Rotavirus has been identified as the main cause of diarrhoeal diseases in infants under 11 months

Over 1,00,000 children, below the age of 11 months, die of diarrhoea annually in India which is the second leading killer of young children globally, after pneumonia. India accounts for the highest number of diarrhoeal deaths, a latest study has suggested.

A new international study published in the latest edition of the British medical journal The Lancet provides the clearest picture yet of the impact and most common causes of diarrhoeal diseases.

The Global Enteric Multicenter Study (GEMS) is the largest study ever conducted on diarrhoeal diseases in developing countries, enrolling more than 20,000 children from seven sites across Asia (including India) and Africa. With approximately 4,57,000 to 8,84,000 hospitalisations and two million outpatient clinic visits each year in Indian children, this study pinpoints the key causes of childhood diarrhoea and suggests a roadmap to save hundreds of thousands of lives.

GEMS, coordinated by the University of Maryland’s School of Medicine’s Center for Vaccine Development, confirmed rotavirus as the leading cause of diarrhoeal diseases among infants under 11 months across all sites and identified other top causes for which additional research is urgently needed.

GEMS evaluated nearly 40 pathogens to map each one’s relative contribution to diarrhoeal disease. Combining data from all seven study countries, GEMS found that approximately one in five children under the age of two suffer from moderate-to-severe diarrhoea (MSD) each year, which increased children’s risk of death 8.5 fold and lead to stunted growth over a two-month follow-up period.

In India, the study was conducted in Kolkata at the National Institute of Cholera and Enteric Diseases and overseen by Principal Investigator Dipika Sur. Similar to other GEMS sites, just four pathogens – rotavirus, Cryptosporidium, Shigella, and ST-ETEC – caused the majority of MSD cases in Kolkata. The overall incidence of MSD was higher in Kolkata than at any other study site.

Infants under 11 months at Kolkata showed the highest burden, with roughly 90 episodes of MSD per 100 children each year, nearly double the next highest-burden site Kenya.

“Without a full picture of which pathogens cause the most harm, it has been difficult to make evidence-based decisions around diarrhoeal disease control,” said Dr. Sur. “GEMS will fill in those critical gaps in knowledge and will help in governments to prioritise resources for research and action to reduce the burden of disease,” she added.

Expanding access to vaccines for rotavirus could save thousands of lives and help avoid numerous hospitalisations, thereby improving the lives of children and families while simultaneously reducing significant burden on the healthcare costs, the report suggested.

GEMS data suggested that accelerating research on vaccines, treatments and diagnostics for the three other leading pathogens – Shigella, Cryptosporidium and ST-ETEC, a type of E. coli – could have a similar impact. Prior to GEMS, Cryptosporidium was not considered a major cause of diarrhoeal disease and consequently, there is currently little research on this pathogen underway.

Across most sites, children with MSD grew significantly less in height in the two months following the diarrhoeal episode. Significantly, 61 per cent of deaths occurred more than one week after the children were diagnosed with MSD, when children may no longer be receiving care and 56 per cent of deaths among cases occurred at home, suggesting that earlier studies focusing only on death occurred in health centres may underestimate the real burden of MSD.

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