Priya Venkatesan

WHO report: air pollution is a major threat to health

for disease in low-income countries. With 12·6 million environment-related deaths seen in 2012, mostly down to the inhalation of dirty air, mostly aff ecting the worlds’ poorest [people], and mostly avoidable, there is a clear and urgent need for action to clean up the air we breathe.” However, Mortimer went on to note, “the conclusion that the use of clean technologies and fuels for cooking is a proven strategy for reducing [some] diseases is overstated. The evidence base [should be] strengthened to ensure that solutions [are] informed by defi nitive research fi ndings.” William J Martin II (Ohio State University, OH, USA) adds, “Much of the global burden of chronic disease results from a lifetime of breathing filthy air. But the origins of adult disease begin early in life, when air pollution is most dangerous. The WHO report is a wakeup call.”

Recombinant influenza vaccine in adults aged 50 years or older

Influenza viruses are grown in eggs to produce inactivated vaccines, but these viruses typically contain mutations in the genes coding for haemagglutinin, which might reduce vaccine effectiveness. A new study published in the New England Journal of Medicine has shown that a recombinant, quadrivalent influenza vaccine provided better protection against influenzalike illness than a standard-dose, egggrown, inactivated influenza vaccine in adults aged 50 years or older. In a randomised, double-blind, multicentre trial, study authors Lisa Dunkle (Protein Sciences, Meriden, CT, USA) and colleagues examined influenza-like illness confirmed by RT-PCR occurring between 14 days after vaccination and the end of the influenza season (the primary endpoint) in participants given either the recombinant vaccine (Flublok Quadrivalent; 45 μg of recombinant haemagglutin per strain) or an inactivated vaccine (15 μg of haemagglutin per strain). Fewer cases of influenza-like illness occurred in participants given the recombinant vaccine (96 [2·2%] of 4303 recipients) than in those given the inactivated version (138 [3·2%] of 4301 recipients), and the probability of influenzalike illness was 30% lower with the recombinant version (95% CI 10–47; p=0·006). About 3% of participants in each group had at least one serious adverse event within 6 months after vaccination, the most common of which in each group was cough; none of the serious events were considered related to the vaccines. Dunkle commented “This study showed that Flublok Quadrivalent, produced with recombinant technology, provided better protection against confirmed influenza-like illness among older adults than standard-dose quadrivalent influenza vaccine produced with traditional technology. Higher influenza vaccination rates with a better vaccine might significantly improve public health”. Peter Openshaw (Imperial College, London, UK) added “This commercially sponsored trial showed that a new influenza vaccine based on recombinant haemagglutinin was better than a standard egg-based vaccine in older adults”. However, Openshaw continued “It’s potentially advantageous to move away from the use of eggs to make influenza vaccines, but the costs need to be compared. This is not the first study to show that older adults might need higher doses of influenza vaccine to be protected and there needs to be a careful assessment made before replacing the tried and tested approved vaccine with a new product”.

Mortality in elderly patients with a systematic ICU admission programme

For the study, see B Guidet et al, JAMA 2017; 318: 1450–59 admitted compared with 34% in the standard practice group, but this higher admission rate did not translate into lower 6-month mortality.” Carl Waldmann (Faculty of Intensive Care Medicine, London, UK) added “This [study] assessed the impact of routine ICU admission on mortality in elderly patients. Increased life expectancy also increases both the incidence of chronic disease and the demand for criticalcare services. Without concurrent expansion, critical care will need to be used wisely but the Faculty of Intensive Care Medicine advises that discussions and decisions relating to intensive care admission should be based on co-morbid conditions and not solely on the basis of age.”