The Hepatitis B vaccine has been linked with the kidney disease glomerulonephritis. The Lancet (23 January 1993) reports the case of a 21 year old man who developed the condition after a third booster of HB vaccine. Glomerulonephritis causes swelling

More evidence casting doubt on the usefulness of vaccination against meningitis has emerged in research by the Haemophilus Influenzae Study Group (JAMA, 13 January 1993). In a study generally extolling the virtues of the Hib vaccination in cutting the number of meningitis cases, the group concedes that a "substantial" fall also occurred in children who hadn't been vaccinated: down from 99.3 per 100,000 in 1989 to 68.5 per 100,000 in 1990. This particular drop, they add, is "consistent with previously identified cyclic variation in meningococcal disease incidence" that is, the disease reaches a peak and then goes into decline over a number of subsequent years.

"Although the reason for this cyclical variation is not known, it raises the possibility that the observed variation in meningococcal disease rates may not represent an effect of changes in medical therapy or diagnosis."

SmithKline Beecham is to continue producing vaccines which contain the Urabe mumps virus strain which has been linked with cases of meningitis. In September last year (WDDTY, vol 3 no 8) the UK Department of Health announced that it was to stop using combined measles, mumps and rubella vaccines which contained the Urabe strain because of the meningitis risk. SmithKline has decided, however, to "continue to produce and supply vaccines that contain the Urabe mumps strain, so that existing immunization programmes in areas where no alternative mumps vaccine is available need not be suspended" (The Lancet, 2 January 1993).

The US Food and Drug Administration has approved an inactivated Japanese encephalitis vaccine (JE-VAX) for use by travellers to Asia (JAMA, 20 January 1993).

Our panel member, former Food and Drug Administration vaccine expert J Anthony Morris, tells us that side effects have occurred in 10 per cent of JE-VAX recipients everything from fever, vomiting and pain to swelling in the arms, legs and joints,and respiratory distress. "Given the opportunity to read and to understand the information in the package insert, the chances are great that the conclusion will be reached that it is in the interests of potential vaccine recipients to avoid not only mosquitoes [which carry the disease] but also the vaccine," he said.