Archive for June, 2017
Stockpiling Ventilators for Influenza Pandemics
Tuesday, June 6th, 2017VentilatorManagement-EID-June-2017
Commentary: VentStockpilingCommentary-EID-June_2017
DOI: http://dx.doi.org/10.3201/eid2306.161417
Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 23, No. 6, June 2017
“Diligent preparation and effective countermeasures are critical to mitigating future influenza pandemics. The 1918 influenza pandemic, the most severe in recent history, resulted in ≈50 million deaths globally, of which nearly 675,000 occurred in the United States (1). The 1957 and 2009 pandemics were less severe, causing ≈70,000 and 9,000–18,000 US deaths, respectively (1).
US Department of Health and Human Services (HHS) estimated that 865,000 US residents would be hospitalized during a moderate pandemic (as in 1957 and 1968) and 9.9 million during a severe pandemic (as in 1918).
When severe influenza outbreaks cause high rates of hospitalization, a surge of medical resources is required, including critical care supplies, antiviral medications, and personal protection equipment. Given uncertainty in the timing and severity of the next pandemic, as well as the time required to manufacture medical countermeasures, stockpiling is central to influenza preparedness (3). However, difficulty in forecasting and limited public health budgets often constrain decisions about sizes, locations, and deployment of such stockpiles. Mechanical ventilators are essential for treating influenza patients in severe acute respiratory failure. Substantial concern exists that intensive care units (ICUs) might have insufficient resources to treat all persons requiring ventilator support. Prior studies argue that current capacities are insufficient to handle even moderately severe pandemics and that sentinel reporting and model-based decision-making are critical for managing limited resources (4–6). For this reason, the United States has stockpiled mechanical ventilators in strategically located warehouses for use in public health emergencies, such as an influenza pandemic. The Centers for Disease Control and Prevention (CDC) manages this Strategic National Stockpile (SNS) and has plans for rapid deployment to states during critical events (7).
However, SNS ventilators might not suffice to meet demand during a severe public health emergency. In 2002, the SNS included ≈4,400 ventilators (8,9), and 4,500 SNS ventilators were added during 2009 and 2010. The American Association for Respiratory Care suggested the SNS inventory should increase to at least 11,000–16,000 ventilators in preparation for a severe influenza pandemic (10). The American Association for Respiratory Care and CDC (11) provide training on 3 types of SNS ventilators—LP10 (Covidien, Boulder, CO, USA); LTV1200 (CareFusion, Yorba Linda, CA, USA); and Uni-vent Eagle 754 (Impact Instrumentation, Inc., West Caldwell, NJ, USA)—to ensure proper use nationwide. In addition to the nationally held SNS, some US states maintain their own stockpiles. Successful deployment of central ventilator stockpiles, whether federal or state, requires rapid distribution to healthcare facilities with patients in need, along with adequate bed space, requisite supplies, and trained personnel Robust methods for sizing and locating ventilator stockpiles have not yet been developed (15). Wilgis (16) discussed the relative merits of central stockpiling of ventilators to be distributed during an emergency versus distributing ventilators to hospitals a priori. Centralized stockpiles benefit from better inventory tracking, more timely repairs, and superior allocation of a limited resource, but hospital-based supplies facilitate staff training, enable immediate use, and avoid the cost and logistical challenges of central storage and deployment. …..”
A clinical trial of an experimental vaccine to prevent infection with chikungunya virus is now enrolling healthy adult volunteers at three sites in the United States.
Tuesday, June 6th, 2017NIAID-Sponsored Trial of Experimental Chikungunya Vaccine Begins
A female Aedes aegypti mosquito, one of the two species that spreads chikungunya virus, is shown feeding.CDCA clinical trial of an experimental vaccine to prevent infection with chikungunya virus is now enrolling healthy adult volunteers at three sites in the United States. The Phase 1/2 trial, which is sponsored by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, is being conducted at several NIAID-funded Vaccine and Treatment Evaluation Units. The candidate vaccine, MV-CHIKV, was developed by Themis Bioscience of Vienna, Austria.
Although chikungunya is rarely fatal, the mosquito-transmitted virus causes an intense inflammatory reaction resulting in severe joint pain, fever, rash and muscle pain. While most symptoms usually resolve in days, the joint inflammation can linger.
“Chikungunya virus can cause debilitating joint pain that can last for months or even longer,” said NIAID Director Anthony S. Fauci, M.D. “A vaccine to prevent infection with this virus would be of considerable benefit to people living in the more than 60 countries where chikungunya transmission has occurred, as well as travelers to those countries.”
Chikungunya virus has been endemic in East Africa since at least the 1950s, when it was first discovered. There it circulates among monkeys and, occasionally, humans. The virus likely arrived in the Caribbean in late 2013, and as of March 2017, may have infected more than two million people in the Americas, according to the Pan American Health Organization (PAHO).
A 2014 Phase 1 trial of the MV-CHIKV vaccine conducted in Austria by Themis Bioscience showed that the experimental vaccine was safe and induced an immune response. The candidate vaccine is a measles vaccine virus modified to produce chikungunya virus proteins. Once inside a human cell, the vaccine induces the production of both measles and chikungunya proteins. The immune system then develops antibodies against those proteins, which may protect the vaccinated person from future infection by chikungunya virus.
Led by principal investigator Patricia Winokur, M.D., of the University of Iowa Carver College of Medicine, the new vaccine study will enroll 180 healthy adults ages 18 to 45 at three sites: the University of Iowa in Iowa City; Baylor College of Medicine in Houston; and Emory University in Atlanta. Participants will receive two injections of either low-dose or high-dose experimental vaccine or placebo. Neither the participants nor the investigators will know whether a volunteer is receiving placebo or investigational vaccine. The volunteers will be assigned at random into different groups that receive the two injections at different intervals (29, 85, or 169 days after the initial injection) in order to help the researchers determine which schedule is most effective.
Clinic staff will follow up with study participants by phone and during clinic visits over the course of 8 to 13 months to monitor for any adverse reactions or safety issues. The participants will provide blood samples to be analyzed for evidence of antibody production, which would indicate that the vaccine is prompting an immune response.
Themis Bioscience is currently conducting a Phase 2 trial in Europe with the same vaccine candidate. Other chikungunya vaccine candidates are also under investigation in different trials, including one that uses virus-like particles (VLPs) to induce an immune response in recipients. NIAID sponsored the Phase 1 trial of the VLP vaccine candidate; a Phase 2 trial began in 2015.
For more information about the MV-CHIKV vaccine study, see ClinicalTrials.gov using the identifier NCT03028441.
NIAID conducts and supports research — at NIH, throughout the United States, and worldwide — to study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing and treating these illnesses. News releases, fact sheets and other NIAID-related materials are available on the NIAID website.
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More than 1,500 people were injured when panic swept through a crowd of Juventus fans watching the Champions League final in a piazza in the northern Italian city of Turin
Monday, June 5th, 2017June 4, 1989: Chinese army troops stormed Tiananmen Square in Beijing to crush the pro-democracy movement; hundreds – possibly thousands – of people died.
Sunday, June 4th, 2017Japan’s Prime Minister Shinzo Abe’s government is instructing municipalities to hold evacuation drills, heightening a sense of urgency among the public.
Sunday, June 4th, 2017“….Sunday’s evacuation drill in this town [Abu] of 3,500 people some 760 km (475 miles) west of Tokyo involved a simulated North Korean missile attack as more Japanese towns and cities take steps to brace for what they hope will never happen……
Security experts say the drills won’t necessarily protect everyone from ballistic missiles, but going through the evacuation procedure in a simulated situation will help people survive in an actual attack…..”
https://www.youtube.com/watch?v=4LIW7f1HitI
London: 7 now dead and 48 taken to 5 hospitals; 3 suspects dead.
Sunday, June 4th, 2017BBC
- Seven people have been killed and three suspects shot dead by police after terror attack at London Bridge and Borough Market
- Speeding van hit pedestrians, before suspects jumped out and stabbed members of public and police officer
- Suspects wore hoax explosive vests, say police
- London Ambulance Service says 48 patients taken to five hospitals
- PM Theresa May condemns the “single evil ideology of Islamist extremism,” saying “enough is enough”
- Police have opened a casualty bureau. Telephone numbers are 0800 096 1233 and 020 7158 0197
- All major political parties suspend national general election campaigning, except UKIP
https://www.youtube.com/watch?v=IorTVnqhnD8