Monovalent 2009 influenza A (H1N1) MF59-adjuvanted vaccine generates antibody responses likely to be associated with protection after a single dose is administered. (ClinicalTrials.gov number, NCT00943358).

The cytokine TWEAK and its cognate receptor Fn14 are members of the TNF/TNFR superfamily and are upregulated in tumors. We found that Fn14, when expressed in tumors, causes cachexia and that antibodies against Fn14 dramatically extended lifespan by inhibiting tumor-induced weight loss although having only moderate inhibitory effects on tumor growth. Anti-Fn14 antibodies prevented tumor-induced inflammation and loss of fat and muscle mass. Fn14 signaling in the tumor, rather than host, is responsible for inducing this cachexia because tumors in Fn14- and TWEAK-deficient hosts developed cachexia that was comparable to that of wild-type mice. These results extend the role of Fn14 in wound repair and muscle development to involvement in the etiology of cachexia and indicate that Fn14 antibodies may be a promising approach to treat cachexia, thereby extending lifespan and improving quality of life for cancer patients.

Frontline healthcare workers will be at increased risk of infection during the next influenza pandemic. Proactive priming with pre-pandemic vaccine may protect staff and reduce nosocomial transmission. Despite campaigns to increase seasonal influenza vaccine coverage, uptake rates among healthcare workers are generally low, so it is uncertain whether they would participate in voluntary pre-pandemic vaccine programmes. We conducted a cross-sectional questionnaire survey of healthcare workers in a large UK teaching hospital during, and six months after, a period of intense media reporting of an H5N1 outbreak at a commercial UK poultry farm. A total of 520 questionnaires were returned, representing 20% of the frontline workforce. More respondents were willing to accept pre-pandemic vaccine during the period of heightened media attention than after (166/262, 63.4% versus 134/258, 51.9%; p=0.009). Following multivariate analysis, factors associated with willingness to accept pre-pandemic vaccine were: receipt of previous seasonal influenza vaccine (odds ratio 5.1, p<0.0001), belief that seasonal vaccine benefits themselves (OR 1.9, p=0.003), pandemic risk is high (OR 35.6, p=0.001) and that healthcare workers are threatened by a pandemic (OR 2.6, p<0.0001). Those who would not accept prepandemic vaccine (220 of 520 respondents, 42.7%) do not perceive pandemic influenza as a serious threat, and have concerns regarding vaccine safety. A majority of healthcare workers are amenable to accepting pre-pandemic vaccination if offered.Improving coverage of seasonal vaccine would increase pre-pandemic vaccine uptake if a proactive priming strategy was implemented.

Introduction People living with HIV (PLWH) are at high risk of active tuberculosis (TB) but this risk in the era of antiretroviral treatment (ART) remains unclear. It is critical to identify the groups who should be prioritised for latent TB (LTBI) screening. In this study we identified the risk factors associated with developing incident TB disease, by analysing a 30‐year observational cohort. Methods We evaluated PLWH in Leicester, UK, between 1983 and 2017 to ascertain those who developed active TB and the timing of this in relation to HIV diagnosis; whether before, concurrently with, or more than 3 months after the diagnosis of HIV (incident TB). Predictors of incident TB were ascertained using Cox proportional hazards models. Results In all, 325 out of 2158 (15.1%) PLWH under care had had active TB; 64/325 (19.7%) prior to HIV diagnosis, 161/325 (49.5%) concurrently with/within 3 months of HIV diagnosis and 100/325 (30.8%) had incident TB. Incident TB risk was 4.57/1000 person‐years. Increased TB incidence in the country of birth was associated with an increased risk of developing incident TB [50–149/100 000 population, adjusted hazard ratio (AHR) = 3.10, 95% CI: 0.94–10.20; 150–249/100 000 population, AHR = 7.14, 95% CI: 3.46–14.74; 250–349/100 000 population, AHR = 5.90, 95% CI: 2.32–14.99; ≥ 350/100 000 population, AHR = 3.96, 95% CI: 1.39–11.26]. Conclusions Tuberculosis risk remains high among PLWH and is related to TB incidence in the country of birth. Further work is required to determine whether specific groups of PLWH should be targeted for programmatic LTBI screening, and whether it will result in high uptake and completion of chemoprophylaxis and is cost‐effective for widespread implementation.

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