In this issue:   

Vol. 7, June 2007

 

Dear colleagues,

We are pleased to bring you the latest issue of JE Newsbriefs. The past few months have been extremely productive, highlighted by the Third Biregional Meeting on Japanese Encephalitis in Ho Chi Minh City, Vietnam, in April. Partners and stakeholders not only shared experiences and lessons learned in all areas of JE control, from surveillance through introduction, but the event also provided an opportunity to look back on the remarkable progress gained in the two years since the last biregional meeting. Global awareness of disease burden has increased dramatically, affordable and safe vaccines are available, and millions of children are now protected from JE.

I am committed to maintaining the momentum of the project as I step into the role of interim director. I would like to acknowledge the leadership of the project’s founding director, Julie Jacobson. Julie’s drive and dedication motivated partners around the world and were instrumental in the achievements of the JE project to date. She would be the first to say, however, that the expertise of the JE project team and the commitment of our partners comprise the foundation upon which the project’s success is built. I could not agree more, and I look forward to working closely with all of you in the busy weeks ahead!

Sincerely,

Dr. Kathleen M. Neuzil

Interim Director
jeproject@path.org

 

Biregional meeting marks progress and maps out next steps

Disease experts and immunization program managers from around the world gathered in Ho Chi Minh City, Vietnam, April 25 to 27 for the Third Biregional Meeting on Japanese Encephalitis hosted by PATH and the Western Pacific Regional Office of the World Health Organization (WHO). The event provided a forum for sharing lessons learned on JE surveillance and vaccine introduction, as well as marking the progress on JE control in the Southeast Asian and Western Pacific regions achieved since the last meeting in 2005. Highlights included an update on JE vaccines in development and preliminary results of clinical studies that are generating key clinical data on the live, attenuated SA 14-14-2 vaccine. Participants represented several endemic countries, research and academic institutions, nongovernmental organizations, UNICEF, the US Agency for International Development, and the US Centers for Disease Control and Prevention, among others. Meeting minutes will be posted on the websites for PATH and WHO in coming months.

 

Case control study demonstrates long-term protection from single dose of SA 14-14-2 JE vaccine

A new study in Vaccine provides important evidence of the long-term impact of immunization against JE with the SA 14-14-2 vaccine. Returning to Nepali villages where they conducted a case control study that revealed 99 percent efficacy after one year among children who received a single dose of the vaccine, investigators found that protection extended through five years with an efficacy of 96 percent. The complete article is available online to subscribers of Vaccine; click here to read the abstract. For nonsubscribers in developing countries, the article may be freely accessible through the WHO’s Health InterNetwork Access to Research Initiative (HINARI).

 

India and Nepal expand JE vaccination
campaigns

Last year’s campaigns to protect vulnerable children from JE were the most ambitious in India’s history, reaching more than 9 million Indian children. Campaigns to administer the SA 14-14-2 vaccine in 11 high-risk districts reached 88 percent of the target population, doubling routine immunization coverage in the country. This year, the Government of India has identified 28 districts in nine states that are at greatest risk, and campaigns are now underway to vaccinate 21 million more through July.

Nepal will also build on its successful introduction of the vaccine last year, during which more than two million children and adults were vaccinated. This year, one million more are set to receive the vaccine in four high-risk districts.

Key data presented to WHO steering committee

In parallel with the biregional meeting on JE, WHO convened its Steering Committee on Dengue and Other Flavivirus Vaccines. PATH presented updated data on the SA 14-14-2 vaccine, as requested by the Global Advisory Committee on Vaccine Safety. Highlights of these presentations include:

·     When measles vaccine and the live, attenuated SA 14-14-2 JE vaccine are coadministered at nine months of age, both vaccines are well-tolerated; high protection rates to both measles and SA-14-14-2 are achieved; and noninterference on measles immunogenicity is demonstrated.

·     Vaccination with the live, attenuated SA 14-14-2 JE vaccine among infants 6 to 12 months of age is well-tolerated and immunogenic, and the rate of adverse reaction with the SA 14-14-2 JE vaccine among this population is comparable to that of the measles vaccine.

·     The SA 14-14-2 JE vaccine is thermostable up to 18 months between 2° to 8°C, and after reconstitution the vaccine remains highly potent for a minimum of six hours at 37°C (actual data demonstrate high potency at greater than 14 hours). These results meet requirements of the WHO open vial policy.

 

Partner profile: University of Liverpool Viral Brain Infections Group

Efforts are growing to determine the mortality associated with JE in endemic regions, but the impact of disability among JE survivors has long been a neglected area of an already neglected disease. The generally accepted rate of significant neurological sequelae following JE infection is around one-third of survivors, but limited follow-up activities mean this incidence could be underestimated. Regardless of specific overall figures, the need for guidelines and directed efforts for evaluating and caring for those disabled by JE is great. The measurement of JE disability can also offer important information for decisionmakers on the potential benefits of JE vaccine introduction.

Investigators from the University of Liverpool’s Viral Brain Infections Group are making strides toward quantifying the burden of JE morbidity with a new tool that provides a standardized measurement of outcomes following JE infection, primarily focused on whether a survivor will be able to live independently. The tool was developed to be used in several different cultural settings by health care workers and nonspecialists alike.

The Liverpool Outcome Score is generated through interviews at discharge and followup visits with caregivers regarding various indicators of child development, in addition to a simple examination of function. For example, questions are posed on speech, feeding, behavior, and mobility, and children are observed performing simple physical tasks. Answers are scored on a scale of 1 to 5, with 1 indicating death and 5 indicating normal function comparable to the child’s peers.

The tool is being validated among children in India and Malaysia, and preliminary results reveal high specificity. Complete results are expected to be published in 2007. A field test version has been made available for use in JE endemic countries, and the score’s developers are collecting feedback to further refine the tool.

The Viral Brain Infections Group has provided advocacy, expertise, and support to the JE project in several additional areas, including the production of a teaching tool for diagnosis and investigation of clinical encephalitis, as well as research and support for the development of WHO JE surveillance standards.

 

New fact sheets outline progress toward JE control

New fact sheets are now available summarizing the JE project’s work in several countries. These materials include updates on surveillance activities in Vietnam, Cambodia, and Indonesia; details on partnerships and a cost-effectiveness study in China; and highlights of the successful introduction of JE vaccination in India. Visit our online library to download these and many more resources.

 

JE project seeks new director

The PATH JE project is seeking qualified candidates in our search for a new director. Leading and managing a global team, the JE project director will be responsible for achieving project milestones and representing the JE project to the donor, international partners, and representatives of government agencies. As a member of PATH’s Immunization Solutions Leadership Team, the JE project director also actively contributes to the overall strategic direction and programmatic priorities toward supporting the integration of vaccines for public health impact and disease control in developing countries.

To learn more about this and other positions, visit PATH’s employment page at http://www.path.org/employment.php or send your resume or inquiry in confidence directly to Dorothy Culjat, SPHR, senior recruiter, at dculjat@path.org.

 

Who's who at the PATH JE project: Kathy Neuzil

Kathleen M. Neuzil, MD, MPH, recently joined the JE project as interim director, bringing expertise that reflects the full spectrum of efforts to make new vaccines accessible in the developing world. As a researcher, she has studied immunogenicity, safety, and efficacy of vaccines against influenza, rotavirus, and other diseases. As a member of several professional organizations, including the CDC’s Advisory Committee on Immunization Practices and the Infectious Diseases Society of America, she has contributed to the development of policies and practices that usher new vaccines into clinical implementation. This rich background provides an important perspective for directing the JE project in moving forward with wide-ranging activities toward the ultimate objective of JE control.

Since assuming the role of JE project interim director in early May, Kathy has noted the breadth of expertise among team members and the crucial partnerships that have fostered significant progress in just a few short years.

“The JE project is a perfect example of PATH’s priority that we be a partner and a catalyst in the countries where we work,” she says.

Moving ahead, she sees her role as helping to remove barriers and continue the project’s momentum, particularly working with partners in the international community, such as WHO and the GAVI Alliance, to identify resources and generate support to sustain recent advances in JE vaccine introduction.

Elsewhere at PATH, Kathy leads clinical trials activities for the Rotavirus Vaccine Program and provides technical assistance on vaccines against influenza and human papillomavirus. She is also an associate professor at the University of Washington School of Medicine, helping students to develop tools to move the public health agenda forward and increase health equity in the world.

“It is an exciting time in international public health,” Kathy says, “With the resources that are now available and the energy that is building behind them, we can really have an impact.”

 

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

WHO Position Paper on JE

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

 

Masthead photo: Richard Lord