In this issue:   

 

Vol. 9, August 2008

 

 

Greetings partners,

 

This edition of JE Newsbriefs highlights many of the activities PATH and partners are undertaking to continue the fight against JE and expand control through sharing key resources and supporting vaccine introduction in endemic countries.

 

Earlier this year, our symposium in Kuala Lumpur, Malaysia, at the International Congress on Infectious Diseases provided the opportunity to summarize achievements and address remaining challenges in JE control efforts. Together with presenters from national, regional, and global organizations, we were encouraged and inspired by the participation of the symposium attendees. These researchers and implementers brought great insight into the issues of measuring, diagnosing, and controlling JE in real-world settings.

 

Such collaboration and partnership are at the core of the JE project. In this issue, we present several examples of successful partnerships, including the contributions of the US Centers for Disease Control and Prevention. Our profile of a team member from Cambodia further signifies the importance of establishing and maintaining solid relations. Recent advances toward JE control in this country and beyond illustrate the power and potential of successful partnerships.

 

Sincerely,

Dr. John R. Wecker
Director, PATH JE project
jeproject@path.org

 

International symposium presents advances in JE detection and prevention

 

A PATH-sponsored symposium at the 13th International Congress on Infectious Diseases in Kuala Lumpur, Malaysia, held June 22, brought together global experts, as well as national and regional immunization officers, to discuss progress in JE control, surveillance, and clinical research on JE vaccines. Presenters represented several countries and disciplines, and topics of discussion included the following:

 

         Dr. Marc Fischer, medical epidemiologist for the US Centers for Disease Control and Prevention (CDC), discussed challenges in JE surveillance and diagnostics, including the complexities of clinical diagnosis and laboratory confirmation of cases. (For more information on the US CDC’s JE work, please see the Partner Profile below.)

         Dr. Ni Ketut Susilarini of the Biomedical and Pharmaceuticals Research & Development Center within the National Institute for Health Research and Development, Indonesia Ministry of Health, presented findings from two years of human surveillance in Indonesia that demonstrated endemic disease across the country.

         Dr. Nihal Abeysinghe, chief epidemiologist for the Ministry of Healthcare and Nutrition in Sri Lanka, outlined the evolution of the country’s JE control strategies toward immunization with the inactivated mouse brain-derived vaccine and upcoming transition to the live, attenuated SA 14-14-2 vaccine.

         Dr. Joachim Hombach, Coordinator of Implementation Research for the World Health Organization (WHO) Initiative for Vaccine Research, summarized global progress toward JE control through vaccination, including availability of current vaccines and development of new vaccine candidates.

 

Complete proceedings from the symposium are under development and will be available on the PATH JE resource website in coming weeks.

 

Vaccine production facilities unharmed in Chengdu’s major earthquake

 

Following the May 2008 earthquake in Sichuan Province, China, facilities were unharmed at the Chengdu Institute of Biological Products, manufacturer of the live, attenuated SA 14-14-2 JE vaccine. Inspection by a team of government representatives found that both the existing JE vaccine production facility and the new facility under construction to increase manufacturing capacity were not damaged. Production of JE vaccine resumed after two weeks, and the new facility construction restarted in June. Further details may be found on the Chengdu Institute’s website.

 

Lancet article highlights inclusion of JE in GAVI Alliance strategy

 

The potential benefits of GAVI support for JE vaccines are summarized in a recent Newsdesk article in the latest issue of Lancet Infectious Diseases, which also features commentary from experts in the field, including Dr. Tom Solomon of the University of Liverpool and JE project Director Dr. John Wecker (full text available with free online registration). Key points of the article include the burden of JE in terms of mortality and lifelong disability among survivors, the economic rationale for introducing JE vaccine in poor endemic areas, and the growing availability of new and improved vaccines.

 

In addition to JE, GAVI also will consider supporting introduction of vaccines against cervical cancer, cholera, typhoid, rabies, and rubella.

 

Positive results in studies of investigational JE vaccine from Intercell

 

Intercell announced promising data from its pediatric Phase 2 clinical trial to study safety and immunogenicity of its investigational vero cell-derived, inactivated JE vaccine among children between one and three years old in India. The data revealed that immunogenicity and safety among children are comparable to rates recorded in Phase 3 trials among adults. The data were presented at the annual meeting of the European Society of Pediatric Infectious Diseases, held in May in Graz, Austria.

 

Intercell also recently published data on long-term immunogenicity of the vaccine in adults.

Meeting recommendations advise development of new JE laboratory network

 

Preparations for the JE laboratory network in the Western Pacific region progressed at a  WHO Polio, Measles and JE Laboratory Network meeting held in July in Manila, Philippines. Presentations from several countries informed plans for development of the network, which include distribution of standard guidelines, institution of a quality assurance program, training, and capacity building. The Western Pacific JE laboratory network will build off existing vaccine-preventable disease networks in the region, as well as lessons learned from the JE laboratory network in the Southeast Asia region (SEAR), and it is anticipated that participating laboratories will be identified later this year.

 

Partner profile: US Centers for Disease Control and Prevention

 

The US CDC has a long history of working to improve awareness and control of JE. Since 2006, in collaboration with WHO and respective ministries of health, the CDC Global Disease Detection (GDD) Project has established sentinel surveillance for acute meningitis and encephalitis syndrome (AMES) at four sites in China, two sites in India, and three sites in Bangladesh. Preliminary findings suggest that despite substantial progress in the use of vaccine, JE is still a significant problem in areas of China and India. In Bangladesh, where currently no JE vaccine is licensed for use, JE is also likely an under-recognized and endemic cause of encephalitis in some areas. To further define the economic and social impact of the disease, CDC is collaborating with the International Centre for Diarrhoeal Disease Research, Bangladesh, to follow the long-term neurologic and functional outcomes of JE patients.

 

As a global reference laboratory for the WHO SEAR JE Laboratory Network, CDC performs proficiency and confirmatory testing for the six laboratories participating in the GDD AMES project and provides technical assistance and training for the 11 laboratories in the network. CDC is also evaluating commercial JE IgM ELISA kits on serum and cerebrospinal fluid specimens using the CDC IgM ELISA and plaque reduction neutralization test as reference standards.

 

CDC also has primary responsibility for monitoring and preventing JE among US travelers. The inactivated mouse brain-derived JE vaccine (JE-VAX) is the only one licensed for use in the United States, but Biken discontinued production of JE-VAX in 2005, and existing inventory will likely be exhausted by early 2009. A Biologics License Application for a new inactivated cell culture-derived JE vaccine manufactured by Intercell was filed with the US Food and Drug Administration in December 2007, and it is expected to be licensed and available in the United States by the end of 2008. The US Advisory Committee on Immunization Practices is currently revising its recommendations for the use of JE vaccine among travelers. CDC is also working with partners to provide information and mitigate a potential gap in the availability of JE vaccine for US travelers.

 

 Who’s Who at the JE Project: Chham Samnang, MD, MPH

 

Recent activities are yielding key data and informing national policy on JE control in Cambodia, and Dr. Chham Samnang, PATH’s Immunization Program Team Leader in the country and Senior Officer for the JE project, has played a key role in this important work.

 

Earlier this year, for example, the Government of Cambodia concluded a disability evaluation among JE survivors, with strong technical and logistical support provide by Dr. Samnang. The study found that one in four children infected with JE either died or suffered severe sequelae that would likely limit their ability to lead an independent life. Dr. Samnang is also leading field work for a cost-effectiveness study and is supporting ongoing JE surveillance in five provinces in collaboration with the Communicable Disease Control Department, National Immunization Program, National Institute of Public Health, and WHO. Surveillance data and results from the disability and cost effectiveness studies have helped improve awareness about JE disease burden in Cambodia and the importance of control through immunization. The Cambodian government is now planning for JE vaccine introduction, and Dr. Samnang and the PATH country team will continue to provide technical assistance for this important next step.

 

These activities, combined with prior experience, have demonstrated to Dr. Samnang the importance of strong collaborations to ensure project success. Before joining PATH, he spent six years with Save the Children Australia in Cambodia’s Kampong Cham province, developing and maintaining relationships with national and local government, communities, and local and international organizations. He credits this background with providing the networking and relationship management skills he now applies to his work with the JE project.

 

“This environment has enabled me to learn from a variety of experts in public health,” he says. “I am proud to be part of the contribution to the development and improvement of the health of the Khmer people and the Kingdom of Cambodia, and I feel very fortunate to be part of the JE team.”

 

JE resources


JE project web page   
www.path.org/je

 

JE on PATH’s Vaccine Resource Library
www.path.org/vaccineresources/japanese-encephalitis.php   

Japanese encephalitis online training module (AIM series)
http://aim.path.org/en/vaccines/je/index.html

 
WHO Position Paper on JE

www.path.org/vaccineresources/files/WHO_JE_position_paper_2006.pdf

 

Masthead photo: Richard Lord