Estimation of the Impact of a Japanese Encephalitis Immunization Program with Live, Attenuated SA 14-14-2 Vaccine in Nepal

Shyam Raj Upreti Child Health Division, Ministry of Health and Population, Kathmandu, Nepal; Arboviral Diseases Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado; Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia; Programme for Immunization Preventable Diseases, World Health Organization, Kathmandu, Nepal; Kanti Children's Hospital, Kathmandu, Nepal; National Public Health Laboratory, Kathmandu, Nepal; Office of the Director, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado; Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Walter Reed/Armed Forces Research Institute of Medical Sciences Research Unit Nepal, Kathmandu, Nepal

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Kristen B. Janusz Child Health Division, Ministry of Health and Population, Kathmandu, Nepal; Arboviral Diseases Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado; Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia; Programme for Immunization Preventable Diseases, World Health Organization, Kathmandu, Nepal; Kanti Children's Hospital, Kathmandu, Nepal; National Public Health Laboratory, Kathmandu, Nepal; Office of the Director, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado; Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Walter Reed/Armed Forces Research Institute of Medical Sciences Research Unit Nepal, Kathmandu, Nepal

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W. William Schluter Child Health Division, Ministry of Health and Population, Kathmandu, Nepal; Arboviral Diseases Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado; Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia; Programme for Immunization Preventable Diseases, World Health Organization, Kathmandu, Nepal; Kanti Children's Hospital, Kathmandu, Nepal; National Public Health Laboratory, Kathmandu, Nepal; Office of the Director, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado; Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Walter Reed/Armed Forces Research Institute of Medical Sciences Research Unit Nepal, Kathmandu, Nepal

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Ram Padarath Bichha Child Health Division, Ministry of Health and Population, Kathmandu, Nepal; Arboviral Diseases Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado; Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia; Programme for Immunization Preventable Diseases, World Health Organization, Kathmandu, Nepal; Kanti Children's Hospital, Kathmandu, Nepal; National Public Health Laboratory, Kathmandu, Nepal; Office of the Director, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado; Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Walter Reed/Armed Forces Research Institute of Medical Sciences Research Unit Nepal, Kathmandu, Nepal

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Geeta Shakya Child Health Division, Ministry of Health and Population, Kathmandu, Nepal; Arboviral Diseases Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado; Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia; Programme for Immunization Preventable Diseases, World Health Organization, Kathmandu, Nepal; Kanti Children's Hospital, Kathmandu, Nepal; National Public Health Laboratory, Kathmandu, Nepal; Office of the Director, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado; Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Walter Reed/Armed Forces Research Institute of Medical Sciences Research Unit Nepal, Kathmandu, Nepal

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Brad J. Biggerstaff Child Health Division, Ministry of Health and Population, Kathmandu, Nepal; Arboviral Diseases Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado; Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia; Programme for Immunization Preventable Diseases, World Health Organization, Kathmandu, Nepal; Kanti Children's Hospital, Kathmandu, Nepal; National Public Health Laboratory, Kathmandu, Nepal; Office of the Director, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado; Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Walter Reed/Armed Forces Research Institute of Medical Sciences Research Unit Nepal, Kathmandu, Nepal

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Murari Man Shrestha Child Health Division, Ministry of Health and Population, Kathmandu, Nepal; Arboviral Diseases Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado; Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia; Programme for Immunization Preventable Diseases, World Health Organization, Kathmandu, Nepal; Kanti Children's Hospital, Kathmandu, Nepal; National Public Health Laboratory, Kathmandu, Nepal; Office of the Director, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado; Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Walter Reed/Armed Forces Research Institute of Medical Sciences Research Unit Nepal, Kathmandu, Nepal

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Tika Ram Sedai Child Health Division, Ministry of Health and Population, Kathmandu, Nepal; Arboviral Diseases Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado; Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia; Programme for Immunization Preventable Diseases, World Health Organization, Kathmandu, Nepal; Kanti Children's Hospital, Kathmandu, Nepal; National Public Health Laboratory, Kathmandu, Nepal; Office of the Director, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado; Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Walter Reed/Armed Forces Research Institute of Medical Sciences Research Unit Nepal, Kathmandu, Nepal

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Marc Fischer Child Health Division, Ministry of Health and Population, Kathmandu, Nepal; Arboviral Diseases Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado; Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia; Programme for Immunization Preventable Diseases, World Health Organization, Kathmandu, Nepal; Kanti Children's Hospital, Kathmandu, Nepal; National Public Health Laboratory, Kathmandu, Nepal; Office of the Director, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado; Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Walter Reed/Armed Forces Research Institute of Medical Sciences Research Unit Nepal, Kathmandu, Nepal

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Robert V. Gibbons Child Health Division, Ministry of Health and Population, Kathmandu, Nepal; Arboviral Diseases Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado; Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia; Programme for Immunization Preventable Diseases, World Health Organization, Kathmandu, Nepal; Kanti Children's Hospital, Kathmandu, Nepal; National Public Health Laboratory, Kathmandu, Nepal; Office of the Director, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado; Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Walter Reed/Armed Forces Research Institute of Medical Sciences Research Unit Nepal, Kathmandu, Nepal

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Sanjaya K. Shrestha Child Health Division, Ministry of Health and Population, Kathmandu, Nepal; Arboviral Diseases Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado; Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia; Programme for Immunization Preventable Diseases, World Health Organization, Kathmandu, Nepal; Kanti Children's Hospital, Kathmandu, Nepal; National Public Health Laboratory, Kathmandu, Nepal; Office of the Director, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado; Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Walter Reed/Armed Forces Research Institute of Medical Sciences Research Unit Nepal, Kathmandu, Nepal

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Susan L. Hills Child Health Division, Ministry of Health and Population, Kathmandu, Nepal; Arboviral Diseases Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado; Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia; Programme for Immunization Preventable Diseases, World Health Organization, Kathmandu, Nepal; Kanti Children's Hospital, Kathmandu, Nepal; National Public Health Laboratory, Kathmandu, Nepal; Office of the Director, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado; Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Walter Reed/Armed Forces Research Institute of Medical Sciences Research Unit Nepal, Kathmandu, Nepal

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DOI:
https://doi.org/10.4269/ajtmh.12-0196
Volume/Issue:
Volume 88: Issue 3
Page(s):
464–468
Restricted access
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Wider availability of the live, attenuated SA 14-14-2 Japanese encephalitis (JE) vaccine has facilitated introduction or expansion of immunization programs in many countries. However, information on their impact is limited. In 2006, Nepal launched a JE immunization program, and by 2009, mass campaigns had been implemented in 23 districts. To describe the impact, we analyzed surveillance data from 2004 to 2009 on laboratory-confirmed JE and clinical acute encephalitis syndrome (AES) cases. The post-campaign JE incidence rate of 1.3 per 100,000 population was 72% lower than expected if no campaigns had occurred, and an estimated 891 JE cases were prevented. In addition, AES incidence was 58% lower, with an estimated 2,787 AES cases prevented, suggesting that three times as many disease cases may have been prevented than indicated by the laboratory-confirmed JE cases alone. These results provide useful information on preventable JE disease burden and the potential value of JE immunization programs.

Author Notes

* Address correspondence to Susan L. Hills, Arboviral Diseases Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 3156 Rampart Road, Fort Collins, CO 80521. E-mail: shills@cdc.gov

Financial support: The Bill & Melinda Gates Foundation provided financial support for this evaluation through a grant to the US Centers for Disease Control and Prevention.

Authors' addresses: Shyam Raj Upreti, Child Health Division, Ministry of Health and Population, Kathmandu, Nepal, E-mail: drshyam@hotmail.com. Kristen Janusz, Marc Fischer, and Susan L. Hills, Arboviral Diseases Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, E-mails: kbjanusz@aol.com, mfischer@cdc.gov, and shills@cdc.gov. W. William Schluter, Programme for Immunization Preventable Diseases, World Health Organization, Kathmandu, Nepal, E-mail: schluterw@wpro.who.int. Ram Padarath Bichha, Kanti Children's Hospital, Kathmandu, Nepal, E-mail: drrpbichha@gmail.com. Geeta Shakya, National Public Health Laboratory, Kathmandu, Nepal, E-mail: geetanphl@yahoo.com. Brad J. Biggerstaff, Office of the Director, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, E-mail: bbiggerstaff@cdc.gov. Murari Man Shrestha and Tika Ram Sedai, Programme for Immunization Preventable Diseases, World Health Organization, Kathmandu, Nepal, E-mails: Shresthamu@searo.who.int and Sedait@searo.who.int. Robert V. Gibbons, US Army Medical Component, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand, E-mail: Robert.Gibbons@afrims.org. Sanjaya Shrestha, Walter Reed Armed Forces Research Institute of Medical Sciences Research Unit, Nepal, E-mail: shresthask@afrims.org.

Copyright:
© The American Society of Tropical Medicine and Hygiene 2013
Received:
27 Mar 2012
|
Accepted:
09 Dec 2012
|
Published Online:
06 Mar 2013
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
Online ISSN:
1476-1645
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