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This article is part of the supplement: The Lives Saved Tool in 2013: new capabilities and applications

Open Access Review

Vaccines for the prevention of diarrhea due to cholera, shigella, ETEC and rotavirus

Jai K Das1, Anjali Tripathi2, Anum Ali1, Amman Hassan1, Chesarahima Dojosoeandy2 and Zulfiqar A Bhutta12*

Author Affiliations

1 Division of Women & Child Health, The Aga Khan University, Karachi, Pakistan

2 Global Child Health and Policy, Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada

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BMC Public Health 2013, 13(Suppl 3):S11  doi:10.1186/1471-2458-13-S3-S11

Published: 17 September 2013

Abstract

Background

Diarrhea is a leading cause of mortality in children under 5 years along with its long-term impact on growth and cognitive development. Despite advances in the understanding of diarrheal disorders and management strategies, globally nearly 750,000 children die annually as a consequence of diarrhea.

Methods

We conducted a systematic review of the efficacy and effectiveness studies. We used a standardized abstraction and grading format and performed meta-analyses for all outcomes. The estimated effect of cholera, shigella, Enterotoxigenic Escherichia coli (ETEC) and rotavirus vaccines was determined by applying the standard Child Health Epidemiology Reference Group (CHERG) rules.

Results

A total of 24 papers were selected and analyzed for all the four vaccines. Based on the evidence, we propose a 74% mortality reduction in rotavirus specific mortality, 52% reduction in cholera incidence due to their respective vaccines. We did not find sufficient evidence and a suitable outcome to project mortality reductions for cholera, ETEC and shigella in children under 5 years.

Conclusion

Vaccines for rotavirus and cholera have the potential to reduce diarrhea morbidity and mortality burden. But there is no substantial evidence of efficacy for ETEC and shigella vaccines, although several promising vaccine concepts are moving from the development and testing pipeline towards efficacy and Phase 3 trials.