Title: Japanese Encephalitis
1Japanese Encephalitis
- Epidemiology and Vaccination in India
2Disease Burden
- Leading cause of viral encephalitis in Asia
- 35,000-50,000 cases annually
- (SourceCDC,2004)
3Death 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.
4JE 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)
5JE Virus Transmission Cycle
6Population 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.
7A 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.
8JE Control
9Different 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
10Role 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)
11JE 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)
12JE vaccination in India - 2006
13Triggering 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
14Target population
- Almost 95 of cases reported are below 15 years
of age
15At risk districts- Prioritization
- Total number of cases reported over the past
decade - Disease incidence
- Recent outbreak
- Serological evidence
- Epidemiological continuity
16Vaccine 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.
17JE Vaccines Today
18In Pipeline
19M-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
20Cell 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
21SA14-14-2 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
22JE 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
23Key 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
242006 2007 Campaigns
25Reported Coverage - 2006
26Reported Coverage - 2007
27Advocacy
28(No Transcript)
29Posters and Banners
30Social Mobilization
31Community Participation
32IEC
33Queue for vaccination
34Recording Pre-vaccination
Photo Courtesy UNICEF
35Promising a healthier life
36Post vaccination
37Recording Post Vaccination
38Emergency drugs
39Waste Disposal
40AEFI - Adverse Events Following Immunization
9.3 million children were immunized in 2006
18.5 in 2007
41Committee - 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
42Summary 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
43JE Vaccination Plan India
44Future Plan
Source Immunization Division, MoHFW, GOI
45Dr Pritu DhalariaProgram ManagerJE
ProjectIndiaPATHpdhalaria_at_path.org
- www.path.org
- www.path.org/je