Hasso-Agopsowicz Mateusz, Lopman Benjamin A, Lanata Claudio F, Rogawski McQuade Elizabeth T, Kang Gagandeep, Prudden Holly J, Khalil Ibrahim, Platts-Mills James A, Kotloff Karen, Jit Mark, Riddle Mark S, Pavlinac Patricia B, Luz Paula M, Pitzer Virginia E, Breiman Robert F, Giersing Birgitte K
World Health Organization, Geneva, Switzerland.
Emory University, Atlanta, United States.
Vaccine. 2021 Dec 20;39(52):7521-7525. doi: 10.1016/j.vaccine.2021.11.033. Epub 2021 Nov 24.
Diarrhoeal infections are one of the leading causes of child's mortality and morbidity. Vaccines against Shigella, enterotoxigenic E. coli (ETEC), norovirus and invasive non-typhoidal Salmonella are in clinical development, however, their full value in terms of short and long-term health and socio-economic burden needs to be evaluated and communicated, to rationalise investment in vaccine development, and deployment. While estimates of mortality of enteric infections exist, the long-term morbidity estimates are scarce and have not been systematically collected.
The World Health Organization (WHO) has convened a Burden of Enteric Diseases Morbidity Working Group (BoED MWG) who identified key workstreams needed to characterise the morbidity burden of enteric infections. The group also identified four criteria for the prioritisation of pathogens of which impact on long-term morbidity needs to be assessed.
The BoED MWG suggested to identify and analyse the individual level data from historical datasets to estimate the impact of enteric infections and confounders on long-term morbidity, including growth faltering and cognitive impairment in children (workstream 1); to conduct a systematic review of evidence on the association of aetiology specific diarrhoea with short- and long- term impact on growth, including stunting, and possibly cognitive impairment in children, while accounting for potential confounders (workstream 2); and to conduct a systematic review of evidence on the association of aetiology specific diarrhoea with short- and long- term impact on health outcomes in adults. The experts prioritised four pathogens for this work: Campylobacter jejuni, ETEC (LT or ST), norovirus (G1 or G2), and Shigella (dysenteriae, flexneri, sonnei).
The proposed work will contribute to improving the understanding of the impact of enteric pathogens on long-term morbidity. The timing of this work is critical as all four pathogens have vaccine candidates in the clinical pipeline and decisions about investments in development, manufacturing or vaccine procurement and use are expected to be made soon.
腹泻感染是儿童死亡和发病的主要原因之一。针对志贺氏菌、产肠毒素大肠杆菌（ETEC）、诺如病毒和侵袭性非伤寒沙门氏菌的疫苗正在进行临床开发，然而，它们在短期和长期健康以及社会经济负担方面的全部价值需要进行评估和传达，以便合理安排疫苗开发和部署方面的投资。虽然存在肠道感染死亡率的估计，但长期发病情况的估计很少且未得到系统收集。
世界卫生组织（WHO）召集了一个肠道疾病发病负担工作组（BoED MWG），该工作组确定了描述肠道感染发病负担所需的关键工作流程。该小组还确定了病原体优先级的四个标准，其中需要评估对长期发病的影响。
BoED MWG建议识别和分析历史数据集中的个体层面数据，以估计肠道感染和混杂因素对长期发病的影响，包括儿童生长发育迟缓和认知障碍（工作流程1）；对病因特异性腹泻与对生长的短期和长期影响（包括发育迟缓，可能还有儿童认知障碍）之间关联的证据进行系统评价，同时考虑潜在的混杂因素（工作流程2）；对病因特异性腹泻与对成人健康结果的短期和长期影响之间关联的证据进行系统评价。专家们为此项工作确定了四种病原体的优先级：空肠弯曲菌、ETEC（LT或ST）、诺如病毒（G1或G2）和志贺氏菌（痢疾志贺氏菌、福氏志贺氏菌、宋内志贺氏菌）。
拟开展的工作将有助于增进对肠道病原体对长期发病影响的理解。这项工作的时机至关重要，因为所有这四种病原体都有处于临床研发阶段的候选疫苗，预计很快将做出关于开发、生产或疫苗采购及使用投资的决策。
