Diarrheal Disease

Diarrheal Disease Kills Almost 2 Million Children a Year

The Global Burden of Diarrheal Disease

Diarrheal diseases are the major cause of childhood hospitalization, primarily for dehydration. Each year in developing countries, roughly four billion episodes of acute diarrhea, or approximately 3.2 episodes per child, occur among children under five years of age.

Diarrheal episodes can be either acute or persistent (lasting two weeks or more). Of all childhood infectious diseases, diarrheal diseases are thought to have the greatest effect on growth, by reducing appetite, altering feeding patterns, and decreasing absorption of nutrients. The number of diarrheal episodes in the first two years of life has been shown not only to affect growth but also fitness, cognitive function, and school performance.

Preventing exposure to the diarrheal-causing pathogens is the ideal way to reduce disease burden.  This requires massive improvement in both sanitation and nutritional status in developing countries.  Immunization with pathogen-specific vaccines would be the other cost-effective approach, and efforts towards developing suitable enteric vaccines for pediatric use are current underway.

OneWorld Health’s Response

The Institute for OneWorld Health is committed to becoming a thought leader and change agent in the area of diarrheal disease control, in partnership with stakeholders and experts in the field.  We have conducted an extensive landscape analysis on the needs and gaps in the field, and have begun to engage researchers, policy experts, funding organizations, and bio/pharma companies to better understand the scope of the diseases.  In collaboration with the global community, iOWH aims to develop safe, effective, and affordable medicines for diarrheal diseases,  that complement existing standard-of-care interventions such as Oral Rehydration Therapy (ORT) and zinc. 

In 2006, iOWH received a grant from the Bill & Melinda Gates Foundation to develop novel anti-secretory drugs to be used as an adjunct to ORT that will safely reduce stool output and shorten duration of diarrheal episodes.  As part of this grant, iOWH assembled both a technical advisory committee (D-TAC) to provide guidance on drug development strategy, and a strategic advisory board (D-SAB) to provide strategic guidance on the critical needs for diarrhea treatment.  Under their guidance, iOWH has identified a number of significant treatment gaps to target in the areas of acute watery diarrhea (AWD), dysentery (bloody diarrhea), and persistent diarrhea.  Our vision of a Diarrhea Disease product portfolio is shown in Figure 1.

Figure 1: iOWH’s vision of a Diarrhea Disease Development Portfolio

In the near term, AWD will be a primary focus.

In the medium term, iOWH plans to address a significant unmet medical need  in shigellosis.  It is apparent that the pathogen has developed resistance to several relatively new antibiotic classes due to widespread and inappropriate antibiotic usage.  We aim to identify and pursue novel drug strategies to create new tools that can allow clinical management to stay ahead of the resistance threat.

In the longer term, iOWH will identify treatment opportunities for persistent diarrhea and seek to understand the intersection of enteric infections with malnutrition and gut inflammation.

As development of new products progresses, iOWH aims to expand our network of partners and to foster mutual relationships that will further the goal of reducing DD mortality and morbidity.