Our achievements in controlling enteric and respiratory infections

Our research on infectious disease prevention and treatment has saved countless lives in Bangladesh and globally. 

Our research has generated important insight into the biology and evolution of Vibrio cholerae. Our practical impact has included the landmark development of oral rehydration solution for treatment of diarrhoea in children, as well as highly influential work on zinc supplementation. Our clinical trials of vaccines have informed local and international policy-making.

Examples of our achievements include:

Development of oral rehydration solution 

• The first effective oral rehydration solution (ORS) for treatment of diarrhoea in children was developed at icddr,b.
• Field studies at Matlab provided the first strong evidence that ORS could save lives in community settings.
• Use of ORS has since saved the lives of millions of children, and the Lancet suggested it was “potentially the most important medical advance of the 20th century”.

Zinc supplementation to prevent diarrhoea

• We generated important evidence that zinc supplementation shortened the duration of diarrhoeal disease in children and protected them from further episodes.
• This and other evidence led the WHO and UNICEF to recommend zinc supplementation, in addition to ORS, for treatment of diarrhoeal disease in children.
• We also ran an innovative programme, SUZY (Scaling Up of Zinc for Young Children), to promote zinc use, which rapidly raised awareness of zinc and has helped Bangladesh achieve very high zinc usage figures by global standards.

The benefits of oral cholera vaccine

• Matlab provided the infrastructure for the world’s first field-based efficacy trial of an oral cholera vaccine, in the 1980s, which demonstrated significant benefits.
• Our clinical trials have shown that an affordable oral cholera vaccine developed from that vaccine can be delivered through Bangladesh’s routine immunisation programme and protects against severe cholera in children and adults.
• Further trials are assessing other practical issues such as the need for refrigeration and dosing schedules, and whether vaccination of children under 14 years of age can confer at least 50% protection on the entire population, which could influence how the vaccine is implemented.

Qadri F et al. Feasibility and effectiveness of oral cholera vaccine in an urban endemic setting in Bangladesh: a cluster randomised open-label trial. Lancet. 2015;386(10001):1362–71.

Qadri F et al. Efficacy of a single dose, inactivated oral cholera vaccine in Bangladesh. N Engl J Med. (In press)

Bubble CPAP treatment for severe pneumonia

• A rigorous controlled trial at Dhaka Hospital showed that a form of oxygen therapy, bubble CPAP, was at least as effective as current WHO-recommended treatment of children with severe pneumonia.
• The trial used low-cost materials, including recycled shampoo bottles, so the approach could potentially be implemented widely in clinical facilities in resource-poor settings.
• The bubble CPAP approach has been adopted at Dhaka Hospital as first-line treatment for children with severe pneumonia and low blood oxygen levels.

Chisti MJ et al. Bubble continuous positive airway pressure for children with severe pneumonia and hypoxaemia in Bangladesh: an open, randomised controlled trial. Lancet. 2015;386(9998):1057–65.

Diagnostic tools for enteric infections

• A diagnostic tool, TPTest, suitable for use in resource-poor settings has been developed to diagnose typhoid and paratyphoid fever (enteric fever).
• A simple serological test, HPTest, has been developed for Helicobacter pylori.
• Both TPTest and HPTest are available in icddr,b's diagnostic facilities.
• Lateral flow devices are being optimised for diagnosis of enteric fever and cholera, in collaboration with an external company.