TY - JOUR
T1 - Considerations for using ETEC and Shigella disease burden estimates to guide vaccine development strategy
AU - Hosangadi, Divya
AU - Smith, Peter G.
AU - Giersing, Birgitte K.
N1 - Funding Information:
This work was supported by the Bill & Melinda Gates Foundation ( OPP1135836 ). The views, findings, and conclusions contained within are those of the authors and should not be construed to represent the positions or policies of the Bill & Melinda Gates Foundation or the World Health Organization .
Publisher Copyright:
© 2017 The Author(s)
PY - 2019/11/28
Y1 - 2019/11/28
N2 - Enterotoxigenic E. coli (ETEC) and Shigella are enteropathogens causing significant global morbidity and mortality, particularly in low-income countries. No licensed vaccine exists for either pathogen, but candidates are in development, with the most advanced candidates potentially approaching pivotal efficacy testing within the next few years. A positive policy recommendation for introduction of any vaccine, following licensure, depends on evidence of vaccine cost-effectiveness and impact on morbidity and mortality. The mortality estimates for these two pathogens have fluctuated over recent years, which has led to uncertainty in the assessment of their relative public health importance for use in low and middle-income countries. This paper summarizes the various ETEC and Shigella disease burden estimates, based on a review of current literature and informal consultations with leading stakeholders in enteric disease modelling. We discuss the factors that underpin the variability, including differences in the modelling methodology; diagnostic tools used to ascertain diarrheal etiology; epidemiological setting; the data that are available to incorporate; and absolute changes in the total number of diarrheal deaths over time. We consider the further work that will strengthen the evidence needed to support future decision making with respect to recommendations on the relative utility of these vaccines.
AB - Enterotoxigenic E. coli (ETEC) and Shigella are enteropathogens causing significant global morbidity and mortality, particularly in low-income countries. No licensed vaccine exists for either pathogen, but candidates are in development, with the most advanced candidates potentially approaching pivotal efficacy testing within the next few years. A positive policy recommendation for introduction of any vaccine, following licensure, depends on evidence of vaccine cost-effectiveness and impact on morbidity and mortality. The mortality estimates for these two pathogens have fluctuated over recent years, which has led to uncertainty in the assessment of their relative public health importance for use in low and middle-income countries. This paper summarizes the various ETEC and Shigella disease burden estimates, based on a review of current literature and informal consultations with leading stakeholders in enteric disease modelling. We discuss the factors that underpin the variability, including differences in the modelling methodology; diagnostic tools used to ascertain diarrheal etiology; epidemiological setting; the data that are available to incorporate; and absolute changes in the total number of diarrheal deaths over time. We consider the further work that will strengthen the evidence needed to support future decision making with respect to recommendations on the relative utility of these vaccines.
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U2 - 10.1016/j.vaccine.2017.09.083
DO - 10.1016/j.vaccine.2017.09.083
M3 - Article
C2 - 29031690
AN - SCOPUS:85030854539
SN - 0264-410X
VL - 37
SP - 7372
EP - 7380
JO - Vaccine
JF - Vaccine
IS - 50
ER -