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Setback for vaccine against genital herpes

N Engl J Med2012;366:34-43OpenUrlCrossRefPubMedWeb of Science

Efforts to develop a vaccine against genital herpes suffered a recent setback when GlaxoSmithKline’s candidate failed to protect women from genital disease caused by the herpes simplex virus (HSV). Overall efficacy was not significantly different from a control vaccine against hepatitis A in a trial of more than 8000 women (efficacy against clinical disease 20%, 95% CI −29% to 50%)⇑.

The authors and sponsors were disappointed and puzzled. The same vaccine had worked in previous trials in serodiscordant couples, and they were hoping for better. The latest trial recruited a broader selection of young women from the US and Canada. None had antibodies to HSV types 1 or 2 (HSV-1 or HSV-2) at the start of the trial. After 20 months of follow-up, 0.9% of women given the herpes simplex vaccine (35/3798) and 1.1% of women given the hepatitis A vaccine (35/3076) had developed genital herpes.

In secondary analyses, GlaxoSmithKline’s vaccine seemed to work better against HSV-1 (genital disease confirmed in 0.3% v 0.7% of women, efficacy 58%, 12% to 80%) than HSV-2 (0.6% v 0.5%, efficacy −38%, −167% to 29%), which is another puzzle, because the vaccine is derived from a glycoprotein in HSV-2. Although HSV-1 is an important cause of clinical disease, say the authors, a vaccine that protects against only one of the two genital herpes viruses is unlikely to be approved for general use.

Poor countries need effective strategies against group B streptococcus

Lancet 2012; doi:10.1016/S0140-6736(11)61651-6

Invasive group B streptococcal infections are a leading cause of neonatal sepsis and death. A meta-analysis covering the past decade reports an incidence of 0.53 per 1000 live births (95% CI 0.44 to 0.62) worldwide, and a mean case fatality rate of 9.6% (7.5% to 11.8%) for infants under 3 months of age. The authors were …