The predicted mean time to attaining
The predicted mean time to attaining the maximal indirect impact is relevant when considering adult vaccination with PCV. Most developed countries do not recommend PCV in adults, believing that with the high coverage in the infant programme, adult disease will (eventually) decline. The US vaccine decision-making body, the Advisory Committee on Immunization Practices, recommended PCV13 vaccination in adults despite high coverage of PCV13 in the infant programme. However, in recognition of the probable changing epidemiology of adult disease, the recommendation built in a review of the evidence, scheduled for 2018, to re-evaluate the decision. Questions remain over whether the indirect impact on invasive pneumococcal disease is mirrored by the same MK-2206 Supplier in pneumonia. A US study of adults admitted to hospital with community-acquired pneumonia suggested a persistent burden of disease due to serotypes contained in PCV13; however, UK and Dutch studies suggest the magnitude of the decline in non-invasive pneumococcal pneumonia in adults mirrors the reduction seen in invasive pneumococcal disease.
Considerable effort has been made to meet the challenges posed by decreased effectiveness of the antimalarial artemisinin and its key partner drugs against in Cambodia and neighbouring countries. Despite the threat of resistance, malaria endemicity has actually been falling over the past decade in the Greater Mekong Subregion. But what if such phenomena began to unfold in Africa, in those countries where the daily incidence of symptomatic malaria cases can equal the annual burden in some Asian countries? Hypolite Mavoko and colleagues report in a study designed to compare current rescue treatment options for malaria in Africa, should front-line therapies fail. The authors set out to formally test whether, in the event of recurrence of malaria symptoms in children receiving the recommended artemisinin-based combination therapy (ACT), retreatment with that same regimen was inferior to either an alternative ACT, or the current WHO recommendation for rescue treatment, oral quinine plus an antibiotic (in phylum study, quinine plus clindamycin, QnC). The team recruited children aged 12–59 months who presented with laboratory-confirmed malaria to either of two clinics, in Kinshasa, DR Congo or Mbarara, Uganda. Both sites serve populations exposed to intense malaria transmission. First-line ACT differs between these countries, with artesunate-amodiaquine (ASAQ) used in DR Congo, and artemether-lumefantrine (AL) in Uganda. In an unusual design, passive follow-up identified treated participants with recurrent symptoms within 42 days; on second presentation with confirmed falciparum malaria, these children were then randomly assigned to one of three second treatments. The first group was retreated with the same ACT as used for the original malaria episode (retreatment ACT group), the second group with the alternative ACT (AL in DR Congo and ASAQ in Uganda) and the third group with the WHO recommendation, QnC. All treatment was fully observed, and 571 randomised children were actively followed up for 28 days.
Human African trypanosomiasis, a disease caused by () , is endemic in 24 countries across sub-Saharan Africa, affecting disproportionately the most impoverished regions, including the Democratic Republic of Congo and Central African Republic. Since the early 1990s, concerted control efforts have achieved a steady decline in incidence. This success has spurred WHO\'s goal to eliminate human African trypanosomiasis caused by as a public health problem by 2020, defined as reducing reported cases to fewer than one per 10 000 inhabitants in at least 90% of settings, with fewer than 2000 cases annually in Africa. The subsequent goal of WHO is to eliminate any reported cases of human African trypanosomiasis caused by in endemic countries by 2030, thereby terminating transmission of the disease globally.