Thailand Expanded Program on Immunization. Suchada Jiamsiri, MD, MPH Division of Vaccine Preventable Diseases Ministry of Public Health, Thailand

Transcription

1 Thailand Expanded Program on Immunization Suchada Jiamsiri, MD, MPH Division of Vaccine Preventable Diseases Ministry of Public Health, Thailand

2 Outline Expanded Program on Immunization Organization Immunization schedule Monitoring New vaccines Vaccines in pipeline Vaccine prioritization Decision making for ne vaccine New immunization plateform Adult immunization clinic

3 National Immunization Framework Ministry of Public Health NHSO -Financing -Vaccine logistics Hospitals -Vaccination Dep. Of Medical Service Dep. Of Disease Control National Vaccine Institute -Vaccine policy Bureau of Epidemiology -AEFI monitoring -Disease surveillance Division of Vaccine Preventable Dis. M&E (coverage, quality of service) Operational guideline and support HR development(training) Research for vaccine policy Office of Dis. Prevention and Control -M&E at regional level -Operational support

4 Current Immunization Schedule in Thailand Month Vaccine Remark Newborn BCG After birth HB Within 24 hrs after birth 1 months HB Those who were born to Hepatitis B carrier 2 months DTP-HB1, OPV1 4 months DTP-HB2, OPV2, IPV 6 months DTP-HB3, OPV3 9 months MMR1 1 year LAJE1 1 year 6 months DTP4, OPV4 2 years 6 months LAJE2, MMR2 4 years DPT5, OPV5 7 yrs (Grade 1 student) Catch up for all vaccines 11 yrs (Grade 5 girls student) HPV1, HPV2 12 yrs (Grade 6) dt Pregnant woman dt Flu

5 Pregnant women Healthcare workers Influenza Vaccine Senior citizens (age>65 years) Children age 6 months 2 years Obese (>1 kg., BMI>35 ) Disable neuro-muscular diseases Chronic medical conditions (COPD, asthma, Heart Disease, CVA, Renal Failure, DM, HIV, Thalassemia)

6 Vaccination coverage monitoring 3- cluster survey Vaccine coverage BCG 99.9 HB DTP OPV Measles/MMR 98.1 DTP OPV JE JE DTP OPV5 79.4

7 Vaccination coverage monitoring Health Data Center (HDC) Hospitals Provicial Health Office Users Essential data 43 folders Standard index

8 Vaccination coverage monitoring Health Data Center (HDC)

9 Vaccine Coverage and Disease Incident Poliomyelitis Measles Neonatal Tetanus Diphtheria Pertussis Encephalitis Vaccine coverage Case rate/1, and case / 1, live births for NNT

10 New vaccines in pipeline HPV Rotavirus vaccine Vaccine prioritization

11 New vaccines in pipeline 1. HPV vaccine Nation wide introduction in 217 Evaluation in 218

12 Rotavirus Vaccine in Thailand ACIP considered Rotavirus vaccine as potential vaccine Started RV effectiveness study Result reported to ACIP Launched Rotavirus vaccine End of Study demonstration project Submitted to NEDL 12

13 Challenges in RV Introduction Burden of disease Perception of diarrhea in Thailand Competing priorities Perception on disease prevention Lengthy new vaccines decision chain Financing for immunization

14 Financing for Vaccines in EPI Single party: NHSO 1.29 billion baht for the vaccines in million baht on basic vaccines 337 million baht on flu vaccine Budget impact for new vaccines 3 million baht for HPV 42 million baht for rotavirus vaccine

15 Burden Dis. severity Efficacy Safety Budget impact Vaccine production Score Social equity CEA New Vaccines Prioritization Vaccines Tdap ± (I) DTwP-HB-Hib + IPV 1 dose n/a Rabies (T) DTwP-HB-Hib + IPV 5 doses (T) Influenza (I) DTaP-HB-Hib-IPV n/a PCV (I) / - (T) Varicella ± (I) Hep A n/a MR n/a DTaP ± (I) Dengue (T) Herpes ± (I)

16 New Vaccines Prioritization Rank Vaccines Target population Tdap Influenza DTwP-HB-Hib DTwP-HB-Hib-IPV MR PCV Dengue Varicella Hep A Rabies (pre-exposure) DTaP-HB-Hib-IPV Zoster Pregnant women Pregnant women (year round) Children under 5 years Children under 5 years Healthcare workers Children under 5 years School student Children under 5 years Children under 5 years Children under 5 years Children under 5 years Senior

17 If the vaccine is considered potential to be in national immunization program Go through NHSO budgetary processes in case of high budget impact Full clearance of all criteria and final approval by the NEDL subcom STEP 1 ID and vaccine WG STEP 2 ACIP Health Economic WG Price Negotiation WG Coordination WG New licensed vaccine NEDL subcommittee P&P subcommittee NHSO approval for vaccine procurement budget Benefit package ubcommittee Financing subcommittee Epidemiology/Dz burden/effectiveness/ Progammatic feasibility/ Overall policy on P&P + CEA CEA/Budget impact/system capacity/equity 17

18 SEVENTIETH WORLD HEALTH ASSEMBLY 217 WHA7.14 Strengthening immunization to achieve the goals of the global vaccine action plan URGES Member States: (4) to expand immunization services beyond infancy to cover the whole life course, as appropriate, guided by evidence, including on the burden of disease, cost effectiveness, budget impact assessment and system capacities, and using the most appropriate and effective means of reaching the other age groups and high-risk populations with immunization and integrated health services;

19 Adult Immunization Clinic Technical Review recommendations for immunization in adult Developing national adult immunization schedule Adult immunization demonstration clinic Established in 217 Area: 4 districts in 4 provinces Evaluation: ongoing Scale up plan: 12 provinces in 218 Vaccines in the demonstration clinic Influenza vaccine in pregnancy (year round) dt vaccine for adult age 2, 3, 3, 4, 5, 6,..