Severe Diarrhea in Young Children - Essay Example

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The leading cause of severe diarrhea in young children under the age of five all over the world is rotavirus. It kills nearly 500,000 children annually in the developing countries, accounts for over 50,000 hospitalizations, and an estimated 50 deaths in the United States each year (Clark, 2009). The symptoms of rotavirus include frequent watery diarrhea, fever, vomiting and abdominal cramps. Kids may also have a running nose and cough. Universal vaccination recommended by the World Health Organization is the single most effective way of preventing and controlling rotavirus incidences. Oral rotaviruses vaccines are used broadly in the world, and many countries have introduced these vaccines in their public immunization programs and in private markets. Because of rotavirus vaccine introduction, the countries have realized indirect economic and health benefits as there are less diarrhea-related deaths and reduced hospitalization due to rotavirus disease.

Despite the reduction in diseases and deaths related to rotavirus, the vaccines have overall lower estimated efficacy in developing countries as compared to developed countries. Gruber et al. note that the Rotavirus Efficacy and Safety Trial which was conducted in developed and developing countries showed a disparity for RV5 vaccine used to treat severe rotavirus gastroenteritis (RVGE) (2017). The vaccine efficacy disparity in both developed and developing counties showed similarity to cholera, polio virus, and typhoid live oral vaccines and there are no apparent clinical or demographic characteristics responsible for this disparity in young children.

The study was conducted in five developing countries namely Kenya, Mali, Ghana, Bangladesh, and Vietnam. The lower efficacies for the first dose of rotavirus vaccines in African countries were attributed to the high levels of anti-rotavirus antibodies circulating in the bodies of adults living in developing countries. This trend is because anti-rotavirus immunoglobulin G antibodies circulating in the bodies of adults can cross the placenta and interfere with the response of the rotavirus vaccines. Another heterogeneity is seen based on gender and region. For instance, there is a lower efficacy in males as compared to females in African countries while Bangladesh and Vietnam indicate lower efficacy in females as compared to males.

Despite the effectiveness of rotavirus vaccines after introduction, there are cases of reported hospitalization for rotavirus-associated gastroenteritis all over the world. Sederdahl et al. observe that the United States has lagged behind in other infant vaccines but had a 72 percent rotavirus vaccinations in 2015 (2017). The burden of rotavirus diseases is contributed by missed opportunities for the reduction of the disease where children were vaccinated against Diphtheria-Tetanus Toxoidsacellular Pertussis (DTaP) within the window for the initiation of rotavirus vaccine but were not vaccinated. Because of this, most of the children tested for rotavirus were not vaccinated, but a small percentage experienced failed rotavirus vaccine (Sederdahl et al., 2017). To reduce the rotavirus burden, there should be an improved link between rotavirus vaccine and DTaP administration.

The United States has experienced an increase in the number of children vaccinated since 2011. This increase in rotavirus vaccines does not only improve the protection of children and adults indirectly but also is instrumental in the reduction of rotavirus disease burden. The causes of low rotavirus vaccine administration in the United States should be identified as this may prove crucial in reducing rotavirus prevalence. Sederdahl et al. observe that provider attitudes and practices may be some of the contributing factors to rotavirus vaccination failure as well as the difference in care received by a pediatrician as compared to a family practitioner-administered vaccines (2017). Provider attitudes should, therefore, be addressed so that rotavirus vaccination may be improved.

Rotavirus causes more deaths in developing countries, and hence international agencies such as the World Health Organization have prioritized rotavirus vaccines in these regions. For instance, the clinical trials of RotaTeq and Rotarix, which are two new live oral attenuated rotavirus vaccines in the middle and high income earning countries in Europe, demonstrated over 85 percent efficacy against rotavirus disease. In developing countries, the RV5 vaccine was associated with 45-49 percent reduction to rotavirus diarrhea in children aged two years and below (Patel et al., 2013). Despite infections repeat in young children, RV5 is more efficient with the increase in the severity of the rotavirus disease. In Nicaragua, the vaccine reduced hospitalization by approximately 50 percent unlike 84 percent and 96 percent admission reduction rates in Finland and the United States respectively (Patel et al., 2013).

Because of the lower rotavirus vaccine performance in Nicaragua as compared to developed countries, Patel et al. suggest a further monitoring of the vaccine regarding access to the vaccine and circulating strains in children between two and three years (2013). Furthermore, it was unclear whether the poor average reduction rates of the vaccine would apply to other developing countries in the world and ongoing studies in Africa and Asia would be instrumental in accessing the performance of the vaccine.

Two rotavirus vaccines have been licensed in the United States: a pentavalent human-bovine reassortant vaccine and an attenuated human rotavirus vaccine and were both effective in clinical trials. Pentavalent rotavirus vaccine is administered in three doses at two, four, and six months and should not be administered to children above 32 months because such children are prone to intussusception. Clark et al. argue that since the introduction of the vaccine, there has been a dramatic and abrupt decline in rotavirus gastroenteritis occurrence between the 2005-2006 and 2007-2008 seasons because of the increased uptake of pentavalent rotavirus vaccine (2009).

According to Clark et al., since the introduction of the pentavalent rotavirus vaccine, herd immunity may has contributed to the effectiveness of the vaccine because the protection rates exceeded the rates of vaccination (2009). The number of children susceptible to rotavirus also decreased as herd immunity might be responsible for the reduced cases of unvaccinated children as they had surpassed the vaccination age.

Primary avian cells are the source of many vaccines for diseases such as measles, mumps, and yellow fever. Vaccine products are usually tested for the possible presence of avian retroviruses as a safety-testing regimen despite avian cells being free from pathogens. The methods used include infectivity culture method and a complement fixation test for avian leucosis (COFAL) but have given inconsistent results and high invalid test rates. Additionally, these methods rely on reagents that are hard to secure and have demonstrated readouts that brings challenges during standardization. For instance, the detection of reverse transcriptase (RT) which indicates the presence of retroviruses, shows the need for effective testing methods.

Birmingham et al. argue that new methods such as DF-1 amplification plus immunostaining method and DF-1 amplification plus F-PERT method are effective in the detection of the presence of avian retroviruses (2013). For instance, DF-1 amplification plus immunostaining method can detect avian leukosis virus (ALV) 6 days after inoculation and provides higher sensitivity levels than those required by authorities. Similarly, DF-1 amplification plus F-PERT method can detect avian retroviruses outside the ALV family hence meets the avian retroviral contaminant safety testing regulatory requirements for the development and production of vaccines. It is, therefore, a suitable stand-alone test that produces vaccines free from avian retroviruses infection.


Birmingham, C. L.; Dupont, D.; Riou, P.; Armanet, C.; Edamura, K. N.; Martinho, B.; Serres, A.; Jacouton, S.; Detrez, V.; Mcneil, B.; Schreiber, M.; Gaillac, D.; Bonnevay, T.; Gisonni-Lex, L.; Mallet, L. Journal of Clinical Microbiology 2013, 51 (5), 14961504.

This journal mainly looks at the detection of the Avian retrovirus by the amplification of the DF-1 cells. It elaborates the new methods of detection of the avian retroviruses that are more effective and efficient as compared to the earlier methods that took long, provided inconsistent results, and high invalid test rates.

Clark, H. F.; Lawley, D.; Mallette, L. A.; Dinubile, M. J.; Hodinka, R. L. Clinical and Vaccine Immunology 2009, 16 (3), 382386.

This article looks at the rate of administration of vaccine among children in the defined population. The article helps to give the effectiveness of the vaccine among the children in the United States. It accounts for the sudden decline of rotavirus gastroenteritis cases after the introduction and increased uptake of the vaccine.

Gruber, J. F.; Hille, D. A.; Liu, G. F.; Kaplan, S. S.; Nelson, M.; Goveia, M. G.; Mast, T. C. The Pediatric Infectious Disease Journal 2017, 36 (1), 7278.

This journal article exemplifies that rotaviruses significantly affect children by causing diarrheal conditions. It indicates that the surest way of preventing retroviral infection is the use of universal vaccination. It also highlights the rotavirus vaccine efficacy in both developed and developing countries. This study investigates the heterogeneity of rotavirus vaccine basing this on the characteristics of infants in developing countries, which is one of its strong areas.

Patel, M. et al. Jama 2009, 301 (21), 2243.

This journal article elaborates the association that occurs between the pentavalent retroviral vaccines and the attenuated oral vaccines. Diarrhea is the common symptom of the according to the research. Furthermore, it highlights the efficiency of RV5 vaccine as the disease becomes severe. The strength of this article is the elaborate discussion on lower rotavirus vaccine performance in Nicaragua as compared to developed countries such as Finland and United States.

Sederdahl, B. K.; Yi, J.; Jerris, R.; Gillespie, S. E.; Westblade, L.; Kraft, C. S.; Shane, A. L.; Lopman, B.; Anderson, E. J. The Pediatric Infectious Disease Journal 2017, 36 (8), 780781.

This journal gives an elaborate explanation of the burden of retroviruses among

unvaccinated children in the united states because some children missed the opportunity for

vaccination. The study identifies some of the reasons why many children in the United States are

not vaccinated and suggests how to bridge the gap as this may prove crucial in

reducing the prevalence of the disease. It elaborates that vaccination is an essential step in the

protection of the infants and the children against diarrhea.



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