Goal is to determine causes and solutions to childhood diarrhea in the poorest countries
The University of Maryland School of Medicine’s Center for Vaccine Development (CVD) has received $27.9 million from the Bill & Melinda Gates Foundation to study diarrheal diseases in young children at locations in Africa and Asia. The goal of the project is to generate information that will lead to the development and dissemination of vaccines and other public health measures in order to prevent illness and death from diarrheal diseases in the world’s poorest countries.
“Diarrheal diseases are the second most common cause of death among young children in developing countries,” says Myron Levine, M.D., D.T.P.H, professor of medicine, microbiology & immunology and pediatrics at the University of Maryland School of Medicine and director of the Center for Vaccine Development. Dr. Levine will serve as coordinating investigator on the multi-year project in collaboration with multiple institutions around the world. “Children die in these countries because of a lack of clean water and proper sanitation and the consumption of contaminated foods. Moreover, the health care infrastructures in the poorest countries typically are not sufficiently developed enough to offer all sick children easy access to care.”
Under the direction of two University of Maryland School of Medicine physicians, Karen Kotloff, M.D., professor of pediatrics and medicine, and James Nataro, M.D., Ph.D., professor of pediatrics and microbiology & immunology, a multidisciplinary team of researchers will investigate the specific agents that cause diarrhea in children in Mozambique, Gambia, Kenya, Mali, India and Bangladesh.
“Diarrhea-related mortality is almost unheard of in the rich world, but is a fact of life for children in the world’s poorest countries. We hope that this research will help lead to more effective tools to fight diarrheal diseases,” says Regina Rabinovich, M.D., director of the Gates Foundation’s infectious diseases program.
According to Dr. Levine, diarrheal diseases are particularly difficult to study because they can be caused by a wide variety of bacterial, viral and protozoal pathogens and sub-types of those pathogens. “Once we know what combination of pathogens is causing diarrhea, we are hopeful that existing vaccines can be introduced in these countries to effectively prevent severe illness or that new vaccines can be created to target these pathogens,” says Dr. Levine.
Previous efforts to study diarrheal diseases in developing countries have produced limited data on their apparent causes, but no study to date has investigated them as extensively and systematically as this new effort. To ensure the quality of the data collected, each site will use the same state-of-the art methodology.
Each of the participating sites will enroll up to 880 children from birth to age five who are suffering from severe diarrhea. Another 880 healthy children without diarrhea will serve as a control group. A parent or guardian for each child will answer a standardized questionnaire about the onset of the illness and its financial implications for the family. Sixty days after enrollment, a field worker will visit the home of each participant to determine the child’s health status, anticipating that certain pathogens may be associated with significant delayed adverse health outcomes. A stool specimen will be collected from each child to identify its specific pathogens. The unique set of pathogens obtained from this global study will be housed in a repository at the University of Maryland School of Medicine’s Center for Vaccine Development for use by investigators in future studies.
“Although diarrheal diseases are recognized to be the second most important killer among children under age five in the poorest developing countries, there is not agreement among scientists and public health practitioners about precisely what pathogens are responsible for this wide range of illnesses,” says Dr. Levine. “It is also not clear whether there are notable geographic differences or differences in urban or rural settings in the distribution of certain pathogens. This study hopes to resolve these controversies.”
As part of the project, economic studies will be conducted to determine the public and private costs of a diarrheal episode, and public perception of the need to prevent diarrheal diseases in children will be assessed.
This latest grant from the Gates Foundation is the third received by the (CVD) at the University of Maryland School of Medicine. In 2000, the CVD received a $20.4 million grant to develop a new type of measles vaccine that could protect infants in developing countries who are too young to receive the current measles vaccine. In 2005, the CVD received another $3.5 million from the Gates Foundation to vaccinate children in Mali, Africa, against a bacterial pathogen that causes fatal meningitis and other serious infections and to monitor the impact of that vaccine.
The research consortium involved in the project represents most of the major players in the world involved in the diagnosis and treatment of diarrheal diseases and vaccine development. Institutions and organizations participating in the project are:
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