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Advancing immunization in Bihar

April 27, 2021 by Isha Jain

Recent outbreaks of Japanese encephalitis in new districts in Bihar, India underscore the importance of widespread immunization coverage and strong surveillance systems.

PATH’s Dr. Satyabrata Routray gives papers for new vaccine transport vans to Bihar government officials. These vans will help strengthen the vaccine supply chain system in Bihar in the wake of the COVID-19. Photo: PATH/Dr. Siddhartha Dutta.

PATH’s Dr. Satyabrata Routray gives papers for new vaccine transport vans to Bihar government officials. These vans will strengthen the vaccine supply chain in Bihar in the wake of the COVID-19 vaccination drive. Photo: PATH/Dr. Siddhartha Dutta.

Japanese encephalitis begins like the flu. But this mosquito-borne viral infection of the brain can quickly progress to life-threatening encephalitis, causing paralysis, seizures, inability to speak, and coma.

The case fatality rate from Japanese encephalitis (JE) can be as high as 30 percent, and most deaths are among children. Nearly half of all survivors can have severe, lifelong neurological disability.

Since 2009, JE has been on the rise in Bihar, India’s third most populous state. Research suggests there were nearly 400 JE cases between 2009 and 2014 and there were more than 400 lab-confirmed cases from 2015 to 2019.

Because there is no treatment for JE, prevention through immunization is key.

Supporting widespread JE vaccination

Over the last decade, immunization coverage in Bihar has increased from 11 percent in 1999 to 71 percent in 2020. As part of these efforts, the government has focused on equity of access, working to ensure everyone, irrespective of caste, gender, religion, and socioeconomic status, can receive lifesaving vaccines.

These improvements are significant, but there is still work to be done—and PATH is supporting ongoing efforts to prevent JE in Bihar.

From 2007 to 2014, PATH partnered with the Bill & Melinda Gates Foundation and the government of India to support JE vaccine introduction through campaigns in 24 of Bihar’s 38 districts. These campaigns targeted children up to age 15.

After the campaign, JE vaccination continued under routine immunization programs in these districts. Since then, new surveillance data from India’s National Vector Borne Disease Control Programme revealed new JE outbreaks in the districts not covered by these campaigns.

“The National Vector Borne Disease Control Programme and the government of Bihar have classified these remaining 14 districts as new endemic districts,” says Satyabrata Routray, MD, director of Neglected Tropical Diseases, Malaria, and Immunization at PATH.

To address these new outbreaks, PATH and the government of Bihar began JE vaccination campaigns in 11 of these new endemic districts last year.

“These recent outbreaks underscore the critical importance of widespread vaccination for everyone at risk of JE infection, combined with strong surveillance systems,” Dr. Routray says. “PATH has decades of experience in these areas, and we worked with the government, providing technical support as needed, to help monitor and vaccinate against JE across the entire state.”

Adapting to meet new challenges

Campaigns in new endemic districts began in January 2020, but activities were soon put on hold due to the COVID-19 pandemic. They resumed in a phased manner—first targeting children not in school, in fewer districts at once.

Using JENVAC, a vaccine against JE manufactured in India by Bharat Biotech, the campaign successfully reached more than 10 million children—or 91 percent of the target population (children under 15 years old) in these 11 districts.

“The campaign was a success, but we needed to ensure we were working with the community to build strong, sustainable immunization systems,” Dr. Routray says. “Every newborn will need immunization against JE, and against a range of other infectious diseases.”

To this end, PATH conducted trainings and workshops with more than 200 medical officers and around 24,000 health workers. PATH also developed guidelines, standard operating procedures, and tools for medical and frontline health workers.

“The trained and well-oriented workforce, paired with ready-to-use tools, will improve vaccination coverage across Bihar, for JE and beyond,” Dr. Routray says. “We’re already seeing its value in responding to COVID-19.”

Even with these systems in place, new challenges arose with the pandemic.

A robust vaccine supply chain management system is the bedrock of any successful vaccination program. It ensures high-quality vaccine storage and efficient transportation from state to regional clinics, and it facilitates distribution in the community.

To strengthen the vaccine supply chain system in Bihar in the wake of the COVID-19 vaccination drive, PATH, with financial assistance from the Bill & Melinda Gates Foundation, supplied the state government with two refrigerated vaccine vans.

“In addition to accelerating the COVID-19 vaccine process, these vaccine transport vans will contribute towards protecting the people of Bihar from other diseases preventable by vaccines—today and well into the future,” says Dr. Routray.

PATH has plans for additional JE vaccination campaigns in the three remaining districts in Bihar and will remain a trusted partner of the government of Bihar in its ongoing effort to ensure everyone has access to lifesaving vaccines.

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