Maternal RSV vaccine holds up outside the trial, and saline holds its ground in septic shock

The edition in brief

Seven non-randomised post-implementation studies covering 7112 infants, 2684 born to vaccinated mothers, were pooled to measure how the bivalent prefusion F RSV vaccine given in pregnancy performs outside its pivotal trial. Effectiveness against RSV-associated lower respiratory tract infection hospitalisation was 82 per cent from birth to 3 months and 78 per cent (95 per cent CI 70 to 84) from birth to 6 months where mothers were vaccinated at least 14 days before delivery. Extended follow-up of a South African randomised trial found a single primary dose plus booster of 13-valent pneumococcal conjugate vaccine kept serotype-specific IgG non-inferior to two doses plus booster all the way to age 5, whether primed at 6 or 14 weeks, while the same reduced schedule with the 10-valent vaccine failed non-inferiority from age 4. A network meta-analysis of 42 randomised trials and 3835 adolescents found pharmacotherapy plus lifestyle treatment most effective, with semaglutide plus counselling giving the largest BMI reduction, and lifestyle treatment alone still reducing BMI by 3.85 on its own. Fifty-three per cent of three-night oximetry studies in children with Down syndrome crossed the screening threshold on some nights and not others, and 76 per cent of moderate-to-severe obstructive sleep apnoea was in children over six. In PRoMPT BOLUS, 8482 children with septic shock across 47 emergency departments showed no difference in major adverse kidney events between balanced fluid and 0.9 per cent saline (3.4 versus 3.0 per cent), though hyperchloraemia was far commoner with saline.