Abstract
BackgroundDiarrhea 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.MethodsWe 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.ResultsA 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.ConclusionVaccines 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.
Highlights
Diarrhea is the leading cause of mortality in children under 5 years along with its long-term impact on growth and cognitive development
Greater than two folds rise in the vibriocidal antibody titres was reported by seven studies and it showed a significant increase (RR of 2.24, 95% confidence intervals (CI): 1.32, 3.80)
Sub group analysis showed that killed oral vaccines were associated with a non-significant rise in vibriocidal antibody titres (RR: 0.97, 95% CI: 0.75, 1.25), while live oral vaccines were associated with a significant rise (RR: 10.73, 95% CI: 1.94, 59.33)
Summary
Diarrhea is the 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 0.75 million children die annually as a consequence of diarrhea [1]. Oral Cholera Vaccines (OCV) are good candidates for the control of cholera in endemic areas. The potential for use of cholera vaccines is immense in public health, especially due to its herd immunity effect and recent research indicates that with this herd protection, even moderate coverage levels of targeted populations with killed OCVs may result in virtually complete control of cholera [7,8]. Despite advances in the understanding of diarrheal disorders and management strategies, globally nearly 750,000 children die annually as a consequence of diarrhea
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