“Forward ever, backward never: onwards with Breaking Through”

About 22% of all annual deaths worldwide due to rotavirus infections are from India; that’s 80,000-100,000 children a year.

New Delhi: The war against diarrhoeal diseases is all set to get a boost as the Government of India has decided to introduce the indigenously developed Rotavac vaccine against them in four more states, including Uttar Pradesh. With this, the vaccine will be available to more than half population of the country. Thus far, it had only been introduced in four states: Andhra Pradesh, Haryana, Himachal Pradesh and Odisha, among 38 lakh children.
Rotavirus is a leading cause globally of severe diarrhoea and diarrhoeal death among children five years or younger. India accounts for 22% of child deaths (or 80,000-100,000 in actual numbers). About nine lakh children are also admitted to hospitals due to episodes of severe diarrhoea.
“It is estimated that every child in the world will become infected with rotavirus if we do not vaccinate them,” said Gagandeep Kang, the executive director of the Translational Health Science and Technology Institute at Faridabad, on the outskirts of Delhi. “Among the children who become infected, one in eight will need a outpatient visit to hospital, one in 30-50 will be hospitalised due to gastrointestinal infection, and one in 1,000 will die because of Rotavirus.”
Kang was involved in phase I to phase III trials of the vaccine.
In 1973, Ruth Bishop, Geoffrey Davidson, Ian Holmes and Brian Ruck, all working in the Royal Children’s Hospital, Melbourne, were examining the cause of dehydrating gastrointestinal infections in children. When they examined the faeces and the gut of children having protracted diarrhoea using an electron microscope, they saw a new virus shaped like wheel. The virus was named rota, from the Latin for ‘wheel’.
Once the virus was discovered to be the cause of the diarrhoea, scientists around the world began working on developing a vaccine against it. After years of research, the first vaccine was licensed in the US in 1998. However, it had to be withdrawn because it had severe side effects. It took another eight years before a second vaccine was developed.
In India, efforts to develop a vaccine started in the 1980s. M.K. Bhan, who was then an assistant professor of paediatrics and later became the secretary of the Department of Biotechnology (DBT), began to work on a vaccine after a rotavirus epidemic broke out in Delhi in 1985. Some newborn children showed evidence of the presence of rotavirus but did not develop the disease. He followed up with these children for two years and found that they had acquired immunity to rotavirus. Meanwhile, C. Durga Rao, a professor at the Indian Institute of Science (IISc), Bengaluru, had also isolated attenuated rotaviruses in newborn children.
At the time, India did not possess the wherewithal to characterise viruses properly. This is when the DBT’s Indo-US vaccine action plan became handy: the virus strain was taken to the US and made into a candidate vaccine. It was subsequently tested on US children and adults.
“The foreign-manufactured vaccine was costing around $200 per child, which was clearly not affordable in India. We decided to develop an indigenous vaccine that should cost less than one dollar per child,” Kang says. “Bharat Biotech in Hyderabad, DBT, and a host of other partners got together and took up the challenge.” After mandatory trials and study, the vaccine was licensed in 2014.
Speaking to India Science Wire, Kang also expressed concern over the persisting problem of worm infestation in children. “Hookworm infestation may not kill. But children get weakened by frequent diarrhoea episodes and they become vulnerable to malnutrition, stunting and opportunistic infections such as pneumonia. We have to make toilets affordable and acceptable to the people”.
Having undertaking field studies on the issue, she notes that people are not antagonistic to toilets and that the problem had to do with how they were selected. “One size cannot fit all. The design of toilets for Rajasthan will not work for say a coastal area with a high water-table,” according to Kang. “Likewise, if faecal excrement floats around open sewerage, people are not going to accept toilets. Functional sewerage system is a must.”
Kang completed her MBBS in 1987 and her MD in microbiology in 1991 from Christian Medical College, Vellore. She obtained her PhD in 1998, and carried out her postdoctoral research with Dr Mary Estes at the Baylor College of Medicine, Houston, before returning to Vellore.
She has helped establish networks of sentinel hospitals and laboratories that carry out surveillance for rotavirus disease in children and ancillary studies in association with the Indian Council for Medical Research and the World Health Organisation. She has also published over 250 papers in national and international journals and has been awarded the Infosys Prize in life sciences for her pioneering contributions to understanding the natural history of the rotavirus and other infectious diseases.
This article was originally published by India Science Wire and has been republished here with permission.