Rotavirus vaccine could save lives of almost 500,000 children a year

A vaccine capable of enduring scorching temperatures for months at a time could strike a decisive blow in the fight against rotavirus, preventing nearly half a million children around the world from dying of diarrhoea each year.

Médecins Sans Frontières (MSF) has hailed successful trials of the BRV-PV vaccine in Niger as a “game changer” in tackling rotavirus infection, which is the leading cause of severe diarrhoea globally and claims the lives of an estimated 1,300 children daily, most of them in sub-Saharan Africa.

According to results published in the New England Journal of Medicine, the vaccine has proven as effective as those currently used to treat severe gastroenteritis. Trials in Niger’s Maradi region successfully treated 4,000 children under the age of two.

Unlike existing vaccines, the BRV-PV vaccine does not require refrigeration and can remain stable for up to one year at 37C or six months at 40C. It is particularly effective against the strains of rotavirus found in sub-Saharan Africa, as well as affordable: at only $ 2.50 (£2), the vaccine could potentially be rolled out quickly in routine immunisation programmes.

“This is a game-changer,” said Dr Micaela Serafini, MSF’s medical director. “We believe that the new vaccine can bring protection against rotavirus to the children who need it most.”

Diarrhoea is the second largest cause of death in infants and children worldwide, primarily in low-income countries where access to clean water and sanitation is limited. Rotavirus is highly contagious, particularly among babies and young children, and can be spread by contaminated hands, objects such as toys and surfaces, and water and food.

Children in the world’s poorest countries account for 82% of rotavirus deaths, but vaccines make a significant difference. In Mexico, diarrhoeal deaths among children under five declined by as much as 50% after rotavirus vaccines were introduced.

The trials in Niger – the first of their kind to be approved in an African country – were conducted by MSF’s research and epidemiology branch Epicentre, in collaboration with Niger’s ministry of health, the Cincinnati children’s hospital and the makers of the vaccine, the Serum Institute of India. According to MSF, the results demonstrated no safety concerns and as a result the vaccine is hoped to fill the current supply gaps of the existing rotavirus vaccines, RotaTeq and Rotarix, both of which require refrigeration.

The World Health Organization recommends that rotavirus vaccines should be included in all national immunisation programmes, and considered a priority in south and south-east Asia and sub-Saharan Africa. The BRV-PV vaccine is awaiting pre-qualification from the WHO before it can be rolled out.

Licensing the product could take up to 18 months, said Anna-Lea Kahn, a WHO technical officer looking at innovations for facilitating vaccine supply and delivery. During that period, WHO scientists evaluate data supporting the vaccine’s quality and safety, drawing on independent specialist help when needed.

Most difficulties with vaccine delivery tend to arise during the “last mile” of the vaccine supply chain, said Kahn. “That’s where it goes wrong the most: where being able to maintain the cold chain is hardest; where constraints are most pronounced, be it due to lack of electricity or lack of resources, or inability to maintain a cold fridge. There may be geographical barriers, too, presenting a logistical challenge.

“In these scenarios, not having to depend on the cold chain … can make a valuable difference in getting vaccines to those who otherwise might not receive it.”

Serafini said: “The success of this trial shows that research and development into vaccines that are specifically adapted for use in low-income countries yields results.”

A spokesperson for Gavi, the international vaccine alliance, said BRV-PV’s results were encouraging.

“Adding more flexibility to the cold chain could allow more vaccines to reach the hardest-to-reach locations, boosting coverage and giving many more children access to lifesaving vaccines,” the spokesperson said. “However, it is anticipated that an important consideration for the countries will be the final recommendations on temperature control conditions of the vaccine, which could be different than the conditions used during the clinical trial.”

Rotavirus vaccine could save lives of almost 500,000 children a year

Paramedics spend 500,000 hours outside busy A&Es, say auditors

Paramedics last year spent 500,000 hours outside hospitals with a patient in the back of their ambulance because A&E staff were too busy to accept them, an official inquiry has revealed.

That was the equivalent of 41,000 12-hour ambulance shifts being taken up with waiting instead of crews being able to attend to other emergencies, according to a report by the National Audit Office.

Ambulance crews are meant to take no more than 15 minutes to hand over a patient to A&E staff and another 15 minutes to prepare their vehicle to get back on the road. “Each failure to meet this standard results in a poor experience for the patient and a delay in an ambulance crew being available for a new emergency call,” the report says.

Last year just 58% of ambulances transferred their patient within 15 minutes and 65% were ready to leave a quarter of an hour later.

All but one of the 10 NHS regional ambulance trusts are breaching 999 call response targets, services are desperately short of paramedics and funding has not kept pace with a surge in the number of patients who need an ambulance.

The NAO report says: “Ambulance services are finding it increasingly difficult to cope with rising demand for urgent and emergency services. Introducing new models of care has helped but there are signs of stress, including worsening performance against response time targets.”

Ambulances are meant to arrive at the scene of 75% of Red 1 and Red 2 calls within eight minutes. Red 1 calls involve life-threatening emergencies such as patients who have suffered a cardiac arrest, are not breathing and do not have a pulse. Red 2 calls are less immediately time-critical but involve events such as a heart attack or stroke. Green 1 calls have a target of 20 minutes.

In 2015-16 the West Midlands ambulance service was the only one of the 10 trusts in England to meet the three main targets, the NAO found.

The NAO flags up a 10% vacancy rate for paramedics, and ambulance trusts’ difficulties in retaining staff, as obstacles to tackling what it describes as “significant challenges”.

It says the ageing population, growing number of patients with alcohol or mental health problems and lack of health services outside hospitals all help to explain the rapidly growing demand for care. The number of calls to ambulance services and transfers from the NHS 111 telephone advice service rose from 7.9m in 2009-10 to 10.7m in 2015-16 – an average year-on-year increase of 5.2%.

Phil McCarvill, deputy director of analysis at the NHS Confederation, which represents NHS trusts including ambulance services, said underfunding elsewhere in the health and care system was a key reason ambulance trusts were under pressure.

“Our highly skilled and dedicated ambulance personnel are working incredibly hard to make sure people get the right care where and when they need it, but they are having to respond to unprecedented demand for health and care services,” he said.

“If we are to relieve the current pressures on ambulance services, we also need to see the right balance of resources going into community, primary care and social care.”

Norman Lamb, the Liberal Democrats’ health spokesman, said: “The health secretary says he wants to make the NHS the safest healthcare system in the world, but these figures show patient care and safety is being severely compromised.

“When thousands of patients are stuck outside A&E departments, ambulances can’t get to other emergencies on time. People suffering from serious conditions such as a stroke will be left with serious disabilities and other life-long problems, and there is a serious risk of lives being lost because emergency calls are delayed.”

Case studies

Rachel, Newcastle upon Tyne: “I was ordered an ambulance by NHS Direct due to a suspected brain haemorrhage. My boyfriend offered immediately to drive me to A&E but they insisted on sending an ambulance, and he was told to wait outside ready to receive the paramedics. Forty-five minutes later we were still waiting, and when we were able to speak to someone we were told that it was in the system but hadn’t been dispatched yet.

“We drove to hospital and were seen immediately. Given that we offered to drive from the outset, it was an unnecessary delay and, had the ambulance arrived, would have been an unnecessary journey.”

Paul Baggaley, Newark: “I came across a pedal cyclist lying in the road after falling off his bike on a slippery surface. A young carer stopped with us and called for an ambulance after five minutes of convincing him that he needed to be seen by hospital. He had injuries and a broken helmet after cracking his head on the road. After coming back to his senses he informed us of two spinal operations he had suffered so we didn’t move him. We kept him warm with blanket and kept him talking.

“After 20 to 30 minutes I rang 101 for police assistance to help with traffic. They arrived in 15 to 20 minutes. We stayed 20 minutes then had to leave. After we had done what we had to do, we came back past that way and still no ambulance. He was lying on the cold ground for over an hour.

“The East Midlands ambulance service is the poorest performing service in the country and things seem to be worst where we are because we are 23 miles from the nearest A&E and so ambulance service is continually stretched.”

Paramedics spend 500,000 hours outside busy A&Es, say auditors

500,000 Britons a year will be diagnosed with cancer by 2035, study shows

More than half a million Britons a year will be diagnosed with cancer by 2035, making it hard for NHS services to cope with the extra demand for testing and treatment, Cancer Research UK (CRUK) has warned.

The number of people across the UK found to have cancer every year is expected to rise from 352,000 to an estimated 514,000 in less than 20 years – more than 160,000 extra cases annually – according to research in the British Journal of Cancer.

The vast majority of the expected 162,000 additional cases – 141,000 – will be caused by the ageing and growing population. However, another 12,600 will be the result of a combination of lifestyle factors, such as smoking, alcohol or poor diet, and also improved screening for the disease.

In 1993, 127,000 men and 128,000 women were diagnosed with the disease. By 2014, the numbers had risen to 173,000 and 179,000 respectively. This future trends analysis, based on examining cancer data going back to 1979, predicts that 244,000 women and more than 270,000 men will be diagnosed in 2035.

Those big rises mean there is an “urgent need to plan for the future of NHS cancer services, which are already stretched to the limit as they struggle to cope with a growing and ageing population”, CRUK said.

“The number of people getting cancer in the UK will incerease sharply in the next two decades. This is mostly the result of an ageing and growing population but, for women, lifestyle factors are playing an increasingly important role”, said Dr Rebecca Smittenaar, the study’s lead author and CRUK’s statistics manager.

Part of the predicted increase in cancer rates has been attributed to improved screening for the disease. Photograph: Getty/Caiaimage

People’s risk of developing cancer will also rise in actual terms, separate to the growing numbers diagnosed, due to increased life expectancy and population expansion.

Cancer incidence rates have risen for both sexes in an almost unbroken way since records began in 1979, though they have recently begun edging downwards for men. Men have always been more likely than women to be diagnosed.

In 1993, 783 f every 100,000 men aged 15 or over were diagnosed with cancer. That rose to 808 per 100,000 in 2014 and is predicted to increase again, albeit slightly, to 812 per 100,000 in 2035.

The number of women in that age group who developed cancer rose from 564 per 100,000 people in 1993 to 664 per 100,000 in 2014. It is due to hit 685 by 2035, according to the study.

CRUK last year revised its prediction for the number of people who would develop cancer at some point in their lives from one in three to one in two.

Sir Harpal Kumar, the charity’s chief executive, said the expected increases in cancer cases were “shocking”. However, four in 10 cancers could be prevented if people drank less, did not smoke, ate a healthy diet and took more exercise, he said.

500,000 Britons a year will be diagnosed with cancer by 2035, study shows