eMJA: In Other Journals, 4 July 2005

A highly potent varicella-zoster vaccine has been reported to more than halve the incidence of herpes zoster and postherpetic neuralgia in healthy, older adults. In the US Shingles Prevention Study, 38 546 immunocompetent adults aged 60 years or older were randomised to receive either a live attenuated varicella-zoster vaccine derived from the Oka strain, or placebo, subcutaneously. The vaccine contained 18 700 to 60 000 plaque-forming units of virus, much more than the approximately 1350 plaque-forming units in the childhood vaccine. Over more than 3 years of follow-up, there were 957 cases of herpes zoster (315 among vaccine recipients and 642 among placebo recipients), and 107 cases of postherpetic neuralgia (27 among vaccine repicients and 80 among placebo recipients). Further, the vaccine reduced the severity of both conditions. At this stage, the "zoster vaccine" is investigational only.

Welcome to my Atopia

More middle-aged men are atopic today than they were 25 years ago because those born in the 1950s were more likely to become atopic than those born in the 1930s, say London researchers. They measured markers of atopic sensitisation and childhood infection in stored serum samples collected from UK men over nearly a quarter of a century from 1975 to 1998. Year of birth rather than age at sampling was linked to the prevalence of atopy (later birth, more atopy). However, childhood infection was not linked to atopy, suggesting that the increase in atopy was not due to declining rates of childhood infection. Instead, the researchers wondered whether an increased exposure to both indoor and outdoor allergens in more recent decades may be responsible for the observed increase in atopy.

BMJ 2005; 330: 1187-1188

Plane trouble

Exposure to aircraft noise could have a negative effect on the reading comprehension of young schoolchildren, according to European researchers. They assessed the cognitive performance and general health status of 2844 children aged 9 or 10 years who attended 89 schools near major airports in The Netherlands, Spain or the UK. Although no effect on sustained attention or self-reported health was detected, each 5-decibel increase in aircraft noise at a school was found to equate with a 2-month reading delay in the UK and a 1-month reading delay in The Netherlands. The researchers concluded that schools exposed to high levels of aircraft noise are not healthy educational environments.

Lancet 2005; 365: 1942-1949

Giving birth to a new rule?

An Australian expert has dared to question the long-held obstetric practice of elective repeat caesarean section after a previous classical caesarean section (CCS), rather than a trial-of-scar. Professor de Costa reviewed the relevant literature after managing a woman who had inadvertently proceeded to four normal vaginal deliveries after a CCS. Although there is not enough evidence to be certain, de Costa concluded that some women who have had a CCS may be able to have a subsequent, uncomplicated vaginal birth — in particular, if the placenta in the current and the CCS pregnancy was not sited under the incision and there had been no postpartum fever after the CCS.

Aust N Z J Obstet Gynaecol 2005; 45: 182-186

Beware the tag

Another Australian case of small bowel perforation due to a swallowed plastic bread-bag clip has been reported. 1 This time, rather than the more typical elderly, edentulous person, 2 a younger, 50-year-old woman was affected — presenting with increasing epigastric pain and vomiting of relatively short duration. The offending non-degradable, non-radio-opaque bread tag was revealed at laparotomy for a distal small bowel obstruction of no obvious cause. The clip still sported its expiry date — more than 2 years before presentation; the patient did not recall ever having swallowed the clip. Could it be time to modify or replace bread-bag clips?

1. ANZ J Surg 2005; 75: 360-362 2. Med J Aust 2002; 176: 506

Antibiotics and the heart

Antichlamydial antibiotic therapy does not reduce deaths or cardiovascular events in patients with coronary artery disease, according to US researchers. They conducted a systematic review and meta-analysis of 11 randomised controlled trials which compared macrolide antibiotics (and in one trial, a fluoroquinolone) with placebo in a total of 19 217 patients. Antibiotic therapy had no effect on all-cause mortality, on the rates of myocardial infarction or on a combined end-point of myocardial infarction and unstable angina. However, the researchers said their meta-analysis did not exclude Chlamydia pneumoniae infection as a potential cause of acute coronary events. They said eradication of this organism in vivo is extremely difficult, if not impossible, to achieve, even with long courses of antibiotics.

JAMA 2005; 293: 2641-2647

Dr Ann Gregory, MJA

The Medical Journal of Australia eMJA