Interventions for the control of diarrhoeal diseases among young children: rotavirus and cholera immunization.

Abstract

The potential effects of rotavirus and cholera immunization (with an improved vaccine) on diarrhea morbidity and mortality among young children are reviewed using data from field studies and theoretical calculations. In developing countries, rotavirus may be responsible for about 6% of all diarrhea episodes and 20% of all diarrhea deaths in children under age 5. In industrial countries, these proportions may be higher. Rotavirus immunization may reduce overall diarrhea morbidity rates by 2-3% and diarrhea mortality rates by 6-10% among children under 5 in developing countries, depending on vaccine efficacy and program coverage. The impact of improved cholera vaccines depends on the prominence of cholera as a cause of diarrhea, and this varies greatly from country to country. Taking the extreme example of Bangladesh, where cholera is endemic and may account for about 0.4% of all diarrhea episodes and 8% of all diarrhea deaths in children under 5 years of age, cholera immunization might reduce overall diarrhea morbidity rates by 0.06-0.13% and diarrhea mortality rates by 1-2% among these children. The similar incidence rates in industrial and developing countries suggest that rotavirus diarrhea may not be controlled by improvements in water supply, sanitation, or hygiene. Control may depend on the widespread use of an effective vaccine. (author's)