expanded programme on immunization (epi) · pdf fileimmunization status of confirmed...

Timor-Leste 2017

FACT SHEET

Expanded Programme on Immunization (EPI)

Acronyms

AD Auto disable

AEFI Adverse events following immunization

AFP Acute flaccid paralysis

BCG Bacillus Calmette-Guérin vaccine

CES Coverage evaluation survey

cMYP Comprehensive multi-year plan

CRS Congenital rubella syndrome

DHS Demographic health survey

DT Diphtheria tetanus toxoid, pediatric

DTP Diphtheria – tetanus – pertussis vaccine

DTP-Hib-HepB Pentavalent vaccine

DTP-Hib-HepB3 3rd dose pentavalent vaccine

EPI Expanded programme on immunization

GDP Gross domestic product

HCW Health care worker

HepB Hepatitis B vaccine

Hib Haemophilus influenzae type b

HPV Human papilloma virus

IgM Immunoglobulin M

IPV Inactivated poliovirus vaccine

JE Japanese encephalitis

JE_Live-Atd JE live attenuated vaccine

JRF WHO UNICEF joint reporting form

LB Live birth

M Measles

MCV1 First dose measles containing vaccine

MCV2 Second dose measles containing vaccine

MICS Multiple indicator cluster survey

MMR Measles mumps rubella vaccine

MNT Maternal and neonatal tetanus

MR Measles rubella vaccine

NCIP National committee on immunization practices

NID National immunization day

NTAGI National technical advisory group on immunization

NPEV Non-polio enterovirus

NT Neonatal tetanus

OPV Oral poliovirus vaccine

bOPV Bivalent OPV

tOPV Trivalent OPV

PCV Pneumococcal conjugate vaccine

SEAR WHO South-East Asia Region

SIA Supplementary immunization activities

SNID Subnational immunization day

Td Tetanus diphtheria toxoid; older children, adults

TT Tetanus toxoid

TT2+ 2 or more doses TT

VDPV Vaccine derived poliovirus

VPD Vaccine preventable diseases

WCBA Women of child bearing age

WPV Wild poliovirus

Contents

Impact of routine immunization Page No.

EPI history 5

Basic information 2016 Table 1 5

Immunization schedule 2016 Table 2 5

National immunization coverage 1980 - 2016 Figure 1 6

Immunization system highlights Table 3 6

DTP3 coverage, diphtheria and pertussis cases 1980 - 2016 Figure 2 7

Reported cases of vaccine preventable diseases 2011 - 2016 Table 4 7

DTP-Hib-HepB3 coverage by district 2015 Figure 3 7

DTP-Hib-HepB3 coverage by district 2016 Figure 4 7

Towards measles elimination and rubella/congenital rubella syndrome control

Page No.

MCV1 and MCV2 coverage, measles and rubella cases, 1980-2016 Figure 10 11

MCV supplementary immunization activities Table 7 11

MCV1 coverage by district 2015 Figure 11 12




Immunity against measles – immunity profile by age in 2016 Figure 15 12

Subnational risk assessment for measles and rubella Figure 16 12

Sporadic and outbreak associated measles cases by month 2011 - 2016 Figure 17 13

Immunization status of confirmed (laboratory and Epi linked) measles outbreak associated cases by age 2011 – 2016 Figure 18 13

Quality of field and laboratory surveillance for measles and rubella 2012 - 2016 Table 8 14

Performance of laboratory surveillance 2012 - 2016 Table 9 14

WHO supported laboratory network for VPD surveillance Figure 19 15

Maternal and neonatal tetanus elimination is sustained Page No.

TT2+ coverage and NT cases 1980 - 2016 Figure 5 8

Polio-free status is maintained Page No.

AFP surveillance indicators 2011 - 2016 Table 5 9

Non-polio AFP rate by district 2015 Figure 6 9

Non-polio AFP rate by district 2016 Figure 7 9

Adequate stool specimen collection percentage by district 2015 Figure 8 10

Adequate stool specimen collection percentage by district 2016 Figure 9 10

OPV supplementary immunization activities Table 6 10

WHO South-East Asia Region

Disclaimer: The boundaries and names shown and the designations used on all the maps do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area of its authorities, or concerning the delimitation of its frontiers or boundaries.

Timor-Leste: district level map

4

EPI history

• EPI started in 1978

• EPI re-structured in March 2000

• DTP-HepB vaccine introduced in 2007

• DTP-Hib-HepB) vaccine introduced in 2012

• MR vaccine introduced in Feb 2016

• Second dose of MR introduced in Feb 2016

• HepB birth dose introduced in Feb 2016

• DPT/DT vaccine (booster dose) introduced in Feb 2016

• IPV introduced in Feb 2016

• tOPV to bOPV switched on 18 April 2016 .

Source: cMYP 2016-2020 and EPI/MOH

Table 1: Basic information1 2016

Total population 1,231,262

Live births 35,426

Children <1 year 33,548

Children <5 years 176,377

Children <15 years 493,795

Pregnant women 38,969

WCBA (15-49 years) 154,605

Neonatal mortality rate 22.3 (per 1,000 LB)

Infant mortality rate 44.7 (per 1,000 LB)

Under-five mortality rate 52.6 (per 1,000 LB)

Maternal mortality ratio 215 (per 100,000 LB)1SEAR annual EPI reporting form, 2016 and WHO, World Health Statistics 2016

Division/Province/State/Region -

Municipalities 13

Postos/Sub-district 65

Sucos/Village 442

Population density (per sq. km) 71

Population living in urban areas 32%

Population using improved drinking-water sources 70%

Population using improved sanitation 39%

Total expenditure on health as % of GDP 1.4%

Births attended by skilled health personnel 21%

Neonates protected at birth against NT 81%

Table 2: Immunization schedule, 2016

Vaccine Age of administration

BCG Birth

OPV Birth, 6 weeks, 10 weeks and 14 weeks

DTP-Hib-HepB 6 weeks, 10 weeks and 14 weeks

MR 9 months and 18 months

TT Females 15 to 49 years (1st pregnancy contact, +1 month, +6 months, +1 year, +1 year)

Vitamin A 6 to 36 months (with 6 months interval)

IPV 14 weeks

DT 6 yearsSource: WHO/UNICEF JRF, 2016

Impact of routine immunization

5

Figure 1: National immunization coverage, 1980-2016

% C

over

age

0

20

40

60

80

100

Source: WHO/UNICEF estimates of national immunization coverage, July 2017 revision

Table 3: Immunization system highlights

cMYP for immunization 2016-2020

NTAGI fully functional

Spending on vaccines financed by the government 76%

Spending on routine immunization programme financed by the government 39%

Updated micro-plans that include activities to improve immunization coverage 13 districts (100%)

National policy for health care waste management including waste from immunization activities in place

National system to monitor AEFI in place

Most recent EPI CES EPI CES Dili municipality and 12 other municipalities 2015

>80% coverage for DTP-Hib-HepB3 13 districts (100%)

>90% coverage for MCV1 7 districts (54%)

>10% drop-out rate for DTP-Hib-HepB1 to DTP-Hib-HepB3 no district

Source: WHO/UNICEF JRF, 2016

2002 2004 2006 2008 2010 2014 2015 2016BCG 75 72 74 85 79 84 84 85DTP3 54 57 63 79 72 77 76 85OPV 38 57 62 79 72 76 75 83MCV1 56 55 61 73 66 74 70 78

6

Figure 3: 2015

Figure 4: 2016

Source: SEAR annual EPI reporting form, 2016 (administrative data)


Figure 2: DTP3 coverage1, diphtheria and pertussis cases2, 1980-2016

Year

Diphtheria Cases Pertussis Cases DTP3 Coverage

% C

over

age

No.

of c

ases

2016201520142013201220112010200820062002 20040

5

10

15

20

25

30

0

20

40

60

80

100

1WHO/UNICEF estimates of national immunization coverage, July 2017 revision2WHO vaccine-preventable diseases: monitoring system 2016

Table 4: Reported cases of vaccine preventable diseases, 2011-2016

Year Polio Diphtheria Pertussis NT(% of all tetanus) Measles Rubella Mumps JE CRS

2011 0 0 4 2 (67%) 802 0 0 0 0

2012 0 0 0 4 (40%) 16 8 0 0 0

2013 0 1 0 1 (9%) 4 0 ND 5 ND

2014 0 2 0 0 47 1 0 0 0

2015 0 1 5 0 48 5 ND 0 0

2016 0 0 6 0 2 8 0 1 0

Source: WHO/UNICEF JRF (2011-2016) ND=No data

DTP-Hib-HepB3 coverage by district

<70% 70% - 79% 80% - 89% > 90%

7

% C

over

age

No.

of c

ases

Year

NT Cases TT2+ Coverage

0

2

4

6

8

10

0

20

40

60

80

100

2002 2004 2006 2008 2010 2011 2012 2013 2014 2015 2016

Figure 5: TT2+ coverage1 and NT cases2, 1980-2016

1 WHO/UNICEF JRF, Country official estimates, 1980-20162WHO vaccine-preventable diseases: monitoring system 2016

Maternal and neonatal tetanus elimination is sustained

MNT elimination in 2012

© WHO/Timor-Leste/S Singh

8

Table 5: AFP surveillance performance indicators, 2011-2016

Indicator 2011 2012 2013 2014 2015 2016

AFP cases 0 5 5 3 0 10

Wild poliovirus confirmed cases 0 0 0 0 0 0

Compatible cases 0 0 0 0 0 0

Non-polio AFP rate1 0 1.00 1.61 0.59 0.00 1.87

Adequate stool specimen collection percentage2 0 40% 20% 67% 0 50

Total stool samples collected 0 5 5 4 0 -

% NPEV isolation 0 0 0 0 0 -

% Timeliness of primary result reported3 0 100 68 100 0 -1Number of discarded AFP cases per 100,000 children under 15 years of age. 2Percent with 2 specimens, at least 24 hours apart and within 14 days of paralysis onset.3Results reported within 14 days of sample received at laboratory.

Figure 6: 2015 Figure 7: 2016

Polio-free status is maintained

Non-polio AFP rate by district

<1 1 – 1.99

>2 No non-polio AFP case


9

Table 6: OPV SIAs

Year Vaccine Geographic coverage Target age

Target population Coverage (%)

Round 1 Round 2 Round 1 Round 2

2005 OPV NID <5 years 177,713 93 102

2015* OPV NID <5 years 522,943 - 96 -

* During MR vaccination campaign.Source: WHO/UNICEF JRF

Adequate stool specimen collection % by district

Figure 9: 2016Figure 8: 2015

<60% 60% - 79%

>80% No AFP

10

Towards measles elimination and rubella/CRS control

Figure 10: MCV1 and MCV2 coverage1, measles and rubella cases2, 1980-2016

Measles Cases Rubella MCV1 Coverage MCV2 Coverage

763

% C

over

age

No.

of c

ases

Year

0

20

40

60

80

100

120

0

20

40

60

80

100

2002 2004 2006 2008 2010 2011 2012 2013 2014 2015 2016

No data

1WHO/UNICEF estimates of national immunization coverage, July 2017 revision2WHO vaccine-preventable diseases: monitoring system 2016

Table 7: MCV SIAs

Year Antigen Geographic coverage Target group Target Coverage

%

2003 M nationwide 9 to 59 months 128,318 99

2006 M nationwide 6 months to 14 years 390,687 40

2009 M nationwide 9 to 59 months 167,136 76

2011 M nationwide 6 months to 14 years 494,427 92

2015 MR nationwide 6 months to 14 years 501,832 97

Source: WHO/UNICEF JRF, (multiple years)

11

0%

20%

40%

60%

80%

100%

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

Per

cent

of p

opul

atio

n

Age (in years)Protected by maternal antibodies Protected by routine vaccination with 1st doseProtected by routine vaccination with 2nd dose Protected by SIAsImmune due to past infection Susceptible

Figure 15: Immunity against measles - immunity profile by age in 2016*

* Modeled using MSP tool ver 2 assuming the schedule and MCV coverage remain unchanged in 2016.

<80% 80% - 89% 90% - 94% >95%


Figure 12: 2016

Figure 11: 2015


Figure 14 : 2016

Figure 13: 2015



Figure 16: Sub-national risk assessment -measles and rubella

MCV1 coverage by district

MCV2 coverage by district

Source: developed using WHO risk assessment tool based on JRF & ARF data base

Very high riskHigh riskMedium riskLow riskNot available

12

Figure 17: Sporadic and outbreak associated measles cases* by month 2011-2016

Sporadic measles

Outbreak associated measles

No

of c

ases

0

5

10

15

20

25

30

35

40

Dec-

16No

v-16

Oct-1

6Se

p-16

Aug-

16Ju

l-16

Jun-

16M

ay-1

6Ap

r-16

Mar

-16

Feb-

16Ja

n-16

Dec-

15No

v-15

Oct-1

5Se

p-15

Aug-

15Ju

l-15

Jun-

15M

ay-1

5Ap

r-15

Mar

-15

Feb-

15Ja

n-15

Dec-

14No

v-14

Oct-1

4Se

p-14

Aug-

14Ju

l-14

Jun-

14M

ay-1

4Ap

r-14

Mar

-14

Feb-

14Ja

n-14

Dec-

13No

v-13

Oct-1

3Se

p-13

Aug-

13Ju

l-13

Jun-

13M

ay-1

3Ap

r-13

Mar

-13

Feb-

13Ja

n-13

Dec-

12No

v-12

Oct-1

2Se

p-12

Aug-

12Ju

l-12

Jun-

12M

ay-1

2Ap

r-12

Mar

-12

Feb-

12

*Includes laboratory confirmed and epidemiologically linked casesSource: SEAR Monthly VPD reports

Figure 18: Immunization status of confirmed (laboratory and EPI linked) measles outbreak associated cases, by age, 2011-2016

2011 2012 2013 2014 2015 2016Immunized Not immunized/ unknown

0

2

4

6

8

10

12

14

16

18

20

> 1

5 ye

ars

10-1

4 ye

ars

5-9

year

s1-

4 ye

ars

< 1

yea

r>

15

year

s10

-14

year

s5-

9 ye

ars

1-4

year

s<

1 y

ear

> 1

5 ye

ars

10-1

4 ye

ars

5-9

year

s1-

4 ye

ars

< 1

yea

r>

15

year

s10

-14

year

s5-

9 ye

ars

1-4

year

s<

1 y

ear

> 1

5 ye

ars

10-1

4 ye

ars

5-9

year

s1-

4 ye

ars

< 1

yea

r>

15

year

s10

-14

year

s5-

9 ye

ars

1-4

year

s

Source: SEAR annual EPI reporting form (2011-2016)


13

Table 8: Surveillance performance indicators for measles and rubella, 2012-2016

Year

No.

of s

uspe

cted

mea

sles

Case classification (number) Indicators

Measles Rubella

Disc

arde

d no

n-m

easle

s non

-ru

bella

cas

es

Annu

al in

cide

nce

of

confi

rmed

mea

sles c

ases

per

m

illio

n to

tal p

opul

ation

Annu

al in

cide

nce

of

confi

rmed

rube

lla c

ases

per

m

illio

n to

tal p

opul

ation

Prop

ortio

n of

all

susp

ecte

d m

easle

s and

rube

lla c

ases

th

at h

ave

had

an a

dequ

ate

inve

stiga

tion

initi

ated

with

in

48 h

ours

of n

otific

ation

Disc

arde

d no

n-m

easle

s non

-ru

bella

inci

denc

e pe

r 100

,000

to

tal p

opul

ation

Prop

ortio

n of

dist

ricts

re

porti

ng a

t lea

st tw

o di

scar

ded

non-

mea

sles n

on-

rube

lla c

ases

per

100

,000

to

tal p

opul

ation

Prop

ortio

n of

sub-

natio

nal

surv

eilla

nce

units

repo

rting

to

the

natio

nal l

evel

on

time

Lab-

confi

rmed

EPI-l

inke

d

Clin

ical

ly-c

onfir

med

Lab-

confi

rmed

EPI-l

inke

d

Target ➔ - - 80% 2 80% 80%

2012 28 4 0 15 0 0 9 16.54 4.35 11.31 0.78 0 100

2013 5 1 0 4 0 0 0 4.24 0 4.24 0 0 100

2014 47 26 0 5 1 0 16 21.0 0.83 100 1.25 15 100

2015 48 6 0 15 4 0 18 5.0 4.16 75 1.83 15 100

2016 132 2 0 130 9 0 121 15.1 68.1 100 8.4 ND 100Source: SEAR annual EPI reporting form (2012-2016) ND=No data

Year

Seru

m sp

ecim

en

colle

cted

from

su

spec

ted

mea

sles c

ases

Seru

m sp

ecim

en

rece

ived

in

labo

rato

ry

with

in 5

day

s of

colle

ction

Spec

imen

po

sitive

for

mea

sles I

gM

Spec

imen

po

sitive

for

rube

lla Ig

M

% R

esul

ts w

ithin

4

days

of r

ecei

pt

% P

ositi

ve c

ases

te

sted

for v

iral

dete

ction

Geno

type

s de

tect

ed

No (%) No (%) No. % No. % Measles Rubella

2012 13 (46%) 13 (100%) 4 31 0 0 0 0 0 0

2013 1 (25%) 1 (100%) 1 100 0 0 100 0 0 0

2014 43 (91%) 43 (100%) 26 72 1 2.77 100 0 0 0

2015 34 (71%) 34 (100%) 6 18 5 15 100 0 0 0

2016 119 (90%) 119 (100%) 2 1.7 9 7.6 100 0 0 0Source: SEAR annual EPI reporting form (2012-2016) ND=No data

Table 9: Performance of laboratory surveillance, 2012-2016

14

Figure 19: WHO supported laboratory network for VPD surveillance

National Health Laboratory, Dili• National measles and rubella laboratory• National Japanese encephalitis laboratory

15

For contact or feedback:Expanded Programme on ImmunizationMinistry of Health, Dilli, Timor-LesteTel: +670-77351964, Fax: +670-7250097Email: [email protected]

Immunization and Vaccine Development (IVD)WHO-SEARO, IP Estate, MG Marg, New Delhi 110002, IndiaTel: +91 11 23370804, Fax: +91 11 23370251Email: [email protected]/entity/immunization

expanded programme on immunization (epi) · pdf fileimmunization status of confirmed...

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