Can the indigenously developed JENVAC curb spread of brain fever?
As acute encephalitis syndrome (AES) spreads to new districts in India, the launch of the country’s first indigenously produced anti- Japanese encephalitis (JE) vaccine—JENVAC—should be welcome news. But doubts persist whether the vaccine would bring about any significant change. JE is characterized by inflammation of the brain and high fever and is thought to be the leading cause of AES.
At present, India purchases anti-JE vaccine from neighbouring China. In spite of the availability of the vaccine, there is an increase in AES cases reported in India, including in Uttar Pradesh, says an article published in Centres for Disease Control and Prevention’s journal, Emerging Infectious Diseases. In the paper, “Acute Encephalitis Syndrome Surveillance, Kushinagar district, Uttar Pradesh, India, 2011-12”, published last month, the researchers say the disease has spread to new districts, urban areas, and villages without pigs, not usually associated with JE transmission. “Thus the assertion that JE is the leading cause of AES has been questioned, and other infectious agents, such as enteroviruses, have been reported as a cause of AES in Uttar Pradesh and other parts of India,” the paper says.
The researchers, including M Kakkar, Sayed Shahid Abbas, Sanjay Chaturvedi and others, are from leading institutes like Public Health Foundation of India (PHFI), Centres for Disease Control and Prevention and Sanjay Gandhi Post-graduate Institute of Medical Sciences in Lucknow.
Union minister of health Ghulam Nabi Azad seemed to be oblivious to these findings when he launched JENVAC at a public function on Friday. He termed the development of the indigenous vaccine as historic and an outstanding example of public private partnership (PPP). The vaccine has been jointly developed by scientists of National Institute of Virology (NIV), Indian Council of Medical Research (ICMR) and Bharat Biotech Ltd.
Work on developing the vaccine began in 2008 at a time when doubts about the causal factor of the diseases were being raised. An agreement was signed between NIV and Bharat Biotech; the research took five years and the vaccine was approved by the Drugs Controller General of India (DGCI) in September 2013.
The JE vaccine was developed using candidate strain 821564 XZ, which was isolated from the blood sample collected from an encephalitic patient admitted to government hospital in Kolar district of Karnataka in 1981.
Though JE vaccines were being imported, their availability was an issue for comprehensive and quick augmentation of the national programme, said health minister Azad at the vaccine launch. He said that it is not only the first fully indigenous vaccine, but it is also based on an Indian strain. Therefore, it is expected to improve the efficacy besides availability and affordability.
The health minister said that the public health need for this vaccine is immense since the birth cohort (number of children born) in the affected 171 districts is about 400,000 annually, which means that the government would eventually need about 10 million doses of the vaccine for comprehensive coverage.
But then the Indian vaccine priced at Rs 70 is considerably costlier than the Chinese vaccine that costs just Rs 14. Azad said that the cost will decrease once the demand for the vaccine increases. He said that availability of effective vaccine is more important than the cost issue. He said that no one purchases the vaccine from their pockets as the Government of India (GoI) provides it to all free of cost.
Will JE vaccine work on AES patients?
On whether the vaccine will work on patients suffering from AES, Managing Director and CEO of Bharat Biotech, Krishna Ella said that the vaccine is effective in few genotypes of AES as well. He informed that the production of the vaccine has begun. Experts present at the launch said that there are STILL many districts where JE is dominant. The new vaccine is expected to play a significant role in controlling JE. Once it is controlled, the scene will be clear regarding the cause of AES, they said.
Speaking to Down To Earth on the matter, director general of ICMR VM Katoch said that every institute has been given responsibility of two districts affected by JE/AES this year. “We are trying to focus on each area so that we can get clear picture about the disease and its cause,” he informed.
Revamped JE/AES programme
Azad also informed that the Union Cabinet has given its approval for a new National Programme for Prevention and Control of JE /AES with more than Rs 4,000 crore outlay. He added that this programme is now being implemented in 60 priority districts for a period of five years from 2012-13 to 2016-17 by the concerned ministries. Interventions are being focused on five states—Assam, Bihar, Tamil Nadu, Uttar Pradesh and West Bengal.
Azad said that the all-round efforts have strengthened the acceleration of research by ICMR, beginning with establishment of the Regional Field Unit of NIV at Gorakhpur. He stated that currently six ICMR Institutes are engaged in research on better methods of prevention and management of JE/AES.
Japanese encephalitis: a review of the Indian perspective
Japanese encephalitis in Tamil Nadu (2007-2009)
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