The introduction of rotavirus vaccine in Bangladesh: sooner or later?

Bangladesh has been planning to introduce the rotavirus vaccine for quite a long time. But it does not seem to be very fast. Children are getting sick from rotavirus diarrhea despite an effective vaccine is in the market and there are mechanisms for funding a national immunization program.

In early 2016, thousands of children got access to rotavirus vaccines in India with the start of a national introduction that marks Asia’s largest to date. But over 90 million children around the world still lack access. Despite the fact that it can be prevented and treated, diarrhea continues to take its devastating toll on children around the world. It is a leading cause of child death and is responsible for hospitalizing millions of children, especially for countries like Bangladesh where poor water, sanitation, and hygiene contribute to the fact to some added folds.

Rotavirus, the most common cause of severe and deadly diarrhea, claims the lives of more than 200,000 children each year and hospitalizes hundreds of thousands more. This one virus is responsible for nearly 40 percent of all diarrhea hospitalizations.

A recent multi-country study showed that children who developed moderate to severe diarrhea had eight-and-a-half times higher risk of dying in the subsequent two months compared to children who did not suffer from diarrhea.

While improvements in hygiene, sanitation and drinking water are important to prevent diarrhea in general, they cannot stop the spread of rotavirus. That is why preventing rotavirus infections is essential. And vaccination is the best tool available today to protect children from rotavirus.

Rotavirus is one of the several viruses known to cause self-limited gastroenteritis, better known as diarrhea. Fluid stool losses may be dramatic, and death from dehydration is not uncommon, particularly in developing countries like Bangladesh.

More than 80 percent of children get infected by 5 years of age. Around 40 percent of the diarrheas in the world are due to rotavirus. In 2013, rotavirus killed 215,000 young children worldwide.

There are dramatic reductions of diarrhoeal deaths among children under five, through providing oral rehydration solution (ORS), increasing access to clinical facilities, and improving water and sanitation programs. However, too many children still suffer growth and cognitive impairments from serious and repeated diarrhoeal diseases.

Under the Comprehensive Multi-Year Plan of the National Immunisation Programme of Bangladesh 2011-2016, it had aimed for the introduction of Rotavirus vaccine by the end of 2014 but it has not till date. Further, according to the hospital-based surveillance study carried out from 2000 to 2006 in Bangladesh revealed 33% of all diarrhea admissions among children less than 5 years were due to Rotavirus. 56% of the reported rotavirus positive cases were less than 1 year. Based on that they have estimated that population-based incident rates of rotavirus ranged from 10.8 to 19.6/1000 children less than 5 years of age.

But when the country is going to introduce the vaccine in its national immunization scheme? We interviewed an eminent scientist working at the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b).

 
Dr. Shams El Arifeen, Senior Director and Senior Scientist at icddr,b recently shared his view about the introduction of rotavirus vaccine in Bangladesh.

He told that rotavirus diarrhea is very common under two years of age and a major cause of hospitalization in that age group. Since overall diarrhea-related mortality has gone down in general, children no longer die of diarrhea in large numbers – in that sense rotavirus is not a major killer in Bangladesh as is seen in many other countries but it is still a major cause of hospitalization.

Although it is taking some time, the process of introduction of rotavirus vaccine in Bangladesh for the public system has been started.

He is hopeful that the government is convinced about the introduction of vaccine by now – it may not prevent the mortality but it can save many hospitalizations and can save a lot of money.

Dr. Shams is very hopeful about lowering the price by negotiating with the companies. A large number of birth of children in Bangladesh every year is fair enough to convince them for a reduced price. Moreover, if we could make a coalition with the neighboring countries in the Saarc region, the job would be much easier.

Finally, he suggested that rotavirus diarrhea is not something that could be prevented only by hygiene practice. The effective preventive tool is vaccination.

Rotavirus vaccines seem to be effective in preventing death in infants and children

Tareq Salahuddin

Dr. Tareq Salahuddin is an award-winning journalist and a Special Correspondent of News Hour. He is a Public Health Professional working in the development sector. Dr. Tareq, a medical graduate, is a member of Public Health Association of Bangladesh and a former member of the Governing Council and Policy Committee of the World Federation of Public Health Associations (WFPHA), a J2J Fellow on HIV/AIDS and a member of the International AIDS Society. To know more about Dr. Tareq, please visit his personal website (www.tareqsalahuddin.net) or simply Google his name.
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