Dr. Navneet Kumar DhamijaAssistant Commissioner - ImmunizationMinistry of Health & FW, Govt. of India

Mobiles : 8826772555, 9911220066Office : 23062993, 23062126, 23062728E-mail : ImmunizationAC@gmail.com

Japanese Encephalitis Vaccination Program In India

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.

104 districts in 11 States were identified as JE endemic

Highest Priority Districts

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

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 14-14-2 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

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.

Sno.Sno. YearYear

No. of No. of Districts Districts

covered till covered till datedate

Target Target population- population- 1-15 years1-15 years

Total JE Total JE vaccination vaccination campaign campaign coverage coverage

JE vaccination JE vaccination campaign campaign

coverage %coverage %

Vaccine Vaccine Requirement Requirement

(million)(million)

11 20062006 1111 1053155410531554 93086889308688 88.3988.39 1313

22 20072007 2727 2175822321758223 1843108718431087 84.7184.71 2323

33 20082008 2222 2004026220040262 1688194116881941 84.2484.24 2525

44 20092009 3030 2717060427170604 1809718218097182 66.6166.61 3030

55 2010 2010 (Ongoing)(Ongoing) 1919 9257562.99257562.9 64421156442115 69.669.6 10.210.2

66 2010*re- 2010*re- campaignscampaigns 99 7659936 7495380 97.8597.85 8.48.4

Total for India till date Total for India till date 118118 9641814296418142 7665639376656393 79.5079.50 109.6

JE Vaccination Program – Overview

JE campaign States & districts

1 Andhra Pradesh 10

2 Kerala 2

3 Uttar Pradesh 34

4 Goa 2

5 Assam 11

6 Bihar 6

7 Haryana 6

8 Karnataka 8

9 Tamil Nadu 10

10 Maharashtra 8

11 West Bengal 5

12 Manipur 5

13 Nagaland 2

14 Arunanchal Pradesh 1

15 Uttrakhand 1

TotalTotal 111111

JE campaigns completedJE campaigns completed

JE campaigns ongoingJE campaigns ongoing

111 JE vaccination campaign districts

2006-2011

Currently JE campaigns are ongoing in Bihar and AP after which the 5 year plan for the JE campaigns in India will be completed

111 Districts - 2006 - 2011

S.N Name of State District's Name

1 Andhra Pradesh Warrangal

2 Andhra Pradesh Kurnool

3 Andhra Pradesh Krishna

4 Andhra Pradesh Nellore

5 Andhra Pradesh Medak

6 Andhra Pradesh Adilabad

7 Andhra Pradesh Khamam

8 Andhra Pradesh Nalgonda

9 Andhra Pradesh Mahboobnagar

10 Andhra Pradesh Nizamabad

11 Kerala Thiruvananthapuram

12 Kerala Alappuzha

13 UP Allahabad

14 UP Ambedkar Nagar

15 UP Azamgarh

16 UP Ballia

17 UP Balrampur

18 UP Barabanki

19 UP Bareilly

20 UP Basti

21 UP Behraich

22 UP Deoria

23 UP Faizabad

24 UP Fatehpur

25 UP Ghazipur

26 UP Gonda

27 UP Gorakhpur

28 UP Hardoi

29 UP Jaunpur

30 UP Kanpur Nagar

31 UP Kheri

32 UP Kushi Nagar

33 UP Lucknow

34 UP Maharajganj

35 UP Mau

36 UP Muzaffar Nagar

37 UP Pratapgarh

38 UP Rae Barelly

39 UP Saharanpur

40 UP Shahjahanpur

41 UP Shrawasti

42 UP Sant Kabir Nagar

43 UP Sitapur

44 UP Siddharth Nagar

45 UP Sultanpur

46 UP Unnao

47 Goa North Goa

48 Goa South Goa

49 Assam Sonitpur

50 Assam Dibrugarh

51 Assam Jorhat

52 Assam Dhemaji

53 Assam Sivsagar

54 Assam Golaghat

55 Assam Tinsukia

56 Assam Lakhimpur

57 Assam Kamrup

58 Assam Udalgiri

59 Assam Nagaon

60 Bihar Champaran West

61 Bihar Muzaffarpur

62 Bihar Gaya

63 Bihar Gopalganj

64 Bihar Nawada

65 Bihar Siwan

66 Haryana Kurukshetra

67 Haryana Ambala

68 Haryana Panipat

69 Haryana Karnal

70 Haryana Yamuna Nagar

71 Haryana Kaithal

72 Karnataka Bellary

73 Karnataka Kolar (+C ballapur )

74 Karnataka Raichure

75 Karnataka Koppal

76 Karnataka Mandya

77 Karnataka Bijapure

78 Karnataka Dharwad

79 Maharashtra Amravati+Amravati MC

80 Maharashtra Bhandara

81 Maharashtra Nagpur Rural

82 Maharashtra Washim

83 Maharashtra Beed

84 Maharashtra Latur

85 Maharashtra Gadchirolli

86 Maharashtra Yavatmal

87 West Bengal Birbhum

88 West Bengal Hoogly

89 West Bengal Burdwan

90 West Bengal Howrah

91 West Bengal West Medinapore

92 Tamil Nadu Cuddalore

93 Tamil Nadu Villupuram

94 Tamil Nadu Virudhunagar

95 Tamil Nadu Trichy

96 Tamil Nadu Thiruvarur

97 Tamil Nadu Madurai

98 Tamil Nadu Perambalur

99 Tamil Nadu Thanjavur

100 Tamil Nadu Thiruvannamalai

101 Manipur Imphal east

102 Manipur Imphal West

103 Manipur Thoubal

104 Manipur Bishnupur

105 Manipur Chandel

106 Nagaland Dimapur

107 Nagaland Mokongchung

108 Arunanchal Pradesh Lohit

109 Uttrakhand Udham Singh Nagar

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 Re-Campaign* Coverage 2010

Year

Districts Covered

Coverage (Million) AEFI Reported Minor Major

Deaths Investigated

2006 11 9.3 504 439 65 22

2007 27 18.5 1209 1059 150 8

2008 22 16.9 1039 996 43 6

2009 15 12.7 755 625 130 5

2010 Ongoing 19 6.4 16 16 0 0

2010* Re-campaigns 9 7.6 180 177 3 1

Total 75 57.4 3507 3119 388 41

AEFIs - During JE Vaccination Campaigns 2006 - 2011

• The 5 year JE vaccination plan is to be completed in 2011 after the campaigns end in Bihar and AP

• 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

Challenges

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 whatIt takes to stand and speak

Courage is also what It takes to sit down and listen