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  • Since the progressive introduction of the meningococcal sero

    2019-05-29

    Since the progressive introduction of the meningococcal serogroup A conjugate vaccine in meningitis belt countries via mass vaccination campaigns of 1–29 year olds starting in 2010, a remarkable effect of the vaccine has been observed. Similar to other conjugate vaccines, MenAfriVac has demonstrated the ability to markedly reduce serogroup A carriage prevalence and generate herd immunity, likely contributing to the near-elimination of serogroup A disease in vaccinated areas. However, epidemics due to other serogroups, such as the 2015 serogroup C epidemics in Niger and Nigeria, continue to occur. Thus, additional strategies for the control of meningococcal disease are needed. The findings of Trotter and colleagues provide further insight into transmission dynamics of within households in the meningitis belt. However, the low sensitivity rate of oropharyngeal swabbing (estimated as 57·8% [95% CI 53·5–62·0] in this study) is a limitation. Nevertheless, results of this evaluation along with surveillance data suggest that targeting school-age children and adolescents for vaccination with conjugate vaccines could provide maximum benefit in terms of direct protection and generation of herd immunity. Further household carriage evaluations specifically carried out during epidemics are needed to assess the relative importance of household transmission in the setting of widespread EZ Cap Reagent AG transmission. Antibiotic chemoprophylaxis of household members of meningococcal disease cases is recommended in the meningitis belt outside of outbreaks, although is rarely practiced due to resource and logistical constraints. Even though no known cases of meningococcal disease were reported in households participating in the study from Trotter and colleagues, the increased rate of subsequent carriage in index households supports this recommendation and efforts to improve its uptake. Additional evaluation of carriage among household contacts of a meningococcal case in both outbreak and non-outbreak settings would provide additional data to inform antibiotic chemoprophylaxis recommendations in the meningitis belt.
    Between 1990 and 2015, the under-5 mortality rate declined by 53%, resulting in approximately 48 million more children reaching their fifth birthday than would have occurred had 1990 mortality rates continued. Many of these children, however, continue to live in conditions of adversity—marked by extreme poverty, undernutrition, conflict, and insecurity—and are not afforded the level of care required to ensure that they meet their developmental potential. Neuroscience research in the past two decades is unequivocal that the period from conception through early childhood (ie, at least the first 3 years) is foundational in terms of brain development. There is increasing evidence (mostly from high-income countries) that delivering quality interventions in the early years is cost-effective, reduces health inequities, improves learning and academic attainment, lowers crime and violence, and can substantially improve adult health and economic productivity. For the first time, the foremost global development framework—the new Sustainable Development Goals (SDGs)—includes child development, under target 4.2. This is also reflected in the new Global Strategy for Women\'s, Children\'s and Adolescents\' Health (2016–2030), within which one of the core objectives is to ensure that all women, children, and adolescents have an equal chance to thrive (and not simply survive). Thus, any research agenda that aims to give young children the chance to both survive and thrive must ensure that early child development (ECD) is prioritised in order to inform policy and programmatic implementation and achieve the SDG target. Although the scientific evidence is clear, donor and policy neglect of ECD has been striking. Recently however, high-level support for ECD has been emerging, including in the recent series. To optimise the impact of this new momentum, ECD research prioritisation is required.