T J John

Christian Medical College Vellore, Velluru, Tamil Nadu, India

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Publications (344)2774.87 Total impact

  • T Jacob John

    No preview · Article · Oct 2015 · Indian pediatrics
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    ABSTRACT: Background: Polio eradication needs a new routine immunisation schedule-three or four doses of bivalent type 1 and type 3 oral poliovirus vaccine (bOPV) and one dose of inactivated poliovirus vaccine (IPV), but no immunogenicity data are available for this schedule. We aimed to assess immunogenicity of this vaccine schedule. Methods: We did an open-label, randomised controlled trial in four centres in India. After informed consent was obtained from a parent or legally acceptable representative, healthy newborn babies were randomly allocated to one of five groups: trivalent OPV (tOPV); tOPV plus IPV; bOPV; bOPV plus IPV; or bOPV plus two doses of IPV (2IPV). The key eligibility criteria were: full-term birth (≥37 weeks of gestation); birthweight ≥2·5 kg; and Apgar score of 9 or more. OPV was administered at birth, 6 weeks, 10 weeks, and 14 weeks; IPV was administered intramuscularly at 14 weeks. The primary study objective was to investigate immunogenicity of the new vaccine schedule, assessed by seroconversion against poliovirus types 1, 2, and 3 between birth and 18 weeks in the per-protocol population (all participants with valid serology results on cord blood and at 18 weeks). Neutralisation assays tested cord blood and sera collected at 14 weeks, 18 weeks, 19 weeks, and 22 weeks by investigators masked to group allocation. This trial was registered with the India Clinical Trials Registry, number CTRI/2013/06/003722. Findings: Of 900 newborn babies enrolled between June 13 and Aug 29, 2013, 782 (87%) completed the per-protocol requirements. Between birth and age 18 weeks, seroconversion against poliovirus type 1 in the tOPV group occurred in 162 of 163 (99·4%, 95% CI 96·6-100), in 150 (98·0%, 94·4-99·6) of 153 in the the tOPV plus IPV group, in 153 (98·7%, 95·4-99·8) of 155 in the bOPV group, in 155 (99·4%, 96·5-100) of 156 in the bOPV plus IPV group, and in 154 (99·4%, 96·5-100) of 155 in the bOPV plus 2IPV group. Seroconversion against poliovirus type 2 occurred in 157 (96·3%, 92·2-98·6) of 163 in the tOPV group, 153 (100%, 97·6-100·0) of 153 in the tOPV plus IPV group, 29 (18·7%, 12·9-25·7) of 155 in the bOPV group, 107 (68·6%, 60·7-75·8) of 156 in the bOPV plus IPV group, and in 121 (78·1%, 70·7-84·3) of 155 in the bOPV plus 2IPV group. Seroconversion against poliovirus type 3 was achieved in 147 (90·2%, 84·5-94·3) of 163 in the tOPV group, 152 (99·3%, 96·4-100) of 153 in the bOPV plus IPV group, 151 (97·4%, 93·5-99·3) of 155 in the bOPV group, 155 (99·4%, 96·5-100) of 156 in the bOPV plus IPV group, and 153 (98·7%, 95·4-99·8) of 155 in the bOPV plus 2IPV group. Superiority was achieved for vaccine regimens including IPV against poliovirus type 3 compared with those not including IPV (tOPV plus IPV vs tOPV alone, p=0·0008; and bOPV plus IPV vs bOPV alone, p=0·0153). 12 serious adverse events occurred (six in the tOPV group, one in the tOPV plus IPV group, three in the bOPV group, zero in the bOPV plus IPV group, and two in the bOPV plus 2IPV group), none of which was attributed to the trial intervention. Interpretation: The new vaccination schedule improves immunogenicity against polioviruses, especially against poliovirus type 3. Funding: WHO, through a grant from Rotary International (grant number 59735).
    No preview · Article · Sep 2015 · The Lancet
  • T Jacob John

    No preview · Article · Sep 2015 · Indian pediatrics
  • Mukul Das · Arun Shah · T. Jacob John

    No preview · Article · Sep 2015 · Current science
  • T Jacob John

    No preview · Article · May 2015 · Indian pediatrics
  • Joseph L. Mathew · T. Jacob John · Ankit Parakh

    No preview · Article · May 2015 · Indian pediatrics
  • O. Mach · R.W. Sutter · T.J. John
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    ABSTRACT: Poliomyelitis, an acute communicable disease affecting primarily children with the major manifestation of muscle paralysis, is caused by an enterovirus - poliovirus - with previously worldwide distribution. The development of first inactivated, and then attenuated, live poliovirus vaccines in the 1950s was an historic public health achievement of the twentieth century. Although polio has been eliminated from most of the world, as of June 2014 it remains endemic in three countries (Afghanistan, Pakistan and Nigeria); and exportations of poliovirus into previously polio-free countries occur frequently, causing large outbreaks if the virus reaches areas with low population immunity. Lessons about research ethics, the selection of appropriate vaccine types for different populations, and the importance of reducing unintended side effects such as vaccine virus-induced paralysis are highlighted in this article.
    No preview · Chapter · Jan 2015
  • T Jacob John

    No preview · Article · Nov 2014 · Indian pediatrics
  • T Jacob John

    No preview · Article · Nov 2014 · Indian pediatrics
  • Arun Shah · T. Jacob John

    No preview · Article · Aug 2014 · Current science
  • 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.
    No preview · Article · Jul 2014 · Indian pediatrics
  • T. Jacob John · Mukul Das

    No preview · Article · May 2014 · Current science
  • 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.
    No preview · Article · May 2013 · The Indian Journal of Medical Research
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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.
    No preview · Article · Apr 2013 · Vaccine
  • T J John · Vipin M. Vashishtha · S M John
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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.
    No preview · Article · Jan 2013 · Indian pediatrics
  • T Jacob John · Vipin M Vashishtha

    No preview · Article · Nov 2012 · The Lancet
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    T Jacob John

    Preview · Article · Oct 2012 · Indian pediatrics
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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.
    Preview · Article · Oct 2012 · The Indian Journal of Medical Research
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    Full-text · Article · Jun 2012 · International Journal of Infectious Diseases
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    T Jacob John · Joy Sarojini Michael

    Preview · Article · Apr 2012 · Indian pediatrics

Publication Stats

4k Citations
2,774.87 Total Impact Points

Institutions

  • 1971-2015
    • Christian Medical College Vellore
      • • Department of Clinical Virology
      • • Department of Clinical Microbiology
      • • Department of Child Health
      • • Department of Nephrology
      • • Department of Medicine
      Velluru, Tamil Nadu, India
  • 1974-2012
    • Christian Medical College & Hospital
      Ludhiana, Punjab, India
  • 2010
    • Sri Ramachandra University
      Porur, Tamil Nādu, India
    • Mangla Hospital and Research Center
      Bijnor, Uttar Pradesh, India
  • 2006
    • American University Washington D.C.
      Washington, Washington, D.C., United States
  • 2000
    • Community Medical Center
      MSO, Montana, United States
    • Christian Hospital
      Saint Louis, Michigan, United States
  • 1999
    • Institute of Child Health Calcutta
      Kolkata, West Bengal, India
  • 1997
    • Johns Hopkins University
      Baltimore, Maryland, United States
  • 1990
    • Medical College Trivandrum
      Tiruvananantapuram, Kerala, India
  • 1986
    • International Agency for Research on Cancer
      Lyons, Rhône-Alpes, France