International Convening on Diarrheal Diseases Surveillance – Goa, 2026
The department recently participated in the International Convening on Diarrheal Disease Surveillance (ICDDS), a three-day global meeting held in Goa and supported by the Gates Foundation. The event brought together leading experts in epidemiology, diagnostics, vaccines, and public health policy from across the world to chart the future of diarrheal disease surveillance.
Why Diarrheal Disease Still Demands Attention
Despite significant progress over recent decades, diarrheal disease remains responsible for approximately 9% of deaths in children under five in low- and middle-income countries. Beyond mortality, repeated infections cause lasting harm — malnutrition, stunting, and cognitive delays that standard burden estimates often fail to capture. The meeting reaffirmed that the global health community cannot afford to deprioritize this disease simply because overall case counts are declining; in many ways, eliminating the remaining burden becomes harder as incidence falls.
Pathogens, Diagnostics, and What the Evidence Shows
A significant portion of the meeting was devoted to reviewing evidence from landmark global studies. While rotavirus remains the leading cause of severe pediatric diarrhea, its contribution is declining in settings where vaccines have been introduced. Shigella, norovirus, and adenovirus 40/41 are emerging as increasingly important pathogens filling that gap. Molecular diagnostic tools, particularly quantitative PCR, are transforming how pathogens are identified — nearly doubling detection rates compared to conventional methods and enabling far more precise attribution of disease to specific causes.
Antimicrobial Resistance — A Growing Concern
Antimicrobial resistance in diarrheal pathogens emerged as one of the meeting’s most urgent themes. Some Shigella strains in parts of South Asia are now resistant to multiple lines of treatment, with a small but growing proportion approaching untreatability. Delegates emphasized that resistance is no longer driven solely by clinical misuse — it spreads across human, animal, and environmental reservoirs, making a coordinated One Health approach essential. Stronger integration of AMR monitoring into routine surveillance systems was identified as a critical next step.
Building Surveillance Systems That Last
A central thread throughout all three days was the need to move away from fragmented, donor-dependent surveillance toward systems that countries genuinely own and sustain. Delegates agreed that surveillance must be designed around clear, decision-linked use cases — supporting vaccine introduction, tracking antimicrobial resistance, and enabling outbreak detection — rather than collecting data without a defined pathway to action. Promising practical innovations discussed included filter-paper stool preservation, which eliminates cold-chain requirements and opens up surveillance in remote settings, and wastewater-based environmental monitoring as a complementary tool for certain pathogens like cholera. The meeting produced broad consensus around the need for a minimum viable surveillance framework, a priority pathogen list, and concrete recommendations for integrating diarrheal surveillance into national health systems.
