Cardiovascular, metabolic and kidney disease: crosscutting science and best practice in multimorbidity - a multispecialty conference at the Royal College of Physicians.

Patients with multimorbidity are increasingly encountered, especially with an ageing population and the co-segregation of lifestyle diseases such as diabetes, obesity and hypertension, but the care of these patients is fragmented and research rarely undertaken within this group. Research into genetic biomarkers and the evolution of crosscutting multiorgan science, resulting in collaboration between specialties for the treatment of patients with multimorbidity, should be the next major step change in medicine. Evolving technology is making this possible. However, there is a necessity to instigate more collaborative multispecialty research efforts to provide the evidence needed to move treatment possibilities forward, leading to the capability for a major redesign of clinical practice. The patient must be at the centre of a new, radically changed and holistic journey and collaborative research with primary care is essential, as general practitioners and primary care colleagues are the experts dealing with common multimorbidities, including those due to long-term poor lifestyle.

Pneumococcal polysaccharide vaccine responses are impaired in a subgroup of children with cystic fibrosis.

BACKGROUND: Pneumococcal immunization is recommended in children with cystic fibrosis (CF). To date, however, there are no published studies on the efficacy of pneumococcal vaccination in this group of patients. METHODS: We carried out a retrospective study of serotype-specific pneumococcal antibody responses to immunization with Prevenar 7 and Pneumovax II in a cohort of children with CF. RESULTS: Nine children had been immunized with Prevenar 7, and all had serotype-specific pneumococcal antibody levels in the protective range (>0.35mg/L) to all 7 immunizing serotypes. In contrast, only 7 of 33 patients (21%) immunized with Pneumovax II made protective antibody responses to all 7 serotypes, and 3 failed to make protective antibodies to any of the serotypes. Controlling for age as a confounder in the analysis, children with impaired antibody responses to pneumococcal polysaccharide (Pneumovax II) immunization had lower Shwachman-Kulczycki scores than children with normal polysaccharide antibody responses. All isolates of Pseudomonas aeruginosa occurred in patients with impaired anti-pneumococcal antibody responses, and a broader range of respiratory pathogens was isolated from these children. CONCLUSIONS: Impaired antibody responses to immunization with Pneumovax II are common in children with CF and this may be associated with increased disease severity.