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Instructions for users

Instructions for users. This slide presentation provides an overview of the control of JE and prevention of JE by immunization. Below many of the slides, there are notes to explain the information in the slide. You should adapt the presentation for your own use.

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Instructions for users

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  1. Instructions for users • This slide presentation provides an overview of the control of JE and prevention of JE by immunization. • Below many of the slides, there are notes to explain the information in the slide. • You should adapt the presentation for your own use. • If you want to present this topic in a more in-depth way, resources are suggested in the notes section below.

  2. Japanese Encephalitis:Control of the Disease

  3. Learning Objectives Participants will: • Understand methods that have been used to try to control JE and problems with them. • Understand the importance of human immunization for JE. • Be familiar with the scientific evidence for effectiveness and cost-effectiveness of JE immunization.

  4. JE transmission cycle and possible control points Control options • Mosquito control? • Pig control? • Human interventions?

  5. Mosquito control ? • Spraying mosquito habitats with insecticide • Time consuming, expensive, it is difficult to cover all mosquito habitats, and causes environmental pollution • Bednets • Mosquitoes bite at dusk before people are in bed NOT THE BEST SOLUTION Photo credit: Julie Jacobson

  6. Pig control ? • Segregating, slaughtering, or vaccinating pigs • Economically not feasible and difficult • Other animals, like birds, may also act as amplifying hosts so even if pigs are eliminated JE will not disappear NOT THE BEST SOLUTION Photo credit: Susan Hills

  7. Conclusion: “Human vaccination is theonly effective long-term control measure against JE. All at-risk residents should receive a safe and efficacious vaccine as part of their national immunization program.” Consensus statements from Global JE meetings 1995, 1998, and 2002

  8. World Health Organization statement: “where affordable, JE vaccination should be extended to all endemic areas where JE is considered a public health problem” WHO, 1998 Weekly Epidemiological Record No. 44

  9. Scientific evidence for JE immunization There is compelling evidence that human immunization is effective for controlling JE. Studies in Korea and Japan showed >99% reduction in JE cases after immunization. Source: Igarashi A. “Control of Japanese Encephalitis in Japan: Immunization of humans and animals and vector control” Current Topics in Microbiology and Immunology 2002. 267: 139-152

  10. JE immunization is cost-effective • Studies in several countries have shown JE immunization to be cost-effective. • A study in China showed JE immunization to be cost-saving (i.e., the costs of procuring and delivering the vaccine were less than the economic costs of treating the disease in the absence of immunization). • This suggests that investing in immunization against JE can actually save resources.

  11. Cost-effectiveness of vaccination – the China study* • The study examined a hypothetical birth cohort of 100,000 persons from Shanghai. • Compared the use of live & inactivated vaccine to no vaccine. • With inactivated vaccine: prevented 420 cases and 105 deaths per 100,000 vaccinees. • Live vaccine: prevented 427 cases and 107 deaths. • Both vaccines cost-saving. • Live vaccine strategy 40% greater cost savings compared to inactivated vaccine strategy. * Ding D et al. Bull WHO 2003;81(5):334-42

  12. Status of JE control with immunization Comprehensive immunization program: Japan, South Korea, Taiwan, China and Thailand Program commenced but needs expansion or development: Sri Lanka, Vietnam, Malaysia and India (state-based) Trial taken place and there are plans to introduce a program: Nepal Data as of November 2004

  13. JE vaccine: what are the options? JE vaccines currently available fall into 2 categories • Inactivated vaccines • Live, attenuated vaccine

  14. Inactivated JE vaccine • First licensed in Japan in 1954. • The most widely used and available vaccine. • Has been produced by several countries, including Japan, S. Korea, Thailand, and Vietnam. • Mouse brain-derived.

  15. Live, attenuated JE vaccine (SA 14-14-2 vaccine) • First licensed in China in 1988. • Used extensively in China. • Recently licensed and used in Nepal and South Korea.

  16. Comparison of the vaccines The benefits of the live attenuated vaccine compared to the inactivated vaccine are as follows: • Simpler schedule • Better safety profile • Longer duration of action • Cheaper price

  17. Comparison of the vaccines (2) • No JE vaccine has been pre-qualified by WHO at this time (May 2005). However WHO does endorse use of JE vaccine in controlling JE. • There are supply problems with the inactivated vaccine; it is difficult to produce, and supply is insufficient for global need.

  18. Control of JE by vaccination: summary • Vaccine supply problems, cost, scheduling difficulties and other issues have resulted in slow progress of implementation of JE immunization in some countries. • However, many countries are making good progress towards control of JE by immunization.

  19. Acknowledgements Please include the following acknowledgement if you use this slide set: This slide set was adapted from a slide set prepared by PATH’s Japanese Encephalitis Project. For information: www.JEproject.org

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