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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
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