Japanese Encephalitis Vaccination Program In India

Dr. Navneet Kumar Dhamija

Assistant Commissioner - Immunization Ministry of Health & FW, Govt. of India Mobiles : 8826772555, 9911220066 Office : 23062993, 23062126, 23062728 E-mail : ImmunizationAC@gmail.com

Introduction of JE Vaccination
In 2005, a massive outbreak hit several districts in many parts of the country and many cases occurred in eastern U.P. and adjoining districts of Bihar and Nepal during this period more than 1600 children were reported to have died of JE

BRD Medical College, Gorakhpur experienced up to 20 admissions per day with patients beyond its capacity where patients were sharing beds, even in the ICU

Criteria to identify JE endemic districts

Case load of JE- Total number of cases reported (AES/ suspected JE/ lab confirmed JE). Incidence of JE Evidence of recent transmission of the disease Serological evidence from JE studies. Epidemiological link to known areas of transmission.
Highest Priority Districts

104 districts in 11 States were identified as JE endemic

High Risk Districts Medium Risk Districts

JE Vaccination Program
Strategy One time campaign covering children aged 1-15 years followed by integration of JE vaccine into UIP as single dose for new cohort at 1-2 years of age

The Multi Year Plan

104 JE endemic districts to be covered with JE mass vaccination campaigns in 11 States in a span of 5 years 2006 2010*
Review of data and strengthening of JE surveillance showed 4 new states as JE endemic thereby including 15 JE endemic states and incerasing the no. of JE campaign districts to 109 in the Multi year plan. Formation of 2 new districts which split up from Kolar and Thiruvannamalai districts Cheyyar and Chikballapur increased the no. of JE endemic districts to 111. And recently another district has split from Rae Bareilly and Sultanpur and a new district has been formed Chattrapati Sahuji Magaraj Nagar which has incerased the JE campaign districts to 112

Vaccine availability
Currently, there are three types of JE vaccines in large-scale use: Mouse brain-derived, purified and inactivated vaccine Cell culture-derived, inactivated JE vaccine based on the Beijing P-3 strain (only available in China and being replaced by live attenuated vaccine). Cell culture-derived, live attenuated vaccine based on the SA 1414-2 strain of the JE virus. Based on research studies, discussions by expert and vaccine availability issues for country needs, SA-14-14-2 JE vaccine manufactured by CDIBP, China was taken up for use

The Multiyear Plan

1 2 3 4 5

Year 2006 2007 2008 2009 2010* 2010*recampaigns

No. of Target Districts population covered till - 1-15 date Total Population years 11 29420139 10531554 27 65934009 21758223 22 57772199 20040262 30 45032191 27170604 19 28292755.21 9336609 7659936 9 118 23211927 249663220 96497188

Total JE vaccination campaign coverage 9308688 18431087 16881941 18097182 7626354 7495380

JE vaccination campaign coverage % 88.39 84.71 84.24 66.61 81.7

97.85 77840632 80.67

Total for India till date

Based on the emergence of JE/ AES new cases and low coverage indicated in the Coverage evaluation survey report in 2 divisions of U.P 7 districts of Basti and Gorakhpur divisions and 2 districts of Assam, a decision to conduct re-campaigns in 2010 thereby increasing the no. of districts from the initially planned 19 to 28.

JE Vaccination Program Overview

JE campaign States & districts
1 2 3 Andhra Pradesh Kerala Uttar Pradesh 10 2 34

112 JE vaccination campaign districts 2006-2011

4
5 6 7 8 9 10 11 12 13 14 15

Goa
Assam Bihar Haryana Karnataka Tamil Nadu Maharashtra West Bengal Manipur Nagaland Arunanchal Pradesh Uttrakhand Total

2
11 6 6 8 10 8 5 5 2 1 1 111 JE campaigns completed

JE vaccination Campaigns in all the 112 districts have been completed in 15 states

111 Districts - 2006 - 2011

S.N 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Name of State Andhra Pradesh Andhra Pradesh Andhra Pradesh Andhra Pradesh Andhra Pradesh Andhra Pradesh Andhra Pradesh Andhra Pradesh Andhra Pradesh Andhra Pradesh Kerala Kerala UP UP UP UP UP UP District's Name Warrangal Kurnool Krishna Nellore Medak Adilabad Khamam 21 22 UP UP UP UP Behraich Deoria Faizabad Fatehpur

23
24 25 26 27 28 29 30 31

UP
UP UP UP UP UP UP UP UP

Ghazipur
Gonda Gorakhpur Hardoi Jaunpur Kanpur Nagar Kheri Kushi Nagar Lucknow

Nalgonda
Mahboobnagar Nizamabad

32
33 34 35 36 37 38 39 40 41 42

Thiruvananthapuram
Alappuzha Allahabad Ambedkar Nagar Azamgarh Ballia Balrampur Barabanki

UP
UP UP UP UP UP UP UP UP

Maharajganj
Mau Muzaffar Nagar Pratapgarh Rae Barelly Saharanpur Shahjahanpur Shrawasti Sant Kabir Nagar

UP
UP

Bareilly
Basti

43 44 45 46 47 48

UP UP

Sitapur Siddharth Nagar

64 65 66 67 68 69 70 71 72 73 74 75 76 77

Bihar Bihar Haryana Haryana Haryana Haryana Haryana Haryana Karnataka Karnataka Karnataka Karnataka Karnataka Karnataka

Nawada Siwan Kurukshetra Ambala Panipat Karnal Yamuna Nagar Kaithal Bellary Kolar (+C ballapur ) Raichure Koppal Mandya Bijapure

UP
UP Goa Goa Assam Assam Assam Assam

Sultanpur
Unnao North Goa South Goa Sonitpur Dibrugarh Jorhat Dhemaji

49
50 51 52

53
54 55 56

Assam
Assam Assam Assam Assam Assam Assam Bihar Bihar Bihar Bihar

Sivsagar
Golaghat Tinsukia Lakhimpur Kamrup Udalgiri Nagaon Champaran West Muzaffarpur Gaya Gopalganj

57
58 59 60 61 62 63

78
79 80 81 82

Karnataka
Maharashtra Maharashtra Maharashtra Maharashtra

Dharwad
Amravati+Amravati MC Bhandara Nagpur Rural Washim

83
84

Maharashtra
Maharashtra

Beed
Latur

85 86

Maharashtra Maharashtra

Gadchirolli Yavatmal

101 102 103 104 105 106 107 108 109

Manipur Manipur Manipur Manipur Manipur Nagaland Nagaland Arunanchal Pradesh Uttrakhand

Imphal east Imphal West Thoubal Bishnupur Chandel Dimapur Mokongchung Lohit Udham Singh Nagar

87
88 89 90 91 92 93 94 95 96

West Bengal
West Bengal West Bengal West Bengal West Bengal Tamil Nadu Tamil Nadu Tamil Nadu Tamil Nadu Tamil Nadu Tamil Nadu Tamil Nadu Tamil Nadu Tamil Nadu

Birbhum
Hoogly Burdwan Howrah West Medinapore Cuddalore Villupuram Virudhunagar Trichy Thiruvarur Madurai Perambalur Thanjavur Thiruvannamalai

97
98 99 100

JE vaccination campaigns - Year coverage 2006 - 2011

97.9%
100 90 80

88%

84.7%

84.2%
66.6% 69.6%

Coverage%

70 60 50 40 30 20 10 0

Year of Campaign
Over 76 million children have been immunized in the JE vaccination campaigns from 2006 2011 Around 3.7 million children have been immunized with JE vaccine till date under RI

JE Vaccination campaign coverage 2006

99.9%

100 90 80 70 60 50 40 30 20 10 0

82.7%

82.6%

Coverage %

56.12%

West Bengal

Assam

Karnataka

U.P.

JE Campaign States

JE Vaccination campaign coverage 2007

100 90 80 70 60 50 40 30 20 10 0

93%

97% 88% 75%

90%

87%

80% 57%

79%

Coverage %

JE Campaign States

JE Vaccination campaign coverage 2008

100

91% 75%

95% 73% 64%

99%

90
80

70%

Coverage %

70 60 50 40 30 20 10 0

57% 42%

JE Campaign States

JE Vaccination campaign coverage 2009

90 80 70 74% 74% 82% 87% 78% 70% 85%

Coverage %

60 50 40 30 20 34% 40%

35%
25%

10 0

JE Campaign States

JE Vaccination campaign coverage 2010

100 96% 93%

Coverage %

90 80 70 60 50 40 77%

87%

85% 72%

89% 82%

30
20 10 0

JE Campaign States

JE Vaccination Re-Campaign* Coverage 2010

100 90 80 70 60 50 40 30 20 10
S.K. Nagar Gorakhpur Sivsagar Kushinagar Deoria Maharajganj

93%

100.2% 99.6%

99%

97%

96%

100%

99%

84%

Coverage %

Assam

Assam

UP

UP

UP

UP

UP

UP

Siddharth Nagar

Dibrugarh

UP

JE Campaign States

Basti

JE vaccination Campaigns and integration in RI in WB

S.No. Name of State 1 2 3 4 5 West Bengal West Bengal West Bengal West Bengal West Bengal District's Name Burdwan Birbhum West Medinapore Hoogly Howrah Year of Coverage Coverage % Campaign 2006 2007 2008 2009 2009 1229404 792872 1091672 379295 440379 56% 74.50% 57% 22.30% 28.80% JE vaccine was to be Actually introduced in introduced in Jan-07 Feb-09 Dec-07 Feb-09 Apr-09 Apr-09 Jan-10 Jan-10 Jan-10 Jan-10

AEFIs - During JE Vaccination Campaigns 2006 - 2011

Districts Covered Coverage (Million) AEFI Reported Deaths Investigated

Year

Minor

Major

2006
2007 2008 2009

11
27 22 30

9.3
18.5 16.9 18

504
1209 1039 755

439
1059 996 625

65
150 43 130

22
8 6 5

2010

19

7.4

16

16

2010* Re-campaigns Total

9 103

7.4 77.5

180 3703

177 3312

3 391

1 42

Challenges
The 5 year JE vaccination plan has been completed in 2011 Previous JE campaign states like Assam, Arunanchal Pradesh, Manipur, U.P., Bihar, Haryana, Karnataka, Kerala, Tamil Nadu, Maharashtra, Goa, West Bengal are still reporting JE cases Issue of Age shift in many states

A large cohort of children still remain un- immunized in previous campaign districts under JE vaccination in RI

Recommendations
Review of JE incidence

Review JE vaccination program at the State and National level to recommend the way forward
Strengthen JE vaccination under RI Coverage reporting Vaccine demand and supply issues Monitoring RI sessions Strengthen coordination and data flow Immediate action required Introduction of JE vaccine in RI in the pending districts

Courage is what It takes to stand and speak

Courage is also what It takes to sit down and listen