children from diarrhea:

1. Expand access to ORS.

Children sick with severe diarrhea can be fully rehydrated within a few hours when provided with ORS. However, only one-third of children in low- and middle-income countries who need ORS get it.

2. Improve nutrition and be sure to feed children suffering from diarrhea to stop the vicious cycle of malnutrition and diarrhea.

Malnutrition weakens immune systems, making children more vulnerable to infections like diarrhea. Diarrhea, in turn, prevents children from absorbing nutrients, contributing to malnutrition. This creates a vicious cycle. Because of malnutrition, one in five children worldwide is moderately to severely stunted. Children with two to three diarrheal disease infections a year suffer an average of 8 cm growth loss and a 10 IQ point loss.

Making the situation worse, many caregivers withhold food from children and babies when they are suffering from diarrhea. It is very important to continue feeding children appropriate food during an episode of diarrhea.

3. Vaccinate all children against rotavirus, the leading cause of severe and deadly diarrhea.

Rotavirus causes 40% of diarrhea hospitalizations—and 200,000 deaths in children under 5 each year. Unlike other forms of diarrhea, rotavirus infections cannot be controlled by hygiene and sanitation alone. Vaccines are essential to prevention.

Two rotavirus vaccines are available and have been internationally licensed since 2006. These vaccines are currently used in the national immunization programs of nearly 80 countries. Despite this, only 15% of the children in Gavi countries—the world’s poorest—have access to this life saving vaccine. Even in countries where rotavirus vaccines are used, the poorest children often do not get vaccinated.

In the US, use of rotavirus vaccines led to a striking decline in rotavirus-related hospitalizations. In some years, there are almost no cases observed. Yet because coverage is still not routinely high (it’s varies geographically from 59-88% now), the accumulation of unvaccinated infants periodically leads to outbreaks. In the US, rotavirus vaccine coverage must be improved.

Worldwide, more than 90 million children still don’t have access to rotavirus vaccines. In countries where the most diarrhea deaths occur, almost none have introduced the rotavirus vaccine, despite considerable evidence of its public health impact, cost saving potential and the prospect of introduction support from Gavi, the Vaccine Alliance.

Public health impact has been dramatic in low- and middle-income countries where rotavirus vaccines have been introduced. In Mexico, the vaccine led to a decrease by 50% in diarrheal deaths in children under 5.

Countries that do not already include the rotavirus vaccine in their national immunization program should consider the striking public health and economic benefits and take steps to introduce it as soon as possible. Countries that do, should work to ensure good coverage.

4. Develop new, low-cost rotavirus vaccines to help reach all children.

New rotavirus vaccines are in the pipeline and could help to accelerate coverage. Companies in China, India, Indonesia and Vietnam are developing new vaccines with prices as low as US$1.00 per dose for governments (such as Bharat Biotech’s ROTAVAC, which India is rolling out soon in four states). There are not yet enough doses of these new vaccines to cover all children in the countries where they are being produced, much less the millions of children around the world who are in need of this vaccine. Yet with new product licensures expected as soon as 2017, the product landscape could be quite different very soon.

One thousand children per day still die from diarrhea—a preventable tragedy. We’ve made progress, but we can do much better.

As Nobel Laurate Gabriela Mistral said:

“We are guilty of many errors and many faults, but our worst crime is abandoning the children, neglecting the fountain of life. Many of the things we need can wait. The child cannot. Right now is the time his bones are being formed, his blood is being made, and his senses are being developed. To him we cannot answer ‘Tomorrow,’ his name is today.”

The Integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhea goal is to reduce mortality from diarrhea in children under 5 to fewer than 1 per 1,000 live births. This is a very ambitious goal but we know it is possible as long as the public health community can work together and garner political support. We need to make it happen.

To learn more about how you can get involved, visit this page.

Dr. Mathuram Santosham is Chair for the Rotavirus Organization of Technical Allies (ROTA) Council, Director of the Johns Hopkins Center for American Indian Health, and Senior Advisor for the International Vaccine Access Center (IVAC) at the Johns Hopkins University, where he is also a Professor of International Health and Pediatrics.

Vaccinate Against Rotavirus

This commentary, authored by Drs. Mathuram Santosham, Zulkifli Ismail, and Lee Way Seah, originally appeared in The Star on September 17, 2015.

From Kuala Lumpur to New York, global leaders are gathering this month to discuss the future of health and development. Critical to achieving the health goals launched at the UN General Assembly will be the paediatric issues discussed here in Malaysia this week, because preventable disease in children is still a serious public health – and economic – problem in much of the world.

Take diarrhoea, for example. Diarrhoea is a leading cause of child illness and death, and rotavirus is the most common cause of severe diarrhoea.

Addressing diarrhoeal disease, and rotavirus in particular, is key to improving child health here and in countries around the globe.

Annually, rotavirus results in dozens of deaths and more than 8,500 hospitalisations for gastroenteritis in Malaysian children under the age of five years.

These illnesses can have devastating consequences. Children who recover from a serious case of diarrhoea are more susceptible to the next illness that strikes. And since it takes two months for the intestine to fully repair itself after a bad bout of rotavirus, children cannot absorb nutrients as well, which can slow their growth during crucial stages of development.

In addition, treating rotavirus is expensive for both families and the nation. The typical out-of-pocket cost of hospitalisation for rotavirus in a 2006 study was RM833, and ranged up to RM3,170 – more than one quarter of the average monthly income of households surveyed.

Costs extend beyond hospital fees, since parents would miss many days of work each time their child is hospitalised with rotavirus. Children with rotavirus illnesses are likely to be severely dehydrated upon admission to hospital.

Because children can become infected with rotavirus and other causes of diarrhoea more than once, preventing illness in the first place is critical.

Vaccination is the best way to protect children from rotavirus. While improvements in hygiene, sanitation and drinking water are important to prevent diarrhoea in general, they cannot stop the spread of rotavirus.

Though the World Health Organization has recommended that rotavirus vaccines be introduced into every country’s national immunisation programme, in Malaysia the vaccines are only available in the private market. This means parents have to pay full price for the vaccine, so it can be out of reach for many families.

These vaccines are improving the health of millions of children, reducing healthcare costs and saving lives today in countries where they are in use. In the first four years of use in the United States, rotavirus vaccines prevented more than 176,000 hospitalisations, 242,000 emergency department visits and 1.1 million doctor’s visits among children under five years old, saving nearly US$1bil in healthcare costs. Two years after the introduction of the vaccine in Australia, there were over 6,500 fewer rotavirus-related hospitalisations in children under five years old. And in clinical trials in Asia, rotavirus vaccines were shown to reduce the risk of severe rotavirus diarrhoea by more than half – 51% – in the first year of life when children face the greatest risk of infection.

Globally, 77 countries have introduced rotavirus vaccines into their national immunisation programmes, including Muslim countries like Bahrain, Iraq, Morocco, Qatar, Saudi Arabia, Sudan and Yemen. Yet, not a single Asian country has introduced rotavirus vaccines nationally.

It’s time to protect all children from a disease that places tremendous burden not only on babies and small children who are hospitalised and sick, but also on the parents who worry at bedsides and shoulder the cost of treatment. The illnesses, anguish and hospitalisations can be prevented in the first place through vaccination.

We call on Malaysian and Asian leaders to stand up for our children by introducing rotavirus vaccines into national immunisation programmes. By doing so, we can take significant strides toward achieving the new global health goals.

Millions of children around the world have already benefited from these vaccines. Millions here in Asia depend on us. Let’s not let them down.

This commentary was also highlighted in Global Health Now on September 22, 2015.

Accelerating Rotavirus Vaccines in Asia: ASVAC Session Summary

The ROTA Council convened representatives* from countries across Asia and beyond at the 5th Asian Vaccine Conference in Hanoi, Vietnam on June 14, 2015 to discuss challenges to rotavirus vaccine introduction in their respective countries, lessons learned from the Philippines—which has introduced rotavirus vaccines regionally—and ways to accelerate the introduction of rotavirus vaccines across Asia.

This meeting was important because despite evidence of significant disease burden, no country in Asia has yet introduced rotavirus vaccines into its national immunization program. The Philippines has introduced at a regional level and Thailand has a pilot program.

Key takeaways of the session include:

  1. Advocacy is needed to raise awareness of the burden of rotavirus disease and the benefits of rotavirus vaccines among providers, parents and policymakers.
    Experience from the Philippines demonstrated that sustained advocacy efforts are essential for successful introduction and implementation of rotavirus vaccines. ROTAPHIL (Rotavirus Organization for Training and Advocacy in the Philippines), a group of pediatric infectious disease, gastrointestinal and vaccine experts who came together to advocate for rotavirus vaccines, used tactics such as:

    • Press conferences with CDC experts and legislators
    • A position paper targeting the senate committee on health
    • Dissemination of key messages such as: “Rotavirus disease should be recognised as one of the highest public health priorities by governments, health administrators and medical community decision makers in Asia. The consensus of the experts at this scientific meeting was that universal vaccination programs to address rotavirus disease should be implemented.”
    • Proactive media engagement
  2. Doctors are trusted messengers for parents and policymakers, so it is important that providers (doctors and nurses) understand the value of rotavirus vaccines and advocate for them.
    Several participants spoke to the importance of involving pediatric associations in advocacy, and how instrumental the voice of healthcare providers has been in the uptake or rotavirus vaccines, the introduction of other vaccines and implementation of various child health interventions.
  3. Government endorsement is important, especially in countries with high confidence in government.
    Currently rotavirus vaccines are available in several countries in Asia in the private market. Parents can choose to pay to have their children vaccinated, but some question the importance of rotavirus vaccines because they are not recommended by health officials. Inclusion of the vaccine in the national immunization program is a form of endorsement, and even publically taking steps in that direction may increase vaccination rates in the meantime.
  4. More research is needed to understand the full cost of rotavirus disease and the full cost-savings of vaccination.
    As noted in the ROTA Council pre-congress workshop, “Emerging Rotavirus Vaccines in Asia,” the decline in rotavirus mortality means it is increasingly important to communicate the impact of rotavirus morbidity. Costs include direct care such as hospital visits, outpatient visits and transportation to medical facilities, as well as parents’ missed work and lost wages. Additionally, hospital beds are filled with children being treated for rotavirus diarrhea, which means beds are not available to treat children suffering from other illnesses. Overcrowded hospital wards promote cross infection and lengthen hospital stays. Additional research is needed to fully quantify the costs of rotavirus, and the benefits of implementing the vaccine on a national scale.
  5. Vaccine pricing remains a barrier, and more consistent or transparent pricing mechanisms are needed.
    Decision makers need accurate information on rotavirus vaccine pricing to develop appropriate plans for the vaccine to be added into their current immunization program. Unfortunately, lack of transparency around true vaccine pricing, or lack of mechanisms to negotiate price prior to tendering,  causes countries to use the private sector price in economic evaluation, leading to the possibly inaccurate conclusion that the vaccine price is too high. For more detail, please see the past work of ROTA Council member Tony Nelson here and here.

For advocacy resources, visit the ROTA Council’s advocacy toolkit.

* Participants included representatives from the following countries:

Hong Kong
Sri Lanka
United States

Emerging Rotavirus Vaccines in Asia: ROTA Council Workshop Summary

The ROTA Council, the Vietnam National Institute of Hygiene and Epidemiology, POLYVAC and the U.S. Centers for Disease Control and Prevention convened global health experts at the 5th Asian Vaccine Conference in Hanoi, Vietnam on June 11, 2015 for a workshop to discuss emerging rotavirus vaccines for Asia.

This meeting was crucial because a healthy vaccine market—one with sufficient supply and competitive pricing—requires three to five globally licensed manufacturers, and currently there are only two for rotavirus vaccines, and there is a current global supply shortfall, which is affecting country introductions.

Highlights from the workshop include:

  1. The health burden and economic burden of rotavirus in Asia are high.
    Though rotavirus diarrhea mortality rates are lower in Asia than in Africa, the overall burden is serious.

    • Rotavirus accounts for 42 percent of diarrheal hospital admissions in Asia, according to the WHO-coordinated Asian Rotavirus Surveillance Network.
    • Though oral rehydration therapy (ORT) can treat mild and moderate cases of rotavirus diarrhea, severe rotavirus requires hospitalization. Not all children have access to ORT or hospital care.
    • Rotavirus strikes at earlier ages in lower-income countries, and many children become infected multiple times.
    • Preventing rotavirus in the first place is better than treating children when they become sick. Approximately one in five children under 2 years of age suffer from an episode of moderate to severe diarrhea each year, and these children are 8.5 times more likely to die within two months of this diarrheal episode after leaving the hospital. If they survive, they are more likely to have developmental delays.
    • There is a steep economic cost to governments and to families for treating rotavirus diarrhea. In addition to the direct medical costs to governments of outpatient visits and treatment, and hospitalization costs, families often pay for care, parents endure opportunity costs such as forgone income and sometimes pay high transportation costs to and from the hospital.
  2. Vaccine pricing remains a barrier, and more consistent or transparent pricing mechanisms are needed.
    Decision makers need accurate information on rotavirus vaccine pricing to evaluate and introduce rotavirus vaccines. Unfortunately, lack of transparency around true vaccine pricing, or lack of mechanisms to negotiate price prior to tendering, causes countries to use the private sector price in economic evaluation, leading to the possibly inaccurate conclusion that the vaccine is too high. For more detail, please see the past work of ROTA Council member Tony Nelson here and here.
  3. Manufacturers should think about the WHO prequalification process early.
    Communicating with WHO early in the vaccine development process and incorporating their feedback can help avoid a situation where a second-generation product is needed to obtain WHO prequalification. Guidelines can be found on the WHO website here. Connecting with key personnel at WHO by sending a list of questions and meeting participants in advance will help secure a meeting to discuss prequalification. Information about expediting prequalification can also be found on the WHO website.
  4. Manufacturers must keep in mind the settings in which their vaccines will be used.
    Packaging size and cold chain requirements can impact the decision to introduce—or not—a vaccine into a country’s national immunization program.

For Rotavirus, Prevention is the Best Medicine

This commentary originally appeared in Global Health Now.

World Immunization Week provides a moment to reflect on the tremendous progress in reducing one of the world’s leading killers of children—diarrhea.

While oral rehydration solution has significantly reduced diarrheal disease mortality since its adoption in 1978, diarrhea continues to be a major cause of childhood illness and death globally. Rotavirus, the most common cause of severe diarrhea, is responsible for approximately 40% of all diarrhea hospitalizations and hundreds of thousands of deaths in children under 5.

Rotavirus vaccines offer the best protection for children and are an essential part of comprehensive diarrhea control. While the WHO recommends that all countries introduce rotavirus vaccines, only 77 have done so, 34 of which are Gavi-eligible countries where many of the deaths occur. Unfortunately, some of the most vulnerable children and communities do not have access to the vaccine.

In particular, Asia has lagged in introducing rotavirus vaccines, even though it accounts for more than 40% of global rotavirus deaths. To date, no country in the region has introduced the vaccine into its national immunization program.

While dramatic reductions in deaths from childhood diarrheal disease have been achieved in Bangladesh, there are still more than 2.4 million rotavirus cases each year. It causes 2 out of every 3 diarrhea-related hospitalizations among children under 5. There are also serious economic consequences. One episode of rotavirus costs the average Bangladeshi family about USD $80 in direct hospital costs, a significant portion of average monthly income.

In neighboring India, where rotavirus is equally ubiquitous, the disease poses a significant financial burden to families and the country’s economy. Studies have shown that a hospitalization for rotavirus could potentially push a family into poverty or keep them there. Depending on the level of care, the total cost of a rotavirus hospitalization could range anywhere from nearly $32 to more than $135, equal to up to 2 months of income for an average Indian family. Rotavirus also burdens the healthcare system with the high cost of hospitalizations and outpatient visits. One study estimated that hospitalizations and outpatient visits cost India approximately $78 million and $86 million each year, respectively—each more than the estimated $72 million it would cost to fund a rotavirus immunization program.

For fast-growing countries like India and Bangladesh, tackling rotavirus—which cheats children and the nation of productivity, well-being and development—should be a priority. However, the available and effective rotavirus vaccines are not yet available in the national immunization programs of either country.

Many of my scientific colleagues in Bangladesh are making a good case to their leaders for national introduction of rotavirus vaccines. And, I’m inspired by the strides being made in India. Last July, Prime Minister Narendra Modi announced that rotavirus will be included in the Universal Immunization Programme; and just last month, the first India-made rotavirus vaccine, ROTAVAC, was launched. Now is the time to get to the finish line—the cost of delaying access to rotavirus vaccines continues to mount. Together we can close this immunization gap and virtually eliminate rotavirus.

Dr. Mathuram Santosham is the Director of the Center for American Indian Health, Chair of the ROTA Council, and Senior Advisor at the International Vaccine Access Center at Johns Hopkins Bloomberg School of Public Health. Dr. Santosham and his colleagues won an Honorable Mention in GHN’s Untold Global Health Stories Contest for their submission of rotavirus in Bangladesh and India. GHN will feature one Honorable Mention story per month from now until the next contest in early 2016.

Roger Glass Awarded Prestigious Sabin Gold Medal for Vaccine Work

Credit: Sabin Vaccine Institute

ROTA Council member Dr. Roger I. Glass received the Albert B. Sabin Gold Medal Award at a ceremony on April 14, 2015, in Bethesda, Maryland. This award is presented annually to a distinguished member of the public health community who has made extraordinary contributions in the field of vaccinology or a complementary field.

Dr. Glass, currently director of the Fogarty International Center at the National Institutes of Health (NIH), is one of the world’s leading experts on gastroenteritis caused by rotavirus and norovirus. He has led global research on the introduction of rotavirus vaccines, adding to the body of knowledge showing rotavirus vaccines are safe, effective and the best way to prevent rotavirus diarrhea.

Dr. Glass is also one of the pioneers of ROTAVAC®, the indigenous Indian vaccine recently introduced into India’s private market and the product of an innovative public-private partnership between the NIH and Bharat Biotech, the U.S. Centers for Disease Control and Prevention and the Indian government, among others.

Other Council members to have received the Sabin Gold Medal include Dr. Mathuram Santosham and the late Dr. Ciro de Quadros.

Read more at the Sabin Vaccine Institute.

Bangladesh: Officials, Experts Agree on Urgent Need for Rotavirus Prevention

Experts gather in Dhaka on January 5, 2015.

The world’s foremost experts on rotavirus recently gathered in Dhaka, Bangladesh to discuss the country’s substantial disease burden, the expense associated with treatment and how to best support the introduction of rotavirus vaccines into the country’s national immunization program. Among the January 5 meeting attendees were government officials, immunization program officers and scientific experts.*

The latest research on rotavirus in Bangladesh indicates:

Rotavirus is a major problem

  • 2.4 million cases each year
  • Responsible for nearly two-thirds of all diarrhea-related hospitalizations in children under age 5 in 2013
  • Half of all rotavirus hospitalizations were among infants age 6-11 months

Rotavirus is expensive

  • Treatment in a hospital can cost a family US$84 per episode, in terms of both direct and indirect costs
  • Direct costs, such as medicine and diagnostic tests, amount to almost 20% of average monthly household income
  • US$66.8 million is the estimated total, annual nationwide cost for rotavirus hospitalizations

Prevention is possible

  • Vaccination against rotavirus can reduce the risk of infection by nearly half during the first year of life, when the threat is greatest
  • Rotavirus vaccines could prevent an estimated 135,000 hospitalizations per year
  • Rotavirus vaccines are safe and cost-effective

While progress has been made in reducing diarrhea-related deaths among children, it is still one of the leading causes of illness among children under 5 in Bangladesh. Rotavirus is a significant cause of these illness and hospitalizations. Rotavirus vaccines could have a powerful public health impact if introduced into Bangladesh’s national immunization program.

The ROTA Council applauds the government of Bangladesh for prioritizing this issue, and encourages officials to take steps toward introducing rotavirus vaccines, such as improving cold chain capacity and applying to Gavi, the Vaccine Alliance, for vaccine introduction support.

You can download a presentation delivered at this meeting by Dr. George Armah on Ghana as a case study here.

*The meeting was hosted by the Hospital Based Rotavirus and Intussusception Surveillance (HBRIS), Bangladesh and the ROTA Council. Attendees included representatives from:

  • Bangabandhu Memorial Hospital
  • Bangabandhu Sheikh Mujib Medical University
  • BRAC
  • Dhaka Medical College
  • Dhaka Shishu Hospital
  • Directorate General of Health Services
  • EPI, Government of Bangladesh
  • Institute of Epidemiology, Disease Control and Research
  • International Centre for Diarrhoeal Disease Research, Bangladesh
  • Jahurul Islam Medical College
  • Jalalabad Ragib-Rabeya Medical College
  • Jessore General Hospital
  • LAMB Hospital
  • Rajshahi Medical College Hospital
  • Sher-e-Bangla Medical College Hospital
  • U.S. Centers for Disease Control and Prevention
  • World Health Organization

Pneumonia and Diarrhea Progress Report 2014

A new report from the International Vaccine Access Center (IVAC) at Johns Hopkins University finds that despite major reductions in pneumonia and diarrhea deaths globally, progress has been slow in the highest-burden countries. The Pneumonia and Diarrhea Progress Report evaluates the progress made by the fifteen highest-burden countries in implementing high-impact interventions from the Global Action Plan on Pneumonia and Diarrhea (GAPPD), and highlights countries making strides toward reducing child mortality from pneumonia and diarrhea.

Read the full report here

Fresh onslaught against ravaging rotavirus disease

This article originally appeared in The Guardian (Nigeria).

The deadly Rotavirus has over the years ravaged Nigerian children unchecked. EMEKA ANUFORO of our Abuja Bureau writes on the cheery news that help is on the way as Nigeria finally announces plans to introduce a vaccine against the virus.

ROTAVIRUS diarrhea is considered a big threat to Nigerian children, and causes more than 160,000 deaths in children under five each year. A recent research indicates that the percentage of cases found in Enugu as the highest in Africa. Despite the availability of its vaccine worldwide, the deadly Rotavirus is still a leading cause of severe diarrhea disease and dehydration in infants and young children in Nigeria.

The World Health Organization (WHO) estimates that the rotavirus disease causes the death of approximately 527,000 young children yearly. About 85 per cent of these deaths are said to occur in developing countries, mainly in South Asia and sub-Saharan Africa.

Rotavirus, according to the United States Centre for Disease Control and Prevention (CDC), is a contagious virus that can cause inflammation of the stomach and intestines.

“Symptoms include severe watery diarrhea, often with vomiting, fever, and abdominal pain. Infants and young children are most likely to get rotavirus disease. They can become severely dehydrated and need to be hospitalized and can even die.”

Unfortunately, despite the deadly nature of the virus, Nigeria is yet to introduce a vaccine to contain the disease. The Guardian had reported that the country has not introduced a vaccine to curb the ailment.

But the good news is that come next year, the vaccine for Rotavirus would be available in Nigeria, if assurances by officials are anything to go by.

Executive Director of the National Primary Healthcare Development Agency (NPHCDA), Dr Ado Mohammed, whose agency has the mandate for vaccination, told The Guardian that the vaccine would be introduced next year (2015).

He said: “Diarrhea accounts for a major percentage of child mortality in Nigeria. We are working towards introducing rotavirus vaccine as part of other interventions that we are doing. You are aware that we have introduced flavored ORS in Nigeria, you are also aware that we have introduced sinc-surphate treatment regiment for diarrhea in Nigeria.

“We are working towards ensuring that we introduce rotavirus vaccine next year. By 2015, Rotavirus will come on board as part of our vaccine plans so that we can change lives and fast track our attainment of the MDGs goals 4 and 5 and ensure that we reduce to the barest minimum deaths attributable to the virus.”

A recent study indicates that the deadly Rotavirus is still ravaging Nigerian children unchecked.

Checks at the World Health Organization (WHO) indicate that vaccination against rotavirus diarrhea is one of the vaccinations recommended by the global body to be given to all children worldwide.

Rotavirus is seen as the primary cause of diarrhea-related illnesses and deaths, and according to experts, is responsible for 160,000 deaths in under -five (5) Nigerian children each year

A new study published in the Pediatric Infectious Disease Journal reveals that vaccines are available, but Nigeria is yet to introduce the vaccines.

An abstract on the publication stressed: “This study found a relatively high incidence of severe rotavirus-associated diarrhea disease in Nigeria and infants were the most affected. It highlights the urgent need for introduction of rotavirus vaccine into the national immunization program, the need to adequately equip health facilities, to enable them administer intravenous fluids to severe diarrhea patients to reduce morbidity and mortality.”

The researchers found in their study that rotavirus is responsible for close to 56 per cent of cases of diarrhea in children and that more case occur in the cool dry months of the year, a finding now regarded as one of the highest rates of diarrhea caused by rotavirus.

Reports indicate that vaccines are known to offer the best protection, and have indicate that vaccines are known to offer the best protection, and have been proven in study after study to be safe and effective in Africa and around the world.

But unfortunately, Rotavirus vaccines are not yet included in Nigeria’s immunization program.

“If Nigeria’s leaders take action, these lifesaving vaccines could be introduced as early as 2015. Every child is vulnerable, regardless of where they live, and for those in places without medical care it can be a death sentence,” the report noted.

A WHO factsheet on the virus indicate that: “Most symptomatic episodes occur in young children between the ages of 3 months and 2 years. The virus spreads rapidly, presumably through person-to-person contact, airborne droplets, or possibly contact with contaminated toys.

“Symptoms usually appear approximately two to three days after infection, and include projectile vomiting and very watery diarrhoea, often with fever and abdominal pain. The first infection is usually the worst one.

There is no specific drug treatment for rotavirus infection, although oral rehydration therapy is recommended. There are now two new rotavirus vaccines to prevent severe rotavirus disease.”

The study ‘Epidemiology of Rotavirus Diarrhea among Children Younger than 5 Years in Enugu, South East, Nigeria was recently conducted and the results published in Pediatric Infectious Disease Journal.

The Pediatric Infectious Disease Journal is an official publication of the European Society for Paediatric Infectious Diseases.

The Guardian learnt that researchers from the Nigerian Ministry of Health, Institute for Child Health and University of Nigeria Teaching Hospital, and World Health Organization recently examined the prevalence of rotavirus in hospitalized children under five (5).

The study was conducted in Enugu and found that the percentage of positive cases reported in Enugu was the highest level observed to date by the WHO Regional Office for Africa in Africa

Among other things, the report also found that more than half (56%) of children under 5 hospitalized with diarrhea were found to have rotavirus, while almost all (96%) of these children were under the age of two (2).

A copy of the report obtained by The Guardian describes January as the peak month for rotavirus infections. 95 per cent of rotavirus cases, it stressed, occurred between December and April,

The study particularly drew attention to the urgent need to protect Nigeria’s children from rotavirus.

The study noted:  “Severe rotavirus diarrhea in children is a major cause of morbidity globally and mortality in developing countries. It is estimated to be responsible for 453,000 deaths in children less than 5 years of age globally and 232,000 in the African region. The aim of the current study was to determine the prevalence of rotavirus gastroenteritis among hospitalized children less than 5 years of age in Enugu and to support awareness and advocacy efforts for the introduction of rotavirus vaccines in Nigeria…

“This study found a relatively high incidence of severe rotavirus-associated diarrhea disease in Nigeria and infants were the most affected. It highlights the urgent need for introduction of rotavirus vaccine into the national immunization program and the need to adequately equip health facilities so as  to enable them administer intravenous fluids to severe diarrhea patients to reduce morbidity and mortality.”

But President of the Nigerian Academy of Science, Prof Oyewale Tomori confirmed that the vaccines had not been introduced in Nigeria and called attention to the urgent need for the Nigerian government to introduce the vaccine into the nation’s vaccination program.

In an interview with The Guardian, he stressed how many of the countries that have introduced Rota vaccine no longer contend with polio, while measles is a minor problem such countries

According to him, “We need to accelerate the introduction of rotavirus vaccine in Nigeria. The vaccine is available for any nation who considers it important enough to give their children.”

On his thoughts on why government was yet o introduce the vaccine, Tomori, who is a virologist, stressed: “I think the government has done a fairly good job, but as we say ‘ water pass gari’.  The government has introduced new vaccines and plans to introduce more between now and 2015. The vaccines include Penta, Pneumococcal conjugate vaccine  (PCV), Human Papilloma Virus Vaccine, (HPV), Tetanus and fractional diphtheria (Td), measles-rubella vaccine (MRV) and rotavirus vaccine

“However, we could do more with the resources we have, if we spend our money wisely and judiciously. We hear of competing interests against vaccinating our children. I wish those competing interests were important things and issues. The things competing against providing our children with vaccines include: wastage, undue process, looting, stealing with conspicuous and obscene life style.”

On the likely implication of non-introduction of the vaccine on Nigerian children, he stressed; “Many of them will die from preventable diseases and we will not meet some of the Millennium Development Goals (MDG).”

He, nevertheless, gave kudos to the efforts of the Nigerian government in introducing vaccines for a number of child killer ailments, but noted:  “The government is trying, but we have too many disease conditions we should have controlled a long time ago.”

The Guardian reached out to a co-author of the study, Dr. George Armah, who noted that there had been several reports on the contribution of rotavirus to the large mortality in children which were in the possession of the Nigerian government.

Armah, Senior Research Fellow and Associate Professor at the University of Ghana, stressed that the introduction of rotavirus vaccines would help avert the risk of the more 41,000 kids dying from this vaccine preventable disease.

“It will reduce considerable the lost time for mothers who have to attend their sick children as well save the economy a lot of Naira from the treatment cost of the disease. “

He said the latest study aimed to determine the prevalence of rotavirus gastroenteritis among hospitalized children less than five years of age in Enugu.

“The data from this study was to augment support awareness and advocacy efforts for the introduction of rotavirus vaccines in Nigeria,” he noted.

He told The Guardian: “The main findings were that more than 50% of children admitted to the hospital with severe diarrhea infected with the human rotavirus. The majority of these unfortunate children (77%) were less than 12 months of age. These are very small and delicate children. The ones who made it to the hospital are the very lucky ones who will survive.

“For an unfortunate child in a hard to reach and inaccessible part of rural Nigeria – it is a death sentence and a lot of anxiety for the parents. The study showed that the incidence of disease, the months at which infection is at its peak (October to February) are very similar to countries in the sub-region and introduction of vaccines will help ameliorate the burden of disease as is being observed in countries that have introduced the vaccines in their Expanded Programme on Immunisation.

Global Buzz for Rotavirus Vaccines

This post originally appeared on Impatient Optimists.

By: Mathuram Santosham

Heading to New Delhi, India recently for the Eleventh International Rotavirus Symposium, I knew that this meeting would be different. Over the past couple of years, notable advancements against rotavirus disease have occurred, including the development of a new indigenously developed vaccine in India, an enormous mass of studies with positive safety and effectiveness results, and many introductions of vaccines into national immunization programs, giving promise that we can beat this leading killer of children.

In the very first moments of my arrival, I learned that my expectations were right.

Never before have more people gathered at this symposium. An astounding 650 experts from 56 countries — more than 16 times as many people who attended our first meeting thirty years ago — came to the conference, themed,“Building on evidence: the case for rotavirus immunization.”

The sheer number and diversity of people are true testaments to the increasing awareness of rotavirus and the essential role of vaccines in reducing the suffering this disease causes.

Pediatricians, epidemiologists, researchers, policy makers, immunization program implementers, government officials and pharmaceutical representatives presented on and heard about a number of important topics. Panels ranged from the Latin American and African experience with vaccines and post-licensure impact and safety of vaccination, to immunity and new insights in strain diversity.

In addition, we discussed the critical policy challenges remaining and advocacy efforts needed to help overcome them. Advocacy among policy-makers, championed by my dear colleague and friend, the late Dr. Ciro de Quadros, along with groundbreaking vaccine development efforts and public-private partnerships are leading to greater prioritization of rotavirus; however, more must be done.

But what also stood out was the excitement of convening this biannual event in India. The new government has made laudable commitments to tackling the burden of rotavirus, and other leading childhood diseases, that will save lives and give all Indian children a chance at being healthy and productive.

Just two months ago, Indian Prime Minister Narendra Modi announced that the Government of India would provide a rotavirus vaccine to all Indian children through the Universal Immunization Program. At the same time, the government has redoubled efforts to improve access to oral rehydration solution (ORS) and other key diarrhea control interventions through its Intensified Diarrhea Control Fortnight. All of these efforts are positive signs for the children of India.

At the symposium, Dr. Harsh Vardhan, India’s Union Minister of State for Health and Family Welfare, spoke about the importance of delivering vaccines to all those in need. Too many children have lost their lives, and too many families are bearing tremendous economic consequences as a result of hospitalizations due to rotavirus. In India, rotavirus is estimated to cause more than 78,000 deaths, 800,000 hospitalizations and three million outpatient visits each year.

However, even with this momentum, we must not become complacent in addressing rotavirus disease, the leading cause of severe and fatal diarrhea in children under five years of age worldwide, killing between a quarter and a half million children each year. While children everywhere are at risk of infection, the majority of deaths occur in South Asia and Sub-Saharan Africa, where children do not have good access to care.

Yet, despite the World Health Organization’s (WHO) recommendation for all countries to introduce rotavirus vaccines in their national immunization programs, only 35 percent of countries worldwide (69) have done so. The most disappointing statistic for me is that only one country in Asia — The Philippines — has introduced the vaccine nationally.

Additionally, while vaccination is the best way to protect children from rotavirus, a comprehensive approach will best protect child health and boost immunity. Vaccination should be part of a broad strategy that includes improved water, sanitation and hygiene; good nutrition; breastfeeding; ORS; and zinc supplementation.

I am hopeful that when we meet again for the next symposium, two years from now, we’ll have even more scientific and policy progress to celebrate and build on. Thanks to all of the dedicated rotavirus experts who participated and whose work is making a lasting difference in the health and well-being of children everywhere.

Thanks also to the conveners and funders: the Bill & Melinda Gates Foundation, U.S. Centers for Disease Control and Prevention, Christian Medical College Vellore, Indian Council of Medical Research, National Institutes of Health Fogarty International Center, PATH, ROTA Council, Sabin Vaccine Institute, Bharat Biotech, GlaxoSmithKline, Merck Pharmaceuticals, Serum Institute of India, Ltd. and WHO.

Learn more about how rotavirus vaccines can improve health and save lives at