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Hyd polio virus derived from vaccin... by Nursing Crusade 30 views
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Injectable Polio Vaccine in Indian Context, presented on 11th Dec 2011 at Haryana State Pediatric Conference, Kurukshetra on 11th Dec, 2011
nilesh shah , Attended m.s.university
Rajiv Ahlawat | NIPER | Mohali at Rajiv Ahlawat | NIPER | Mohali
1. IPV – Need of the hour Dr Gaurav Gupta Pediatrician, Charak Clinics, Mohali [email_address]
2. A brief history of Polio

First described by Michael Underwood in 1789

First outbreak described in U.S. in 1843

21,000 paralytic cases reported in the U. S. in 1952

Global eradication in near future

3. A brief history of Polio Vaccine

1955 Inactivated vaccine

1961 Types 1 and 2 monovalent OPV

1962 Type 3 monovalent OPV

1963 Trivalent OPV

1987 Enhanced-potency IPV (eIPV)

4. Summary of Key Attributes of OPV and IPV Adapted from 1, 11 Sutter et al. Vaccines , 2008 Plotkin & Vidor . Vaccines , 2008
5. Despite Significant Progress, 4 Countries Still Remain Endemic for Polio WHO. Poliomyelitis Fact sheet. Available at: http://www.who.int/mediacentre/factsheets/fs114/en/print.html , 2009 WHO. Polio Case Count. Available at: http://www.who.int/immunization_monitoring/en/diseases/poliomyelitis/case_count.cfm , 2009 Graph adapted from WHO. Progress Towards Global Immunization Goals. Available at: http://www.who.int/immunization_monitoring/data/SlidesGlobalImmunization.pdf , 2009 Polio Eradication Progress, 1988-2008

1988 : 350,000 estimated cases

 >125 endemic countries

2008 : 1,652 cases

 4 endemic countries

India, Nigeria, Afghanistan, Pakistan

Endemic with wild polio virus (4 Countries) Certified polio-free regions (114 countries) Not certified but non-endemic (73 countries)
6. Polio Eradication: A Godzilla of Campaigns

Just think…..

In 2008, India administered more than one billion doses of OPV during polio vaccination campaigns.

On any given National Immunization Day (NID), more than 72 million children were immunized across a single weekend, making these regular occurrences repeatedly the largest immunizations in history !

And somewhere in India, polio campaigns were conducted in 24 out of the 52 weeks in the year.

7. Weekly AFP and VPD Update for Week 48, 2011 Data as of 05 December 2011
8. Wild Polio Virus India, 2010 *Dots are randomly placed within blocks (Sub-districts) Data as of 05 Dec 2011 Districts with cases in 2010 = Most recent P3 Wild polio case = Most recent P1 Wild polio case
9. Wild Polio Virus India, 2011 *Dots are randomly placed within blocks (Sub-districts) Data as of 05 Dec 2011 = Most recent P1 Wild polio case Districts with cases in 2011 Districts with cases in current week
10. Vaccine Derived Polio Virus (VDPV) India, 2011 *Dots are randomly placed within blocks (Sub-districts) Data as of 05 Dec 2011 Districts with cases in 2011 Districts with cases in current week = Most recent P2 VDPV case = Most recent P3 VDPV case
11. Wild Polio Cases by Type (P1, P3) and Month of Onset India, 2007-2011 Data as of 05 Dec 2011
13. But why talk about IPV now?

“ The primary challenge to India’s energetic and comprehensive polio eradication efforts is the failure of the vaccine to optimally protect children in the remaining infected areas of the country.”

WHO (GPEI. Annual Report 2008)

Concerns about VAPP is being increasingly realized.

Reemergence of type 2 poliovirus in the form of VDPV

Reintroduction of wild PV circulation in previously polio-free countries through importations

GOI has recognized the need for IPV in our country and granted license for use in India (50 years after its development).

Role of IPV in ‘Polio End Game’ – WHO position

IAP recommendations

14.

Suboptimal OPV efficacy

Inadequate Herd effect

Vaccine Associated Paralytic Poliomyelitis (VAPP)

Vaccine Derived Polio Virus (VDPV)

Issues Surrounding the Use of OPV
15. Polio is Still Endemic in 4 Countries, Reflecting both “Failure to Vaccinate” and “Vaccine Failure” WHO. Polio Case count. Available at: http://www.who.int/immunization_monitoring/en/diseases/poliomyelitis/case_count.cfm , 2009 Graphs from WHO. Polioeradication. Progress & Prospect. 2008 Roberts. Science , 2009 W. Uttar Pradesh Bihar Rest of country High risk Medium risk Rest of country In Nigeria, high “failure to vaccinate” In India, polio cases despite high coverage, thus “high vaccine failure” 0 doses 1-3 doses 4-6 doses 7+ doses OPV doses administrated per area in Nigeria 2003-2008 OPV doses administrated per area in India 2003-2008 % of children < 5 years receiving doses % of children < 5 years receiving doses
16. Seroconversion after 3 doses of OPV

Industrialized versus low-income countries

95% Seroconversion in industrialized countries

Seroconversion in low-income countries

Review of 32 studies. Patriarca, Wright & John. Rev Infect Dis 1991; 13:926-39 Type Weighted average seroconversion 1 2 3 73% 90% 70%
17. Paralytic polio cases are occurring predominantly among the children who had received 4 or more doses of vaccine, and lately among those who had received more than 7 doses of OPV. On the other hand among the polio cases percentage of unvaccinated children is very low. In case children develop paralytic disease after taking many doses of OPV, it means that many doses of vaccine had failed to provide protection.
18. VAPP: A Rare But Serious and Inevitable Adverse Event Associated with OPV

Vaccine-Associated Paralytic Polio :

Definition: PP in vaccinee following OPV administration

Cause: Mutation of vaccine virus during replication in the gut of vaccinee (reversion to neurovirulence)

Form: VAPP undistinguishable from naturally occurring polio

Same incubation period, range of severity and Case Fatality Rate

May affect both vaccinees & close contacts

Sutter et al. Vaccines , 2008 Paul. Vaccine , 2004 John. Bull of the WHO , 2004
19. VDPV: No Longer Just a Theoretical Concern

Vaccine Derived Polio Virus or VDPVs:

Definition: derivatives of Sabin OPV strains exhibiting 1-15% divergence in the sequence of viral protein vp1

Origin: accumulation of mutations by

Replication of the live vaccine strains within the vaccinee’s guts

Recombination with other enteroviruses

Potential to cause paralytic polio in humans and sustained circulation

Factor favoring emergence & spread are same as for wPV :

Low OPV coverage

Poor sanitation

High population density

Tropical conditions

3 Types cVDPV, iVDPV, aVDPV

WHO. WER , 2006
20.

Particular concern: re-emergence of type 2 (as VDPV) whereas the wild type was declared eradicated in 2002 and reported in 5 independent cVDPV outbreaks since then

According to some experts: “more likely several million individuals were infected during these events, and many thousand more have been infected by VDPV lineages within outbreaks which have escape detection”

2000- July 2009: At Least 13 cVDPV Outbreaks in 12 Countries Caused et Least of 300 Paralytic Polio cases DOR / HAITI 2000-01 VDPV 1 21 cases NIGER 2006 VDPV 2 2 cases NIGERIA 2005-08 VDPV 2 148 cases DR CONGO 2008 VDPV 2 11 cases MADAGASCAR VDPV 2 2001-02 5 cases 2005 3 cases MYANMAR 2006-07 VDPV 1 5 cases INDONESIA 2005 VDPV 1 46 cases CHINA 2004 VDPV 1 2 cases CAMBODIA 2005-06 VDPV 3 2 cases PHILIPPINES 2001 VDPV 1 3 cases ETHIOPIA 2008-09 VDPV 2 4 cases WHO. cVDPV 2000-2008. Available at: http://www.polioeradication.org/content/general/cvdpv_count.pdf , 2009 GPEI.Strategic Plan 2009-2013. Available at: http://www.polioeradication.org/content/publications/PolioStrategicPlan09-13_Framework.pdf ,2009 Wringe et al. Plos One , 2008 INDIA 2009 VDPV 1, 2 2 & 18 cases
22. The OPV Paradox – how OPV Use May Compromise the Final Goal of Eradication

Given risk of VAPP and VDPV associated with OPV, continued use of OPV may end up causing more cases of polio than wild polio virus ( OPV paradox )

WHO. cVDPV 2000-2008. Available at: http://www.polioeradication.org/content/general/cvdpv_count.pdf , 2009 GPEI. Strategic Plan 2009-2013. Available at: http://www.polioeradication.org/content/publications/PolioStrategicPlan09-13_Framework.pdf ,2009 WHO. WER , 2004 Jacob. Bull of the WHO , 2002 Dowdle et al. Rev Med Virol , 2003 RISK FREQUENCY GLOBAL ESTIMATES VAPP 2-4 per million birth cohort 250-500 cases/year (WHO) 400-800 cases/year (other experts’ estimate) cVDPV 13 independent cVDPV outbreaks in 12 countries since 2000 iVDPV 33 cases since 1962
23. eIPV: The Vaccine of Choice for Today and the Future

High Immunogenicity Even After 2 Doses

Long-term Persistence of Antibodies

Good Efficacy / Effectiveness

Good Herd Immunity

Favorable Health Economics

24. eIPV: High Immunogenicity, Even After 2 Doses

High immunogenicity of IPV even in developing and tropical countries where OPV is suboptimal

High immunogenicity after 2 doses (including 27 developing countries) :

In 30 trials involving >4500 subjects, seroprotection against poliovirus:

89-100% against type 1

92-100% against type 2

70-100% against type 3

Immunogenicity expectedly reinforced after 3rd dose

In 48 trials involving >6000 subjects

95-100% seroprotection rates against all 3 types

Comparative study in India, 1990s

92% efficacy of IPV vs 66% for OPV

(3 doses of respective vaccines)

Polio Eradication Committee et al. Indian Pediatr , 2008 Plotkin & Vidor. Vaccines , 2008
25. IPV Provides Good Herd Immunity

Herd immunity:

Protection of the population to a greater extent than that expected by the actual population vaccination coverage

Excellent herd immunity reported wherever IPV used on large scale

e.g. : USA

John. Expert Rev Vaccines , 2009 Stickle. Am J Public Health , 1954 Paralytic Poliomyelitis Cases Expected with or without Vaccine use, 1951-1954 Observed Expected in absence of vaccine use Expected with vaccine effect limited to vaccinees
26. Role of OPV + eIPV

Better mucosal immunity of OPV + IPV

Very low risk of VAPP – early OPV protection against VAPP by maternal antibodies. Subsequently protected by IPV. IPV alone may not be enough.

Higher seropositivity of OPV + IPV in multiple trials in Gambia, Oman, Thailand, Israel & Pakistan.

Benefit of continuing the government policy regarding OPV with highly predictable immunogenicity & efficacy of IPV.

OPV & IPV are not contradictory but complementary !
27. Indian Academy of Pediatrics: Schedules

OPV at birth,

OPV and IPV at 6, 10 and 14 weeks.

OPV and IPV at 15-18 mths and

OPV at 5 years.

OPV on all NID’s and SNID’s.

Indian Pediatrics 2008; 45: 635-648 Polio immunization naïve child Child has received OPV primary series

IPV given as two doses at 2 month interval

Continue OPV with DPT booster, and on all NID’s and SNID’s

28.

IPV should be the preferred vaccine

The schedules are as before with a booster dose of IPV at 5 years

Indian Academy of Pediatrics: Schedules Immunocompromised child Indian Pediatrics 2008; 45: 635-648
29. ‘ End game’ & ‘Post –eradication’ strategy – IAP PEC

End game - Use b-OPV for SIA’s, and add IPV for highly endemic region.

Post eradication – Introduce IPV and try to achieve high coverage before discontinuing OPV. Start with south states free of wild polio  gradually universal use. Continue OPV through 3 Pulse NIDs until WPV transmission stopped.

Hyd polio virus derived from vaccine, health min
Eating spicy food daily reduces health risks
Turkish polio ipv
Pokachy
The benefits of the polio vaccine for child
Worldwide Pertussis Vaccine Industry Analysis and Revenue Forecast 2017

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Cardboard people by Kaletski, Alexander: Dillon Gallery 9780964834026 0th Edition. - Better World Books
Home Kaletski, Alexander Cardboard people
Published by Dillon Gallery, 1996
ISBN 10: 0964834022 / ISBN 13: 9780964834026
Shows some signs of wear, and may have some markings on the inside. Bookseller Inventory # GRP47872076
Synopsis: art book w/ painted cardboard people
Title: Cardboard people
Publisher: Dillon Gallery
1. Cardbaord people.
Published by Dillon Gallery
ISBN 10: 0964834022 ISBN 13: 9780964834026
Book Description Dillon Gallery. Buch ist in gutem Zustand, geringe Gebrauchs- Alters- oder Lagerungsspuren. Deutsch 450g. Seller Inventory # 335066
Published by Dillon Gallery (1996)
Book Description Dillon Gallery, 1996. Hardcover. Condition: Very Good. Open Books is a nonprofit social venture that provides literacy experiences for thousands of readers each year through inspiring programs and creative capitalization of books. Seller Inventory # mon0000427946
3. Alexander Kaletski. Cardboard people.
Book Description Dillon Gallery, 1996. 28,5 x 22,5 cm. Hardback. Illustrated in color throughout. [ Art / international artist ]. Seller Inventory # #108112
4. Alexander Kaletski: Cardboard People
Kaletski, Alexander and Oswald diPhilippo
Book Description Dillon Gallery, 1996. Hardcover without dustjacket as issued, unpaginated, very good condition, no internal marks, clean and crisp. Foreign shipping may be extra. Seller Inventory # AlKaDi15
5. Cardboard People
Published by Dillon Gallery, U.S.A. (1996)
Book Description Dillon Gallery, U.S.A., 1996. Hardcover. Condition: Very Good. Dust Jacket Condition: No Jacket, As Issued. SIGNED BY ALEXANDER KALETSKI. Hard bound. No dust jacket as issued. Boards show minor wear, otherwise in very good condition. Signed by Author(s). Seller Inventory # 43354
6. CARDBOARD PEOPLE
Published by Dillon Gallery Press
Book Description Dillon Gallery Press. Condition: Very Good+, No Dust Jacket. Signed, 1996. 4TO, unpaginated, Color Photos, Hardcover Hardcover: Signed by author on title page. Tan binding with title on front board and on spine. Illustration tipped in on front board. Paste-downs and endpapers are spotless. Text and art pages are printed on coated stock. Kaletski uses 'found' materials. Pre-fabricated cardboard boxes are a prime material. Nice tight binding. Seller Inventory # 024063
7. Cardboard People
Published by Dillon Gallery, New York (1996)
Book Description Dillon Gallery, New York, 1996. Hardcover. Condition: Fine. First Edition. 8vo 8" - 9" tall. Seller Inventory # 35909
Book Description Dillon Gallery, 1996. Condition: Good. A+ Customer service! Satisfaction Guaranteed! Book is in Used-Good condition. Pages and cover are clean and intact. Used items may not include supplementary materials such as CDs or access codes. May show signs of minor shelf wear and contain limited notes and highlighting. Seller Inventory # 0964834022-2-4
9. Cardboard people
Book Description Dillon Gallery, 1996. Hardcover. Condition: Used: Good. Seller Inventory # SONG0964834022
10. Cardboard people
Book Description Dillon Gallery, 1996. Condition: UsedAcceptable. book. Seller Inventory # M0964834022_4

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The Oxford handbook of deliberative democracy (Book, 2018) [WorldCat.org]
I thought you might be interested in this item at http://www.worldcat.org/oclc/1047870897 Title: The Oxford handbook of deliberative democracy Author: Andre Bachtiger Publisher: New York, NY : Oxford University Press, 2018 ISBN/ISSN: 9780198747369 0198747365 9780191064562 0191064564 9780191064579 0191064572 9780191809699 0191809691 OCLC:1047870897
The Oxford Handbook of Deliberative Democracy is the authoritative guide to deliberative democracy, mapping the field and exploring its links to other research fields, spanning social sciences, law, and philosophy. Read more...
Find more information about: Andre Bachtiger
9780198747369 0198747365 9780191064562 0191064564 9780191064579 0191064572 9780191809699 0191809691
1047870897
Preface1: Andre Bachtiger, John Dryzek, Jane Mansbridge, and Mark Warren: IntroductionPart I: Roots of the Deliberative Approach2: Antonio Floridia: The Origins of the Deliberative Turn3: Simone Chambers: The Philosophical Origins of Deliberative Ideals4: Francesca Polletta and Beth Gardner: The Forms of Deliberative Communication5: Jensen Sass: Deliberative Ideals Across Diverse Cultures6: Martin Hebert: Indigenous Sphere of DeliberationPart II: Theory of Deliberative Democracy7: David Estlund and Helene Landemore: The Epistemic Value of Democratic Deliberation8: Stephan Rummens: Deliberation and Justice9: Edana Beauvais: Deliberation and Equality10: Monique Deveaux: Deliberative Democracy and Multiculturalism11: Mark Brown: Deliberation and Representation12: Stephen Elstub: Deliberation and Participatory Democracy13: Andrew March and Alicia Steinmetz: Religious Reasons in Public Deliberation14: Gerry Mackie: Deliberation and Voting Entwined15: Michael Morrell: Listening and Deliberation16: Michael McKenzie: Deliberation and Long-Term Decisions: Representing Future GenerationsPart III: Deliberation within Political Systems: Forums, Publics, and Systems17: Paul Quirk, William Bendix, and Andre Bachtiger: Institutional Deliberation18: Graham Smith and Maija Setala: Minipublics and Deliberative Democracy19: James Fishkin: Deliberative Polling20: Simon Niemeyer and Julia Jennstal: Scaling Up Deliberative Effects - Applying Lessons of Minipublics21: Rousiley Maia: Deliberative Media22: Kim Strandberg and Kimmo Groenlund: Online Deliberation23: Pamela Johnston Conover and Patrick Miller: Taking Everyday Political Talk Seriously24: Donatella della Porta and Nicole Doerr: Deliberation in Protests and Social Movements25: Carolyn Hendriks and John Boswell: Governance Networks26: John Ferejohn: Deliberation and Citizen Interests27: John Parkinson: Deliberative Systems28: Michael Neblo and Avery White: Politics in Translation: Communication Between Sites of the Deliberative SystemPart IV: Deliberative Approaches within Disciplines and Fields29: Christian List: Democratic Deliberation and Social Choice: A Review30: Nicole Curato and Jurg Steiner: Deliberative Democracy and Comparative Democratization Studies31: John Gastil and Laura Black: Deliberation in Communication Studies32: Thomas Risse: Arguing and Deliberation in International Relations33: Christopher Karpowitz and Tali Mendelberg: The Political Psychology of Deliberation34: Thomas Leeper and Rune Slothuus: Deliberation and Framing35: Erik Schneiderhan and Shamus Khan: Deliberation in Sociology36: Frank Fischer and Piyapong Boossabong: Deliberative Policy Analysis37: John Forester: Deliberative Planning Practices Without Smothering Invention: A Practical Aesthetic View38: David Ponet and Ethan Leib: Deliberative Law39: Hoi Kong and Ron Levy: Deliberative Constitutionalism40: Alfred Moore: Deliberative Democracy and ScienceMethods41: Andre Bachtiger: Preface to Studying Deliberation Empirically42: David Esterling: Deliberation and Experimental Design43: Mark Bevir and Quinlan Bowman: Qualitative Assessment of DeliberationPart V: Practical Applications44: Janette Hartz-Karp, Lyn Carson, and Michael Briand: Deliberative Democracy as a Reform Movement45: Lawrence Susskind, Jessica Gordon, and Yasmin Zaerpoor: Deliberative Democracy and Public Dispute Resolution46: Daniel Naurin and Christine Reh: Deliberative Negotiation47: Ian O'Flynn and Didier Caluwaerts: Deliberation in Deeply Divided Societies48: Walter Baber and Robert Bartlett: Deliberative Democracy and the Environment49: Ryan Gunderson and Thomas Dietz: Deliberation and Catastrophic RisksPart VI: Deliberative Democracy Around the World50: Beibei Tang, Tetsuki Tamura, and Baogang He: Deliberative Democracy in East Asia: Japan and China51: Ramya Parthasarathy and Vijayendra Rao: Deliberative Democracy in India52: Emmanuel Ani: Africa and Deliberative Politics53: Thamy Pogrebinschi: Deliberative Democracy in Latin America54: Erik Eriksen and John Erik Fossum: Deliberation Constrained: an Increasingly Segmented European Union55: William Smith: Transnational and Global DeliberationPart VII: Reflections56: Interview with Jurgen Habermas57: Robert Goodin: If Deliberation Is Everything, Maybe It's Nothing58: Amy Gutmann and Dennis Thompson: Reflections on Deliberative Democracy: When Theory Meets Practice
Andre Bachtiger; [edited by] John S. Dryzek, Jane Mansbridge, Mark E. Warren.
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<http://worldcat.org/isbn/9780191064562>
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schema:isbn "9780191064562" ;
<http://worldcat.org/isbn/9780191064579>
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<http://worldcat.org/isbn/9780191809699>
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<http://worldcat.org/isbn/9780198747369>
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schema:about <http://www.worldcat.org/oclc/1047870897> ; # The Oxford handbook of deliberative democracy

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text:
Lipopolysaccharide preconditioning increased the level of regulatory B cells in the spleen after acute ischaemia/reperfusion in mice. - PubMed - NCBI
1 selected item: 29803621
Brain Res. 2018 Dec 15;1701:46-57. doi: 10.1016/j.brainres.2018.05.036. Epub 2018 May 24.
Wang Z1, Zhou Y2, Yu Y3, He K1, Cheng LM4.
Institute of Reproductive and Stem Cell Research, School of Basic Medical Science, Central South University, ChangSha 410000, China.
The Second Xiangya Hospital, Central South University, ChangSha 410000, China.
National Engineering Research Center for Human Stem Cell, ChangSha 410000, China.
Institute of Reproductive and Stem Cell Research, School of Basic Medical Science, Central South University, ChangSha 410000, China; National Engineering Research Center for Human Stem Cell, ChangSha 410000, China. Electronic address: mmlamei@163.com.
The inflammatory reaction of the spleen is an important component in the pathophysiology of cerebral ischaemia (CI). Regulatory B cells (Bregs) derived from the spleen can inhibit the expansion of inflammation and reduce the damage caused by CI.
The aim of the present study was to explore changes in spleen function and Bregs production due to lipopolysaccharide preconditioning (LPS PC) in ischaemia/reperfusion (I/R) and to uncover potential protective effect of LPS PC on stroke.
Focal cerebral I/R mice were induced by middle cerebral artery occlusion (MCAO). Infarct size and inflammatory cell infiltration in brain tissue, athletic ability, and immune status were analysed by immunostaining, behavioural analyses, and flow cytometry, respectively.
The volume of the cerebral infarct was significantly decreased in I/R mice with LPS PC (LPS + I/R) compared to I/R mice, and neuronal apoptosis was ameliorated by LPS PC. After preconditioning with LPS, locomotor activity, forelimb strength, motor endurance, motor coordination, and short-term memory were improved to varying degrees. Moreover, blood-brain barrier (BBB) dysfunction was reversed, and CD11b+, major histocompatibility complex-II positive (MHC-II+), and Gr-1+ cell infiltration in the brains of LPS + I/R mice was also significantly reduced. B cell-activating factor (BAFF), tumour necrosis factor alpha (TNF-α), interleukin-1 beta (IL-1β), and IL-6 in the brain and spleen in the LPS + I/R group decreased to different degrees, while the levels of transforming growth factor-β (TGF-β) and IL-10 increased. LPS PC alleviated atrophy of the spleen following I/R. In addition, the number of CD8+ T cells, macrophages, TNF+ cells, NF-κB+ cells, and neutrophils in the spleen was reduced, while the number of proliferating cells and CD19+-IL10+ Bregs was significantly increased. The number of follicular B (FO B) cells and marginal zone B (MZ B) cells in the spleens of LPS + I/R mice was also increased.
I/R mice preconditioned with LPS showed significantly reduced pathological damage, motor dysfunction, cognitive dysfunction, and inflammatory responses. LPS PC may initiate anti-inflammatory protective mechanism in the spleen after stroke, may increase the number of anti-inflammatory cells, such as Bregs, in the spleen, and may play a protective role in stroke.
IL-10; Inflammation; Ischaemia/reperfusion; Lipopolysaccharide; Regulatory B cells; Spleen
29803621
10.1016/j.brainres.2018.05.036

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Laura Gaskill November 5, 2016
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Tell us: Will you be hosting any big events during the holidays this year? What do you do to prepare? Share your tips and tricks in the Comments!
Browse products: Stools | Benches | Folding chairs
Holiday Party Prep: Plan Your Table Settings Full Story
Holiday Party Prep: Ready Your Space Full Story
Abigail Media Console, Gray
Borrow the Host and Hostess chair from the dining room! This can be helpful for living room seating. Clients tell us they find them to be very comfortable!
Beautiful Raleigh transformation · More Info
See before & after photos at this Houzz site.
Laura thanks for the tip about bringing a bedroom bench into the living room! That's an item we often forget about, which can be multi purpose! Great article!
1 Like November 5, 2016 at 12:25PM
Our pub style family room has padded benches on either side of the centre tables....perfect seating for a casual meal, but also as footstools on movie nights. When a large group visits, they are pulled out into the seating circle and can accommodate up to 6 additional people
Like November 6, 2016 at 9:24AM
We have an extra chair that is in every bedroom which we just pull out and use at the table when needed. We also have two Eames chairs with arms that are always at the ends of our dining table that can easily be pulled into the living room for extra seating. Makes it easier to use what you have already.
Like November 7, 2016 at 11:07AM

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text:
Absolute Gem! - Review of Epchris House, Ilfracombe, England - TripAdvisor
Absolute Gem! - Epchris House
I stayed here for two nights for the wedding of friends at Tunnels Beaches and loved it.
Nicky was a wonderful host throughout my stay, starting with her phoning me on the evening I was due to arrive to check all was ok as I was later than expected. I had been caught in torrential rainstorms and a road diversion, and was going to arrive later than the usual checking cut off, but Nicky was happy to wait until I finally made it.
I had a huge room on the top floor with very comfortable double bed and a single. It was spotlessly clean and beautifully decorated and furnished. The bathroom was large, with bath and separate shower, and a lovely view of Ilfracombe. There was a TV and DVD player, and lots of useful information about the town.
Breakfast was delicious, with cereals, yoghurt, toast and a range of cooked options. Each morning I was left full but wishing I could have eaten more! I didn't use the bar but it looked very cosy and inviting.
It was a 5 minute walk down to Tunnels Beaches, and a few more into town.
A great place to stay, and as someone used to staying in large impersonal hotels, I loved the personal touch found at Epchris house. Very highly recommended!More
Ask WelshGirlTravels2015 about Epchris House
All reviewsgarden roomhonesty bartunnels beachesbridal partyguest houseswimming poolstayed two nightswarm welcomebreakfast was excellentwould definitely stay here againfabulous staystayed longereach morningowners and staffa lovely place to stayon arrivalbreakfast room
We have just returned from a Monday to Friday stay at this wonderful Guest House in Ilfracombe. We booked the King room, which had a lovely big, verrry comfortable bed. Nicky was a wonderfully accommodating host, with a wealth of information on the area, breakfast was superb and set us (me and hubby) up until lunch time. We were both made to feel very welcome and had the keys to the front door to come and go as we wished.
Very good location, but the walk back up the hill from town was very tiring. If you want a sandwich at lunchtime then look no further that Dolly's opposite the Theater.
Ask smootherjuanita about Epchris House
BrendanW311
Family wedding in Ilfracombe.
We have just returned from Ilfracombe following the wedding of my niece at the Tunnels Resort which was a 5 minute walk down the hill.
We had booked three rooms for my wife and I, our daughter and partner and our son.
We had a fantastic welcome and assured that everything would be done to make our stay comfortable and it was!!
Epchris House was beautifully decorated, spotlessly clean, comfortable and exactly as advertised on the web site.
Our breakfast was a joy and kept us going throughout the day until the wedding reception at 6pm.
We were given keys to the front door and were able to come and go as we pleased.
What a fantastic place to stay. Thoroughly recommended.
Ask BrendanW311 about Epchris House
2 Thank BrendanW311
Lovely spotless overnight stay. Hosts fantastic, nothing was too much trouble,excellent attention to individual guests needs I.e. long mirror for bride and my car brought up steep drive owing to very dodgy knee! Hosts proactive as well as reactive! Only a minor quibble I don't like synthetic duvets , but can see why they have them!
Ask anneamie about Epchris House
Thank anneamie
Nice hosts, good house and garden, reasonable walking distance to town.But...the bed in our room we thought it was quite small, no bath instead there is a wet room. Not very pleased about this. Breakfast was ok but quite limited.
Ask Kin5666 about Epchris House
Nicky E, Owner at Epchris House, responded to this reviewResponded April 5, 2013
Thank you for your review. Just to clarify a few points. The double bed as booked is a 4'6'' double, industry standard double bed size, not a small double. We do have rooms with king size beds and when the guest booked these were available but they chose to book the double instead. On the on line site they booked through it does state double en suite rooms have en suites some with bath and separate shower and some shower only, no request was made for a en suite room with bath either prior to or during their stay. Our breakfast consists of 8 different types of cereals, fresh fruit, yoghurts, grapefruit segments, followed by cooked breakfast, egg of your choice, bacon x 2 rashers, premium local butcher sauage, fresh tomatoes, baked beans and mushrooms, vegetarian sauages are available, or you can have poached or scrambled eggs or baked beans on toast, or english muffin with scrambled egg and smoked salmon, kippers or crossaints. We are approachable if you wish to have an omllette or something off menu within reason let us know. We feel that this is a very good choice for for a bed and breakfast, all items are locally sourced as able and bacon and sauages from a local butcher and eggs free range. At no point during the stay was anything mentioned that they were unhappy with so we have been supprised by some comments. We ask guests to please let us know if there is an issue with their accommodation or stay so we can resolve any issues at once if able. Best wishes Nicky
Ilfracombe's gem
Nicky made our overnight in Ilfracombe extremely pleasant. Wonderful host. Unbelievable breakfast. Location is fantastic for a 15 min walk to the High St & maybe 20 min to the harbour. Nicky gave us great options for supper & made us quote at home. Delightful.
Ask gettalife about Epchris House