In this issue:   

Vol. 6, January 2007

 

Dear colleagues,

With the holiday season behind us and the Chinese New Year at hand, this is a welcome opportunity to look ahead at the new challenges, new milestones, and new achievements that 2007 will hold for the JE project and our international partners.

The momentum of successful campaigns recently conducted in India and Nepal, which brought JE vaccine to more than 11 million children, offers a great boost in kicking off the new year. The governments of India and Nepal are among those spearheading JE control in 2007, with both countries aiming to double the number of vulnerable children reached with JE vaccine through continuation of last year’s immunization strategies.

Last year’s experiences in advancing JE control throughout Southeast Asia have provided fertile ground to stimulate discussions at key conferences, including December’s Global Vaccine Research Forum. New documents and reports also continue this dialogue. An expert committee convened by the Government of India recently released its review of adverse events reported during the country’s 2006 campaigns. After close evaluation, the committee found no causal link between the JE vaccine and reported events, a significant statement on the vaccine’s safety. And with the publication of operational guidelines for introduction of the SA 14-14-2 vaccine in Southeast Asia, the World Health Organization further demonstrated its support of this promising approach.

Other events in coming months will allow us to continue these crucial interactions, particularly at the WHO/PATH Biregional JE Meeting in April. In the two years since the previous meeting, awareness and opportunities for JE control have grown exponentially, and we are excited to hear about impact and lessons learned across the region.

Dr. Julie Jacobson, project director, and the JE project team
jeproject@path.org

 

JE immunization highlighted at Global Vaccine Research Forum

Discussion surrounding JE vaccines was a highlight of the 2006 WHO Global Vaccine Research Forum, held December 3 through 6 in Bangkok, Thailand. JE project director Dr. Julie Jacobson was invited to present the experiences and lessons learned from the recent successful JE immunization campaigns in India’s high-risk districts. Participants in attendance applauded the efforts of the government of India for this achievement and noted that the vaccine’s introduction in some of the country’s most impoverished settings offered insight on bringing similar interventions to hard-to-reach populations. The introduction was also cited as an opportunity to strengthen routine immunization coverage in the country.

During the meeting’s opening comments, Dr. Samlee Plianbangchang, director of the WHO Southeast Asia Regional Office (SEARO), noted the importance of JE control through immunization and called on the GAVI Alliance to consider funding for JE vaccine introduction in the region’s endemic countries. Stay tuned to the forum’s website for an upcoming posting of meeting presentations.

 

WHO/SEARO issues guidelines on SA 14-14-2 vaccine introduction

New operational guidelines published by WHO offer guidance to program managers for introducing the SA 14-14-2 vaccine in endemic Southeast Asian countries. Also geared toward district medical officers and field workers, the document is a hands-on resource for a variety of programmatic activities, including planning mass campaigns, routine immunization and surveillance, and monitoring and reporting. An extensive section on vaccine procurement addresses a range of considerations, including licensing and registration, supply issues, and cold chain requirements. Click here to download the complete document.

 

Enhanced web library of JE resources

PATH’s online listing of JE resources has been updated and improved to provide comprehensive materials on subjects ranging from disease overview to studies on vaccine safety. Visit the JE section of PATH’s Vaccine Resource Library to access documents and training materials developed by PATH, WHO, the US Centers for Disease Control and Prevention, and others. JE documentaries produced by PATH and partners are also accessible on the site. Future enhancements will include the addition of country-specific resources.

 

Partner profile: Center for Vaccine Development, Mahidol University

Based at the Institute of Science and Technology for Research and Development at Mahidol University, the Center for Vaccine Development is a key partner in clinical trials that PATH is conducting, including the coadministration of measles and JE vaccines and the immunogenicity of the SA 14-14-2 JE vaccine in different settings. Successful results from a coadministration trial in the Philippines demonstrated that measles and JE vaccines can be safely provided together, eliminating the need for an additional clinic visit and providing support for the vaccine's introduction in rural settings where clinic visits are often few and far between.

Under the direction of Dr. Sutee Yoksan, the Center for Vaccine Development received and analyzed samples from the clinical trial to determine seroconversion rates for the measles and JE vaccines, which measure how well the vaccines stimulate antibody protection. The initial trial was completed in mid-2006, and Dr. Sutee's laboratory will also perform testing for follow-up at 12 and 24 months. In addition, as a similar trial begins in Sri Lanka later this year, the lab will provide validation for samples tested locally. The facility is also serving to validate a JE antibody assay for the National Institute of Virology (NIV) in Pune, India , to ensure the consistency of testing between labs analyzing serum samples collected during India’s 2006 mass JE vaccination campaigns.

Globally, few labs are validated to provide this service in relation to JE vaccines. The facility also has extensive experience working with WHO on dengue vaccine research and has conducted clinical trials on the safety and immunogenicity of several candidate vaccines. As a WHO collaborating center, the Center for Vaccine Development provides scientific expertise globally and regionally on the development of vaccines for dengue and other flaviviruses. Visit the Institute of Science and Technology's website to learn more.

Promising feedback on PATH’s JE e-learning module

Results are in from PATH’s evaluation of the Advanced Immunization Management (AIM) e-learning module “Considerations for introduction of Japanese encephalitis vaccine.” In mid-2006, PATH distributed a survey to national public health managers and decision-makers to determine the tool’s effectiveness. The majority of the 52 responses from 11 JE endemic countries came from ministry of health officials and in-country WHO staff.

Major findings from the evaluation confirmed that AIM is well received as a flexible training tool addressing different information needs and that the module improved skills and knowledge about JE. Comments from respondents provided evidence that AIM will continue to be used in future decision-making. For example, one respondent noted, “AIM builds a foundation and then permits the application of analytical tools for appropriate decision-making.” A full report on the evaluation is under development, and the JE module will be updated in 2007 according to user requests. New information will be added on vaccine considerations, implementing a JE immunization program, and monitoring and evaluating vaccine introduction. To view the current AIM JE module, click here.

 

Pediatric trials begin for candidate JE vaccine manufactured by Acambis

Vaccine manufacturer Acambis recently announced the initiation of the first pediatric clinical trial to evaluate the ChimeriVaxTM-JE vaccine. The trial is being conducted in India and will compare the safety and immunogenicity of one dose of ChimeriVaxTM-JE with two doses of the locally produced, inactivated, mouse brain-derived JE vaccine. Concurrent administration of the the measles vaccine with Acambis’s JE vaccine will also be investigated.

Last year, Acambis recorded positive results in Phase 3 trials with ChimeriVaxTM-JE among adults. In India, the manufacturer has partnered with Bharat Biotech International Limited for future marketing and distribution, as well as end-stage fill/finish processing.

 

Who's who at the PATH JE project: Chutima Suraratdecha

The business of biotechnology led Dr. Chutima Suraratdecha down a path toward her current work with the JE project. As an undergraduate studying food technology and biotechnology at Chulalongkorn University in Bangkok, Chutima discovered that, in the world of business, marketing is key and “economics is a fundamental component of everything.” Today, as a health policy and economics officer at PATH, she is applying a wide range of experience toward estimating demand and evaluating cost-effectiveness of JE vaccines.

After advanced studies in business with a concentration in health and pharmaceutical care economics at the University of Memphis (Tennessee), Chutima returned to Thailand to apply her drive and skill to strengthening health care in the public sector. Her expertise soon expanded throughout the region, where she managed multicountry projects evaluating health financing schemes for the poor, program and household costs for treatments, access to health services among the poor, and regulatory systems for public health sectors. But it was her work with the World Bank and the International AIDS Vaccine Initiative estimating demand for an HIV vaccine and analysis of cost and effectiveness of health interventions with UNAIDS and the International Vaccine Initiative that focused Chutima’s efforts and eventually brought her to the JE project.

Joining PATH gave Chutima the opportunity to apply her research in demand forecasting, economic evaluation, health financing, and health policy toward implementation to achieve a tangible impact. Her scope grew to include a strong presence in the field where, she says, she learns as much as she teaches.

“Working in the field is a give-and-take. We are there to provide technical assistance, but at the same time, we learn a lot. We are able to see the context of JE within other priorities and tailor our work to a country’s specific needs and settings.”

In just two years with the JE project, Chutima has made significant contributions, including the development of an interactive model that allows program officers to specify demand for a JE vaccine in their countries, to be launched this April at the WHO/PATH Biregional JE Meeting. Previous models used generic regional and global data, but this new tool will not only provide country-specific estimates, it will also illustrate the potential, real-world impact of JE immunization.

 

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

 

JE films: Kill or Cure? Japanese Encephalitis and Shadow lives: The human toll of Japanese encephalitis

www.path.org/vaccineresources/japanese_encephalitis-films.php

 

Japanese Encephalitis Prevention Network
www.jepn.org

WHO Position Paper on JE

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

Preformatted PubMed searches:

General Japanese encephalitis search
www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search&db=pubmed&term=japanese+encephalitis

JE vaccine search
www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search&db=pubmed&term=japanese+encephalitis+vaccines