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Nasal vaccine protects children from 'flu
THE LANCET
SCIENCE AND MEDICINE
Antibiotic cuts risk of recurrent heart disease he presence of a common respiratory pathogen, Chlamydia pneumoniae, quadruples the risk of secondary coronary events, say UK investigators who have carried out the first prospective antibiotic eradication trial for heart disease. The excess risk was completely eliminated by a 3-day course of azithromycin (Circulation 1997; 96: 404–07). Researchers from St George’s Hospital Medical School (London, UK) studied 213 male postmyocardial infarction patients in a randomised placebo-controlled trial of azithromycin. They found that patients with the highest antibody titres to C pneumoniae (Cp) had four times the risk of cardiac events such as myocardial infarction, coronary artery bypass grafting, angioplasty, and angina in the following 18 months compared with similar patients who had no detectable Cp antibodies. Cp-positive patients who received azithromycin had a risk of cardiac events equivalent to that of patients with no trace of the pathogen, regardless of possible confounders such as smoking, diabetes, and aspirin therapy. Research leader Sandeep Gupta said the study, though small, has important implications for prevention of both secondary and primary coronary events, particularly given the
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safety and cost of azithromycin. “50 to 60 per cent of the variation in coronary heart disease prevalence and severity is not explained. This may explain why someone with high cholesterol has three-vessel disease while another with similarly high cholesterol has two or none.” The group suggest that Cp may be carried into arteries by macrophages and promote atherosclerosis either by setting up chronic inflammation, or by triggering production of prothrombotic factors such as tissue factor. “It is an intriguing study”, said British Heart Foundation medical director Brian Pentecost (London, UK). “There has been a great deal of interest in a possible infectious side to coronary heart disease, but with most of the organisms studied so far there have been confounding factors which diminish their role when you look more closely. This is a very small study but it creates the environment needed for a large powerful trial.” President-elect of the American Heart Association, Valentin Fuster (Mount Sinai Medical School, NY, USA), said the study suggested that Cp could be as important a trigger for heart disease as smoking, and that antibiotic therapy as useful a preventive tool as quitting smoking. Hilary Bower
Infrared reveals the “iceman’s” adipocere have assumed that the iceman was t a meeting on the Tyrolean “iceonly desiccated. Bereuter et al claim man”(Vienna, Austria, June 25), that at some point the body lay in Werner Platzer (University of water and desiccaInnsbruck, Austria) tion followed. reminded the audi(a) Histology shows ence that in a skin lacking an epi7-week period in dermis, a finding 1991 six bodies had compatible with emerged from the (b) exposure to water. Tyrolean glaciers. And infrared specThe next sensatroscopy patterns tional find was –1 from skin suggest “Ötzi”, the Ötztal cm 4000 3000 2000 1500 1000 adipocere or “grave iceman, a Neolithic wax” contributed hunter who is still Infrared spectra (part) for inner to mummification the subject of scien- side of skin samples: (a) iceman (Chem Eur J 1997; tific inquiry and (b) reference adipocere specimen 3: 1032–38). speculation. Glacier bodies often exhibit Now, Thomas L Bereuter and adipocere—these changes in body-fat colleagues (Institute of Organic composition can occur in both ice Chemistry, University of Vienna) and water. Infrared spectra from the have come up with a new theory on Iceman closely resemble an how the man’s body was preserved adipocere reference specimen from for more than 5000 years. Until now, parts of a tourist’s body found in notes Bereuter, most research groups
A
Vol 350 • July 19, 1997
Nasal vaccine protects children from ’flu n influenza vaccine nasal spray has proven very effective in preventing ’flu in healthy young children in a large multicentre US trial. In the study—supported by the National Institute of Allergy and Infectious Diseases (Bethesda, MD) and the biopharmaceutical company Aviron—the vaccine conferred 93% protection against ’flu, overall. Only 1% of 1050 children given the attenuated live-virus vaccine developed culture-confirmed ’flu during last year’s influenza season, compared with 18% of 532 children given placebo. Last year, the same vaccine conferred 85% protection against ’flu in a direct-challenge efficacy study of 92 healthy adults. A large trial of the vaccine in working adults is planned, to find out whether it reduces healthcare costs and absenteeism from ’flu. The vaccine is cold-adapted and cannot grow at temperatures found in the lower respiratory tract. “But it grows well in the cooler nasal passages”, says Brian Murphy of NIAID. “This allows the vaccine to mimic a natural infection and induce immunity without actually causing disease.” Unlike the currently licensed vaccine, the new one stimulates nasal as well as systemic immunity.
A
Dorothy Bonn
Doctor’s ancient toolkit found Archeologists in Colchester, Essex, UK, unearthed a rare find last week—a grave containing a set of surgical instruments from the Roman era. The experts believe that the tools were probably buried with a doctor who may have used them to perform operations around AD50. The similarity to modern versions has been called “slightly worrying”. See www.peipa.essex.ac.uk/CAT/ Kelly Morris
1994 after 64 years in the ice (figure). Bereuter regards the infrared spectra as important because “they clearly show (in a non-destructive way) that adipocere formation had taken place, despite the impression one might have at first glance”. Ötzi froze to death and remained where he died, sheltered from the forces of the moving glacier. David Sharp
191
SCIENCE AND MEDICINE
Antibiotic cuts risk of recurrent heart disease he presence of a common respiratory pathogen, Chlamydia pneumoniae, quadruples the risk of secondary coronary events, say UK investigators who have carried out the first prospective antibiotic eradication trial for heart disease. The excess risk was completely eliminated by a 3-day course of azithromycin (Circulation 1997; 96: 404–07). Researchers from St George’s Hospital Medical School (London, UK) studied 213 male postmyocardial infarction patients in a randomised placebo-controlled trial of azithromycin. They found that patients with the highest antibody titres to C pneumoniae (Cp) had four times the risk of cardiac events such as myocardial infarction, coronary artery bypass grafting, angioplasty, and angina in the following 18 months compared with similar patients who had no detectable Cp antibodies. Cp-positive patients who received azithromycin had a risk of cardiac events equivalent to that of patients with no trace of the pathogen, regardless of possible confounders such as smoking, diabetes, and aspirin therapy. Research leader Sandeep Gupta said the study, though small, has important implications for prevention of both secondary and primary coronary events, particularly given the
T
safety and cost of azithromycin. “50 to 60 per cent of the variation in coronary heart disease prevalence and severity is not explained. This may explain why someone with high cholesterol has three-vessel disease while another with similarly high cholesterol has two or none.” The group suggest that Cp may be carried into arteries by macrophages and promote atherosclerosis either by setting up chronic inflammation, or by triggering production of prothrombotic factors such as tissue factor. “It is an intriguing study”, said British Heart Foundation medical director Brian Pentecost (London, UK). “There has been a great deal of interest in a possible infectious side to coronary heart disease, but with most of the organisms studied so far there have been confounding factors which diminish their role when you look more closely. This is a very small study but it creates the environment needed for a large powerful trial.” President-elect of the American Heart Association, Valentin Fuster (Mount Sinai Medical School, NY, USA), said the study suggested that Cp could be as important a trigger for heart disease as smoking, and that antibiotic therapy as useful a preventive tool as quitting smoking. Hilary Bower
Infrared reveals the “iceman’s” adipocere have assumed that the iceman was t a meeting on the Tyrolean “iceonly desiccated. Bereuter et al claim man”(Vienna, Austria, June 25), that at some point the body lay in Werner Platzer (University of water and desiccaInnsbruck, Austria) tion followed. reminded the audi(a) Histology shows ence that in a skin lacking an epi7-week period in dermis, a finding 1991 six bodies had compatible with emerged from the (b) exposure to water. Tyrolean glaciers. And infrared specThe next sensatroscopy patterns tional find was –1 from skin suggest “Ötzi”, the Ötztal cm 4000 3000 2000 1500 1000 adipocere or “grave iceman, a Neolithic wax” contributed hunter who is still Infrared spectra (part) for inner to mummification the subject of scien- side of skin samples: (a) iceman (Chem Eur J 1997; tific inquiry and (b) reference adipocere specimen 3: 1032–38). speculation. Glacier bodies often exhibit Now, Thomas L Bereuter and adipocere—these changes in body-fat colleagues (Institute of Organic composition can occur in both ice Chemistry, University of Vienna) and water. Infrared spectra from the have come up with a new theory on Iceman closely resemble an how the man’s body was preserved adipocere reference specimen from for more than 5000 years. Until now, parts of a tourist’s body found in notes Bereuter, most research groups
A
Vol 350 • July 19, 1997
Nasal vaccine protects children from ’flu n influenza vaccine nasal spray has proven very effective in preventing ’flu in healthy young children in a large multicentre US trial. In the study—supported by the National Institute of Allergy and Infectious Diseases (Bethesda, MD) and the biopharmaceutical company Aviron—the vaccine conferred 93% protection against ’flu, overall. Only 1% of 1050 children given the attenuated live-virus vaccine developed culture-confirmed ’flu during last year’s influenza season, compared with 18% of 532 children given placebo. Last year, the same vaccine conferred 85% protection against ’flu in a direct-challenge efficacy study of 92 healthy adults. A large trial of the vaccine in working adults is planned, to find out whether it reduces healthcare costs and absenteeism from ’flu. The vaccine is cold-adapted and cannot grow at temperatures found in the lower respiratory tract. “But it grows well in the cooler nasal passages”, says Brian Murphy of NIAID. “This allows the vaccine to mimic a natural infection and induce immunity without actually causing disease.” Unlike the currently licensed vaccine, the new one stimulates nasal as well as systemic immunity.
A
Dorothy Bonn
Doctor’s ancient toolkit found Archeologists in Colchester, Essex, UK, unearthed a rare find last week—a grave containing a set of surgical instruments from the Roman era. The experts believe that the tools were probably buried with a doctor who may have used them to perform operations around AD50. The similarity to modern versions has been called “slightly worrying”. See www.peipa.essex.ac.uk/CAT/ Kelly Morris
1994 after 64 years in the ice (figure). Bereuter regards the infrared spectra as important because “they clearly show (in a non-destructive way) that adipocere formation had taken place, despite the impression one might have at first glance”. Ötzi froze to death and remained where he died, sheltered from the forces of the moving glacier. David Sharp
191