Which hepatitis A vaccine you stock may matter more than you thought

The edition in brief

A meta-analysis of four randomised cohorts and 3,282 children compared the two inactivated hepatitis A vaccine strains in use worldwide. TZ84-based vaccines produced higher seroconversion at one month (odds ratio 3.05, 95% CI 1.88 to 4.96) and higher geometric mean concentrations at seven months than HM175-based vaccines, with comparable adverse events (risk ratio 0.95, 0.76 to 1.20). The evidence rests on surrogate immunogenicity endpoints from a small number of cohorts, most of them Chinese, so it is a reason to ask what your clinic stocks rather than to switch on the strength of antibody titres alone. The US Food and Drug Administration has approved the first messenger RNA influenza vaccine, reported here as a news item without trial data attached — an approval, not an indication change or a recommendation from any immunisation committee. A meta-analysis of 31 observational studies found that a history of arthroscopic surgery was associated with more infection after arthroplasty (overall odds ratio 1.33, 95% CI 1.14 to 1.56; deep infection 1.38, 1.17 to 1.63), with the association clear for knee and shoulder but not hip. A Lancet Infectious Diseases Personal View proposes replacing the binary definition of a sexually transmitted infection with three tiers, which would determine what enters surveillance and screening. A pearl covers blood cultures and the sepsis clock. The edition closes with a randomised trial in 185 patients with infected upper urinary tract stones, where a flexible negative-suction ureteral access sheath produced lower white cell counts, C-reactive protein and procalcitonin at 6 and 24 hours, higher stone-free rates and fewer complications than a traditional sheath.