The edition · Infectious Diseases
A higher-dose cell-derived flu vaccine beats the adjuvanted egg-based one — except on H3N2
A 7,677-adult phase 3 trial sorts three influenza vaccines by strain, a Bayesian synthesis puts neurocysticercosis behind a quarter of epilepsy in endemic regions, and a Lancet ID argument asks whether sepsis is the right frame for malaria and leptospirosis deaths.
The edition in brief
Today's infectious diseases edition leads with a phase 3 trial in 7,677 adults aged 50 and over comparing an MF59-adjuvanted cell-derived higher-dose quadrivalent influenza vaccine (aQIVc) with the adjuvanted egg-derived version (aQIV) and a recombinant vaccine (QIVr). aQIVc was superior to aQIV for all four strains, with geometric mean titre ratios of 1.22 to 1.73. Against the recombinant vaccine it met non-inferiority for H1N1 and both B strains but failed for A/H3N2 (GMT ratio 0.69, 97.5% CI 0.65–0.74) — the strain that matters most in older adults. A meta-analysis of four randomised cohorts finds TZ84-based paediatric hepatitis A vaccines produce higher seroconversion than HM175-based ones, on surrogate immunogenicity endpoints and with the evidence concentrated in China. A Lancet Infectious Diseases Personal View argues that framing malaria, leptospirosis and tuberculosis deaths as sepsis obscures how differently they behave, and proposes disease-specific severity stratification instead. A Bayesian meta-analysis of 35 well-defined studies estimates that 25.2% of people with epileptic seizures in endemic regions have neurocysticercosis, with the proportion falling since 2008. The regulatory sweep carries a generic nitrofurantoin application supplement, which is administrative. The edition closes on the case for combination triazole-echinocandin therapy in invasive aspergillosis.
A higher-dose cell-derived flu vaccine beat the egg-based adjuvanted one, and lost to recombinant on H3N2
Prefer the recombinant vaccine over aQIVc in adults aged 50 and over if both are available, because of the A/H3N2 shortfall.
Calling a malaria death a sepsis death may cost the patient the right treatment
Treat organ dysfunction as sepsis and the pathogen as its own diagnostic problem — the bundle does not substitute for identifying what is actually growing.
A quarter of people with epileptic seizures in endemic regions have neurocysticercosis
In an endemic area, new-onset seizures warrant imaging before anyone calls the epilepsy idiopathic.
One hepatitis A vaccine strain outperformed the other on antibody response in children
A reason to prefer a TZ84-based product when choosing, and no reason at all to revaccinate anyone.
FDA cleared a supplement to a generic nitrofurantoin application
Nothing to act on — an administrative supplement to a generic application, with no change to how nitrofurantoin is used.
Ask the microbiology laboratory what it did not test
Before escalating on a susceptibility report, ring the laboratory and ask what was not tested.
The case for triazole plus echinocandin in invasive aspergillosis, reopened
For proven or probable invasive aspergillosis in an immunocompromised patient, put combination triazole-echinocandin therapy back on the table with your stewardship team.
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