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Latest News: Ebola vaccine shows promise in human trials

Thursday November 27 2014

The vaccine did cause a fever in some people but this passed after a day

It is hoped the vaccine will be ready by 2015

“Ebola vaccine trial results promising, says manufacturer,” The Guardian reports. Initial results from a trial involving 20 healthy adults found that the vaccine seems to be safe.

The trial was what is known as a phase one trial, which is designed to test if a drug or intervention is safe, rather than whether it is effective against Ebola.

There were some minor side effects – such as mild pain, fever and generally feeling under the weather – but all symptoms resolved after a few days.

Although the purpose of the study was to assess safety, the researchers also measured the antibody levels that had been produced following the vaccine, which gives an indication that it might be effective in granting immunity against infection.

Ebola risk remains low in the UK

It is important to note there is currently no direct threat to people in the UK from the Ebola virus. Outbreaks of Ebola are nothing new, but health professionals are concerned about the size of the current outbreak.

 

Read more on why the threat of Ebola to people in the UK is very low.

Antibodies of a level similar to that shown to be effective against Ebola in primate studies was seen in 19 people against the Zaire strain of Ebola, and 15 people against the Sudan strain of Ebola.

The effectiveness of this particular vaccine is now being evaluated in larger clinical trials. Of note, large human trials are ongoing into another newly-developed Ebola vaccine that may be effective just against the Zaire strain of Ebola, which is responsible for the current outbreak.

Hopefully, one or both vaccines will be available by 2015, which are likely to be given first to high-risk groups, such as healthcare workers.

 

Where did the story come from?

The study was carried out by researchers from National Institutes of Health in Maryland, GlaxoSmithKline Vaccines in Belgium and the University of Naples. It was sponsored by the National Institute of Allergy and Infectious Diseases, Vaccine Research Center, Maryland. Some of the authors have a pending patent related to the vaccine, representing a financial conflict of interest.

The study was published in the peer-reviewed New England Journal of Medicine. It was published on an open access basis, so is free to read online.

The UK media have reported the study accurately and emphasised that the results of further larger trials are required before any vaccination programmes can be initiated.

 

What kind of research was this?

This was a phase one trial, which is the first type of study that is performed on humans to test the safety of a new drug or vaccine. Phase one trials are generally conducted on a small number of people. In this case, a low dose of the vaccine was used to start with to make sure the tests were as safe as possible for the volunteers.

The effects of the vaccine were then monitored. If phase one trials are successful, then the vaccine will progress to phase two trials, which assess the effectiveness of the vaccine.

The Ebola epidemic in West Africa was declared to be an international public health emergency in August 2014. Since then, efforts to develop a vaccine have been sped up. One of them, the cAd3 Ebola vaccine, has been developed over the past three years with the aim of providing immunity to both the Zaire and Sudan strains of Ebola. It was initially effective in a study of macaque monkeys, but this wore off over the following months. Subsequent tests found that longer-term immunity for up to 10 months was improved by giving a booster dose. The first phase one trial of this drug was planned for the beginning of 2015, but this was brought forward because of the rising Ebola epidemic.

 

What did the research involve?

The Ebola vaccine was tested on 20 healthy volunteers to assess its safety in humans. This group was composed of nine men and 11 women, with an average age of 37 years.

Eligibility criteria for the study were:

  • 18 to 50 years old
  • availability for 48 weeks after enrolment, so they could be clinically reviewed
  • proof of identity
  • able and willing to complete the informed consent process
  • willing to donate blood to be used in future research
  • good general health without clinically significant medical history
  • a body mass index (BMI) of 40 or less
  • normal blood tests

Women who wished to participate had to have a negative pregnancy test and agree to effective birth control for 21 days prior to the study and 24 weeks after injection of the virus.

Each volunteer was paid approximately $1,700 (£1,074).

The first 10 volunteers received a small dose of the cAd3-EBO vaccine by injection into the shoulder muscle. The next 10 volunteers had a dose 10-fold stronger.

To minimise any risk, only one person was injected per day for the first three people in each group.

All participants were then followed up for four weeks to assess any potential side effects and to monitor the immune response.

 

What were the basic results?

There were no serious side effects or safety concerns. Mild to moderate reported symptoms included:

  • one person had a severe fever of 39.9C and one person had a mild temperature within eight to 24 hours of the higher injection dose; both resolved within one day
  • the blood tests of three people (one low dose, two high dose) showed that the time it took for their blood to clot had roughly doubled; in addition, four people (one low dose and three high dose) had low white blood cell counts (the cells that fight infection) in the days following the injection
  • 10 people had mild tenderness at the injection site, but no-one had any redness or swelling
  • one person felt moderately unwell after the injection and nine felt mildly unwell

The study’s primary goal was to assess the safety of the vaccine in humans, but tests to determine if the vaccine might be effective were also promising at four weeks:

  • nine low-dose volunteers and 10 high-dose volunteers had antibodies against the Zaire strain
  • seven low-dose volunteers and eight high-dose volunteers had antibodies against the Sudan strain

 

How did the researchers interpret the results?

The researchers concluded that “no safety concerns were identified” in this small study.

 

Conclusion

This phase one trial of a potential vaccine against two strains of Ebola (from Zaire and Sudan) did not raise any safety concerns. A few minor to moderate symptoms were reported, but all resolved within the four-week period studied.

Further clinical trials to test the effectiveness of the vaccine are currently underway. They will also monitor side effects in larger study groups and over a longer time period. It will be very interesting to see the results of these trials, as the primate studies showed that immunity wore off within a few months, but could be prolonged with a booster dose. It remains unclear how long any such immunity could last in humans.

It is worth stressing that all volunteers were healthy. Therefore, it is important to assess whether the vaccine is safe in more vulnerable groups, such as the very young and very old, or people with a pre-existing health condition.

The researchers also report that a vaccine that has been developed solely to protect against the Zaire strain of Ebola, which is responsible for the 2014 outbreak, is currently being tested on humans in the UK, US, Mali, Uganda and Switzerland.

We expect to see further developments in this field during the first half of 2015.

Analysis by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

Latest News: Ten-point plan to tackle liver disease published

Thursday November 27 2014

All types of liver diseases are on the rise

Both obesity and alcohol abuse can cause liver disease

"Doctors call for tougher laws on alcohol abuse to tackle liver disease crisis," The Guardian reports. But this is just one of 10 recommendations for tackling the burden of liver disease published in a special report in The Lancet.

The report paints a grim picture of an emerging crisis in liver disease in the UK, saying it is one of the few countries in Europe where liver disease and deaths have actually increased rapidly over the last 30 years. It concludes with 10 recommendations to tackle the burden of liver disease.

The media has approached the recommendations from many different angles, with many sources only reporting on one, not all, of the recommendations.

For example, BBC News and The Daily Telegraph focused on the call for improved diagnosis in primary care: "GPs should offer liver scans to those who drink too much," reported The Telegraph.

The Guardian focused on calls for tougher regulation of the alcohol industry, such as minimum pricing for alcohol and a restriction on advertising and sponsorship by alcohol manufacturers, while the Mail's reporting focused on their core audience: "The middle class are fuelling an increase in death from liver disease".

 

What is liver disease?

There are more than 100 types of liver disease, which together affect at least 2 million people in the UK.

In the UK, the three most common types are:

All three are preventable:

 

Who wrote this report?

The report was compiled by a group of UK doctors and academics, and was published in the peer-reviewed medical journal, The Lancet.

The work was organised by The Lancet to "provide the strongest evidence base through the involvement of experts from a wide cross-section of disciplines, making firm recommendations to reduce the unacceptable premature mortality [death] and disease burden from avoidable causes, and to improve the standard of care for patients with liver disease in hospital".

The report stated that no people involved in the report were compensated for their time and no competing interests were declared.

The report involved many of the major medical and liver research councils in the UK, including the British Liver Trust, the Royal College of General Practitioners, the Children's Liver Disease Foundation, the Royal College of Physicians, the British Society of Gastroenterology, the Foundation for Liver Research, and the British Association for the Study of the Liver.

The views expressed in the report were described as those of the authors and do not necessarily represent the views of any of the organisations involved in this report.

 

What were the issues identified in the report?

The report outlined how liver disease in the UK "stands out as the one glaring exception" to the vast improvements in health and life expectancy made over the past 30 years for many diseases, such as stroke, heart disease and many cancers.

The rise in liver disease-related deaths was described as being linked to similar rises in known risk factors for liver disease, namely alcohol consumption, obesity and an increasing number of cases of viral hepatitis (especially hepatitis C).

Deficiencies in hospital and primary care of liver disease were also highlighted alongside the financial impact to the NHS.

Some of the key facts used to describe the current "crisis" in liver disease include:

  • Death rates from liver disease have increased 400% since 1970 overall, and almost 500% in those under 65.
  • Liver disease is the third most common cause of premature death in the UK, and the rate of increase in liver disease is substantially higher in the UK than other countries in Western Europe.
  • More than 1 million admissions to hospital per year are the result of alcohol-related disorders, and both the number of admissions and the increase in deaths closely parallel the rise in alcohol consumption in the UK over the past 30 years.
  • Of the 25% of the population now categorised as obese, most will have non-alcoholic fatty liver disease, and many (up to 1 in 20) will have ongoing inflammation and scarring that finally leads to cirrhosis. Of those patients with cirrhosis, 5-10% will get liver cancer.
  • This increasing burden of liver disease is added to by chronic viral hepatitis – annual deaths from hepatitis C have almost quadrupled since 1996, and about 75% of people infected are estimated to be still unrecognised. The same applies to chronic hepatitis B infection, which can progress to cirrhosis and liver cancer.
  • The cost to the UK's National Health Service is equally staggering, with estimates of £3.5 billion per year for alcohol-related health problems and £5.5 billion per year for the consequences of obesity.
  • There is an unacceptable variation in the health outcomes of people attending different specialist liver disease services across the country. This means some specialist centres are performing much worse than others.
  • Based on survey data, the care of patients acutely sick with liver disease dying in hospital was judged to be good in less than half of cases. Other unacceptable findings were the inadequate facilities and lack of expertise of those caring for patients.
  • Deficiencies exist in primary care, which has crucial opportunities for the early diagnosis and prevention of progressive disease.
  • Those affected most by the burden of liver disease and death are the poorest and most vulnerable in our society.

 

What were the suggested solutions?

The report states the recommendations made were selected on the basis that they will have the greatest effect, and that these need to be implemented urgently.

"Although the recommendations are based mostly on data from England, they have wider application to the UK as a whole, and are in accord with the present strategy for healthcare policy by the Scottish Health Boards, the Health Department of Wales, and the Department of Health and Social Services in Northern Ireland."

The report's 10 most high-impact and urgently needed recommendations are:

1. Strengthen the detection of early liver disease and its treatment by improving the level of expertise and facilities in primary care.

2. Improve support services in the community setting for screening of high-risk patients.

3. Establish liver units in district general hospitals to be linked with 30 specialist centres distributed regionally to make highly specialised investigations and treatment available.

4. A national review of liver transplantation services to ensure better access for patients in specific areas of the country, and provide sufficient capacity for the anticipated increase in the availability of donor organs.

5. Strengthen the continuity of care in transition arrangements for the increasing number of children with liver disease surviving into adult life.

6. Implement a minimum price per unit, health warnings on alcohol packaging, and the restriction of alcohol advertising and alcohol sales.

7. The promotion of healthy lifestyles to reduce obesity in the country and its results on health, governmental regulations to reduce sugar content in food and drink, and the use of new diagnostic pathways to identify people with non-alcoholic fatty liver disease.

8. Eradicate infections from chronic hepatitis C virus in the UK by 2030 using antiviral drugs, reduce the burden of hepatitis B virus, target high-risk groups for these viruses, including immigrant communities, and use a universal six-in-one hepatitis B vaccination for infants.

9. Increase provision of medical and nursing training in hepatology, and wider educational opportunities for healthcare professionals to increase the number of doctors and nurses in hospitals and primary care.

10. Increase awareness of liver disease in the general population with a national campaign led by NHS England – clinical commissioning groups (CCGs) should increase awareness in area health teams.

 

Is the report reliable?

The report was an evidence-based piece combining established trend data and research evidence with expertise from various academics and doctors involved in liver disease and research.

It stresses the need for the recommendations to be evidence-based and scientifically focused. This gives us some confidence it is broadly reliable and represents the views of clinical opinion leaders and academics in liver disease research and treatment.

But, as far as we can tell, there was no systematic attempt to search and review the literature and data to ensure all relevant material was considered, as would be the case with a systematic review.

This means it is not clear to what extent evidence was used to support an existing stance, or whether certain relevant evidence or viewpoints have been intentionally or unintentionally excluded.

This leaves open the possibility that the report may present an overly critical or sensationalist view of the current state of affairs to stimulate a sense of urgency and instigate the action the authors perceive to be necessary.

But as the report used relatively objective data sources and stressed being scientifically focused, the impact of any bias is likely to be minimal.

 

What happens next?

It is difficult to predict. Some of the recommendations, such as providing resources to make the early diagnosis of liver disease more likely, are purely clinical.

Whether or not the recommendation is taken up will probably be based on whether the resources are available and this can be justified.

But other recommendations – such as introducing minimal alcohol pricing, restricting alcohol sales to certain times of the day, and bringing in new rules regarding the advertising of alcohol – are politically controversial, and are likely to meet with fierce opposition from the alcohol industry.

It would be surprising if any party publically supported the recommendations this side of the upcoming general election.

Governments do have the power to change behaviour, which, as with the smoking ban, can prove very successful in achieving large-scale change.

But ultimately the responsibility of preventing liver disease is yours. If you moderate your alcohol consumption, try to maintain a healthy weight, and never share needles (if you are an injecting drug user), you should have a good chance of avoiding liver disease.

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

Latest News: Pele moved to quieter wing of Brazil hospital, aide says

SAO PAULO (Reuters) - Brazilian football great Pele, who is in a Sao Paulo hospital for treatment for a urinary tract infection, has been moved to a hospital wing where he won't be besieged by as many visitors, his spokesman told Reuters on Thursday.

The Albert Einstein Hospital had issued a short statement saying Pele, 74, had been moved to a special care unit after suffering "clinical instability". The hospital did not provide details.

Jose Fornos Rodrigues, the former player's personal aide, said Pele was "completely fine" and the move was primarily to protect his privacy.

"He was uncomfortable with so many people coming. It'll be quieter now," Rodrigues said by telephone.

A hospital spokeswoman declined to elaborate on Pele's condition, but said he was not in intensive care.

Pele was discharged from the same hospital on Nov. 13 after undergoing surgery to remove kidney stones.

Pele, often called the greatest football player in history, has suffered a long list of health problems in the past decade, including emergency eye surgery for a detached retina and a hip replacement.

(Reporting by Brian Winter; Editing by Peter Galloway)

Latest News: Bird flu outbreak in India caused by strain humans can contract - OIE

PARIS (Reuters) - A bird flu virus found in India this week is the H5N1 strain that can be transmitted to humans, the World Organisation for Animal Health (OIE) said on Thursday.

However, the organisation said it was not concerned about the situation, because India had faced outbreaks of the virus before. No human case has been reported since at least 2003.

India has found thousands of dead ducks infected by a highly contagious bird flu virus in the southern state of Kerala, prompting the authorities to cull more than 200,000 birds.

In a report submitted to the OIE, the Indian farm ministry had said the fowl had died of an H5 variant of the virus but did not specify the strain. A follow-up report posted on the OIE website showed the ministry had now identified it as H5N1.

The H5N1 strain can be fatal to humans. It caused the deaths of nearly 400 people and hundreds of millions of poultry after it spread from Asia into Europe and Africa in 2005 and 2006.

Since 2006, India has culled 6.4 million birds because of bird flu, OIE Director General Bernard Vallat told Reuters this week. The latest outbreaks were not a particular cause for concern, he said.

According to the latest available World Animal Health data, no human cases of H5N1 were confirmed in India during the period reviewed, from 2003 to Oct. 2 this year. The OIE was also not aware of any people that had been infected by this outbreak.

However, the flu cases in India were not related to a wave of cases that hit Europe in recent weeks.

Germany, the Netherlands and Britain were struck by another highly pathogenic bird flu strain, H5N8. It devastated flocks in Asia, mainly South Korea, earlier this year but has never been detected in humans.

(Reporting by Sybille de La Hamaide; Editing by Larry King)

Latest News: Ebola cases near 16,000, Sierra Leone to overtake Liberia soon with most cases – WHO

GENEVA (Reuters) - (Story corrects headline to clarify reference to Sierra Leone)

The death toll in the world's worst Ebola epidemic has risen to 5,689 out of 15,935 cases reported in eight countries by the end of Nov. 23, the World Health Organization said on Wednesday.

Almost all cases and all but 15 deaths have been in Guinea, Sierra Leone and Liberia - the three hardest-hit countries, which reported 600 new cases in the past week, the WHO said in its latest update.

"The total number of cases reported in Sierra Leone since the outbreak began will soon eclipse the number reported from Liberia," it said. The former British colony has reported 6,599 cases against 7,168 in Liberia.

Transmission of the virus remains intense in Sierra Leone, apart from the southeast, with the capital Freetown still the worst affected area, it said.

"Liberia and Sierra Leone report that fewer than 70 percent of patients are isolated, though there is wide variation among districts," the WHO said.

Peter Piot, a leading specialist on the disease, said on Wednesday that West Africa's Ebola epidemic could worsen further before abating, but that but new infections should start to decline in all affected countries by the end of the year.

(Reporting by Stephanie Nebehay; Editing by Kevin Liffey)

Latest News: How much will the chancellor give the NHS?
Doctor holding moneyNHS chiefs think £2bn is the minimum needed next year

Related Stories

Will be £1.5bn or could it be £2bn? That's the debate around the higher echelons of the NHS in England as they await Chancellor George Osborne's Autumn Statement next week.

Since the call for £1.5bn extra for next year's NHS budget was made earlier this month there has been no downplaying of the idea in Whitehall.

It came from the health minister Norman Lamb in an interview with me and was met with a resounding silence at the Treasury.

Easy, you might have thought, for sources close to the chancellor, to dismiss the idea as the unrealistic political posturing of a Liberal Democrat.

Pig stethoscopeHow much is going to be in the NHS pot?

There was no reaction either from Health Secretary Jeremy Hunt, who presumably would be delighted if Mr Osborne handed over a cheque.

Lib Dem leader Nick Clegg has also mentioned that £1.5bn figure.

Labour have called for an extra £1bn, paid for by banking industry fines, as well as the £2.5bn the party has pledged annually over the new parliament, part funded by a mansion tax.

All of this suggests that new money for health will be part of the Autumn Statement. But the question is now much?

Might the chancellor wish to appear to trump the Liberal Democrats and conjure up £2bn extra for the financial year beginning in April? The silence from the Treasury is deafening. Something is up.

Unusual times

However much new cash is cobbled to together for the NHS, the chancellor will no doubt present it as an example of the government's commitment to essential public services even at a time of austerity.

"Billions more for the NHS" is a headline he would be happy to see the day after the Autumn Statement.

But as far as NHS chiefs are concerned, a £2bn injection next year is the minimum needed to keep the service going without cuts to staffing and lower quality care.

The NHS under pressure

Service Target Performance

A&E

95% of patients admitted, discharged or transferred in four hours

Missed in recent weeks with average for 2014-15 running at 94.7%

Cancer

Several. Most high-profile is the 62-day target for treatment

Missed for the last nine months

Hospital operations

90% of operations to be done in 18 weeks of a referral

Missed for four months - part of allowed breach to tackle long waiters

For some months they have been concerned about a gap between anticipated demand for health care next year and the budget for 2015/16 already settled with the Treasury. I reported as much back in June.

It was no coincidence that the Kings Fund think tank and the group representing many health trusts, NHS Providers, both called for a £2bn boost for next year.

Without it, they argued, a financial crisis was looming. I sense they would not be satisfied with the £1.5bn mooted by Messrs Lamb and Clegg.

In normal times, finding £2bn from behind the sofas at the Treasury is not difficult. But these are unusual times.

Government borrowing is higher over the financial year to date than it was this time last year and Mr Osborne can only hope the budget watchdog the Office of Budget Responsibility (OBR) predicts the full year figure will be falling.

The last thing he really wants is to raise spending above existing plans.

'Difficult judgements and strong nerves'

All of the above is about next year. But the current financial year is throwing up major challenges.

Over the first six months of the year, health trusts in England were £630m in the red and that figure was recorded, even after a discreet injection of extra money by the government into the weakest trusts.

And that's before winter is here.

Of course the Department of Health's main concern is that the sums across the NHS balance at the end of the year.

If hospitals are running deficits but local commissioning groups are in surplus then all will be well. But it may be a close run thing by the time winter has run its course.

Keeping within budget will require difficult judgements and strong nerves - like landing a Harrier jump jet on one half of a tennis court according to one source.

This year's financial struggle underlines why health chiefs are so keen to see new money for next year.

If they only just squeak through this year, then the relentlessly rising demands on the service over the next 12 months, they reason, can only be met with added resources.

Latest News: Ebola shows WHO needs revamp, says U.N. reformer Rudd

By Tom Miles

GENEVA (Reuters) - The World Health Organization (WHO) needs reform to prevent a recurrence of crises such as West Africa's Ebola outbreak, former Australian prime minister Kevin Rudd said on Thursday.

Rudd is leading a two-year study to suggest ways to improve the effectiveness of the United Nations system and other global bodies, which are often deadlocked by disagreements between states or hamstrung by their internal bureaucracy.

The WHO's Africa office has been widely criticised for its slow response to the Ebola epidemic, which has now killed at least 5,689 people. The WHO has promised to investigate its handling of the outbreak once the epidemic is over.

Rudd said he was seeking practical recommendations to improve the system's effectiveness, adding he thought the WHO suffered from a "systemic problem" in the way power was shared between its central organisation and regional branches.

"If you do not want this sort of thing to repeat itself then a substantive reform would lie in sufficiently empowering WHO globally to act globally on threats to global public health," Rudd told reporters in Geneva after briefing diplomats.

That is the kind of "too-difficult-to-handle" issue that diplomats are now avoiding, Rudd added.

His commission plans to publish its ideas as it goes along, winding up as the United Nations names a replacement for Secretary-General Ban Ki-moon, whose term ends on Dec. 31, 2016.

Rudd, 57, said global institutions were coming under unprecedented pressure due to rapid shifts in world power relations, demographics, technology, the emergence of non-state actors and a shrinking funding base.

People are increasingly finding ways to work around international organisations, threatening the U.N. system with "death by a thousand cuts", he said.

"None of us wants to see that happen."

(Editing by Gareth Jones)

Latest News: Most chickens sold in UK stores have traces of food bug - watchdog

LONDON (Reuters) - Almost three-quarters of fresh chickens sold by British retailers were found to have traces of a potentially fatal food-poisoning bug, a food watchdog warned on Thursday and said major grocers were not doing enough to tackle the problem.

Tackling the campylobacter bug, the most common form of food poisoning in Britain, affecting an estimated 280,000 people a year, is the Foods Standards Agency's (FSA) number one food safety priority and it is leading a campaign to bring together the whole food chain to deal with the problem.

Publishing results from the first two quarters of a year-long survey of campylobacter in fresh chickens, the FSA said no retailers were meeting end-of-production targets for reducing contamination.

"These results show that the food industry, especially retailers, need to do more to reduce the amount of campylobacter on fresh chickens," said FSA Director of Policy Steve Wearne.

Its survey found that 18 percent of chickens tested had campylobacter over 1,000 colony forming units per gram (cfu/g), the highest level of contamination, and more than 70 percent of chickens had some campylobacter on them.

"This shows there is a long way to go before consumers are protected from this bug," said Wearne, though he stressed that if chicken is cooked thoroughly and preparation guidelines are properly followed, the risk to public health is extremely low.

The FSA said its survey found Wal-Mart's Asda to be the only major grocer to have a higher incidence of chicken contaminated by campylobacter at the highest level, compared to the industry average, while market leader Tesco was the only major grocer to have a below industry average incidence.

A spokeswoman for Asda said: "We take campylobacter seriously and it goes without saying that we're disappointed with these findings. There is no 'silver bullet' to tackle this issue, but along with other retailers, we're working hard to find a solution."

(Story refiles to remove extraneous word from first paragraph)

(Reporting by James Davey; Editing by Pravin Char)

Latest News: Eight dead from Lassa fever in Benin, 170 under observation

Eight people have died in the west African nation of Benin from an outbreak of Lassa fever, while 170 others have been placed under observation, officials said Thursday.

Fourteen suspected cases of the virus have been identified, with two confirmed and eight deaths in the small country bordering Nigeria, said a joint statement from the WHO, Benin's health ministry and UNICEF.

The outbreak has occurred in the north of the country of some nine million people.

"A total of 170 contacts have been identified in the towns of Tanguieta and Cobly and are under daily monitoring," the statement said.

According to the WHO, Lassa fever is an acute haemorrhagic illness which belongs to the arenarvirus family of viruses, which also includes the Ebola-like Marburg virus.

It was first identified in 1969 in the north Nigerian town of the same name.

The virus, which is endemic in rodents in west Africa, is transmitted to humans by contact with food or household items contaminated with the animals' faeces and urine.

Person-to-person contact is also possible through bodily fluids, particularly in hospitals when adequate infection control measures are not taken.

People with Lassa fever do not display symptoms in 80 percent of cases but it can cause serious symptoms and death in the remainder.

The US Centers for Disease Control and Prevention said that the number of Lassa fever infections in west Africa every year is between 100,000 to 300,000, with about 5,000 deaths.

Latest News: Venezuela says 13 inmates die of overdose after robbing infirmary ward

CARACAS (Reuters) - Thirteen inmates have died after breaking into a Venezuelan jail's infirmary and ingesting medical products including antibiotics and pure alcohol in the latest outbreak of unrest in the country's turbulent prisons.

A total of 145 prisoners were intoxicated during a revolt in the David Viloria penitentiary centre in the western state of Lara on Monday, the government said on Thursday.

Inmates had launched a hunger strike to demand the dismissal of an official, and the protest quickly spiralled.

"Around 8.30 a.m. they became violent and started to break the walls and the doors of the confined areas, so the National Guard was called in for support," a government statement said.

Hours later, "some prisoners were in a state of overdose after violently entering the infirmary area, robbing the pharmacy... and ingesting, without prescriptions, multiple pharmaceuticals such as antibiotics, antihypertensives, aspirin, absolute alcohol, among other things."

Also this week, 41 inmates escaped from a hole in the wall of a prison in Los Teques, near the capital Caracas.

Venezuela's overcrowded prisons are notorious for gang-fights, riots and widespread access to drugs and weapons.

(Reporting by Alexandra Ulmer; Editing by Andrew Cawthorne; and Peter Galloway)

Latest News: Phillip Hughes: How is the brain injured?
Phillip Hughes playing cricket for Australia in September 2014Phillip Hughes played in 26 Tests for Australia before his death at the age of 25

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Phillip Hughes collapsed after being hit by a cricket ball at the top of his neck and the base of the skull.

One of the major arteries into the brain split and caused massive bleeding.

The brain is a very delicate and vulnerable organ, which is surrounded by the skull - a defensive wall of bone - and a cushioning fluid.

But it is not a simple case of the brain having specific weak spots.

"The brain is protected by the skull, but the upper neck is vulnerable," said Peter Hutchinson, a professor of neurosurgery at University of Cambridge.

He told the BBC: "We evolved to enable a neck with a lot of movement, but the consequence is a risk of injury to the vessels from excessive movement or direct trauma."

The vertebral arteries run up both sides of the neck and the blow from the ball caused a dissection, in which the artery ruptures.

Antonio Belli, a reader in neurotrauma at the University of Birmingham, said: "The vertebral arteries supply the brain stem, which controls breathing and heart rhythm, so I think that could be why he stopped breathing immediately."

Veins and arteries in the brainHow the brain is fed by arteries (in red) and veins (in blue) in the head and neck
Types of injury

While vertebral artery dissections are rare, there are two common types of brain injury known as "focal" and "diffuse".

Focal injuries tend to be caused by falls and assaults. They are the result of a damage to one area of the brain, which results in a blood clot.

This occupies space and causes pressure on the surrounding brain, starving the organ of oxygen leading to brain cells dying. It is treated by removing the clot.

However, damage may not be confined to just the site of the impact - known as a "coup injury".

The brain floats inside the skull so can collide with the side of the skull opposite the impact causing a "contra-coup injury".

The front of Olympic rower James Cracknell's brain was damaged when he was struck on the back of the head while cycling.

Widespread

The other class of injury is largely the result of high speed road accidents.

The new style of cricket helmet, worn by New Zealand cricketer Ish Sodhi in 2014The latest model of cricket helmet, which is said to be more protective, worn by New Zealand cricketer Ish Sodhi

In diffuse injuries the damage is spread across the brain, which becomes swollen.

The pressure builds in the tight confines of the skull and the flow of blood can be impaired.

Treatment requires lowering the pressure in the brain.

It is also possible to damage the brain without a direct blow to the head.

The brain sits in fluid inside the skull and can bounce around if there is enough force.

In something like severe whiplash the brain can be shaken around the skull, even though no blow is delivered.

Mr Belli told the BBC: "Often what does the damage is not the direct impact, but rotational forces.

"You could argue from an evolutionary point of view, we're well designed to withstand a direct blow, but not engineered well to withstand the rotational forces in a road traffic accident."

Thinner walls

The skull itself does have stronger and weaker parts.

A region called the pterion, close to the ears, is the thinnest part of the skull so is most vulnerable to fracture.

But the relatively reinforced forehead and back of the skull can still be damaged.

"They may be thicker parts of the skull, but you can still fracture them if you transmit enough force," Prof Hutchinson noted.

"There isn't a safe point or a weak point, you get a lot of damage from the way the force travels through the head," added Mr Belli.

Lasting damage

Damage varies hugely from one patient to another - one patient who has a seemingly severe injury can show better recovery than injuries which appear minor.

Prof Hutchinson said it the lasting damage depended on where the damage was caused as "some areas are more critical".

"Bleeding in the motor cortex can result in paralysis while damage to the visual cortex would result in blindness."

He said sport was not taking head injury seriously enough, but changes in American football were driving reform.

"In terms of sport, the most controversial is boxing because it is a deliberate act, horse riding creates a lot of serious injuries, and rugby increasingly so.

"There are racing drivers who have had an accident in the early part of the weekend, raced the whole weekend and not remembered a thing."

"People need to be aware of brain injury."

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