The global problem of childhood diarrhoeal diseases: emerging strategies in prevention and management

Abstract

Acute diarrhoeal diseases remain a leading cause of global morbidity and mortality particularly among young children in resource-limited countries. Recent large studies utilizing case-control design, prospective sampling and more sensitive and broad diagnostic techniques have shed light on particular pathogens of importance and highlighted the previously under recognized impact of these infections on post-acute illness mortality and growth. Vaccination, particularly against rotavirus, has emerged as a key effective means of preventing significant morbidity and mortality from childhood diarrhoeal disease. Other candidate vaccines against leading diarrhoeal pathogens, such as enterotoxigenic and spp., also hold significant promise in further ameliorating the burden of enteric infections in children. Large studies are also currently underway evaluating novel and potential easy-to-implement water, sanitation and hygiene (WASH) preventive strategies. Given the ongoing global burden of this illness, the paucity of new advances in case management over the last several decades remains a challenge. The increasing recognition of post-acute illness mortality and growth impairment has highlighted the need for interventions that go beyond management of dehydration and electrolyte disturbances. The few trials of novel promising interventions such as probiotics have mainly been conducted in high-income settings. Trials of antimicrobials have also been primarily conducted in high-income settings or in travellers from high-income settings. Bloody diarrhoea has been shown to be a poor marker of potentially treatable bacterial enteritis, and rising antimicrobial resistance has also made empiric antimicrobial therapy more challenging in many settings. Novel effective and sustainable interventions and diagnostic strategies are clearly needed to help improve case management. Diarrhoeal disease and other enteric infections remain an unmet challenge in global child health. Most promising recent developments have been focused around preventive measures, in particular vaccination. Further advances in prevention and case management including the possible use of targeted antimicrobial treatment are also required to fully address this critical burden on child health and human potential.

A New Phage Cocktail Against Multidrug, ESBL-Producer Isolates of Shigella sonnei and Shigella flexneri with Highly Efficient Bacteriolytic Activity

“…2 Due to two serious risk factors, the easy fecal/oral transmission of Shigella (direct contact with the infected individuals or consuming contaminated foods and water) and the low infectious dose (<200 bacteria), several outbreaks have been reported all over the world. 2,3 The rapid spreading of antibiotic-resistant phenotypes among microorganisms is a global critical health issue as a consequence of abuse, inappropriate, and extensive use of antimicrobial agents against bacteria. 4 In 2013, the Centers for Disease Control and Prevention announced that human being stands in the postantibiotic era, 5 however, just a few periods and decrease the chance of successful treatment.…”

Overview of acute diarrheal disease at the dawn of the 21st century: The case of Mexico

“…As reported by the literature, the factors that have contributed to the decrease in DD mortality in Mexico have been, mainly, the distribution and widespread use of ORS; the program Piso firme; 15,29 the increase of exclusive breastfeeding; an improvement in nutrition, sanitation, and hygiene conditions; vaccination against rotavirus and measles; and Zinc supplementation. 5,30,31 Our data suggest an important increase in emergency health services utilization, in concordance with official norms and programs launched by state and federal health authorities, 32,33 as well as an important decrease in the DD mortality rate in the emergency services.…”

Compliance with 14 day zinc therapy for acute diarrhoea: a prospective observational study

“…Acute diarrheal diseases remain a leading cause of global morbidity and mortality particularly among young children in resource-limited countries. 1 In 2016, diarrhea was the fifth leading cause of death among children younger than 5 years and rotavirus was the leading etiological agent. 2 Acute diarrhea is one of the leading causes of childhood deaths despite the use of oral rehydration therapy (ORT).…”

“…2 Acute diarrhea is one of the leading causes of childhood deaths despite the use of oral rehydration therapy (ORT). 1 On 8 May 2004, the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) recommended routine administration of zinc in the management of children, aged less than five years, with acute diarrhoea. 3 In making the recommendation, WHO and UNICEF also suggested careful monitoring for adverse events associated with the routine administration of zinc, particularly unusual or excess vomiting.…”