PLOS Medicine Specialty Consulting Editor Lorenz von Seidlein presents some highlights from the first Epicentre scientific day in Niger
Epicentre, the research arm of Médecins Sans Frontières, organised its first scientific day in Niger on 24th January in the Blue Zone Hippodrome, Niamey. The goals were to discuss and encourage biomedical research specifically in Niger and francophone Africa at large.
Besides appropriate case management and the free distribution of insecticide treated bednets, seasonal malaria chemoprophylaxis (SMC) is one of the main malaria control strategies in Niger. Children under 5 years receive annually 4 rounds of 3 days sulfadoxine-pyrimethamine and amodiaquine (SP/AQ) during the malaria season. Challenges to the optimal implementation of this strategy include: suboptimal coverage, adherence to the 12 dose-regimen, and the cost of around $4/child/season, which some of the participants considered too high. When initially implemented in 2013, adherence and effectiveness of SMC was satisfying, but in the subsequent years adherence and with it the effectiveness has decreased. Considerable resources are required to optimize SMC through strategies such as directly observed therapy in places like Niger.
The introduction of the conjugate meningococcal group A vaccine (MenAfriVac) in Niger has eliminated Meningococcus A from the country. However, the meningitis outbreaks in Niger in 2015 and 2016 were due to Meningococcus group C. This development highlights again the need for a polyvalent meningococcal vaccine for countries in the meningitis belt. The Serum Institute of India, which is producing MenAfriVac, is currently developing a conjugate pentavalent (A, C, W135, X, Y) vaccine which could become available in three years. In contrast to meningococcal A vaccine, the pentavalent vaccine is not financially backed by the Gates Foundation, adding uncertainty to the vaccine development. Meanwhile, targeted ciprofloxacin prophylaxis appears a promising intervention until polyvalent meningococcal vaccines can replace the monovalent vaccine in the national vaccine programme.
Rebecca Grais provided an overview of research and recent trials on malnutrition in Niger. Considering the perennial and large size of the problem, there remains a surprising scarcity of hard evidence how programmes can address malnutrition in the most efficient fashion. Offering trial participants cash incentives or a combination of food supplements and cash initiatives holds promise. However, including cash incentives in nutrition programmes is neither free of challenges nor controversy.
In March 2017 the findings from a randomised controlled trial of a low-cost, heat-stable rotavirus conducted in Niger were published. Three doses of a live, oral bovine rotavirus pentavalent vaccine at 6, 10, and 14 weeks of age afforded 67% protection. The trial has been pivotal for the licensing of the vaccine in India. How the vaccine can now be introduced in the national vaccination programme of Niger remains an open question.
With the potential control of rotavirus, other enteric pathogens gain in importance. Enterobacteriaceae resistance to fluoroquinolones and extended-spectrum cephalosporins is cause for concern, especially in the absence of alternative antibiotics. The spread of cloxacillin-resistant Staphylococcus aureus is another serious problem. Strategies to reverse the steady increase in resistant pathogens in Niger and elsewhere are lacking.
Lorenz von Seidlein has worked for 20 years on malaria and other issues in global health. Lorenz is currently coordinating a malaria elimination project with the Mahidol Oxford Research unit in Bangkok, Thailand. He is a Specialty Consulting Editor for PLOS Medicine.
Feature image credit: Lorenz von Seidlein