title: Vaccines for the prevention of diarrhea due to cholera, shigella, ETEC and rotavirus.
abstract: BACKGROUND
  Diarrhea is a leading cause of mortality in children under 5 years along with its long-term impact on growth and cognitive development. Despite advances in the understanding of diarrheal disorders and management strategies, globally nearly 750,000 children die annually as a consequence of diarrhea.
  
  
  METHODS
  We conducted a systematic review of the efficacy and effectiveness studies. We used a standardized abstraction and grading format and performed meta-analyses for all outcomes. The estimated effect of cholera, shigella, Enterotoxigenic Escherichia coli (ETEC) and rotavirus vaccines was determined by applying the standard Child Health Epidemiology Reference Group (CHERG) rules.
  
  
  RESULTS
  A total of 24 papers were selected and analyzed for all the four vaccines. Based on the evidence, we propose a 74% mortality reduction in rotavirus specific mortality, 52% reduction in cholera incidence due to their respective vaccines. We did not find sufficient evidence and a suitable outcome to project mortality reductions for cholera, ETEC and shigella in children under 5 years.
  
  
  CONCLUSIONS
  Vaccines for rotavirus and cholera have the potential to reduce diarrhea morbidity and mortality burden. But there is no substantial evidence of efficacy for ETEC and shigella vaccines, although several promising vaccine concepts are moving from the development and testing pipeline towards efficacy and Phase 3 trials.
authors.forename: Jai K
authors.initials: JK
authors.lastname: Das
authors.forename: Anjali
authors.initials: A
authors.lastname: Tripathi
authors.forename: Anum
authors.initials: A
authors.lastname: Ali
authors.forename: Amman
authors.initials: A
authors.lastname: Hassan
authors.forename: Chesarahima
authors.initials: C
authors.lastname: Dojosoeandy
authors.forename: Zulfiqar A
authors.initials: ZA
authors.lastname: Bhutta
mesh_terms: D001428:Bacterial Vaccines / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D002771:Cholera / Q000453:epidemiology / Q000517:prevention & control*; D022121:Cholera Vaccines / Q000627:therapeutic use; D015897:Comorbidity; D003967:Diarrhea / Q000453:epidemiology / Q000517:prevention & control*; D004403:Dysentery / Q000453:epidemiology / Q000517:prevention & control*; D004405:Dysentery, Bacillary / Q000453:epidemiology / Q000517:prevention & control; D004927:Escherichia coli Infections / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D007115:Immunization Schedule; D007223:Infant; D008297:Male; D012400:Rotavirus Infections / Q000453:epidemiology / Q000517:prevention & control*; D022281:Shigella Vaccines / Q000627:therapeutic use; D014765:Viral Vaccines / Q000627:therapeutic use*
chemical_list: D001428:Bacterial Vaccines; D022121:Cholera Vaccines; D022281:Shigella Vaccines; D014765:Viral Vaccines