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Bone marrow transplant in SCID
Severe combined immunodeficiency (SCID), although rare (around 1 in 60 000), is undoubtedly the most devastating of the congenital immunodeficiencies. Before the advent of haematopoietic cell transplantation, it was universally fatal. Clinicians throughout North America have collaborated to report on the outcomes of 240 children who received transplants at 25 centres between 2000 and 2009 (Pai SY and colleagues. NEJM 2014;371:434–46). Outcomes were very encouraging: around 90% 5-year survival overall. Those who received cells from matched sibling donors did better than those who received mis-matched T-cell depleted donations from relatives (survival 97% vs 79%). Active infections at the time of transplant reduced survival rates. More significantly, there was a trend to better survival when the transplant was done in younger infants (94%<3.5 months vs 90% >3.5 months without infection; p=0.07). As many are not diagnosed until they are several months old, this study makes a good case for universal neonatal screening for SCID: some states in the US have already implemented this, using T-cell receptor excision circle (TREC) assays.
Polio vaccine: injected makes oral work better
Oral polio vaccine (OPV) has been a massive global success, because its ease of administration, low price and mucosal immunogenicity make it particularly effective in low-income countries. However the duration …