on October is an annual opportunity to revitalise attention

, on October 24, is an annual opportunity to revitalise attention and efforts towards the global eradication of this now rare but still fatal and devastatingly disabling infectious disease. 2014 has not felt like a good year for infectious disease control, yet just 3 months from now, a major date in the will be reached. The first objective of the plan, launched in April last year, was “to stop all [wild poliovirus] transmission by the end of 2014”. Given all that has happened this year, is this target still realistic? WHO\'s declaration of polio as a in May did not bode well. In response to an upsurge in exportation of wild poliovirus across national borders in late 2013 and early 2014, the agency urged countries from which wild poliovirus was known to have been exported to adopt a set of emergency measures. Thus Pakistan, Cameroon, and Syria were instructed to ensure that all residents and long-term visitors leaving these countries were vaccinated prior to travel. Afghanistan, Equatorial Guinea, Ethiopia, Iraq, Israel, Somalia, and Nigeria were also encouraged to adopt this strategy.
As we approach the final target year for the Millennium Development Goals (MDGs), it is already clear that the world is not quite going to achieve MDG4: to reduce the child mortality rate (under 5) by two-thirds between 1990 and 2015. The most recent report of the UN Interagency Group for Child Mortality Estimation has estimated that the child H-Ser-OH dropped by 49% between 1990 and 2013, from 12·7 million deaths in 1990 to 6·3 million in 2013. Yet, despite an acceleration in the rate of reduction, from a global average 1·2% per annum in 1990–95 to 4·0% per year in 2005–13, progress remains insufficient to reach MDG4. In this context, the report by Shefali Oza and colleagues in this issue of provides an important input to our understanding of what needs to be done to accelerate progress in ending preventable child deaths in the post-2015 era. Although the number of under-5 deaths worldwide has decreased by 49% since 1990, the neonatal mortality rate (ie, deaths within the first 28 days of life), only declined by 40%. As a result, the proportion of under-5 deaths occurring in the first month of life has increased from 37% in 1990 to 44% in 2013. A recent report by Liu and colleagues in identified the causes of child death that have contributed most to the reduction in child deaths worldwide. Liu and colleagues found that reductions in pneumonia, diarrhoea, and measles collectively were responsible for half of the 3·6 million fewer deaths recorded in 2013 versus 2000. In 2013, the three leading causes of under-5 deaths worldwide were preterm birth complications (0·97 million), pneumonia (0·94 million), and intrapartum-related complications (0·67 million). Two of these three causes are concentrated in the neonatal, and particularly the early neonatal, period (the first week of life). The methods used by the Child Health Epidemiology Reference Group (CHERG) and WHO to estimate causes of child death for all countries were revised recently to model deaths separately in the early neonatal period (0–6 days) and the late neonatal period (7–27 days), and the report by Oza and coauthors provides important additional evidence on the distribution of deaths by day across the neonatal period, which will contribute to improved estimation of trends in neonatal causes of death.
Exposure to faecal pathogens including rotavirus, pathogenic strains of spp, serotype Typhi, hepatitis E virus, and soil-transmitted helminths can precipitate serious human illness. However, systematic reviews of efforts to reduce exposure to human faeces through improvement of sanitation have shown that the evidence of a health benefit is based on weak study designs that restrict scientific inference and do not provide conclusive evidence that approaches being implemented to improve sanitation in low-income communities actually improve health.