Stop the Cycle

Diarrheal Disease Solutions

Vaccines

Vaccines are one of the most effective tools we have to protect children from contracting a diarrheal disease. Currently, vaccines have already been developed or are in development for a number of diarrheal diseases, including rotavirus, Enterotoxigenic Escherichia coli (ETEC), and Shigella.

Vaccines

Vaccines produce immunity to disease. Several vaccines that provide protection against diarrheal disease pathogens are available today.

“The best way to protect children from deadly disease is to prevent them from getting it in the first place.”

– Dr. Ruth F. Bishop, member of team that discovered rotavirus
in PATH’s Diarrheal Disease: Solutions to Defeat a Global Killer report

  • Problem: limited access to urgent care

    Diarrhea can be deadly, and children who suffer repeated infections can be left with lasting disabilities. Communities with poor infrastructure or that are particularly susceptible to natural disasters are at heightened risk for outbreaks of diarrheal diseases like cholera and the spread of rotavirus, ETEC, and Shigella. Because the specific cause of diarrhea is often unknown—and can be a virus, bacteria, or parasite—inappropriate antibiotics are often used for treatment, contributing to the global antibiotic resistance crisis.

  • Solution: protect children from infection in the first place

    Vaccines for rotavirus, the most common and deadly cause of severe diarrhea in young children, are available now and are making a significant impact in countries where they have been introduced. Vaccines against ETEC and Shigella, the leading causes of bacterial diarrhea, are in development.

    Vaccines are also available to prevent cholera, a diarrheal disease commonly associated with outbreaks and linked to unsafe water and sanitation-related challenges. And vaccines are under development for other diarrheal diseases like norovirus, paratyphoid, and non-typhoidal Salmonella. (Typhoid vaccines are available, but it should be noted that typhoid is not a diarrheal disease.)

  • Impact: infections prevented, lives saved

    Six pathogens (including rotavirus, ETEC, and Shigella), account for nearly 80 percent of diarrheal infections. Vaccinations against these pathogens could prevent hundreds of millions of deaths and prevent the kinds of repeated diarrheal episodes that keep far too many children from reaching their full potential. By preventing illness and the use and misuse of antibiotics, vaccines also help prevent the development of further drug resistance.

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Rotavirus

  • Problem: incredibly contagious

    Rotavirus is a highly contagious virus that can cause diarrhea. It is often accompanied by vomiting and fever. If left untreated, it can lead to severe dehydration and death. While nearly every child in the world is at risk regardless of where he or she lives, children in poverty disproportionately die from rotavirus due to lack of access to emergency care. Even less-severe rotavirus cases can have a tremendous economic impact on families due to the high cost of treatment.

    Unlike the bacteria and parasites that cause other forms of diarrhea, rotavirus cannot be prevented by improvements in water, hygiene, and sanitation—vaccines provide the best protection against it.

  • Solution: prevent infections, save lives

    In the countries where they are in use, rotavirus vaccines are saving lives and protecting child health. To date, more than 95 countries have introduced rotavirus vaccines into their national immunization program. However, fewer than 1 in 2 infants worldwide—over 75 million infants—still do not have access to them. Uptake in Asia, in particular, remains slow. We must do more to reach these children.

    If introduced in all Gavi countries—including the remaining countries that have not introduced—rotavirus vaccines could prevent nearly 600,000 deaths and approximately US$900 million in treatment costs between 2018 and 2027.

  • Global guidance: rotavirus

    The World Health Organization (WHO) recommends that all countries introduce rotavirus vaccines into their national immunization programs.

    • There are currently four globally available vaccines against rotavirus.
    • Vietnam and China each have nationally licensed rotavirus vaccines.

    Countries can learn about available vaccines here: WHO: Rotavirus

    And learn about vaccine introduction here: ROTA Council: How to Introduce.

    Get more evidence on the impact of the rotavirus vaccine.

    For qualifying countries, Gavi, the Vaccine Alliance provides rotavirus vaccine introduction support.


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ETEC & Shigella

  • Problem: leading bacterial causes of diarrhea

    ETEC and Shigella are the leading bacterial causes of diarrhea among children under five years. Shigellosis and illness from ETEC usually follow the ingestion of contaminated food or water. Shigella can also be transferred by person-to-person contact. Compounding the problem, use and misuse of antibiotics for diarrhea strengthens the resistance of bacterial pathogens to drugs. Many species of Shigella have developed resistance to commonly used antibiotics, making cases more difficult and expensive to treat. Persistent bacterial infections lead to long-term consequences such as malnutrition and stunting.

  • Solution: prevent infections, save lives

    Vaccines against ETEC and Shigella are currently under development. PATH is collaborating with private- and public-sector partners to advance safe, effective, and affordable vaccines against these pathogens. If introduced in high-burden countries or sub-national regions, ETEC and Shigella vaccines are projected to have a significant public health impact.


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Cholera

  • Problem: outbreak potential

    Like other forms of diarrhea, cholera thrives in poor conditions and kills by rapidly dehydrating its victims. But cholera is uniquely prone to outbreaks and epidemics because the bacteria (Vibrio cholerae) spreads rapidly. In addition, it takes a significant amount of the bacteria to cause cholera illness, which means that cholera “hotspots” occur in exceptionally neglected, crowded, and unsanitary conditions that are ripe for outbreaks: conflict zones, urban slums, during natural disasters, and in refugee settlements, to name a few. Some areas experience more predictable seasons of cholera during rainy months, which are at risk of intensifying as a result of climate change.

  • Solution: short-term vaccine delivery, long-term WASH efforts

    Cholera elimination is possible. In Africa, 90% of cholera cases occur in hotspots inhabited by less than 5% of the population.

    First made available in the World Health Organization’s global stockpile in 2013, oral cholera vaccine (OCV) has dramatically improved the ability to rapidly contain cholera outbreaks. OCV is safe, inexpensive, easy to deliver, and effective. By providing immediate protection and lasting two to three years, it acts as a stop-gap measure that buys time as communities invest in long-term prevention efforts like water, sanitation, and hygiene.

  • Global guidance: cholera

    Launched in 2017 by the Global Task Force for Cholera Control, the Global Roadmap to 2030 aims to achieve a 90% reduction in cholera deaths by 2030. The Roadmap outlines actions for countries, technical partners, and donors on three key areas: early detection and quick response; a targeted multi-sectoral approach to prevent cholera recurrence; and an effective mechanism of coordination for technical support, advocacy, resource mobilization, and partnership at local and global levels.


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