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  • br Cholera remains a serious global

    2019-05-23


    Cholera remains a serious global public health problem, disproportionately affecting poor individuals, causing illness and death for thousands of people each year. Cholera cases are on the rise, with 47% more cases reported to WHO in 2014 than in 2013. Innovative approaches to control the disease are urgently needed, and the study by Andrew Azman and colleagues in contributes to growing evidence of the important part that oral cholera alpha adrenergic blockers strategies have to play in this regard. Cholera can have devastating consequences, especially in epidemic settings. Azman and colleagues\' study assesses the effectiveness of a single dose of bivalent whole-cell oral cholera vaccine on epidemic cholera in Juba, South Sudan. Typically, this oral cholera vaccine is given in two doses 14 days apart, and studies have shown its efficacy and effectiveness with this dosing schedule. However, the use of one dose of vaccine for an outbreak response would reduce costs and double the number of people that could be served, which is especially important considering the global shortage of vaccine that is expected to last for the next few years. Faced with an emerging epidemic of cholera in South Sudan, limited vaccine supply, and some evidence that a single dose of vaccine might give sufficient protection to thwart an epidemic, local public health officials and the non-governmental organisation Médecins Sans Frontières decided to proceed with a single-dose public health oral cholera vaccine campaign in Juba. Public health activities and a research study took place hand in hand. The study found that the adjusted single-dose vaccine effectiveness was 87·3% (70·2–100·0) for reducing medically attended cholera for up to 2 months. This adds to existing evidence including a randomised study of a single-dose regimen from Bangladesh that found 40% direct effectiveness for reducing all cholera, and 63% direct effectiveness for reducing severely dehydrating cholera at 6 months. By contrast, Azman and colleagues used a case-cohort study design in an effort to measure both the direct and indirect protection offered by the vaccine (ie, herd protection), and measured effectiveness in a shorter period. This design makes the study particularly interesting and pertinent to dilemmas in the approach to cholera outbreak control. Debate continues between water, sanitation, and hygiene (WASH) purists, who believe that investments in cholera vaccination campaigns are a distraction from the goal of universal access to water and sanitation, and a more progressive public health community that advocates for a combined approach to cholera control including vaccination and evidence-based WASH interventions. In this context, a study that helps us to measure the herd protection of an oral cholera vaccine strategy is key to understanding the population-level effect and therefore the public health usefulness of oral cholera vaccine (beyond individual protection).
    In the Book of Exodus, the description of the fifth plague of Egypt evokes a high mortality epizootic disease affecting livestock such as camels, goats, and sheep. It is debatable whether Rift Valley fever was that biblical plague but it is undeniably an ancient zoonosis and its modern history is no less dramatic. The virus was first isolated in 1930 after a heavy mortality of newborn lambs was reported on a Merino sheep farm in Naivasha, Rift Valley, Kenya following unusually heavy rainfall. The associated human disease was identified 20 years later in South Africa and the relevant microbiology, clinical disease, ecology, and epidemiology seemed to be well established. This dominant disease narrative continues to be punctuated by multiple novel revelations including those reported in by Maria Baudin and colleagues.
    Countdown to 2015 for Maternal, Newborn and Child Survival began monitoring and analysing country progress towards achieving Millennium Development Goals (MDGs) 4 (reduce child mortality) and 5 (improve maternal health) to support a call to action stemming from \'s Child Survival Series published in 2003. Over the course of 12 years, gathered and synthesised data on intervention coverage and its key determinants, and regularly disseminated country profiles, synthesis reports, scientific articles, and in-depth country analyses (Afghanistan, Bangladesh, China, Ethiopia, Kenya, Malawi, Niger, Pakistan, Peru, and Tanzania). Countdown occupied a specific niche during the MDG era—it provided rigorous, independent analyses and monitored coverage of key cost-effective interventions for preventing maternal and child deaths, with a focus on equity and health system factors. Through its global and country-level tracking efforts and its policy-oriented communications, Countdown provided a broad-based and objective assessment of progress towards MDGs 4 and 5, and pioneered accountability for women\'s and children\'s health.