Many of the emerging non vaccine serotypes

Many of the emerging non-vaccine serotypes in carriage after PCV13 implementation (11A, 15B/C, 15A, 21, 23B, and 35F) show low potential for causing invasive disease, but some—eg, 12F, 22F, 24F, 8, and 9N—have high disease potential. Moreover, in vulnerable populations (eg, immunocompromised people), serotypes with low disease potential could induce severe invasive pneumococcal disease. Changes in serotype distribution have resulted in changes in the profile and spectrum of pneumococcal disease (eg, in the proportion of meningitis, bacteraemic pneumonia, and bacteraemia without focus) and an increase in the proportion of patients with underlying conditions who are easily infected by non-vaccine serotypes. Not surprisingly, in the study by Cohen and colleagues, 26% of children with invasive pneumococcal disease who were not infected with HIV had an underlying condition. The study by Cohen and colleagues probably underestimates the effectiveness of PCV13 not only because case-control studies ignore the herd effect but also because of the use of small sample sizes, as the authors underline. The new data from South Africa and The Gambia show a high degree of effectiveness of pneumococcal conjugate vaccine, comparable with that seen in high-income countries, and should encourage countries that have not yet incorporated pneumococcal conjugate vaccines into their national immunisation programmes to do so. Assessing the effect of pneumococcal conjugate vaccines should be multifaceted (invasive pneumococcal disease, pneumonia, nasopharyngeal flora) and continual because of the permanent THZ2 of pneumococcus to escape external pressures such as vaccination and antibiotics.
On Jan 31, 2017, heads of states and governments of the African Union and the leadership of the African Union Commission will officially launch the Africa Centres for Disease Control and Prevention (Africa CDC) in Addis Ababa, Ethiopia. As detailed in the African Union\'s Africa Agenda 2063—a roadmap for the development of the continent—some of the concerns that justified the establishment and initiation of an Africa-wide public health agency include rapid population growth; increasing and intensive population movement across Africa, with increased potential for new or re-emerging pathogens to turn into pandemics; existing endemic and emerging infectious diseases, including Ebola; antimicrobial resistance; increasing incidence of non-communicable diseases and injuries; high maternal mortality rates; and threats posed by environmental toxins. In addition to these concerns, African countries are burdened with insufficient public health assets including surveillance, laboratory networks, competent workforce, and research expertise that hinder evidence-based decision-making.
The 2008 Maputo Declaration on Strengthening of Laboratory Systems and the subsequent 2012 African Society for Laboratory Medicine Ministerial Call for Action drew attention to the importance of laboratory services. Most recently, laboratories have gained prominence in the accurate detection of infectious diseases—including emerging public health threats—and monitoring of antimicrobial drug resistance, especially within the context of the . Equally important, but relatively marginalised, is the role of laboratories in dealing with all diseases, in ensuring quality clinical care towards universal health coverage (UHC), and meeting the targets of Sustainable Development Goal 3. At the African Society for Laboratory Medicine meeting in Cape Town, South Africa, in December, 2016, we met to discuss the state of laboratory services in the light of Africa\'s burden of both communicable diseases and non-communicable diseases. We highlighted gaps in coverage, quality, human resources, infrastructure, access, and sustainability, and discussed how these gaps could be bridged in an economically viable manner. We summarise our discussions and key messages () here.