Infection

Molnupiravir plus usual care versus usual care alone as early treatment for adults with COVID-19 at increased risk of adverse outcomes (PANORAMIC): an open-label, platform-adaptive randomised controlled trial 2023 (Butler CC, Hobbs FDR, Gbinigie OA, Rahman NM, Hayward G, Richards DB)

The PANORAMIC trial evaluated the safety, effectiveness, and cost-effectiveness of molnupiravir in vaccinated adults at increased risk of COVID-19 morbidity and mortality in the community. This UK-based, national, multicentre, open-label, adaptive randomized controlled trial enrolled participants aged ≥50 years, or ≥18 years with relevant comorbidities, with confirmed COVID-19 of ≤5 days’ duration. Participants were randomly assigned to receive 800 mg molnupiravir twice daily for 5 days plus usual care (n=12,821) or usual care alone (n=12,962). The primary outcome was all-cause hospitalization or death within 28 days, analyzed using Bayesian models. Among 25,054 participants included in the primary analysis, mean age was 56.6 years and 94% had received at least three SARS-CoV-2 vaccine doses. Hospitalizations or deaths occurred in 1.0% of both the molnupiravir plus usual care group (105/12,529) and the usual care group (98/12,525), with an adjusted odds ratio of 1.06 (95% Bayesian credible interval 0.81–1.41; probability of superiority 0.33), and no significant subgroup interactions. Serious adverse events were rare and not attributed to molnupiravir. These findings indicate that, in a highly vaccinated community population at increased risk, adding molnupiravir to usual care did not reduce COVID-19–related hospitalizations or deaths.

Study Link

https://doi.org/10.1016/S0140-6736(22)02597-1

A cross-sectional observational study of pneumococcal carriage in children, their parents, and older adults following the introduction of the 7-valent pneumococcal conjugate vaccine 2015 (Hamaluba M, Kandasamy R, Ndimah S, Morton R, Caccamo M, Robinson H)

Following the introduction of the 7-valent pneumococcal conjugate vaccine (PCV7) and prior to the rollout of the 13-valent vaccine (PCV13) in the United Kingdom, we evaluated pneumococcal colonization and its relationship to invasive disease in children, their parents, and older adults. In a cross-sectional observational study, nasopharyngeal swabs were collected from children aged 25–55 months who had received three doses of PCV7, their parents, and adults aged ≥65 years. Serotyping was performed according to WHO guidelines, with nontypeable isolates further analyzed molecularly, alongside concurrent national invasive disease surveillance. Pneumococcus was detected in 47% of children, 9% of parents, and 2.2% of older adults. PCV7 serotypes accounted for 1.5%, 0.0%, and 15.4% of carriage, with additional PCV13 serotype coverage of 20.1%, 44.4%, and 7.7%, respectively. Invasive disease due to PCV7 serotypes was 1.0%, 7.4%, and 5.1%, with further attribution to PCV13 serotypes of 65.3%, 42.1%, and 61.4%. High carriage in children demonstrated direct vaccine impact, while reduced carriage and disease in unvaccinated parents and older adults indicated indirect herd protection. These findings highlight the effectiveness of PCV7 and inform strategies for PCV13 implementation..

Study Link

https://doi.org/10.1097/MD.0000000000000335.