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Japanese Encephalitis

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Cell culture-derived, live attenuated vaccine based on the SA 14-14-2 strain of the JE virus. ... Vaccine type and strain. M-b derived inactivated vaccine ... – PowerPoint PPT presentation

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Title: Japanese Encephalitis


1
Japanese Encephalitis
  • Epidemiology and Vaccination in India

2
Disease Burden
  • Leading cause of viral encephalitis in Asia
  • 35,000-50,000 cases annually
  • (SourceCDC,2004)

3
Death and disability from JE
  • Up to 30 of all patients with JE die.
  • For those that survive the illness, more than 30
    cases are left with disability.
  • Disability is both physical and cognitive.

4
JE Virus
  • Belongs to the flavivirus family
  • Antigenically related to several other flavivirus
    including St. Louis encephalitis and West Nile
    fever
  • Vector-borne
  • Transmitted by biting Culex mosquitoes that breed
    in rice paddies, ditches, and ground pools
  • Zoonotic
  • Pigs Amplifying Hosts
  • Birds - Reservoirs.
  • Humans are not infectious reservoirs.
  • There is no human to human transmission.

Culex tritaeniorhynchus (Cx vishnui group)
5
JE Virus Transmission Cycle
6
Population at risk
  • People living in rural areas have the highest
    risk of disease because the mosquitoes that
    spread JE breed in rice paddies and pools of
    water.
  • Cases in urban areas also occur.

7
A typical JE case in India
  • An unvaccinated child below 15 years living in
    the rural rice growing regions of India. Close
    proximity to pig farming increases the risk of
    infection.

8
JE Control
9
Different approaches
  • Control programs for JE have focused on three
    major areas
  • Mosquito control
  • Amplifying host (Pig) control
  • Vaccination
  • Neither mosquito control nor pig control have
    proven to be reliably effective public health
    measures to control JE in human

10
Role of vaccination in JE control
  • With the availability of safe, effective and
    affordable vaccines, JE control is now possible,
    as an integrated part of the public health
    system. Vaccination now provides an effective and
    reliable public health intervention
  • (WHO/SEARO/2006)
  • "Vaccination is the single most important control
    measure JE vaccination should be extended to all
    areas where JE is a demonstrated public health
    problem." (WHO JE position paper, 2006)

11
JE vaccination strategy
  • A proven immunization strategy for JE control
    seems to be to initiate a preventive campaign in
    high risk areas and age groups followed by
    introduction of vaccine into the routine EPI
    programme
  • (Bi-regional JE Meeting, 2005 WHO/PATH)

12
JE vaccination in India - 2006
13
Triggering Factor (s)
  • Massive outbreak of JE in districts of Eastern
    Uttar Pradesh and adjoining Bihar in 2005
    adjoining Terai Region of Nepal
  • In 2005, More than 1600 deaths and more than 6000
    cases were reported from eastern Uttar Pradesh
    alone
  • Evidence of JE transmission since 1950s
  • Outbreak of JE reported since 1970s
  • Over the past decade repeated cyclical outbreaks
    causing large number of deaths and disabilities
    reported from 12 States

14
Target population
  • Almost 95 of cases reported are below 15 years
    of age

15
At risk districts- Prioritization
  • Total number of cases reported over the past
    decade
  • Disease incidence
  • Recent outbreak
  • Serological evidence
  • Epidemiological continuity

16
Vaccine availability
  • Currently, there are three types of JE vaccines
    in large-scale use
  • Mouse brain-derived, purified and inactivated
    vaccine
  • Cell culture-derived, inactivated JE vaccine
    based on the Beijing P-3 strain (only available
    in China and being replaced by live attenuated
    vaccine).
  • Cell culture-derived, live attenuated vaccine
    based on the SA 14-14-2 strain of the JE virus.

17
JE Vaccines Today
18
In Pipeline
19
M-b derived inactivated vaccine
  • Has been used globally successfully to control JE
  • Safe, efficacious
  • Manufactured in India and used in many states
    since 70s
  • Multiple doses ( 3 Primary Booster)
  • High cost
  • Low availability
  • Production stopped by major manufacturers
    globally
  • CRI may also close down the production

20
Cell culture-derived, inactivated JE vaccine
  • Used in China for domestic purpose
  • Not available in Global market
  • Being replaced by SA14-14-2 live attenuated
    vaccine

21
SA14-14-2 Live attenuated JE Vaccine
  • Has been used since 1988 in China
  • Over 200 million children vaccinated
  • Safe and efficacious (GACVS)
  • High immunogenicity following single dose
  • Nepal campaign study ( Lancet GACVS)
  • Licensed in Nepal and South Korea and Thailand
  • Following this the vaccine has been licensed in
    India for use in public health programs and is
    in the final stages of licensing in Sri Lanka
  • Special cost of vaccine for public program in
    GAVI eligible countries
  • Approximately 13 children could be vaccinated
    with the SA14-14-2 vaccine with the cost of
    vaccinating one child with the inactivated m-b
    derived vaccine

22
JE Vaccination Strategy for India
  • Vaccinate all children between the age group of
    1-15 years with a single dose of live attenuated
    SA14-14-2 JE vaccine in a one time campaign
  • Integration into the routine immunization in the
    district to cover the new cohort of 1-2 years
  • Pre introduction and concurrent clinical studies
    specific for the Indian population (ICMR
    recommendation)
  • Animal Toxicity Test
  • Immunogenicity Studies
  • Post marketing surveillance
  • Adult Viraemia
  • Post Introduction - Effectiveness of vaccine
    (NTAGI recommendation)
  • Vaccine Effectiveness Case Control Study

23
Key Operational Strategies
  • To cover entire district
  • Village to village campaign
  • Vaccination cards as record
  • Only AD syringes to be used
  • Injection safety measures
  • Intensified surveillance for AEFI

24
2006 2007 Campaigns
25
Reported Coverage - 2006
26
Reported Coverage - 2007
27
Advocacy
28
(No Transcript)
29
Posters and Banners
30
Social Mobilization
31
Community Participation
32
IEC
33
Queue for vaccination
34
Recording Pre-vaccination
Photo Courtesy UNICEF
35
Promising a healthier life
36
Post vaccination
37
Recording Post Vaccination
38
Emergency drugs
39
Waste Disposal
40
AEFI - Adverse Events Following Immunization
9.3 million children were immunized in 2006
18.5 in 2007
41
Committee - 2006
  • Following report of AEF mass campaigns with the
    SA14-14-2 JE vaccine, GOI set up an expert
    committee to investigate all cases of reported
    AEFIs
  • Members
  • Dr T Jacob John ( Team leader)
  • Dr Ramteke, DCGI
  • Dr Dipali Mukherjee, ICMR
  • Dr Shah Hossain, NICD
  • Dr Pradeep Haldar, GOI
  • The Objective of the committee was to review
    State Investigation reports and to investigate
    the AEFI with live attenuated SA14-14-2 vaccine
    against JE in high risk districts covering 4
    States in the country

42
Summary Statement
  • No direct causality has been established
    between the reported illnesses and the live
    attenuated SA14-14-2 JE vaccine.
  • No stricture on the further use of the vaccine
    is warranted

43
JE Vaccination Plan India
44
Future Plan
Source Immunization Division, MoHFW, GOI
45
Dr Pritu DhalariaProgram ManagerJE
ProjectIndiaPATHpdhalaria_at_path.org
  • www.path.org
  • www.path.org/je
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