The Lancet
Dec 13, 2014 Volume 384 Number 9960 p2083-2172 e63-e66
http://www.thelancet.com/journals/lancet/issue/current

Editorial
Universal health coverage post-2015: putting people first
The Lancet
DOI: http://dx.doi.org/10.1016/S0140-6736(14)62355-2
Summary
Dec 12, 2014 marks the world’s first Universal Health Coverage (UHC) Day. Defined in the World Health Report 2010, UHC means that all people who need quality, essential health services (prevention, promotion, treatment, rehabilitation, and palliation) receive them without enduring financial hardship. UHC also means different things to different people. Vivian Lin, health systems director (WHO regional office for the Western Pacific), told The Lancet, “some define UHC as a journey or an aspiration but it is actually a strategy to get to equitable and sustainable outcomes”.

Comment
Meningococcal carriage: the dilemma of 4CMenB vaccine
Muhamed-Kheir Taha, Ala-Eddine Deghmane
Published Online: 18 August 2014
DOI: http://dx.doi.org/10.1016/S0140-6736(14)60935-1
Summary
The prevalence of acute bacterial meningitis and septicaemia due to Haemophilus influenzae b (Hib), Streptococcus pneumoniae, and Neisseria meningitidis has greatly decreased in Europe and North America since the successful introduction of capsular polysaccharide conjugate vaccines targeting Hib, serogroup C (and ACWY in the USA) meningococci, and S pneumoniae. Incidence of meningitis due to N meningitidis serogroup A has also decreased in sub-Saharan Africa since the introduction of the meningococcal serogroup A conjugate vaccine (MenAfriVac).

Comment
Ebola and human rights in west Africa
Patrick M Eba
Published Online: 19 September 2014
DOI: http://dx.doi.org/10.1016/S0140-6736(14)61412-4
Summary
The fear caused by the Ebola outbreak in west Africa, which is projected to infect some 20 000 people, is understandable.1 However, the disproportionate measures recently adopted in some of the affected countries are a cause for concern. Some 25 years ago, Jonathan Mann, then Director of WHO’s Global Programme on AIDS, warned world leaders alarmed at the relentless spread of HIV.

Comment
Offline: Making it happen for women and girls
Richard Horton
DOI: http://dx.doi.org/10.1016/S0140-6736(14)62046-8
Summary
It was not a matter of forgetting. “There were forces within the UN that didn’t want to include contraception.” Dr Babatunde Osotimehin is the Executive Director of the United Nations Population Fund (UNFPA) and doesn’t mince his words. He was speaking last week at the launch of the Guttmacher Institute’s signature report, Adding It Up. Sexual and reproductive health and rights were “deliberately” dropped by the UN back in 2000, he argued. Those forces are still active today. And they are “more nimble in pushing back”.

Articles
Effect of a quadrivalent meningococcal ACWY glycoconjugate or a serogroup B meningococcal vaccine on meningococcal carriage: an observer-blind, phase 3 randomised clinical trial
Prof Robert C Read, MD, David Baxter, PhD, David R Chadwick, PhD, Prof Saul N Faust, FRCPH, Prof Adam Finn, PhD, Prof Stephen B Gordon, MD, Prof Paul T Heath, FRCPCH, Prof David J M Lewis, MD, Prof Andrew J Pollard, PhD, David P J Turner, PhD, Rohit Bazaz, MD Amitava Ganguli, MRCP, Tom Havelock, MRCP, Prof Keith R Neal, MD, Ifeanyichukwu O Okike, MD, Begonia Morales-Aza, BSc, Kamlesh Patel, BSc, Matthew D Snape, MD, John Williams, MRCP, Stefanie Gilchrist, MSc, Steve J Gray, PhD, Prof Martin C J Maiden, PhD, Daniela Toneatto, MD, Huajun Wang, MSc, Maggie McCarthy, MPH, Peter M Dull, MD, Prof Ray Borrow, PhD
Published Online: 18 August 2014
DOI: http://dx.doi.org/10.1016/S0140-6736(14)60842-4
Summary
Background
Meningococcal conjugate vaccines protect individuals directly, but can also confer herd protection by interrupting carriage transmission. We assessed the effects of meningococcal quadrivalent glycoconjugate (MenACWY-CRM) or serogroup B (4CMenB) vaccination on meningococcal carriage rates in 18–24-year-olds.
Methods
In this phase 3, observer-blind, randomised controlled trial, university students aged 18–24 years from ten sites in England were randomly assigned (1:1:1, block size of three) to receive two doses 1 month apart of Japanese Encephalitis vaccine (controls), 4CMenB, or one dose of MenACWY-CRM then placebo. Participants were randomised with a validated computer-generated random allocation list. Participants and outcome-assessors were masked to the treatment group. Meningococci were isolated from oropharyngeal swabs collected before vaccination and at five scheduled intervals over 1 year. Primary outcomes were cross-sectional carriage 1 month after each vaccine course. Secondary outcomes included comparisons of carriage at any timepoint after primary analysis until study termination. Reactogenicity and adverse events were monitored throughout the study. Analysis was done on the modified intention-to-treat population, which included all enrolled participants who received a study vaccination and provided at least one assessable swab after baseline. This trial is registered with ClinicalTrials.gov, registration number NCT01214850.
Findings
Between Sept 21 and Dec 21, 2010, 2954 participants were randomly assigned (987 assigned to control [984 analysed], 979 assigned to 4CMenB [974 analysed], 988 assigned to MenACWY-CRM [983 analysed]); 33% of the 4CMenB group, 34% of the MenACWY-CRM group, and 31% of the control group were positive for meningococcal carriage at study entry. By 1 month, there was no significant difference in carriage between controls and 4CMenB (odds ratio 1•2, 95% CI 0•8–1•7) or MenACWY-CRM (0•9, [0•6–1•3]) groups. From 3 months after dose two, 4CMenB vaccination resulted in significantly lower carriage of any meningococcal strain (18•2% [95% CI 3•4–30•8] carriage reduction), capsular groups BCWY (26•6% [10•5–39•9] carriage reduction), capsular groups CWY (29•6% [8•1–46•0] carriage reduction), and serogroups CWY (28•5% [2•8–47•5] carriage reduction) compared with control vaccination. Significantly lower carriage rates were also noted in the MenACWY-CRM group compared with controls: 39•0% (95% CI 17•3–55•0) carriage reduction for serogroup Y and 36•2% (15•6–51•7) carriage reduction for serogroup CWY. Study vaccines were generally well tolerated, with increased rates of transient local injection pain and myalgia in the 4CMenB group. No safety concerns were identified.
Interpretation
Although we detected no significant difference between groups at 1 month after vaccine course, MenACWY-CRM and 4CMenB vaccines reduced meningococcal carriage rates during 12 months after vaccination and therefore might affect transmission when widely implemented.
Funding
Novartis Vaccines.