What the influenza vaccine actually buys, and a 40-minute mpox result

The edition in brief

A JAMA evidence review of 69 studies sets the expectations for the coming influenza season. In older adults, effectiveness against influenza-related hospitalisation ranged from 19.0% (95% CI 0.0 to 34.0) to 43.0% (30.0 to 53.0) and against mortality from 29.0% to 65.8%. In children aged 6 months to 17 years, a case-cohort analysis over eight seasons found 80.0% effectiveness (95% CI 75.0 to 84.0) against laboratory-confirmed influenza-associated death. High-dose vaccine beat standard dose in older adults, relative effectiveness 43.6% (27.5 to 56.3). A self-controlled case series in 9973703 people found no excess of serious adverse events, including Guillain-Barre syndrome, whether influenza vaccine was given alone or with RSV or COVID-19 immunisation. In Uganda, the Dragonfly point-of-care molecular platform was evaluated prospectively on lesion swabs from 300 people meeting the WHO suspected-case definition for mpox, of whom 196 were PCR-positive: overall agreement with laboratory qPCR was 98.7% (95% CI 96.6 to 99.5), sensitivity for monkeypox virus 98.5% and specificity 96.2%, with results in under 40 minutes. The FDA approved a supplement to Hikma's vancomycin hydrochloride application (TYZAVAN, NDA211962) on 18 August; the record states the approval but not what changed. A meta-regression across 25 clinical studies and 301 neutralisation studies found neutralising antibody titre associated with protection from progression to severe COVID-19, relative risk 0.57 per ten-fold rise in geometric mean titre (95% CI 0.51 to 0.64) - but vaccination protected better than passively given antibody, so titre is not the whole mechanism. Long-term follow-up of a Vietnamese cluster-randomised trial found a one-dose-plus-booster PCV10 schedule still non-inferior at 5.5 years, with indirect protection in unvaccinated caregivers.