Fight against encephalitis gets powerful champion
Gates Foundation helps immunize kids against deadly virus
http://seattlepi.nwsource.com/local/278675_brainfever25.html
By TOM PAULSON
P-I REPORTER
A bird-borne Asian virus that kills one-third of those who suffer serious infection, leaving many survivors with brain damage, is expanding its geographic reach and today threatens several billion people on the planet.
It's not bird flu. The afflicted call it brain fever. Scientists call it Japanese encephalitis. This has been a disease of the world's poor, said Dr. Julie Jacobson, director of the Japanese encephalitis program at Seattle-based Program for Appropriate Technology in Health. As such, Jacobson said, most of those killed or maimed by the virus have gone uncounted, misdiagnosed or regarded as the tragic, inevitable victims of an orphan disease.
That was before the Bill Melinda Gates Foundation adopted this orphan. It was kind of a forced adoption, in a sense, but it's worked out well.
Today, PATH will celebrate, along with the government of India, having immunized 9 million children against Japanese encephalitis as part of a campaign aimed at reaching 11 million in high-risk districts.
Like West Nile, Japanese encephalitis infects the brain. Unlike West Nile, it is much more likely to kill or cause permanent brain damage -- causing serious illness in perhaps one in 25 infected, killing 30 percent and causing brain damage in perhaps 40 percent. Because the disease is so poorly monitored, the annual death toll of 10,000 is considered a gross underestimate.
There is no viable treatment for the infection. Children are at highest risk, so the children of India are the ones being targeted for immunization.
This is so exciting, said Jacobson, speaking by telephone from Indonesia, where PATH hopes to launch a similar vaccination campaign. For many years, at every twist and turn, it looked impossible. But now it's happening.
It's happening, in part, because of a $27 million grant the Gates Foundation gave to PATH in 2003 to support a vaccination campaign in Asia. But it's really happening because Jacobson and her colleagues were willing to listen to Indian officials and change course.
In 2000, the Gates Foundation gave PATH $25 million to launch an immunization improvement project in the south Indian state of Andhra Pradesh with an emphasis on introducing a vaccine against hepatitis B (which is rampant worldwide, causing liver disease and liver cancer).
Local government and health officials agreed to devote resources and funding to the project as well, but only if the Seattle team incorporated an additional disease target -- Japanese encephalitis.
I didn't know anything about it, said Jacobson. I was trained in tropical medicine, but even in our specialized textbooks there were maybe two paragraphs about JE.
Negotiations ensued. The Gates grant to PATH didn't include money for JE vaccinations. And the existing vaccine was cumbersome -- made from mouse brains, requiring three injected doses -- too expensive and in short supply.
Things didn't look good, and I don't mean they didn't look good at first or for a while; I mean often, said Jacobson.
But she and her colleagues at PATH, in the course of these negotiations, also learned why the Indians were so adamant about this disease threat.
With the seasonal arrival of migrating egrets and cranes every year about this time comes brain fever season. The virus, which appears to be spreading in Asia largely because of these migrations, infects birds and is passed to humans by mosquitoes that have fed on infected animals.
The hospitals were just overwhelmed by all these children having seizures, going into comas, Jacobson said. She didn't need any more convincing, she said, but there were still plenty of obstacles -- such as the nature of the vaccine itself.
As the Andhra Pradesh PATH project gathered momentum, focusing largely on expanding access to basic vaccines and improving the quality of the public health system, Jacobson spun off to focus on Japanese encephalitis. Andhra Pradesh would move ahead with the mouse-brain vaccine, but a better solution was needed to expand immunizations throughout Asia.
China had what looked like a better vaccine, Jacobson soon discovered. Grown from hamster kidney cells, it could be delivered in a single dose and was a lot cheaper and easier to manufacturer in large amounts. But it wasn't approved for international use yet and, Jacobson noted, it can be a bit dicey, suggesting to India that it needs to use a Chinese vaccine.
India doesn't like to depend upon China for anything, she said. But such concerns disappeared last year, she said, when the Indian state of Uttar Pradesh suffered a massive JE outbreak.
After the outbreak, the government decided it had to act, Jacobson said. PATH, with assistance from the World Health Organization and UNICEF, helped negotiate India's purchase of
