A new global study published recently in The Lancet has confirmed rotavirus as a leading cause of diarrhoeal disease in children in India and across the world. With more than one lakh children dying of rotavirus every year in India, this research must catalyse all stakeholders into action to protect children’s health and well-being.
India has experienced impressive improvements in economic status and population health during the past few decades. However, the country still lags behind others in child survival. The mortality rate for children aged five and younger currently stands at 61 per thousand live births. This is higher than many countries of similar per capita gross domestic product.
Diarrhoeal diseases are significant contributors to these high child mortality rates. Despite being largely preventable and treatable, diarrhoeal diseases are the second leading cause of death among children under five years of age globally, following pneumonia. In 2010, experts estimated that almost 17 lakh children less than five years old died in India. In India, Morris et al showed that 18% deaths occurring in young children are due to diarrhoeal diseases.
Diarrhoea is caused by many different bacteria, viruses and other pathogens. The challenge, in the absence of clear data on which pathogens account for the most severe illness and death, has been on how to prioritize resources and research to reduce the burden of diarrhoeal diseases.
The release of new findings from the Global Enteric Multicenter Study (GEMS) reveals critical new information that can help us target our approach and finally reduce this burden. GEMS is the largest and most in-depth study on diarrhoeal diseases to date – conducted in four sites in sub-Saharan Africa and three in South Asia, including Kolkata, India – and provides new insight on the causes and impact of these diseases.
The study found that the incidence of moderate to severe diarrhoea in India was the highest of the seven countries studied. GEMS estimated that there are roughly 90 episodes of moderate to severe diarrhoea among every 100 infants ages 0-11 each year. Rotavirus was the leading cause of illness in children under the age of two in the slums of Kolkata and, on its own, caused an episode of MSD in approximately one of every four infants each year.
To reduce the burden of diarrhoea in India, we will need to deliver a comprehensive package of proven interventions. This includes access to oral rehydration therapy, zinc supplementation, encouraging exclusive breastfeeding for the first six months of a child’s life, and improvements in hygiene, sanitation, and drinking water. Previously published GEMS data found that less than 30 percent of children with diarrhoeal disease who stayed at home received ORS – an affordable and effective treatment for dehydration.
To supplement these interventions, rotavirus vaccines offer significant, targeted hope for protecting children from this terrible disease.
This is where India has an advantage. India’s strong scientific community can innovate new technologies very quickly and our vaccine manufacturers are capable of producing quality vaccines for the world. India has already developed an indigenous rotavirus vaccine. The vaccine, designated 116E, has demonstrated to be safe and immunogenic in Indian infants. Bharat Biotech, based in Hyderabad, with the Department of Biotechnology, was developing this vaccine with Govt. of India in a uniquely designed private-public partnership model. And the results are here to be seen.
India is at a critical juncture. It’s been over two years since our last case of polio, which highlights the success we can have if strong partnerships are formed between multiple stakeholders. However, with diarrhoeal diseases still a major child killer, this is no time to rest. The true legacy of polio eradication in India could fade if the government does not invest in innovations and new vaccines to fight diseases, which cause the maximum number of child deaths in our country. Not only would it provide tremendous social and economic returns, we would be making great strides towards a more equitable country where all children achieve their right to survival, good health and holistic development.
Dr Dipika Sur is Secretary General IPHA and Deputy Director, Sr. Head, Division of Epidemiology, National Institute of Cholera & Enteric Disease