this week TWINS page 423 • VACCINATING CHILDREN page 424 • BRITISH CYCLING page 427 FRANK HOERMANN/DPA/PA/ALAMY FRANK WHO backs rollout of AstraZeneca vaccine Doctors have warned of the risks associated On 16 March WHO’s chief scientist, Soumya The World Health Organization with pausing or delaying vaccination Swaminathan, said, “We do not want has urged people not to panic programmes against covid-19, as the people to panic, and we would, for the time amid reports of blood clotting number of European countries that have being, recommend that countries continue disorders in patients receiving the vaccine halted use of the Oxford University and vaccinating with AstraZeneca . So far, we AstraZeneca vaccine rose to 16. do not fi nd an association between these Denmark, Norway, Bulgaria, Iceland, events and the vaccine.” France, Germany, Italy, Spain, Portugal, The EMA said there had been 30 reports Slovenia, and Cyprus have suspended all of thromboembolic events among nearly use of the vaccine. Five other countries fi ve million people given the AstraZeneca (Austria, Estonia, Latvia, Lithuania, and vaccine in the European Economic Area. Luxembourg) have paused the use of a AstraZeneca has said 37 blood clots have LATEST ONLINE batch of a million doses of the vaccine. been reported among more than 17 million NHS and social The moves came after reports of people vaccinated in the EU and Britain. care need an extra blood clotting disorders. The Norwegian Five of the cases were deep vein thrombosis, £12bn to get back Medicines Agency said last week it was and 22 were pulmonary embolisms. “This on track after looking into several cases of blood clots is much lower than would be expected to pandemic, says or reduced platelet counts, including at occur naturally in a general population of think tank least one death from a brain haemorrhage. this size and is similar across other licensed Covid-19: Danish authorities also launched a safety covid-19 vaccines,” it said in a statement. Underfunding of review after the death of a recipient, while Phil Bryan, vaccines safety lead at the health workforce Austrian offi cials said a person who had UK Medicines and Healthcare Products left many multiple thrombosis diagnosed after Regulatory Agency, said, “Blood clots can European nations vulnerable, says vaccination had died and another was occur naturally and are not uncommon. commission recovering from pulmonary embolism. “More than 11 million doses of The World Health Organization and the the AstraZeneca vaccine have been Italy reimposes widespread European Medicines Agency have said administered across the UK, and the lockdown as there does not seem to be an increased risk number of blood clots reported after having transmission rate of blood clots with the vaccine and have the vaccine is not greater than the number rises again advised that vaccinations should continue. (Continued on page 424) the bmj | 20 March 2021 421 SEVEN DAYS IN Capsule endoscopies will be trialled in England Miniature cameras in a capsule for patients to swallow are set to be trialled in England to check for colorectal cancer and other bowel disorders such as Crohn’s disease. The imaging technology, known as colon capsule endoscopy, takes two pictures a second as it passes through the body over about 5-8 hours and transmits the images to a data recorder worn on the patient’s waist. Patients can be treated at home with minimal disruption to their day, NHS England said. A group of 11 000 patients in more than 40 areas will receive the cameras initially. Although traditional endoscopies are still being performed, the infection control measures required to make them covid secure mean that they take much longer to do, reducing the number of people who can have them. Ed Seward, a consultant gastroenterologist at University College London Hospital who has been using the technology, said the device is useful for people who don’t want to leave home. Alastair McKinlay, president of the British Society of Gastroenterology, said the cameras may off er a real advantage for patients. “We welcome the opportunity for a proper service evaluation so the limitations and advantages of this technique can be properly assessed,” he said. “This information will put the UK at the forefront of the world in this important new area.” GASTROLAB/SPL Zosia Kmietowicz , The BMJ Cite this as: BMJ 2021;372:n692 Covid-19 whether a shorter schedule may continued to accelerate. GPs have reaching their full potential and Vaccine is linked to lower be offered if people are unlikely to already been inviting patients will offer solutions to improve household transmission return for the second dose at 12 with underlying conditions such children’s lives and develop A study by Public Health Scotland weeks, it said. as diabetes and some forms of tough targets to hold the and the University of Glasgow cancer. The NHS texts are part of government and others to of 300 000 healthcare workers EMA recommends J&J a renewed effort to reach people account. employed by the NHS in Scotland vaccine for authorisation who have not been vaccinated, and their households showed The European Medicines giving them a link to arrange a Lung cancer that the rate of SARS-CoV-2 Agency recommended granting jab at a vaccination centre or Screen over 50s who infection in people living with a conditional marketing pharmacy led service. smoke, says US taskforce healthcare workers was at least authorisation for Johnson 30% lower when the worker had & Johnson’s covid vaccine Child health been vaccinated after a single in over 18s. The single dose Launch of “Beveridge dose and at least 54% lower vaccine made by Janssen, the report for children” after the second vaccination. pharmaceutical arm of Johnson England’s new children’s As household members can & Johnson, will be the fourth commissioner, Rachel de also be infected through other vaccine approved in the EU, after Souza (below), announced a people, this 30% relative risk Pfizer-BioNTech, Moderna, and once-in-a-generation review of reduction is an underestimate of Oxford-AstraZeneca. “Authorities the future of childhood, with The US Preventive Services Task the true effect of vaccination on across the European Union will an ambitious call to rebuild Force updated its guidance transmission. have another option to combat childhood after the covid-19 on lung cancer screening to the pandemic and protect the pandemic. The Childhood recommend that people over Prioritise homeless people lives and health of their citizens,” Commission will be inspired 50 with a smoking history of at for vaccine, says JCVI said Emer Cooke, the EMA’s by the ambition of William least 20 pack years should be The Joint Committee on executive director. Beveridge’s pioneering offered an annual scan using low Vaccination and Immunisation 1940s report, which dose computed tomography, advised the UK government to NHS texts vulnerable laid the foundations increasing the number of people prioritise homeless people for the people for vaccination of the postwar social eligible for screening from covid vaccine, including those The NHS sent text security system. The nine million to 15 million. The sleeping rough. It said that local messages to millions commission new guidelines advise against teams should consider offering of clinically vulnerable will identify screening people who stopped vaccines to homeless adults people this week to the smoking at least 15 years ago alongside those in priority group encourage them to get barriers or those who cannot benefit 6 without the need for an NHS a covid vaccination preventing from early detection because number or GP registration. Local as its national children they are unwilling or unable to decisions should be taken on programme from have surgery. 422 20 March 2021 | the bmj SIXTY SECONDS MEDICINE ON . TWINS Vaccination AM I SEEING DOUBLE? Novavax vaccine is highly Very probably. The chances of seeing twins effective, results show are higher now than ever. Since the 1980s the The covid-19 vaccine developed twinning rate has risen from 9 to 12 per 1000 deliveries, says a global overview in Human by the US company Novavax is Reproduction . About 1.6 million twins are 96% effective against the original born each year—one in every 42 newborns. variant of SARS-CoV-2 and 86% effective in protecting against the WHAT’S BEHIND THE BUMP? variant B1.1.7 discovered in Kent, Novavax data show its A major reason is the growth in medically the company disclosed. Phase III vaccine is 96% effective against assisted reproduction. The various trial results from a UK based study the original variant of the virus techniques started in wealthier countries showed overall effectiveness in the 1970s and in Asia and Latin America of 90%. Novavax said a smaller are biologically plausible reasons in the 1980s and 90s, reaching more phase IIb trial in South Africa, why smoking may worsen mental NHS prosperous parts of South Asia and Africa where the more transmissible health through neuroadaptations aft er 2000. Another cause is the delay in B1.351 variant is circulating, had arising from chronic smoking, childbearing, since the twinning rate rises CARE with the mother’s age. found an efficacy of 55.4% among leading to frequent nicotine HIV negative trial participants. withdrawal symptoms (e.g. Out of 3200 IS IT IDENTICAL AROUND THE WORLD? anxiety, depression, irritability), NHS patients No, there are clear diff erences. Among 122 Intensive care in which case smoking cessation who said they countries that had data from 1980-85 and Staff will feel covid impact may help to improve rather than increased their 2010-15, the twinning rate increased by for “years to come” worsen mental health.” more than 10% in 83 countries and fell by use of technology more than 10% in seven.