Findings published
in The Lancet can guide prevention, treatment and research on diarrheal
diseases, which claim the lives of 800,000 children annually
KARACHI, 14 May 2013 – A new international study published
today in The Lancet provides the clearest picture yet of the impact and
most common causes of diarrheal diseases, the second leading killer of young
children globally, after pneumonia. The Global Enteric Multicenter Study (GEMS)
is the largest study ever conducted on diarrheal diseases in developing
countries, enrolling more than 20,000 children from seven sites across Asia and
Africa.
GEMS, coordinated by the University of Maryland School of
Medicine’s Center for Vaccine Development, confirmed rotavirus as the leading
cause of diarrheal diseases among infants and identified other top causes for
which additional research is urgently needed. GEMS found that approximately one
in five children under the age of two suffer from moderate-to-severe diarrhea
(MSD) each year, which increased children’s risk of death 8.5-fold and led to stunted
growth over a two-month follow-up period.
“When it comes to childhood morbidity and mortality,
diarrheal diseases remain a leading culprit.” said Dr. Anita Zaidi from the Aga
Khan University, who served as Principal Investigator at the Pakistan study
site. “The GEMS data are the most conclusive evidence we have to date on which
pathogens we must target and suggest ways to improve prevention and treatment.”
Despite many causes, GEMS found that targeting just four
pathogens – rotavirus, Shigella, Cryptosporidium,
and ST-ETEC – could prevent the majority of MSD cases. Expanding access to
existing tools targeting these pathogens and accelerating research on new
treatments, diagnostics and vaccines to help control them could save thousands
of lives. Prior to GEMS, Cryptosporidium was not considered a major
cause of diarrheal disease and as a result there is currently little research
on this pathogen underway.
“The GEMS findings help set priorities for investments that
could greatly reduce the burden of childhood diarrheal diseases,” said Dr.
Thomas Brewer, deputy director of the Enteric & Diarrheal Diseases team at
the Bill & Melinda Gates Foundation, which funded the study. “Vaccines and
treatments available today can save thousands of children right now but
targeted research to develop new tools to combat severe diarrhea could save
many more lives in the future.”
The GEMS findings also suggest that longer-term monitoring
and care of children with diarrheal diseases could reduce mortality and nutritional
deficits. Children with MSD grew significantly less in height in the two months
following the diarrheal episode when compared with control children without
diarrhea, and were 8.5 times more likely to die over the course of the
two-month follow-up period. Notably, 61 percent of deaths occurred more than a
week after the initial diarrheal episode, with 56 percent of deaths happening
after families had returned home from a healthcare facility.
The GEMS study in Pakistan was conducted in coastal villages
near Karachi by the Aga Khan University. Similar to other sites, rotavirus, Shigella, Cryptosporidium and ST-ETEC
were leading causes of diarrheal disease. Uniquely in the Pakistan and
Bangladesh sites, Aeromonas, another
type of bacteria, was the second leading cause of MSD, confirming its regional
importance as a pathogen. Linear growth delays were significant among children
ages 1-5 years old in Pakistan, and a single episode of MSD increased
children’s risk of death more than thirteen-fold.
“GEMS strongly indicates that follow-up care after the
initial diarrheal episode is critical to protect the health and wellbeing of
children,”said Professor George Griffin, Senior Co-Chair of the GEMS
International Strategic Advisory Committee and Professor at St. George’s,
University of London. “By focusing only on the acute diarrhea that brings
children to hospitals, we overlook a significant portion of diarrheal diseases’
burden.”
Expanding access to existing interventions that protect
against or treat all diarrheal diseases, including oral rehydration solutions,
zinc supplements, clean water and sanitation, can save lives and improve the
health of children immediately.
“GEMS is a landmark study for the child health community,”
said Professor Fred Binka, Co-Chair of the GEMS International Strategic Advisory
Committee and Vice-Chancellor at the University of Health and Allied Sciences,
Ghana. “By using consistent methods across countries, GEMS sites generated data
that can guide evidence-based decision making at both the local and global
levels.”
Release of the GEMS findings follows last month’s
announcement by the World Health Organization and UNICEF of the first-ever
Integrated Global Action Plan for the Prevention and Control of Pneumonia and
Diarrhea (GAPPD). The GEMS findings add to the scientific evidence cited in the
GAPPD strategy for effectively controlling pneumonia and diarrhea, which
together are the two leading causes of death among young children globally.
###
About GEMS
GEMS, coordinated by the University of Maryland School
of Medicine’s Center for Vaccine Development, was a case control study
conducted at seven diverse, high-burden sites in Asia and Africa: The Gambia,
Kenya, Mali, Mozambique, Bangladesh, India and Pakistan. The study enrolled
22,568 children under five years of age, a sample size that is large enough to
provide comprehensive data on the causes, incidence and impact of the range of
diarrheal diseases affecting children around the world.
GEMS established a network of well-equipped laboratories in
the study countries that can be used to accelerate future research on diarrhea
and other child health priorities. Investigators have provided open access to
their data, which can provide baselines for further studies. Supplemental
materials on GEMS methods and sub-studies can be found in Clinical
Infectious Diseases (volume 55, supplement 4, and December 2012) and
the American Journal of Tropical Medicine and
Hygiene. Additional analyses of GEMS data are ongoing.
For further information, please visithttp://www.aku.edu/gems or http://medschool.umaryland.edu/GEMS/.
About the Center for Vaccine Development
The
Center for Vaccine Development (CVD) at the University of Maryland School of
Medicine in Baltimore has earned an international reputation as an academic
vaccine development enterprise. Since its inception in 1974, the Center is
known for creating and testing vaccines against cholera, typhoid fever,
paratyphoid fever, non-typhoidal Salmonella disease, shigellosis (bacillary
dysentery), Escherichia coli diarrhea, malaria, and other infectious
diseases, including influenza. Its global staff includes molecular
biologists, microbiologists, immunologists, internists, pediatricians,
epidemiologists, malariologists, biostatisticians and informaticians. The CVD
is engaged in the full range of vaccinology, from basic laboratory science
research through vaccine development, early clinical evaluation, large-scale
pre-licensure field studies and post-licensure assessments. In addition to its
research and outpatient facilities in Baltimore ,
Maryland , the CVD has facilities to conduct
clinical studies in Mali , West Africa , Malawi ,
Southern Africa and Santiago , Chile and undertakes time-limited field studies
in many other countries in Africa, Asia and Latin America .
Media Contacts
Rachel Sam
Global Health Strategies
+1 212 929 7888 ext. 45
+1 617 899 9932
rsam@globalhealthstrategies.com
Fabeha Pervez
Aga Khan University
+92 21 3486 2925
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