Priority Medicines for Europe and the World 2013 Update. Background Paper 6 - Priority Diseases and Reasons for Inclusion. BP 6.20 - Diarrhoea
(2013; 62 pages)


In 2004, the Priority Medicines for Europe and the World report was written by Warren Kaplan and Richard Laing and published by the World Health Organization (WHO). This chapter (6.20) and background paper on diarrhoea are newly added to the 2013 update report, since diarrhoeal burden of disease is one of the highest globally.

Although diarrhoea is a preventable disease, it remains the second leading cause of death (after pneumonia) among children aged under five years worldwide. It is estimated that in 2010, diarrhoeal diseases accounted for 60.1 million disability-adjusted life years (DALYs) and for 666 000 deaths among children aged under five years - down from 70.6 million DALYs and 782 000 deaths in 2005. The risk factors for diarrhoeal diseases include childhood underweight, suboptimal breastfeeding, unsafe drinking water and sanitation, vitamin A deficiency, and zinc deficiency. At highest risk of diarrhoeal diseases are the poorest and most vulnerable children in communities lacking basic human needs such as safe drinking water, adequate sanitation, and optimal nutrition. Around 50% of deaths among children under five occur in sub-Saharan Africa and 40% in South Asia...

From the perspective of the cost-effectiveness of interventions to improve water and sanitation compared with vaccination in endemic areas, the environmental interventions should be prioritized for investment. Access to existing treatment is also highly cost-effective. However, vaccines can greatly reduce the burden of disease and appear to be very effective in areas where access to safe water and sanitation cannot be guaranteed. There are no vaccines available to protect against several pathogens, such as Shigella and ETEC, and more research is needed to develop new vaccines against these pathogens. The development of affordable and easy-to-use diagnostic tools would change the treatment protocol and enable health care workers to provide pathogen-specific treatment...

There are a number of promising vaccine candidates against rotavirus, Shigella and ETEC, including some in Phase II clinical trials. Meanwhile, candidate vaccines against Campylobacter are currently in the preclinical phase. The need for further research on rotavirus vaccines largely depends on the outcome of current vaccines in terms of their efficacy in endemic regions and their ability to provide cross-protection against a range of rotavirus strains. There are currently fewer medicines in the pipeline, compared with vaccines.

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