Rhode Island | Recent child death resulting from Staphylococcus Aureus Sepsis associated with EV-D68

The Rhode Island Department of Health has confirmed that a Rhode Island child died last week as a result of Staphylococcus aureus sepsis associated with enteroviral infection (EV-D68). Infection by both Staphylococcus aureus sepsis and EV-D68 is a very rare combination that can cause very severe illness in children and adults.

The Centers for Disease Control and Prevention has detected EV-D68 in specimens from a few patients in a few states who had died and had samples submitted for testing. The role that EV-D68 infection played in these deaths is unclear at this time.

Only a very small portion of people who contract EV-D68 will experience problems beyond a runny nose and a low grade fever. Most viruses produce mild illnesses from which people are able to recover. After an outbreak, however, a small portion of the population may have a number of different complications. The Centers for Disease Control and Prevention continues to investigate EV-D68 and its associated illnesses, but the reason for the current EV-D68 outbreak is not completely understood.

“We are all heartbroken to hear about the death of one of Rhode Island’s children,” says Michael Fine, M.D., Director of the Rhode Island Department of Health. “Many of us will have EV-D68. Most of us will have very mild symptoms and all but very few will recover quickly and completely. The vast majority of children exposed to EV-D68 recover completely.”

The Enterovirus D68 is a virus with flu-like symptoms that has been confirmed in 472 people, most of them children, in 41 states and the District of Columbia, according to the Centers for Disease Control and Prevention. Identified in 1962, EV-D68 was infrequently tested for and only began getting attention last month as a number of people with respiratory problems were found to have EV-D68.

The mild symptoms are similar to the common cold, but can progress to wheezing and problems breathing. Infants, children, and teens are most at risk, especially children with asthma. There is no antiviral treatment for people with EV-D68 and no vaccine to prevent it. There are 9 recent case reports about acute neurologic illness – limb weakness and MRI changes that have occurred at the same time as there has been an outbreak of EV-D68.

“While we can’t prevent EV-68 with a vaccine, it’s important for everyone to get the flu shot – it is as bad as or worse than EV-68. And, we do have a shot to prevent the flu. The sooner you get the flu shot, the better,” says Michael Fine, M.D.

Here are recommendations from health officials for how to avoid contracting EV-D68:

* Wash your own and your child’s hands often with soap and warm water 5 or 6 times a day (there is some evidence that hand washing is better than alcohol hand sanitizers at killing enteroviruses). Wash for at least 20 seconds. Children should sing their ABCs or “Happy Birthday” twice in a row while washing their hands to ensure the proper length in time.

* Avoid touching your eyes, nose, and mouth with unwashed hands, and remind children to keep their hands away from their faces. * Asthma management is particularly important at this time of year. Ensure your child is taking the appropriate medications as prescribed by your child’s doctor. It is the important that parents have a current Asthma Action Plan for children with asthma.

* Clean surfaces often, including toys, doorknobs, phone receivers, and keyboards.

* Avoid kissing, hugging, and sharing cups or eating utensils with people who are sick.

*If fever is present, stay home while sick and for at least one day after the fever is gone, without the use of fever-reducing medicines.

*Seek medical help right away for a child with asthma who is having trouble breathing or suffers worsening respiratory symptoms that do not improve as expected with their usual medicines.

*Get a flu shot today!

USA | For The Record: CDC confirms first Ebola case diagnosed in the United States

CDC Press Conference: CDC Confirms First Ebola Case Diagnosed in the United States

Tuesday, September 30, 2014, 5:30 p.m. ET

BARBARA REYNOLDS: Good afternoon.  This is the CDC Ebola media briefing.  I’m Barbara Reynolds from public affairs at CDC.  We’ll hear briefly from four speakers and take questions from the media.  Our first speaker is CDC director Dr. Tom Frieden.

TOM FRIEDEN: Good afternoon, everybody.  Thanks for joining us.  As you have been hearing us, Ebola is a serious disease.  It’s only spread by direct contact with someone who’s sick with the virus.  It’s only spread through body fluids.  The incubation period is 8 to 10 days after exposure.  Can be as short as two days or as long as 21days.  It’s a severe disease which has a high case fatality rate, even with the best of care.  But there are core tried and true public health interventions that stop it.  Today, we are providing the information that an individual traveling from Liberia has been diagnosed with Ebola in the United States.  This individual left Liberia on the 19th of September, arrived in the U.S. on the 20th of September, had no symptoms when departing Liberia or entering this country, but four or five days later around the 24th of September began to develop symptoms.  On the 26th of September initially sought care and Sunday the 28th of September was admitted to a hospital in Texas and placed on isolation.  We received in our laboratory today specimens from the individual, tested them and they tested positive for Ebola.  The state of Texas also operates a laboratory that found the same results.  Testing for Ebola is highly accurate.  It’s a PCR test of blood.  So what does this mean?  The next steps are basically threefold.  First, to care for the patient.  We’ll be hearing from the hospital shortly, to provide the most effective care possible as safely as possible to keep to an absolute minimum the likelihood, the possibility that anyone would become infected.  Second, to maximize the chances that the patient might recover.  Second, we identify all people who may have had contact with the patient while he could have been infectious.  Remember, Ebola does not spread from someone who is not infectious.  It does not spread from someone who doesn’t have fever and other symptoms.  It’s only someone who is sick with Ebola who can spread the disease.  Once those contacts are all identified, they are all monitored for 21 days after exposure to see if they develop fever.  If they develop fever then those same criteria are used to isolate them and make sure they are cared for as well as possible so they maximized their chances and to minimize or eliminate the chance that they would infect other people.  The bottom line here is that I have no doubt that we will control this importation or case of Ebola so it does not spread widely in this the country.  It is certainly possible that someone who had contact with this individual, a family member or other individual could develop Ebola in the coming weeks.  But there is no doubt in my mind that we will stop it here.  It does reflect the ongoing spread of Ebola in Liberia and West Africa where there are large numbers of cases.  While we do not currently know how this individual became infected, they undoubtedly had close contact with someone who was sick with Ebola or who had died from it.  In West Africa, we are surging the response not only of CDC where we have more than 130 people in the field, but also throughout the U.S. government.  The president has leaned forward to make sure we are acting proactively there and the defense department is on the ground, already strengthening the response.  We are working with us aid and other parts of the government as well as with a broad global coalition to confront the epidemic there.  Ultimately, we are all connected by the air we breathe.  And we are invested in ensuring that the disease is controlled in Africa, but also in ensuring that where there are patients in this country who become ill, they are isolated.  We do the tried and true core public health interventions that stop the spread of Ebola.

BARBARA REYNOLDS: Thank you, Dr. Frieden.  I would like to next introduce our second speaker, Dr. David Lakey, commissioner of the Texas department of state health services.  Dr. Lakey.

DAVID LAKEY:  Good afternoon, everyone.  Thank you, Dr. Frieden, for your support, the support of the CDC as we work through this current situation.  As i start off, I first want to say our thoughts and prayers are with the family, with the patient and the treatment team for this individual.  Our laboratory, the Texas public health laboratory in Austin has a specially trained team to handle high risk specimens like this.  We were certified on the 22nd of August to do Ebola testing.  At 9:00 this morning we received a blood sample.  All controls were within expected ranges and the PCR was definitely positive for Ebola.  We got that result at 1:22 this afternoon.  I want to reiterate we have no other suspected cases in the state of Texas at this time.  We are closely monitoring the situation and we are ready to assist in any way needed.  We have been in contact with the hospital, with the local health department and the CDC.  They have our full support as we work through this situation.  We are committed to keeping Texas safe.  So again, I want to thank the CDC and local state health department and Dallas County and the hospital for the notes we are getting.  We are working through the situation together.  Thank you.

BARBARA REYNOLDS: Thank you, Dr. Lakey.  Our third speaker is Dr. Edward Goodman, hospital epidemiologist with the Texas health Presbyterian hospital Dallas.  Dr. Goodman?

EDWARD GOODMAN:  Thank you to Dr. Frieden, Dr.  Lakey, the CDC.  I want to correct one statement that might have been misinterpreted by Dr. Frieden when he commented on the air we breathe.  Ebola is not transmitted by the air.  It is not an airborne infection.  Texas health Dallas is a large community hospital with a robust infection control system that works in close cooperation with the Dallas county health department, centers for disease control and epidemiologists within the system and community.  We have had a plan in place for some time now in the event of a patient presenting with possible Ebola.  Ironically enough in the week before this patient presented we had a meeting of all the stake holders that might be involved in the care of such a patient.  Because of that we were well prepared to deal with this crisis.  Thank you.

BARBARA REYNOLDS: Thank you, Dr. Goodman.  Our final speaker is the Dallas County health and human services director, Zachary Thompson.  Director Thompson?

ZACHARY THOMPSON: Good afternoon.  Our hearts and prayers go out to the family as well.  I want to thank Dr. Frieden, CDC, Dr. Lakey, Department of state health services, Texas health Presbyterian for our response to the case in Dallas County.  I also want to commend our medical director health authority and the epi team for the work that they have been doing in conducting public health follow up on the patient which includes contact investigation to gather information based on the patient’s travel history, activities and close contact.  Dallas county health and human services will proceed with the public health follow up per CDC guidelines.  Dallas county health and human services wants Dallas county residents to be reassured that your public health is our number one priority.  Dallas county health and human services staff will continue to work hard to protect the health and welfare of the citizens of Dallas County.  Thank you.

BARBARA REYNOLDS: Thank you director Thompson.  We’ll now take questions.  Dr. Frieden?

TOM FRIEDEN: Thank you very much.  For questions, we will start in the room and then go to the phones. Thank you very much also Dr.  Goodman.  As empathizes, Ebola only spreads through direct contact.  It doesn’t spread by any other route in any outbreak we have seen.  I also want to thank Texas and Dallas County health departments for their collaboration.  CDC has a team of epidemiologists on route to Texas now at the request of the Texas department of health.  We work hand in hand collaboratively to do what public health does best which is protect people.  We protect people in this case by making sure we find the contacts, identify them and make sure they are traced every day for 21 days.  If they develop a fever they are immediately isolated and their contacts would be identified as well.  First question in the room.

DENISE DILLON: Denise Dillon with Fox 5, so you were saying that he started showing symptoms, went to a hospital and was released, sent home and wasn’t admitted until a day or two later?

TOM FRIEDEN: The initial symptoms of Ebola are often nonspecific.  That means they are symptoms that may be associated with other conditions and may not be identified immediately as Ebola.  We encourage all emergency department physicians to take a history of travel within the last 21 days.  That’s something to reiterate and to do rapid testing.  Dr. Goodman, is there anything else you would like to say?

EDWARD GOODMAN: No.  You summarized it well.

TOM FRIEDEN: Next question in the room.

RACHEL STOCKMAN: Dr. Frieden, I know you are limited a little bit with patient privacy.  Can you tell us a little bit — was this person involved in fighting the Ebola epidemic and also did they travel on a commercial aircraft?  Rachel from WSB-TV.

TOM FRIEDEN:  From the information that we have now it does not appear the individual was involved in the response to Ebola, but that is something we will investigate more.  In terms, of the airline flight, I really do want to emphasize, the focused here over the period should be the patient, and we are trying to get any assistance we can to the patient who we understand is critically ill at this point.  Identifying contact in the community, family members or others.  Then any possible contacts through the health care setting.  And then tracing those contacts.  In terms of the flight, I understand that people are curious about that and wonder about it.  Remember, Ebola doesn’t spread before someone gets sick.  And he didn’t get sick until four days after he got off the airplane.  We do not believe there is any risk to anyone who was on the flight at that time.  He left on the 19th and arrived on the 20th.  Next question in the room.

MICHELLE ELOY: Michelle Eloy from WABE, how likely is this to continue to be a concern with people coming back from the region who aren’t showing symptoms then but may later and what’s being done at airports and the first lines of people coming into the country to ensure that something like this doesn’t continue to be an issue.

TOM FRIEDEN:  As long as there continue to be cases in West Africa, the reality is patients travel.  Individuals travel.  As appears to have happened in this case, individuals may travel before they have symptoms.  One of the things that CDC has done in Liberia, Sierra Leone, Guinea and Lagos is to work with the airport authorities.  100% percent of the individuals getting on planes are screened for fever before they get on a plane.  If they have a fever they are pulled out of the line, assessed for Ebola and don’t fly unless Ebola is ruled out.  This is one way to make sure the airplanes themselves are safe during transit and the airlines are willing to keep flying.  But that doesn’t rule out a situation like this where someone was exposed and came in while they were incubating the disease but not infectious with it.

JESS MCDONALD: Jess McDonald with ABC.  Can you tell us where he was and do you know why he was in those countries?

TOM FRIEDEN:  The details of the individual are things that we will investigate.  Some of that has to do with patient confidentiality.  We’ll defer to the hospital and to the family for any further information on those details.  We have a question here.  Shall we go to the phone for the first question after this one?

DOUG STODDART:  Doug Stoddart with NBC News.  Do you expect the patient to remain in Texas and be treated there or transferred to Emory or another special facility that’s been treating them in the past?

TOM FRIEDEN: One of thing we want to emphasize is virtually any hospital in the country that can do isolation can do isolation for Ebola.  Over the past decade, this is the first Ebola patient in this country.  We have had five patients with other forms of very deadly viruses like viral hemorrhagic fevers.  None of the five patients spread the disease to anyone who cared for them in the hospital even though they weren’t properly diagnosed because it was an unusual situation.  We don’t see the need to try to move the patient.  Dr. Goodman.  Is there anything more you would like to say?

EDWARD GOODMAN: No.  I think that summarizes it very well.

TOM FRIEDEN:  On the phone?

OPERATOR:  To ask a question by phone, please press star-one and record your name at the prompt.  The first question comes from Miriam Falco with CNN news.  Your line is open.

MIRIAM FALCO: Hi Thanks for taking the call.  Can you tell us more about how sick the patient is, how the patient is being treated and how many contacts you are trying to reach?  It might be something for the folks in Texas.  Also, will this patient be staying at the hospital in Dallas?

TOM FRIEDEN:  Let me turn first to Dr.  Goodman.  Any information that you can share about the patient’s status and treatment.

EDWARD GOODMAN:  Well, because of the patient privacy, we are unable to share any information about the patient’s symptoms or his treatment at this time.  I can say that he is ill, under intensive care, being seen by highly trained, competent specialists.  And the health department is helping us in tracing any family members that might have been exposed.

TOM FRIEDEN:  Director Thompson, do you want to say anything further about contacts?

ZACHERY THOMPSON:  I want to echo that the staff has been doing the public health follow up since day one.  We’ll continue the process.  We’ll have more details in the days to come.  Right now, everything is on time.  Thank you.

TOM FRIEDEN:  thank you.  As I mentioned earlier, we have a team on route to Texas now.  They will work hand in hand with state and local and hospital public health and staff to identify all possible contacts and then monitor them every day for 21 days to see if they have fever.  This is core public health work.  This is what we do in public health.  We are delighted to be doing it in partnership with Texas.  We are concerned obviously about the status of the patient and very much hoping for his recovery.  On the phone?

OPERATOR: The next question comes from Betsy McKay at the Wall Street Journal.  Your line is open.

BETSY MCKAY: Hi.  Thanks.  I wondered if I could ask for more detail about potential exposures.  Is there anything any of you could say more about what this patient was doing between the 24th when he had symptoms and the 28th when he was admitted?  Was he just at home so only family members were potentially exposed or how many people — was he out?  Are we talking about a handful of people who were potentially exposed or more than that?  Or Dozens?

TOM FRIEDEN: I think handful is the right characterization.  We know there are several family members.  They may have been one or two or three other community members.  We are there to do investigations to identify other possibilities.  Our approach in this kind of case is to cast the net widely to ensure that we are identifying even people who may not have had direct contact so that we are erring on the side of safety.  Mr. Thompson, anything else you would like to add?

ZACHARY THOMPSON:  I concur.  Our role is to look at suspected cases and we really appreciate, Dr. Frieden sending your CDC Epi team down to support us in this effort.  We think, again, it’s a small framework that we are looking at in terms of the number of people.  Once we get additional information we’ll report out to the public.

TOM FRIEDEN: And I would comment, this is a tried and true protocol, this is what we do in public health and this is what we do in this country for a variety of infectious diseases and what we do at CDC globally in Ebola cases. In fact, by coincidence, today we released in the Morbidly and Mortality Weekly Report or weekly bulletin a report of the Nigeria case investigation, when a single patient came in unlike this, that individual was not cared with infection control and resulted in a number of secondary cases but even in Lagos and even with 19 secondary cases that appeared to be able to stop the outbreak. I have no doubt that we will stop it in its tracks in the U.S., but I also have no doubt as this outbreak continues in Africa we need to be on our guard. Next question in the room.

WSAA REPORTER: Can you give us a number or a scale for how big this team from CDC is going to be and who that directly entails? Are these doctors that are going to be in the hospital, are these going to be people standing out in the community? Can you give us a little more information?

TOM FRIEDEN: I can get back to you with the exact size of the team. We provide epidemiologists or disease detectives, we provide communications experts, we provide hospital infection control and laboratory experts as need in a situation. Every CDC staff there or the 130 in Africa are tired tightly to experts here who provide back-up 24/7. We defer to the local and state health departments. They’re there on the ground, they’re the lead and we’re there to support. In the room?

OPERATOR: Next question comes from Lauren Neergaard of AP. Your line is open.

LAUREN NEERGARRD: Thank you. Do we know, can you even say if this is an America or is this a visitor? Has the health department already reached any of those contacts? Has that contact tracing begun?

TOM FRIEDEN: What I can say is that the individual was here to visit family who live in this country. Further details I think are to be identified in the coming days, relevant or not, we’ll see. In terms of contact tracing, we’re just beginning the process and investigation just began today, but the health department had already been very forward leaning on that and locating information on individuals so that can begin immediately. On the phone?

OPERATOR: The next question comes from Maggie Fox of NBC News. Your line is open.

MAGGIE FOX: Thanks. I know that you have been extremely clear that people don’t spread this virus unless they are showing symptoms. Nonetheless, I think everybody knows that the reaction in the United States is disbelieving of this. I’m wondering what steps you might take to reassure people who fear they may have travelled on the same plane as this patient or passed through the same airport as this patient that they are not at risk.

TOM FRIEDEN: People can always call us at CDC-INFO, they can also check on our website. The flight in question is a specific flight departing Liberia on the 19th and arriving on the 20th, so that would be a very small number of people who would have that level of concern. But really I think it’s important that we understand a lot about Ebola. Ebola is a virus that is easy to kill by washing your hands. It’s easy to stop by using gloves and barrier precautions. The issue is not that Ebola is highly infectious, the issue is that the stakes are so high. And that’s why at the hospital in Texas, they’re taking all of the precautions they need to take to protect healthcare workers who are caring for this individual. People are infectious with Ebola when they’re sick. In fact, think of it this way, when we begin doing testing on people as they become sick, even in the initial phases of illness when they have a fever, even the most sensitive tests in the world sometimes don’t detect it because there is so little virus that they have. It’s only as they become sicker that they become more infectious and if patients die from Ebola, they can have very large quantities of virus there. So there is no risk from someone who has recovered from Ebola- and I went to the region myself and embraced people who had recovered from Ebola-  or by people who have been exposed but not yet sick from it. Next question on the phone?

OPERATOR: Next question comes from Newsweek. Your line is open.

NEWSWEEK REPORTER: Hi. Thank you. You’ve been saying “he” so I know you can’t give many details about the patient. But I want to confirm this is a male, and I don’t know if there is any age range you can give. Also wondering is this the first ever case diagnosed in the United States, if not, when was the previous case diagnosed if ever?

TOM FRIEDEN: This is the first patient diagnosed outside of Africa to our knowledge with this particular strain of Ebola. As I mentioned earlier, we have had other patients with hemorrhagic fever, including a patient in 2007 with Marburg, which is a virus that is quite a bit like Ebola. That individual in 2007 was hospitalized, went through surgery before being diagnosed and did not result in a spread to any other individuals. This is the first case of Ebola diagnosed in the U.S., and as far as we understand, the first strain diagnosed outside of Africa. I think we’ve referred to the patient in any way that we can so far. Next question on the phone?

OPERATOR: Next question is from Kelly Gilblom of Bloomberg News. Your line is open.

KELLY GILBLOM: Hi. Thank you. I’m just wondering if you can tell me a little bit more about the contact tracing process and how that’s done and how you can assure that you’ve reached all the people that the person was in contact with when they were sick.

TOM FRIEDEN: So contact tracing is a core public health function. We do it in a very systematic manner. We interview the patient if that’s possible, we interview every family members, we identify all possible names, we outline all of the movements that could have occurred from time of possible onset of symptoms until isolation. Then in a cascading manner, we identify every other individual who can add to that information, and with that, we put together these maps essentially that identify the time, the place, the level of the contact, and then we use a concentric circle approach to identify those contacts who might have had the highest risk of exposure, intermediate risk and those who might have had exposure even though we think that may be unlikely.  We always err on the side of contacting more contacts than less.  In Lagos with 20 cases, we at CDC and elsewhere working with Nigerian authorities, identified nearly 900 contacts and monitored them all day for 21 days.  In Senegal, we identified a single patient who came in, had exposures at two different healthcare facilities and community.  We monitored more than 60 contacts every day.  None of them became ill.  So this kind of contact tracing is really core public health and it’s what we do day in and day out and what we will be doing here to identify any possible spread and ensure there aren’t further chains of transmission.  On the phone?  Two more questions.

OPERATOR: Next question is from Julie Steenhuysen of Reuters, your line is open.

JULIE STEEENHUYSEN: I have two questions.  First, I want to confirm the timeline.  My understanding is a patient arrived in the United States on the 20th.  Initially sought treatment on the 26th.  I’m assuming it was then sent home and came back again on the 28th of September and was admitted.  The second question is will you be offering this patient any convalescent serum of experimental therapy?

TOM FRIEDEN: You are correct about the timeline.  In terms of possible experimental therapies, that’s something being discussed with the hospital now and with the family and if appropriate, would be provided to the extent available.  The last question on the phone.

OPERATOR: The next question comes from Denise Grady of The NewYork Times.  Your line is open.

DENISE GRADY: Thanks very much.  I think that people have touched on this, but I would just like to ask any way just in case we can get any more clarity on it.  Was this, can you tell us is this person an American or American citizen, will you be releasing the flight information and is it correct to assume he was staying at a home with family members rather than in a hotel.

TOM FRIEDEN: The patient was visit family members and staying with family members who live in this country.  We will contact anyone who we think has any likelihood of having had an exposure to the individual while they were infectious.  At that point, at this point, that does not include anyone who might have traveled with him because he was not infectious at that time.  And you asked a third question, which I don’t remember.

DENISE GRADY: I asked if he’s an American citizen.

TOM FRIEDEN: He’s visiting family who live in this country.  Do we have any other question questions in the room?

REPORTER: Will you identify the flight information?

TOM FRIEDEN: We will identify any context where we think there is a risk of transmission.  At this point, there is zero risk of transmission on the flight.  The illness of Ebola would not have gone on for ten days before diagnosis.  He was checked for fever before getting on the flight and there’s no reason to think anyone on the flight that he was on would be at risk.  I want to end with just a bottom line before we stop.

Ebola is a scary disease because of the severity illness it causes and we’re really hoping for the recovery of this individual.  At the same time, we’re stopping it in its tracks in this country.  We can do that because of two things.  Strong health care infection control that stops the spread of Ebola and strong core public health functions that trace contacts, track contacts, isolate them if they have any symptoms and stop the chain of transmission.  We’re stopping this in its tracks.  Thank you very much.

OPERATOR: Thank you.  This concludes our Ebola media briefing.

Global | Update on experimental Ebola vaccines from WHO

WHO consultation on Ebola vaccines

From 29–30 September, WHO organized an expert consultation to assess the status of work to test and eventually license two candidate Ebola vaccines. More than 70 experts, including many from affected and neighbouring countries in West Africa, attended the event.

The expertise represented among participants ranged from the virology of emerging infections, to regulatory requirements that must be met, to medical ethics, public health, and infectious diseases. Heads of clinical research and other executives from the pharmaceutical industry also presented their views.

Some participants came with more than 3 decades of experience working in Africa on other infectious diseases.

Experts on the use of innovative, cutting-edge trial designs also shared their most recent work.

The overarching objective was to take stock of the many efforts currently under way to rapidly evaluate Ebola vaccines for safety and efficacy. The next step is to make these vaccines available as soon as possible – and in sufficient quantities – to protect critical frontline workers and to make a difference in the epidemic’s future evolution.

All agreed on the ultimate goal: to have a fully tested and licensed product that can be scaled up for use in mass vaccination campaigns.

Two promising candidate vaccines

Given the public health need for safe and effective Ebola interventions, WHO regards the expedited evaluation of all Ebola vaccines with clinical grade material as a high priority.

Two candidate vaccines have clinical-grade vials available for phase 1 pre-licensure clinical trials.

One (cAd3-ZEBOV) has been developed by GlaxoSmithKline in collaboration with the US National Institute of Allergy and Infectious Diseases. It uses a chimpanzee-derived adenovirus vector with an Ebola virus gene inserted.

The second (rVSV-ZEBOV) was developed by the Public Health Agency of Canada in Winnipeg. The license for commercialization of the Canadian vaccine is held by an American company, the NewLink Genetics company, located in Ames, Iowa. The vaccine uses an attenuated or weakened vesicular stomatitis virus, a pathogen found in livestock; one of its genes has been replaced by an Ebola virus gene.

Phase 1 clinical trials

WHO and other partners have helped facilitate expedited evaluation of these two vaccines in order to generate phase 1 safety and immunogenicity data for decision-making. A series of coordinated phase 1 trials is currently under way or will soon be initiated with international consortia at more than 10 sites in Africa, Europe and North America.

These studies aim to ensure good communication and harmonization of key design elements to allow for merging of data from different trials of the same candidate products.

The trials, which are being conducted in healthy human volunteers, are designed to test safety and immunogenicity and select the appropriate dose. Two phase 1 trials of the cAd3-ZEBOV started in September 2014 in USA and UK, and the first Phase 1 trial of VSV-ZEBOV is due to start early in October in USA.

The government of Canada has donated 800 vials of rVSV-ZEBOV to WHO. Once data on dosing from phase 1 trials become available, this donation could translate into about 1500 to 2000 doses of vaccine.

Both companies are working to augment their manufacturing capacity. The goal is a very significant increase in scale during the first half of 2015.

No delays

One shared mindset was readily apparent during the two-day discussions. Nothing must be allowed to slow down the goal of making vaccines accessible to people in affected West African countries. The phrase, “Nothing can be allowed to delay this work”, was heard over and over again.

The ambition: to accomplish, within a matter of months, work that normally takes from two to four years, without compromising international standards for safety and efficacy.

In other words: to give the African people and their health authorities the best product that the world’s scientists, working collectively, have to offer.

What the experts considered

Against this background, the meeting looked specifically at the objectives and key design elements for moving in an expedited manner to conduct additional clinical trials (phase 2 trial designs) that will generate additional safety data and evidence that the vaccine confers protection.

Parallel pathways for emergency use of experimental candidate vaccines with data collection, among frontline health care workers and other critical personnel, were also explored.

Apart from the great sense of urgency, the overall spirit of the discussions was characterized by a strong sense of solidarity with the people of West Africa, their governments, and their medical, scientific, and public health communities.

Equally strong was the insistence on ensuring that evidence on safety, immunogenicity, and efficacy of the vaccines is collected properly.

Multiple challenges

Multiple potential challenges and uncertainties were put forward and assessed. Issues ranging from barriers to rapid implementation of R&D, to the design of trials and their use to guide eventual widespread vaccination, were discussed together with proposed ways to overcome them.

Some of the practical issues discussed included how to address communities’ perceptions regarding vaccines in general, and vaccine studies more specifically, public expectations for vaccine availability for widespread use, and whether there is an adequate infrastructure in place to rapidly and safely evaluate and distribute vaccines.

One important technical challenge is the fact that the candidate vaccines must be stored at a temperature of -80°C.

Further issues that need to be urgently addressed include identifying staff who can conduct trials meeting international standards, logistical issues (such as cold chain needs for the vaccines), and the resources needed to start the studies quickly.

Some of the scientific challenges include how to conduct studies as safely and rapidly as possible to inform decisions about mass production of vaccines and their administration.

Key questions

Discussions focused on the main questions that studies should help address, which part of the research should be conducted in non-affected areas and which part in affected areas, and how such decisions could either help expedite or delay the availability of robust evidence.

One overarching conclusion was that the international community, joining the affected countries as a whole, has a responsibility and a role to play in accelerating the evaluation, licensing, and availability of the candidate vaccines – if proven safe and effective.

For all these reasons, the actions emerging from the consultation clearly identify a role for each of the main stakeholders.

Randomized controlled trials

Regarding the issue of how to accelerate the assessment and licensure of the vaccines, experts reiterated that, if feasible, randomized controlled trials are the design of choice because they provide the most robust data, in the shortest amount of time, to judge whether a vaccine is safe and induces protection.

Trials must be expedited, while preserving ethical and safety standards. Efficacy data of high quality must be gathered. Trials need to be carefully designed so that they concomitantly address the most important questions regarding safety, immunogenicity, and efficacy.

While individually randomized controlled trials provide the most robust data, alternative designs should be considered when these trials are not judged feasible. These include cluster-randomized and stepped-wedge designs. As long as the amount of vaccine remains limited, units – such as health or treatment facilities – can be randomized. Regardless of the design chosen, trials should move forward as quickly as possible.

Alternative study designs

Alternative study designs will not delay deployment of vaccine to those who need it. Instead, they will influence the choice of people who receive the vaccine. For some months to come, the critical limiting factor is extremely restricted vaccine supply, and not the need to conduct studies using alternative designs.

Descriptions of the so-called “randomized stepped wedge” design attracted lively interest and much discussion. In this design, a “wedge” (like a slice of a pie or a cake) of the study population is selected for step-wise inclusion in the trials.

As each “wedge” receives the vaccine, all lessons learned or needed to adjust the study design are then applied to the next group to be included in the study. The selection of study populations can be randomized by units, as described above; the entire study population eventually receives the vaccine if trials demonstrate sufficient efficacy.

Such a design makes it possible to roll out vaccinations and evaluate efficacy at the same time. It further has features that meet the explicit objective of fairness.

Other designs will be more relevant when large numbers of vaccine doses are available.

Involving countries

Decisions on study designs and target populations must be made with the active participation of experts from the three hardest-hit countries. Consultations with frontline health workers should be undertaken as a matter of urgency to identify the most feasible approaches to evaluate vaccine efficacy and identify factors influencing acceptability of randomized trials.

The experts discussed the importance of making sure that the trials are appropriately designed to inform the use of these vaccines in all populations, including children, pregnant women, and immunocompromised populations, including people who are HIV positive.

The group also discussed how best to use the doses of experimental vaccine donated by Canada and additional doses that may be available later this year and in 2015.

If vaccine doses are used in the short term, vaccines should be deployed to consenting frontline health workers.

The decision to initiate such deployment should be informed by data emerging from the phase 1 studies, and will occur with data collection on the deployment itself.

Equity is important and therefore vaccine should be made available in an equitable and consensual manner to the affected countries. Maximizing the information gained from the use of these vaccines during this phase is critical.

Information sharing

A cross-cutting issue is the need for data sharing – in real time – among the research, medical, and public health communities, coordinated by WHO. This was considered of paramount importance to inform decisions on future studies and scaling up the production of those experimental vaccines that look most promising.

Vaccine development normally takes a long time and is notoriously costly. Even under the best conditions and with the massive efforts of many partners, a significant number of doses will not be available until late in the first quarter of 2015.

One important factor for the completion of all the above steps is to secure the funding to ensure the production of the vaccine and to support priority studies. Major international funding partners should promptly pledge or commit the necessary funding so that this critical research is completed without further delay.

The African perspective

The presence of West African researchers, scientists, clinicians, and health officials vastly enriched the discussions, especially concerning the practical dimensions of trial design.

These experts further underscored the importance of communicating with communities and engaging their views, and called for qualitative studies to begin immediately. For example, some cultures are deeply distrustful of “Western” medicine and foreign medical staff in general, and of vaccines in particular.

Interventions from the three hardest-hit countries, Guinea, Liberia, and Sierra Leone, clearly stated that international assistance is both greatly needed and fully welcomed.

Families and entire villages have been shattered. Some communities are on the verge of hopelessness and helplessness. Many do not comprehend what hit them and why, especially as this is the first time that the Ebola virus and Ebola virus disease have been seen in West Africa.

Governments are on board. Clinicians are on board. Researchers and their institutes are on board.

Statements made by West Africans reminded all participants of what life is really like in these countries. Children do not play in school yards, play pens, fenced back yards, or terraced gardens. They play in the bush.

These realities of daily African life need to be kept in mind when high-risk exposures are considered and defined.

Health workers

Participants were further reminded that the definition of “health care workers” in these African countries includes doctors, nurses, and laboratory technicians but also hospital cleaners, ambulance drivers, burial teams, mortuary attendants, and in some instances, traditional healers.

As hospitals in many areas are overflowing or closed, the number of treatment beds in all three countries is woefully inadequate, and people frequently do not trust the health care system, more and more patients are being cared for by their loved ones in homes or within the community.

These people are also at very high risk of infection and should be considered when priorities for support – in all its forms – are being set. The importance of community engagement cannot be overstated.

Operational changes made since the unprecedented resolutions on Ebola virus disease were adopted by an emergency session of the UN Security Council (on 18 September) and by a UN General Assembly high-level session on Ebola (on 25 September) involve a vast ground-swell scaling-up of international support to affected countries. This support includes a much larger number of medical staff working in countries, thanks to generous support from the governments of China, Cuba, and many others.

Lessons learned

Participants also drew heavily on lessons learned, in the African setting, during trials for candidate malaria, HIV/AIDS, cholera, epidemic meningitis, hepatitis B, and other vaccines.

As some experts noted, never again can the international community allow what boils down to “market failure” to create such catastrophic suffering for humanity in any country, in any region of the world.

The sense of urgency and need for speed, without compromising the integrity of studies or the quality of their data, are fully justified by the dire situation in affected countries and the risk that other countries may soon experience their first imported cases.

The Ebola outbreak currently ravaging parts of West Africa is the most severe acute public health emergency in modern times. Never before in recent history has a biosafety level 4 pathogen infected so many people so quickly, over such a wide geographical area, for so long.

Key expected milestones

October 2014:
Mechanisms for evaluating and sharing data in real time must be prepared and agreed upon and the remainder of the phase 1 trials must be started

October–November 2014:
Agreed common protocols (including for phase 2 studies) across different sites must be developed

October–November 2014:
Preparation of sites in affected countries for phase 2 b should start as soon as possible

November–December 2014:
Initial safety data from phase 1 trials will be available

January 2015:
GMP (Good Manufacturing Practices) grade vaccine doses will be available for phase 2 as soon as possible

January–February 2015:
Phase 2 studies to be approved and initiated in affected and non-affected countries (as appropriate)

As soon as possible after data on efficacy become available:
Planning for large-scale vaccination, including systems for vaccine financing, allocation, and use.

West Africa | Ebola update to 1 October 2014 – 7178 cases with 3338 deaths

OVERVIEW

The total number of probable, confirmed and suspected cases in the current outbreak of Ebola virus disease (EVD) in West Africa reported up to 28 September 2014 is 7178, with 3338 deaths.

Countries affected are Guinea, Liberia, Nigeria, Senegal and Sierra Leone. For the second week in a row the total number of reported new cases has fallen. It is clear, however, that EVD cases are under-reported from several key locations. Transmission remains persistent and widespread in Guinea, Liberia and Sierra Leone, with strong evidence of increasing case incidence in several districts. There are few signs yet that the EVD epidemic in West Africa is being brought under control.

1. COUNTRIES WITH WIDESPREAD AND INTENSE TRANSMISSION

The upward epidemic trend continues in Sierra Leone and most probably also in Liberia. By contrast, the situation in Guinea appears to be more stable, though it must be emphasized that in the context of an outbreak of EVD, a stable pattern of transmission is still of grave concern, and could change quickly.

GUINEA

Reports from Guinea show a slight fall in the number of new cases reported compared with each of the past five weeks. This fall is largely attributable to a drop in the number of new cases reported from Macenta district, which had seen a surge in the number of new cases over the past five weeks.

Transmission is persistent in Gueckedou, the region in which the outbreak originated, which has reported between five and 20 new cases over the past 10 weeks. There has been a slight increase in the number of new cases reported in the capital, Conakry, with 27 new confirmed cases reported this week. Beyla district, which borders Côte d’Ivoire, has now reported its first confirmed case.

LIBERIA

The continued fall in the number of reported new cases is largely attributable to the sharp drop in the number of confirmed new cases reported from Liberia over the past two weeks. Last week there were no new reported confirmed cases from the capital, Monrovia, which in previous weeks had reported a surge in cases. This week, five new confirmed cases have been reported in Monrovia, but there remains compelling evidence obtained from responders and laboratory staff in the country that there is widespread under-reporting of new cases, and that the situation in Liberia, and in Monrovia in particular, continues to deteriorate.

A large number of suspected new cases (and deaths among suspected cases) have been reported from Liberia over the past week. It is very likely that a substantial proportion of these suspected cases are genuine cases of EVD, and that the reported fall in confirmed cases reflects delays in matching laboratory results with clinical surveillance data. Efforts are being made to urgently address this problem, and it is likely that the figures will be revised upwards in due course. At the present time, the numbers of probable and suspected cases, together with those confirmed, may be a more accurate reflection of case numbers in Liberia. The counties of Bong, Grand Bassa, Margibi and Nimba continue to report high numbers of new cases. There has been little change in the number of new cases reported in Lofa, which borders Gueckedou in Guinea, for the past three weeks, with 38 confirmed and probable cases reported this week.

SIERRA LEONE

Nationally, the situation in Sierra Leone continues to deteriorate, with an increase in the number of new confirmed cases reported over each of the past six weeks. The neighbouring districts of Port Loko, Bombali, and Moyamba, which are adjacent to the capital, Freetown, have now been quarantined after a surge in new cases over the past four weeks. Tonkolili has also reported a rise in the number of new cases this week. By contrast, a very low number of new cases have been reported from Kailahun and Kenema for the past two weeks. These areas had previously reported high levels of transmission. Further investigation will be required to confirm whether this fall is genuine, or a result of under-reporting. At present, the latter appears more likely.

HEALTH-CARE WORKERS

The high number of EVD infections in health-care workers (HCWs) continues to be a cause of great concern. 377 HCWs have now been infected with EVD as of 28 September, 216 of whom have died.

RESPONSE IN COUNTRIES WITH WIDESPREAD TRANSMISSION

Case management: Ebola treatment centres, referral, and infection prevention and control One new referral unit has now opened in Sinoe district (Sinoe county) in Liberia. Also in Liberia, a site has been identified by the Ministry of Health for a referral unit in Grand Kru district 7 (Maryland county): an area in the south of the country which only recently reported its first confirmed cases of EVD. In Sierra Leone, three isolation centres were opened in Bombali district. No new Ebola treatment centres (ETCs) opened this week; there remains a significant shortfall in capacity. In Liberia, an estimated 1500 beds are required in addition to those in place or soon to be in place; in Sierra Leone, an additional 450 beds are needed.

WHO will convene a meeting of the Guideline Development Group on the 6–7 October, which will discuss the development of new guidelines on the use of personal protective equipment to control health-care associated Ebola transmission, and to allow satisfactory working conditions in the context of EVD outbreak response.

Case confirmation

Two US Navy mobile laboratories have now arrived in Liberia. One team will be based in Gbarnga (Bong county), with the other based in Montserrado (the district containing the capital, Monrovia). Both teams will be operational by 5 October. In Sierra Leone, the Chinese mobile laboratory team based in Freetown started testing samples on 29 September 2014, with a testing capacity of 20 samples per day. All other mobile laboratories in Guinea, Sierra Leone and Liberia remain functional and are operating at full capacity.

Surveillance

In Guinea, contact tracing efforts need to be reinforced in the districts of Dalaba and Forecariah. In Liberia, daily contact tracing achievement was under 90% on average during the week to 28 September in the districts of Grand Cap Mount, Grand Gedeh, Grand Kru, River Ghee, Margibi, Maryland, and Rivercess. In Sierra Leone, under 90% of contacts were traced each day, on average, during the week to 28 September in Kailahun district and the capital, Freetown. Elsewhere, the success rate was over 90%, though it should be kept in mind that no contacts are traced for cases that are unreported.

Safe and dignified burials

In Liberia, an International non-governmental organisation, Global Communities, has started to support the Ministry of Health in training to facilitate the safe handling of dead bodies and management of safe burials in the districts of Bomi, Nimba, and Sinoe.

Social mobilization

In Guinea, a door-to-door campaign including the delivery of hygiene kits (soap, chlorine) and flyers has reached 71 000 households composed of 486 000 people. The campaign’s messages were reinforced with radio programmes and religious activities. In addition, outreach activities succeeded in opening a dialogue with some households in the sub-prefecture of N’zerekore that had been resistant to mobilization efforts.

In Sierra Leone, communication and social mobilization activities continue in all districts, with the use of radio jingles, discussion programmes (daily on Radio Maria) and community dialogues. Efforts are ongoing to sensitize communities to the importance of self-reporting in selected communities in Kailahun and Bonthe. In Bombali, communities have been identified as being at high risk of transmission, and have been targeted for communication and engagement.

COUNTRIES WITH AN INITIAL CASE OR CASES, OR WITH LOCALIZED TRANSMISSION

Two countries, Nigeria and Senegal, have now reported a case or cases imported from a country with widespread and intense transmission. In Nigeria, there have been a total of 20 cases and eight deaths. In Senegal, there has been one case, but as yet there have been no deaths or further suspected cases attributable to Ebola.

Contact tracing and follow-up is ongoing. In Nigeria, all contacts (out of 891 total contacts) have now completed 21-day follow-up (362 contacts in Lagos, 529 contacts in Port Harcourt), with no further cases of EVD reported. The last confirmed case in Lagos was reported on 5 September. The last confirmed case in Port Harcourt was reported on 1 September.

In Senegal, all contacts have now completed 21-day follow-up, with no further cases of EVD reported. The last confirmed case in the country was reported on 28 August. A 42-day follow-up (2 × 21-day incubation period) period with no further cases must have elapsed before an outbreak in a country is considered to have ended.

PREPAREDNESS OF COUNTRIES TO RAPIDLY DETECT AND RESPOND TO AN EBOLA EXPOSURE

The second meeting of the Emergency Committee convened by the WHO Director-General under the IHR 2005 regarding the 2014 EVD outbreak in West Africa was conducted with members and advisors of the Emergency Committee through electronic correspondence from 16 September 2014 through 21 September 2014.

The Committee emphasized that all States should reinforce preparedness, validate preparation plans and check their state of preparedness through simulations and adequate training of personnel.

Texas | CDC team assisting Ebola response in Dallas

Ten experts from the Centers for Disease Control and Prevention – supported 24/7 by the CDC’s full Emergency Operations Center and Ebola experts in CDC’s Atlanta headquarters – have arrived in Texas and are working closely with Texas state and local health departments to investigate the first Ebola case in the United States.

Nine members of the CDC team arrived last night and one arrived today.

The CDC team consists of:

  • Three senior scientists with expertise in public health investigations and infection control
  • A communications officer
  • Five Epidemic Intelligence Service (EIS) officers – CDC’s disease detectives
  • A public health advisor

These CDC experts will assist state and local health departments find, assess, and assist everyone who came into contact with the Ebola patient between the time he became symptomatic (before having symptoms, people with Ebola cannot spread the infection) and the time he was placed in an isolation ward. The CDC experts will help ensure that proper infection control procedures are followed, and monitor healthcare workers treating or attending to the patient. Long experience shows that these tried-and-true core public health interventions stop the spread of Ebola

“We are stopping Ebola in its tracks in this country,” said CDC Director Tom Frieden, M.D., M.P.H. “We can do that because of two things: strong infection control that stops the spread of Ebola in health care; and strong core public health functions to trace contacts, track contacts, isolate them if they have any symptoms and stop the chain of transmission. I am certain we will control this.”

The CDC team now is:

  • Making sure the patient is receiving treatment and is isolated;
  • Interviewing the patient and close contacts, such as family members, to obtain detailed information on their travel history and exposures;
  • Ensuring the hospital uses appropriate infection control measures;
  • Identifying people who had close contact with the patient and
    • interviewing them,
    • monitoring them to see if they become ill,
    • collecting and testing specimens from them, if needed, and
    • requesting that they monitor their health and seek care if they develop symptoms; and
  • Monitoring the health status of healthcare providers who cared for the patient

Any hospital following strict CDC infection control recommendations and that can isolate a patient in their own room with a private bathroom is capable of safely managing a patient with Ebola.

“We recognize that it is essential that appropriate measures are taken to prevent the virus from spreading,” Dr. Frieden said. “CDC is working closely with partners to implement those measures.”

Travelers from Guinea, Liberia, Nigeria, or Sierra Leone should monitor their health for symptoms, fever greater than 101.5 degrees Fahrenheit, severe headache, muscle pain, diarrhea, vomiting, stomach pain, or unexplained bruising or bleeding, for 21 days after travel. They should see a healthcare provider as soon as any of these symptoms develop, letting them know of their travel history and symptoms.

CDC is issuing a general reminder to travelers and healthcare providers on best practices. Healthcare providers should take a travel history from any person with symptoms of viral infection. They should consider Ebola in patients who develop fever greater than 101.5 degrees Fahrenheit, severe headache, muscle pain, diarrhea, vomiting, stomach pain, or unexplained bruising or bleeding 21 days after traveling from Guinea, Liberia, Nigeria, or Sierra Leone. They should immediately take infection control precautions and contact their state or local health department if they have any questions.

CDC and the state of Texas will post new information about Ebola on their websites:

CDC is part of a whole-government approach to protecting the American public from Ebola and ending the Ebola epidemic in West Africa.

UK | Man receives £100 fine after assaulting LAS paramedic

A man who pushed a paramedic against a wall while he was being treated has been found guilty of assault and ordered to pay £100 compensation.

David Rose of Islington was convicted of assault by beating at Highbury Magistrates Court on 26 September.

Paramedic Ben Flavell was called to the defendant’s address on Georges Road on the morning of Saturday 3 March.

Ben, who’s based at Islington ambulance station, said: “When I turned up and tried to treat Mr Rose he quickly became very aggressive and pushed me up against the wall. I had a Doctor observing with me that day we managed to get out of the house and lock ourselves in the car before the situation got any worse.”

The police were called and arrested Rose while Ben gave a statement before carrying on and finishing his shift.

Ben added: “Thankfully these types of incidents are very rare but they are scary nonetheless.

“I am glad that he has been prosecuted and hope it serves as a warning to others that medics will not tolerate any abuse at work, especially when we are there to help.”

UK | Roy Sampson retires after 35 years of saving lives in the Black Country

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After 35 years of saving lives, a paramedic from the Black Country is hanging up his uniform to retire and start a new chapter in his life.

Willenhall-based Paramedic, Roy Sampson, worked his last shift on Wednesday this week and was thrown a surprise farewell party by his colleagues who had turned out en masse to wish him well.

Roy, 54 from Cradley Heath, swapped his first job at a bakery to join the Trust as a fresh-faced teenager to become an ambulance attendant in Birmingham in 1979. In the early years, as well as working on the ‘front line’ Roy also tried his hand at patient transport services taking people to and from hospital appointments. After qualifying as a paramedic at Hob Moor Road in the 1980s, he quickly worked his way up the career ladder and moved around Birmingham and the Black Country to take on more senior positions.

After several years of working in the Emergency Operations Centre in Brierley Hill, Roy recently returned to the road for his final role as paramedic Area Support Officer (ASO) based at Willenhall Hub.

On Wednesday 24th September, Roy said: “Working my last shift has been very emotional. The ambulance service has been such a big part of my life and it’s difficult to comprehend not being here anymore and not working with my friends. I feel sad that I’m leaving but I know it’s the right time for me.

“I’ve still got a nice journey ahead of me in my retirement and I’m really looking forward to what the future holds. My partner and I have got some holidays booked for starters and next year, when I’m ready, I’ll look for a part time job to keep active.”

Paul Baylis, Black Country North Area Manager, said: “Roy will be sorely missed as he is irreplaceable and truly a one off. He’s always been dependable and a respected pillar of the ambulance service and I know I speak on behalf of everyone when I wish Roy a long, happy and healthy retirement.”

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UK | ASDA stores deploy AEDs across the nation

asda-tunstall-defib-1-30-09-14

ASDA stores throughout Staffordshire have now been fitted with lifesaving defibrillators.

The specialist devices are being installed in all ASDA’s stores throughout the country in conjunction with the British Heart Foundation. A defibrillator is a device that can be used to restart someone’s heart when they’ve suffered a cardiac arrest. These machines are extremely easy to use, meaning people of all ages and walks of life can provide emergency care to those who need it, quickly and effectively prior to the arrival of an ambulance.

Over the last few months members of staff from the retailer have undertaken training in the use of the lifesaving equipment and first aid to ensure that if any shoppers become seriously ill whilst at the centre, they are given the best possible chance of survival.

WMAS Community Response Manager, Matt Heward said: “The ambulance service strongly believes that by having defibrillators installed in public places, such as shopping centres, schools and business premises, and having people trained in their use and basic first aid techniques, really can help to save lives.

“It is excellent news that ASDA has recognised the importance of installing such lifesaving equipment nationally. Eighty-five percent of those people who suffer cardiac arrests have the ability to be corrected by defibrillation. The quicker someone is defibrillated, not only improves the chance of their survival but it can also help to improve the chances of a patient’s full recovery and reduce the time to do so. For every minute a patient is in cardiac arrest, their chance of survival decreases by 10 percent.”

Bev Capon, Community life Champion at ASDA said “I can safely speak for all Asda store managers and colleagues when I say we are proud to part of this fantastic initiative.

“Here at Asda Tunstall we have had cause to use our defibrillator when one of our colleagues suffered a cardiac arrest in store. The colleague made a full recovery and is now enjoying his retirement with his family.

“If we can help save just one life in our local community, then the device location will be more than worthwhile.

“We have colleagues in every store who are trained in the use of the defibrillator and we have made all surrounding retailers aware of its location so that in an emergency they will know it is at hand.”

Following the national roll out Asda Tunstall now has a spare defib, which it would love to home within the local community. If you are a business owner, work in a sports club or in any other public area, that you think would benefit from receiving a free defib and training please contact WMAS Community Response Manager, Matt Heward via Matthew.heward@wmas.nhs.uk

UK | Yorkshire | Supermarket provides standby space for YAS rigs

Yorkshire Ambulance Service NHS Trust (YAS) is now officially on standby in a new location thanks to the support of Richmond Co-operative. The supermarket has provided space in its car park to act as an official standby point for the Trust’s emergency vehicles in the town.

Standby points are strategically positioned sites used by the ambulance service to ensure their staff are best placed geographically to respond as quickly as possible in local communities.

YAS regularly uses a number of standby points across the region with facilities ranging from simple parking spaces, to semi-permanent cabins and other buildings equipped to provide the same facilities for staff as a traditional ambulance station.

YAS has worked closely with Hambleton, Richmondshire and Whitby Clinical Commissioning Group to review the availability of ambulances in the local area and make patient-focussed improvements in efficiency. Part of this work involved examining the locations of YAS ambulances before receiving a 999 call, to ensure resources were best placed to reach a life-threatening emergency as quickly and safely as possible.

The new standby point has been kindly provided by The Co-operative and will see a space reserved for use by YAS vehicles when awaiting a call.

Pete Summerfield, Locality Manager for the Yorkshire Dales at YAS commented: “It is our priority to respond to all 999 calls as quickly and safely as possible and we are delighted to be working in partnership with The Co-operative for the benefit of residents living in the Richmond and Hambleton area.

“The Co-operative was identified as an ideal location to position emergency vehicles, allowing better access to rural areas in North Yorkshire and enabling us to reach patients more quickly.”

The new standby point joins a further four locations across the area, including Hipswell Road (at the Mountain Rescue facility), Bedale Medical Centre, Catterick Village Medical Centre and Harewood Medical Centre at Catterick Garrison.

The points will be available for use by all the Trust’s emergency vehicles, whether that’s a Rapid Response Vehicle (RRV), a motorbike or an ambulance.

Mike Frankland, Operations Manager for The Co-operative Food in Richmond, said: “As a community retailer we are committed to playing an active role in local life, and by supporting this initiative we will help make a real difference to people’s lives in the Richmond and Hambleton area. We are delighted to work in partnership with Yorkshire Ambulance Service and provide a standby point at our store, which will ensure they are best-placed to reach life-threatening emergencies as quickly as possible.”

Charles Parker, GP and Governing Body member with Hambleton, Richmondshire and Whitby Clinical Commissioning Group, said: “We are very pleased to be working with Yorkshire Ambulance Service to identify new, flexible ways of providing appropriate emergency ambulance care. Every minute counts when responding to emergencies, especially in rural areas. This new stand-by point at The Co-operative complements a range of efforts being made to improve response times, which are making a significant difference.”

UK | Sedgefield – Cyclist’s resuscitation via CPR leads to AED installation

L-R Neil Bunney, Sedgefield Surgery; Ean Parson, SVG; Barry Watson; Peter Fields, NEAS.
L-R Neil Bunney, Sedgefield Surgery; Ean Parson, SVG; Barry Watson; Peter Fields, NEAS.

Residents in Sedgefield have celebrated the installation of a public defibrillator in the village following a year-long fund-raising campaign.

The machine – which is very easy to use – can shock a cardiac arrest’s patient heart back into rhythm.

Local people decided to buy one for Sedgefield after keen cyclist Barry Watson suffered a coronary while cycling in March 2013.

Fortunately, a passer-by who knew how to deliver CPR, saw what happened and was able to pump Barry’s heart until a NEAS ambulance crew arrived at the scene.

Barry has since made a full recovery.

When someone goes into cardiac arrest, every minute without CPR or defibrillation reduces survival chances by 10%.

Barry said: “When I collapsed I was extremely lucky that someone who knew how to perform CPR was passing, particularly as there was no defibrillator nearby. It’s great that Sedgefield now has its own defibrillator in such a prominent and central location.

“In an emergency the defibrillator can be accessed by a quick 999 call. The caller will be given a log-on number to use on the machine, and then it’s ready. It’s very easy to use, and there are also audio instructions that played from the defibrillator. It’s now vital that we make sure as many people as possible in the local community know about it.”

The device has been installed on Sedgefield Surgery Wall in the centre of the village.

Funding for the defibrillator came from Sedgefield Village Games, Sedgefield Rotary, Ladies Escape, Right Lines Communications, Sedgefield Squash Club, Sedgefield Harriers and Sedgefield Surgery.

Simon Hill, Secretary of the Sedgefield Village Games, said:” Along with North East Ambulance Service and Sedgefield Surgery, we would now like to use this occasion as a platform for improving general first aid skills in the area, and train as many residents as possible so that they know how to use it if required.”

Be well. Practice big medicine.