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The Program for the Prevention and Control of neurological Infections due to Haemophilus influenzae type b (Hib) and Japanese Encephalitis Virus in Children in the Democratic People's Republic of Korea

Background
In 2007, the IVI launched a program to prevent and control Japanese encephalitis (JE) and haemophilus influenzae type b (Hib) - two infections of the central nervous system - in children in the Democratic People's Republic of Korea (DPRK), also known as North Korea. The program is being funded by the Ministry of Unification of the Republic of Korea, Glovax and Shantha Biotechnics.


Senior scientists from the IVI and officials from the Academy of Medical Sciences (AMS) of the Democratic People's Republic of Korea (DPRK) in Pyongyang on October 6, 2006 following the signing of a memorandum of understanding to launch the Hib/JE project in the DPRK.

Hib, a bacterial infection, can lead to pneumonia, meningitis and blood infections (sepsis) and is believed to cause around 386,000 deaths per year worldwide, mainly in children under five years of age. JE, a virus of the genus Flavivirus that is spread by mosquitoes, is endemic in many Asian countries and mainly affects children. The disease causes 25,000 - 50,000 deaths per year and severe neurological disability in 25-75% of survivors, including mental retardation, paralysis, seizures, and behavioral problems. Because of the limitations in the diagnosis of JE and Hib in the DPRK, the magnitude of these diseases in the country is unknown. However, the country has many risk factors for JE - including rice cultivation, which is conducive to mosquito breeding on paddies; the raising of pigs, which serve as amplifying reservoirs for the JE virus; and the presence of the main JE mosquito vector (Culex tritaeniorhynchus). Therefore, the risk of JE among North Korean children is likely to be comparable to that of surrounding countries, such as South Korea and China, before they introduced JE vaccination. The incidence of Hib, which is found in all countries, both industrialized and developing, is also likely to be substantial in North Korea.

The DPRK program focuses on strengthening the country's capacity to diagnose and conduct surveillance for Hib and JE and on helping the country to introduce modern vaccines against these diseases into its national Expanded Program on Immunization (EPI). The principal target for building capacity in JE and Hib laboratory testing and surveillance is the Academy of Medical Sciences (AMS), North Korea's main center of medical research. Once it has attained this capacity, AMS will then be able to provide expertise and support to clinical microbiological laboratories in hospitals and provincial anti-epidemic stations throughout the country, in the aim of establishing nation-wide laboratory-based surveillance for JE and Hib.

Goals
The main goals of this program are to:

  • Build capacity in the DPRK for the surveillance and laboratory diagnosis of Hib and JE by conducting study tours in Asia of laboratory and vaccine production facilities and hands-on training for DPRK scientists from the Academy of Medical Sciences;

  • Establish a functional Hib and JE laboratory reference diagnostic facility in the DPRK with the Academy of Medical Sciences and Institute for Microbiology (IMB).

  • Pave the way for the introduction of vaccines against Hib and JE delivered through the country's EPI program.

Projects

Study tours and training for AMS scientists in laboratory diagnosis of Hib and JE

Scientists from the Academy of Medical Sciences have participated in study tours to diagnostic laboratories, hospitals and vaccine production facilities in China and Vietnam. They also visited HaTay Province in Vietnam to review the country's JE case-referral system. They also have received training at NIHE, Hanoi, in basic laboratory methods for the detection of Hib and JE infections, using modern diagnostic tests and international standard procedures.

Establishment of national Hib and JE reference laboratories

The IVI is assisting the AMS in creating national reference laboratories within their facilities for the diagnosis of Hib and JE. This involves: the provision of laboratory equipment, on-site training in diagnostic testing using this equipment, development of standard operating procedures (SOPs), and implementation of quality assurance and quality control procedures to ensure high-quality laboratory testing for Hib and JE.

Pilot introduction of modern Hib and JE vaccines

As a first step towards the introduction of new-generation Hib and JE vaccines, the IVI, in collaboration with the AMS and the DPRK's Ministry of Public Health, is conducting a pilot vaccination project for both vaccines to assess the feasibility of incorporating them into the country's EPI and to train and prepare EPI staff in planning and implementing all aspects involved in the introduction of these vaccines. This includes training in: developing a standardized immunization registry, cold chain maintenance, screening children for eligibility, evaluating and recording adverse events following immunization, safe injection practices, and safe waste disposal.


Dr. John Clemens, Director General of the IVI, with children at a daycare center in the city of Sariwon in the Democratic People's Republic of Korea (DPRK), where a pilot introduction of JE has taken place involving 3,000 children.

In the first half of 2008, 3,000 children 1-6 years of age were successfully vaccinated against JE in the city of Sariwon, using the live, attenuated SA14-14-2 vaccine. Another 3,000 children, six weeks to three years of age in the city of Nampo have received the Hib conjugate vaccine. An analysis of the safety, logistical feasibility and population coverage of these pilot introduction projects will inform decisions about future expansion of Hib and JE vaccination in the country.

Collaborators:

  • Ministry of Public Health, DPRK
  • Academy of Medical Sciences (AMS) (DPRK)
  • Institute for Microbiology (IMB) (DPRK)
  • National Institute of Hygiene and Epidemiology, Vietnam (NIHE)
  • National Institute for Control of Drugs and Biological Products (NICDBP), China
  • Glovax, South Korea
  • Shantha Biotechnics, India
  • Beijing Serum and Vaccine Institute, China
  • Lanzhou Institute for Biological Products, China

Last Updated : June 2008