T J John

Christian Medical College Vellore, Velluru, Tamil Nadu, India

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Publications (304)2283.74 Total impact

  • T Jacob John
  • T Jacob John
  • T Jacob John
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    ABSTRACT: In spite of being the pioneer-leader of research into epidemiology and prevention of tuberculosis among low-income countries, India has the highest population-based burden of tuberculosis among all nations. Children with latent tuberculosis are the pool from which adult pulmonary tuberculosis emerges many years later. In the absence of primary prevention of infection by BCG, sociologic/behavioral interventions must be applied to reduce air-borne transmission. In addition to maximizing passive surveillance of adult disease, pediatric tuberculosis must also be brought under surveillance. Those with latent tuberculosis must be detected and treated to remove them from the pool. Epidemiologically, the realistic monitoring method of tuberculosis control trajectory is documenting progressive reduction of the short incubation period pediatric disease through surveillance, and not the reduction of long incubation period adult pulmonary tuberculosis. Application of scientific tools for the detection and management of pediatric tuberculosis infection - latent and active - holds the key to effective tuberculosis control.
    Indian pediatrics 07/2014; 51(7):523-7. DOI:10.1007/s13312-014-0440-x · 1.01 Impact Factor
  • T Jacob John, Vipin M Vashishtha
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    ABSTRACT: India's success in eliminating wild polioviruses (WPVs) has been acclaimed globally. Since the last case on January 13, 2011 success has been sustained for two years. By early 2014 India could be certified free of WPV transmission, if no indigenous transmission occurs, the chances of which is considered zero. Until early 1990s India was hyperendemic for polio, with an average of 500 to 1000 children getting paralysed daily. In spite of introducing trivalent oral poliovirus vaccine (tOPV) in the Expanded Programme on Immunization (EPI) in 1979, the burden of polio did not fall below that of the pre-EPI era for a decade. One of the main reasons was the low vaccine efficacy (VE) of tOPV against WPV types 1 and 3. The VE of tOPV was highest for type 2 and WPV type 2 was eliminated in 1999 itself as the average per-capita vaccine coverage reached 6. The VE against types 1 and 3 was the lowest in Uttar Pradesh and Bihar, where the force of transmission of WPVs was maximum on account of the highest infant-population density. Transmission was finally interrupted with sustained and extraordinary efforts. During the years since 2004 annual pulse polio vaccination campaigns were conducted 10 times each year, virtually every child was tracked and vaccinated - including in all transit points and transport vehicles, monovalent OPV types 1 and 3 were licensed and applied in titrated campaigns according to WPV epidemiology and bivalent OPV (bOPV, with both types 1 and 3) was developed and judiciously deployed. Elimination of WPVs with OPV is only phase 1 of polio eradication. India is poised to progress to phase 2, with introduction of inactivated poliovirus vaccine (IPV), switch from tOPV to bOPV and final elimination of all vaccine-related and vaccine-derived polioviruses. True polio eradication demands zero incidence of poliovirus infection, wild and vaccine.
    The Indian Journal of Medical Research 05/2013; 137(5):881-94. · 1.66 Impact Factor
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    ABSTRACT: The Global Meningococcal Initiative (GMI) consists of an international group of scientists and clinicians, with expertise in meningococcal immunology, epidemiology, public health and vaccinology that aims to prevent meningococcal disease worldwide through education, research, cooperation and vaccination. In India, there is no national policy on routine meningococcal vaccination to control the disease. The GMI convened a meeting in India, with local medical leaders and public policy personnel, to gain insight into meningococcal disease burden and current surveillance and vaccination practices in the country. Neisseria meningitidis is the third most common cause of sporadic bacterial meningitis in children <5 years, with higher incidence in temperate northern versus tropical southern India. Incidence is not reliably known due to suboptimal surveillance and insufficient microbiological support for diagnosis. Since 2005, there have been a number of outbreaks, all attributable to serogroup A. Outbreak responses were ad hoc and included mandatory case reporting by hospitals in Delhi, temporary strengthening of laboratory diagnostics, chemoprophylaxis of close contacts/high-risk groups and limited reactive use of polysaccharide vaccine. Although a conjugate serogroup A vaccine (MenAfriVac™) is manufactured in India, it is not presently used in India. Epidemiological data on meningococcal disease in India are sparse. Meningococcal disease control efforts should focus on establishing systematic surveillance and educating physicians and officers of the Immunization Division of the Ministry of Health on the importance of N. meningitidis as a cause of morbidity and mortality. Conjugate vaccine should be used for outbreak control and the immunization of high-risk persons.
    Vaccine 04/2013; 31(25). DOI:10.1016/j.vaccine.2013.04.003 · 3.49 Impact Factor
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    ABSTRACT: India established the National Tuberculosis Control Project (NTCP) 50 years ago and re-designed it as Revised NTCP (RNTCP) 19 years ago. Tuberculosis (TB) control was beset with obstacles-BCG vaccination was found ineffective in TB control in 1979; human immunodeficiency virus began spreading in India since 1984 with TB as the commonest opportunistic disease; multi-drug resistance was found to be prevalent since 1992. The World Health Organization declared TB as global emergency in 1993. Yet, RNTCP was extended to the whole nation very slowly, taking 13 years from inception. The first objective of RNTCP, namely 85% treatment success has been achieved and case-fatality had dropped by 90%;. Still, TB burden continues to remain huge; about half the cases are not getting registered under RNTCP; pediatric TB is neglected; TB drains national economy of US$ 23 billion annually. Therefore, TB control is in urgent need of re-design and re-invigoration, with additional inputs and system re-organization to cover all such gaps. We highlight the need for Public Health infrastructure under which all vertical disease control projects such as RNTCP should be synergized for better efficiency and for establishing Public Health Surveillance for collecting denominator-based data on incidence and prevalence to guide course corrections. India ought to spend 3 to 5 times more on TB control than at present. Control needs clear epidemiologic definition and measurable parameters for monitoring the level of control over time. TB control is both a measure of, and a means to, socioeconomic development.
    Indian pediatrics 01/2013; 50(1):93-8. DOI:10.1007/s13312-013-0021-4 · 1.01 Impact Factor
  • T Jacob John, Vipin M Vashishtha
    The Lancet 11/2012; 380(9854):1645. DOI:10.1016/S0140-6736(12)61944-8 · 39.21 Impact Factor
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    T Jacob John
    Indian pediatrics 10/2012; 49(10):787. DOI:10.1007/s13312-012-0179-1 · 1.01 Impact Factor
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    Joy Sarojini Michael, T Jacob John
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    ABSTRACT: Background & objectives: Extensively drug resistant tuberculosis (XDR-TB) has become a new threat for the control of TB in many countries including India. Its prevalence is not known in India as there is no nation-wide surveillance. However, there have been some reports from various hospitals in the country. Methods: We have reviewed the studies/information available in the public domain and found data from 10 tertiary care centres in 9 cities in India. Results: A total of 598 isolates of XDR Mycobacterium tuberculosis have been reported in the studies included. However, the reliability of microbiological methods used in these studies was not checked and thus the XDR-TB data remained invalidated in reference laboratories. Interpretation & conclusions: Systematic surveillance and containment interventions are urgently needed.
    The Indian Journal of Medical Research 10/2012; 136(4):599-604. · 1.66 Impact Factor
  • International Journal of Infectious Diseases 06/2012; 16:e305. DOI:10.1016/j.ijid.2012.05.994 · 2.33 Impact Factor
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    T Jacob John, Joy Sarojini Michael
    Indian pediatrics 04/2012; 49(4):335. · 1.01 Impact Factor
  • T Jacob John, Vipin M Vashishtha
    Indian pediatrics 02/2012; 49(2):95-8. DOI:10.1007/s13312-012-0018-4 · 1.01 Impact Factor
  • T Jacob John
  • T Jacob John
    The Indian Journal of Medical Research 12/2011; 134(6):746-8. · 1.66 Impact Factor
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    Vipin M Vashishtha, Amit Garg, T Jacob John
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    ABSTRACT: We retrospectively studied clinical and etiological profile of acute bacterial meningitis in hospitalized children for two consecutive years at a pediatric hospital in western Uttar Pradesh. Etiological diagnosis could be made in 30 (44.8%) out of 67 cases with either culture or latex agglutination test. Pneumococcus was the commonest pathogen found in 17 (25.4%) cases. The overall mortality was 10.5%.
    Indian pediatrics 12/2011; 48(12):985-6. · 1.01 Impact Factor
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    ABSTRACT: The Expanded Programme on Immunization (EPI) has succeeded in establishing a vaccine delivery system in all low and middle income (LMI) countries. Because EPI has focused on immunization delivery, its major outcome is measured in many countries only as vaccine coverage, not as disease reduction, the real goal of EPI. Monitoring disease reduction requires real-time case-based disease surveillance and appropriate interventions, for which a functional public health infrastructure is needed. If the highest priority for assessing impact of EPI shifts to disease prevention and control from vaccine coverage, the programme may be transformed to one of control of childhood communicable diseases (CCCD), with the potential of expanding the range of diseases of children and adults for control and of integrating all other current vertical (single disease) control efforts with it. EPI provides the essential platform on which CCCD can be built to create a public health infrastructure.
    Vaccine 11/2011; 29(48):8835-7. DOI:10.1016/j.vaccine.2011.08.100 · 3.49 Impact Factor
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    ABSTRACT: The continued presence of polio in northern India poses challenges to the interruption of wild poliovirus transmission and the management of poliovirus risks in the post-eradication era. We aimed to assess the current immunity profile after routine doses of trivalent oral poliovirus vaccine (OPV) and numerous supplemental doses of type-1 monovalent OPV (mOPV1), and compared the effect of five vaccine formulations and dosages on residual immunity gaps. We did a community-based, randomised controlled trial of healthy infants aged 6-9 months at ten sites in Moradabad, India. Serum neutralising antibody was measured before infants were randomly assigned to a study group and given standard-potency or higher-potency mOPV1, intradermal fractional-dose inactivated poliovirus vaccine (IPV, GlaxoSmithKline), or intramuscular full-dose IPV from two different manufacturers (GlaxoSmithKline or Panacea). Follow-up sera were taken at days 7 and 28. Our primary endpoint was an increase of more than four times in antibody titres. We did analyses by per-protocol in children with a blood sample available before, and 28 days after, receiving study vaccine (or who completed study procedures). This trial is registered with Current Controlled Trials, number ISRCTN90744784. Of 1002 children enrolled, 869 (87%) completed study procedures (ie, blood sample available at day 0 and day 28). At baseline, 862 (99%), 625 (72%), and 418 (48%) had detectable antibodies to poliovirus types 1, 2, and 3, respectively. In children who were type-1 seropositive, an increase of more than four times in antibody titre was detected 28 days after they were given standard-potency mOPV1 (5/13 [38%]), higher-potency mOPV1 (6/21 [29%]), intradermal IPV (9/16 [56%]), GlaxoSmithKline intramuscular IPV (19/22 [86%]), and Panacea intramuscular IPV (11/13 [85%]). In those who were type-2 seronegative, 42 (100%) of 42 seroconverted after GlaxoSmithKline intramuscular IPV, and 24 (59%) of 41 after intradermal IPV (p<0·0001). 87 (90%) of 97 infants who were type-3 seronegative seroconverted after intramuscular IPV, and 21 (36%) of 49 after intradermal IPV (p<0·0001). Supplemental mOPV1 resulted in almost total seroprevalence against poliovirus type 1, which is consistent with recent absence of poliomyelitis cases; whereas seroprevalence against types 2 and 3 was expected for routine vaccination histories. The immunogenicity of IPV produced in India (Panacea) was similar to that of an internationally manufactured IPV (GSK). Intradermal IPV was less immunogenic.
    The Lancet Infectious Diseases 11/2011; 12(2):128-35. DOI:10.1016/S1473-3099(11)70190-6 · 19.45 Impact Factor
  • T Jacob John
    Indian pediatrics 10/2011; 48(10):823-4. · 1.01 Impact Factor
  • T Jacob John, Valsan P Verghese
    The Indian Journal of Medical Research 09/2011; 134:256-9. · 1.66 Impact Factor
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    T Jacob John, Vipin M Vashishtha
    Indian pediatrics 09/2011; 48(9):738. · 1.01 Impact Factor

Publication Stats

3k Citations
2,283.74 Total Impact Points

Institutions

  • 1971–2014
    • Christian Medical College Vellore
      • • Department of Clinical Virology
      • • Department of Child Health
      Velluru, Tamil Nadu, India
  • 2010–2013
    • Mangla Hospital and Research Center
      Bijnor, Uttar Pradesh, India
    • Sri Ramachandra University
      Porur, Tamil Nādu, India
  • 1980–2012
    • Christian Medical College & Hospital
      Ludhiana, Punjab, India
  • 2006
    • American University Washington D.C.
      Washington, Washington, D.C., United States
  • 2001
    • Johns Hopkins Medicine
      • Department of Pediatrics
      Baltimore, MD, United States
  • 2000
    • Community Medical Center
      MSO, Montana, United States
  • 1994–2000
    • Christian Hospital
      Saint Louis, Michigan, United States
    • Johns Hopkins University
      • Department of International Health
      Baltimore, MD, United States
  • 1991
    • The University of Tokyo
      Tōkyō, Japan
  • 1990
    • Medical College Trivandrum
      Tiruvananantapuram, Kerala, India
  • 1986
    • International Agency for Research on Cancer
      Lyons, Rhône-Alpes, France