In this issue:
Vol. 12, December 2009
Welcome to the final issue of JE Newsbriefs. It has been our sincere pleasure to bring you the
latest news and events related to JE control over the past six years. We have
been honored to highlight the unprecedented advances made possible by the
commitment of national governments and the dedication of so many partners all
working toward the common goal of protecting vulnerable populations from
death and disability caused by JE. In addition to our organizational
partners, I would like to extend a special thanks to Dr.
Our collaborations throughout the JE project have been truly rewarding, not only in terms of the progress made in endemic countries, but also with regard to valuable lessons learned. PATH will carry this insight forward in future projects aimed at improving immunization services and accelerating access to lifesaving vaccines.
JE-endemic countries continue to achieve historic milestones, but the work is not complete. Moving forward, partners and stakeholders must continue to sustain progress and mobilize resources. It has truly been a memorable journey thus far and we look forward to seeing what lies ahead for the future of JE control through immunization.
In October 2009,
exciting development is the result of the commitment since 2006 of the Cambodian
Ministry of Health’s Communicable Disease Control Department, National
Immunization Program, and National Institute of Public Health, in
collaboration with the World Health Organization (WHO) and PATH, to establish
a surveillance system for JE and meningo-encephalitis
excellent example of cross-country cooperation and learning, a Nepali
delegation observed the JE immunization campaign in
to Dr. Upreti, the Goa visit was “very useful to
help us strengthen our program in
The Fourth Biregional Meeting on Control of Japanese Encephalitis, organized by WHO and PATH, was held on June 8 and 9, 2009, in Bangkok, Thailand. This year’s meeting marked the conclusion of the current phase in JE control efforts with PATH’s JE project closeout in October of this year, and the continuation of planning for future activities to continue momentum.
Approximately 70 participants attended, including immunization officials from 11 JE-endemic countries and technical officers from WHO headquarters and regional offices; UNICEF, industry, nongovernmental organizations, research and academic institutions, and the Bill & Melinda Gates Foundation also were represented.
Objectives of the meeting were to review progress in endemic countries toward JE control through immunization; to provide updates and identify challenges of JE surveillance, laboratory diagnostics, and immunization strategies; and to summarize ongoing development of a plan for JE control by 2015, with an emphasis on the partnerships necessary to maintain progress.
Minutes of the 2009 biregional meeting will be published by the WHO Western Pacific Regional Office.
The United States Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) addressed the changing landscape of JE control in July 2009 when it provisionally updated its recommendations for the use of JE vaccine in travelers.
JE vaccine is recommended for travelers who plan to spend a month or longer in endemic areas during the JE virus transmission season. Clinicians are asked to consider vaccinating even short-term travelers who visit endemic areas during the transmission season if they will have an increased risk of exposure to JE virus, such as spending “substantial time outdoors in rural or agricultural areas, especially during the evening or night.”
Since the previous guidelines for JE vaccination were adopted in 1993, new vaccines have been in development while supplies of JE-VAX® have dwindled. ACIP’s recommendations encompass both US-licensed JE vaccines. With the US Food and Drug Administration’s 2009 approval of the Ixiaro™ vaccine (manufactured by Intercell Biomedical and distributed in the US by Novartis) for adults 17 years of age or older, remaining stockpiles of JE-VAX® have been restricted to children between the ages of 1 and 16 years.
ACIP’s final recommendations are expected to be published by the end of the year in Morbidity & Mortality Weekly Report.
Sanofi Pasteur has filed applications
TFDA has agreed to a fast-track review of IMOJEV™,
bolstered by the country’s experience in the vaccine’s clinical trials, which
were also conducted in
Epidemiology Unit of Sri Lanka’s Ministry
of Healthcare and Nutrition announced the introduction of the live, attenuated SA-14-14-2 JE
vaccine into its national immunization program starting July 1, 2009.
The disease has been contained in endemic areas due to high immunization coverage. However, sporadic JE outbreaks have occurred in previously unaffected areas without immunization, underlining the need for national expansion of the program. The annual cost of JE vaccination with inactivated, mouse brain–derived vaccine comprised three quarters of the national vaccine budget, and the projected cost of expanding routine JE vaccination threatened the sustainability of the entire program. The AEFI surveillance system also has recorded a growing trend of AEFIs with the inactivated vaccine. Given all these factors, a safe, immunogenic, and cheaper alternative to the inactivated vaccine was required.
The Epidemiology Unit’s suggestion to shift to SA 14-14-2 vaccine was approved by the Advisory Committee on Communicable Diseases after review of the recommendations of the WHO Strategic Advisory Group of Experts; scientific literature; safety and cost-effectiveness data; and the experiences of China, India, and Nepal. Results of local safety and immunogenicity studies of the vaccine were the final deciding factor.
The significant cost-savings from the switch to SA 14-14-2 vaccine will not only allow sustainability of the JE immunization program already in place, but also expansion of the program to vulnerable adults in high-risk areas.
After six years of helping JE-endemic countries better understand and reduce the toll of JE on their children, families, and communities, PATH’s JE project came to an official close on October 31, 2009. From its inception in 2004, the project conducted activities that contributed to its vision of eliminating clinical JE in endemic countries by improving disease surveillance and diagnostic testing, accelerating the availability of JE vaccine, assisting with vaccine introduction, and increasing global and national awareness and support of JE-endemic countries.
PATH will continue to support access to an efficacious, safe, and affordable vaccine through assistance to the Chengdu Institute of Biological Products for the preparation and submission of the SA 14-14-2 vaccine dossier for WHO prequalification, furthering the project’s long-term goal of securing affordability and vaccine financing for endemic countries.
After PATH’s exit, the JE Control Working Group will
continue its long-term guidance for JE control in the
Final reports are under way to document the compelling work of the JE project. The success of PATH’s JE project reflects the success of its many partner countries and organizations in identifying needs, developing capacity, and acting to bring lifesaving interventions to at-risk children in JE-endemic areas.
Recent articles present a wide range of topics from country
research on JE in
Gilden, D. Faster,
better, cheaper: new vaccine promises to control Japanese encephalitis. In Case Studies for Global Health: Building relationships. Sharing
This case study provides a helpful overview of the multifaceted partnership between the JE project and the Chengdu Institute of Biological Products to provide an affordable and effective JE vaccine.
Buhl MR, Lindquist L. Japanese encephalitis in travelers: review of cases and seasonal risk. Journal of Travel Medicine. 2009;16(3):217–219.
Authors review cases of JE among travelers and expatriates
Dhillon GP, Raina VK. Epidemiology of Japanese encephalitis in context with Indian Scenario. Journal of the Indian Medical Association. 2008;106(10):660–663.
article provides a historical overview JE in
Kollaritsch H, Paulke-Korinek M, Dubischar-Kastner K. IC51 Japanese encephalitis vaccine. Expert Opinion on Biological Therapy. 2009;9(7):921–931.
This article describes Intercell’s
new JE vaccine, Ixiaro™, which was approved this
Touch S, Hills S, Sokhal B, Samnang C, Sovann L, Khieu V, et al. Epidemiology and burden of disease from Japanese encephalitis in Cambodia: results from two years of sentinel surveillance. Tropical Medicine and International Health. 2009;14(11):1365–1373. Epub 2009 Sep 11.
A report on two years of JE surveillance integrated in to routine meningo-encephalitis surveillance in six sentinel hospitals, this study demonstrates that JE is an important cause of meningo-encephalitis in Cambodian children and suggests immunization would reduce JE morbidity and mortality.
Partner Profile: Walter Reed/AFRIMS
Forces Research Institute of Medical Sciences (AFRIMS) in
validation study in 2005 evaluated the performance of three commercially
available diagnostic kits for JE against AFRIMS’ own JE IgM
antibody-capture, enzyme-linked immunosorbent
assay. Results from this study have informed the use of these kits by WHO and
JE-endemic countries. In 2007, WARUN assisted
In addition to their research contributions, AFRIMS senior virologists also serve on the WHO JE Laboratory Working Group of experts, providing advice on lab and diagnostic issues, kit recommendations, and technical assistance and training to WHO and JE-endemic countries undertaking laboratory-based surveillance of JE. The technical expertise of AFRIMS and WARUN has helped bring more accurate laboratory confirmation of JE cases to endemic countries, giving their governments clearer understanding of disease burden.
Chris Victor knows clinical trials—his first vaccine trial
was as a doctoral student leading a 4,500-person study in
Chris entered epidemiology and vaccinology in 1995 for the science. Given the frequently long timelines of clinical research, he says “one of the challenges inherent to the work is that the science often progresses during the time between designing of a trial and when results are obtained.” Reconciling trial results with the current state of knowledge can be complex, but this problem is also what makes the work interesting. “You are always trying to generate the best data you can to move the science and decision-making forward; it’s often not that straightforward, but it’s almost always fun!”
Chris realized early that he would need to go where the burden of disease is greatest to have impact; he really values being able to play a part in helping developing countries generate their own data for local decision-making. Chris has always been impressed with the exceptional potential of developing-country researchers. The capacity for high quality is there, he says, “it only takes some training and a little supervision.” His overarching goal is to “support the local investigator in taking ownership and leadership of the study.” One of the greatest rewards of his work is seeing local field researchers strengthening their expertise in conducting clinical research and independently leading studies.
JE on PATH’s Vaccine Resource Library
Masthead photo:Richard Lord