Diarrhea & Enteric Diseases Overview

Enteric and diarrheal diseases include infectious diarrhea and non-diarrheal enteric diseases such as typhoid (Salmonella typhi, Salmonella paratyphi), hepatitis A and E, geoheminths (worms), and a host of other viral, bacterial, and parasitic pathogens.

The opportunity to prevent and treat enteric and diarrheal diseases is greater than ever.

Today there are established, low-cost interventions such as oral rehydration therapy, breastfeeding, good hygiene, and new tools such as zinc therapy. Most promisingly, there are now safe and effective vaccines for rotavirus, cholera, and typhoid.

However, diarrhea still disables and kills millions of children.

• Diarrheal diseases kill nearly 1.7 million children annually and cause the hospitalization of millions.
• Repeated bouts of diarrhea and persistent diarrheal disease—typically 2 to 10 episodes of diarrhea annually per child—radically impairs gut function, which is the single greatest contributor to childhood malnutrition and growth retardation.

There is a need to improve and deliver existing drugs, diagnostics, and vaccines.

Despite the proven effectiveness of existing prevention and treatment approaches, some approaches have limitations and many are not delivered to those in need. For example, existing vaccines for rotavirus, cholera, and typhoid could address approximately 25 percent of child deaths due to enteric and diarrheal diseases; however these vaccines remain too costly for many countries to deliver.

A better understanding of diarrhea is needed to inform the development of improved tools and treatments.

Malnutrition and diarrheal diseases are linked in a complex, vicious cycle, as undernutrition contributes to the severity of diarrheal diseases, and diarrheal infections affect the body’s capacity to absorb nutrients. However, the mechanisms underlying these relationships are poorly understood, which impedes the development of new and more effective vaccines and treatments. Additionally, the unavailability of diagnostic tools prevents the determination of the cause of many cases of diarrhea. Improved diagnosis are needed to help health care providers prescribe more effective treatments.

We aim to develop and deliver innovative tools and approaches to help prevent, diagnose, and treat enteric and diarrheal diseases around the world.

Next: Our Approach

We’re supporting the following strategies in the prevention and treatment of enteric and diarrheal diseases:

Conduct research to identify the causes and progress of diarrheal diseases.

We’re funding studies in several developing countries to analyze where diarrheal diseases come from and to what extent they infect the population. This research helps our efforts to develop the appropriate vaccines and treatments for each disease.

Develop innovative vaccines.

Existing vaccines for rotavirus, cholera, and typhoid could address approximately 25 percent of child deaths due to enteric and diarrheal diseases. To ensure access to such vaccines in the developing world, we’re funding efforts by manufacturers in endemic countries to develop low-cost versions of these vaccines. We’re also supporting the development of new vaccines against Escherichia coli (ETEC) and Shigella.

Research diarrhea biomarkers and host mechanisms.

Biomarkers are elements in the body that can be detected and measured to detect disease (for example, measuring body temperature for fever). We’re funding studies to identify biomarkers for diarrheal-related conditions, which will help the development of new vaccines and better nutritional and drug treatments. We’re also funding a number of studies to improve and increase the availability of diagnostics for acute diarrhea, which will help to improve drug selection and reduce antibiotic resistance.

Treat diarrheal diseases with new, more effective therapies.

We’re supporting efforts to deliver oral rehydration therapy (ORT) —one of the most effective treatments for diarrhea—in combination with zinc to decrease the length of time children suffer from diarrhea. We’re also investing in the development of additional safe, effective, and affordable therapies to that would reduce the impact and shorten the duration of diarrhea.

Promote effective nutritional practices.

Poor nutrition contributes to enteric and diaherreal diseases and the reverse is also true. We’re working toward developing and delivering a set of proven interventions to ensure adequate nutrition of infants and young children. These include exclusive breastfeeding for the first six months of life; the addition of nutrient-dense complementary foods beginning at age six months; and the use of proper feeding practices, such as immediate and continued breastfeeding for 24 months. Additional details about this work are included in our Nutrition strategy.

Improve water, sanitation, and hygiene

Enteric and diarrheal diseases thrive where people don’t have safe water, adequate sanitation facilities, or effective handwashing routines. Through our Global Development Program, we work with partners around the world to provide improved water, sanitation, and hygiene services and technologies.