Expanded Programme on Immunization (EPI)

Transcription

1 Indonesia 217 Expanded Programme on Immunization (EPI) FACT SHEET

2 Acronyms AD Auto disable MCV1 First dose measles containing vaccine AEFI Adverse events following immunization MCV2 Second dose measles containing vaccine AFP Acute flaccid paralysis MICS Multiple indicator cluster survey BCG Bacillus Calmette-Guérin vaccine MMR Measles mumps rubella vaccine CES Coverage evaluation survey MNT Maternal and neonatal tetanus cmyp Comprehensive multi-year plan MR Measles rubella vaccine CRS Congenital rubella syndrome NCIP National committee on immunization practices DHS Demographic health survey NID National immunization day DT Diphtheria tetanus toxoid, pediatric NTAGI National technical advisory group on immunization DTP Diphtheria tetanus pertussis vaccine NPEV Non-polio enterovirus DTP-Hib-HepB Pentavalent vaccine NT Neonatal tetanus DTP-Hib-HepB3 3rd dose pentavalent vaccine OPV Oral poliovirus vaccine EPI Expanded programme on immunization bopv Bivalent OPV GDP Gross domestic product topv Trivalent OPV HCW Health care worker PCV Pneumococcal conjugate vaccine HepB Hepatitis B vaccine SEAR WHO South-East Asia Region Hib Haemophilus influenzae type b SIA Supplementary immunization activities HPV Human papilloma virus SNID Subnational immunization day IgM Immunoglobulin M Td Tetanus diphtheria toxoid; older children, adults IPV Inactivated poliovirus vaccine TT Tetanus toxoid JE Japanese encephalitis TT2+ 2 or more doses TT JE_Live-Atd JE live attenuated vaccine VDPV Vaccine derived poliovirus JRF WHO UNICEF joint reporting form VPD Vaccine preventable diseases LB Live birth WCBA Women of child bearing age M Measles WPV Wild poliovirus

3 Contents Impact of routine immunization EPI history 5 Basic information 216 Table 1 5 Immunization schedule 216 Table 2 5 National immunization coverage Figure 1 6 Immunization system highlights Table 3 6 DTP3 coverage, diphtheria and pertussis cases Figure 2 7 Reported cases of vaccine preventable diseases Table 4 7 DTP-Hib-HepB3 coverage by province 215 Figure 3 7 DTP-Hib-HepB3 coverage by province 216 Figure 4 7 Maternal and neonatal tetanus elimination is sustained TT2+ coverage and NT cases Figure 5 8 Polio-free status is maintained Page No. Page No. Page No. AFP surveillance indicators Table 5 9 Non-polio AFP rate by province 215 Figure 6 9 Non-polio AFP rate by province 216 Figure 7 9 Environmental surveillance sites for polio detection Figure 8 1 Adequate stool specimen collection percentage by province 215 Figure 9 1 Adequate stool specimen collection percentage by province 216 Figure 1 1 OPV supplementary immunization activities Table 6 1 Towards measles elimination and rubella/congenital rubella syndrome control Page No. MCV1 and MCV2 coverage, measles and rubella cases, Figure MCV supplementary immunization activities Table 7 11 MCV1 coverage by province 215 Figure MCV1 coverage by province 216 Figure MCV2 coverage by province 215 Figure MCV1 coverage by province 216 Figure Immunity against measles immunity profile by age in 216 Figure Subnational risk assessment for measles and rubella Figure Sporadic and outbreak associated measles cases by month Figure Immunization status of confirmed (laboratory and EPI linked) measles outbreak associated cases by age Figure Quality of field and laboratory surveillance for measles and rubella Table 8 14 Performance of laboratory surveillance Table 9 14 WHO supported laboratory network for VPD surveillance Figure 2 15

4 WHO South-East Asia Region Indonesia: province level map 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. 4

5 Impact of routine immunization Table 1: Basic information EPI history EPI launched in 1977 HepB vaccine introduced in 1997 AD syringe introduced in 22 MCV2 introduced in 24 DTP-HepB vaccine introduced in 24 (in phases) IPV introduced in one province in 27 Pentavalent vaccine introduced in four provinces in 213 and expanded to all provinces by 214 topv to bopv switched on 4 April 216 IPV vaccine launched in national routine immunization programme from July 216. Source: cmyp and EPI/MOH Total population 258,74,986 Live births 4,858,6 Children <1 year 4,76,891 Children <5 years 23,96,31 Children <15 years 7,96,861 Pregnant women 5,312,1 WCBA (15-49 years) 52,172,843 Neonatal mortality rate 13.5 (per 1, LB) Infant mortality rate 22.8 (per 1, LB) Under-five mortality rate 27.2 (per 1, LB) Maternal mortality ratio 126 (per 1, LB) 1 SEAR annual EPI reporting form, 216 and WHO, World Health Statistics 216 Table 2: Immunization schedule, 216 Vaccine Age of administration HepB Birth to 7 days BCG 1 month OPV 1 month, 2 months, 3 months and 4 months DTP-Hib-HepB 2 months, 3 months, 4 months and 18 months Measles 9 months and 24 months DT 6 to 7 years Td 7 to 8 years and 8 to 9 years TT 15 to 39 years Vitamin A 6 to 59 months IPV 4 months Source: WHO/UNICEF JRF, Division/Province/State/Region 34 District 514 City 98 Village 79,411 Population density (per sq. km) 132 Population living in urban areas 52% Population using improved drinking-water sources 85% Population using improved sanitation 59% Total expenditure on health as % of GDP 3.% Births attended by skilled health personnel 83% Neonates protected at birth against NT 85%

6 Figure 1: National immunization coverage, % Coverage BCG DTP OPV MCV Source: WHO/UNICEF estimates of national immunization coverage, July 217 revision Table 3: Immunization system highlights cmyp for immunization NTAGI fully functional Spending on vaccines financed by the government 9% Spending on routine immunization programme financed by the government 88% Updated micro-plans that include activities to improve immunization coverage National policy for health care waste management including waste from immunization activities National system to monitor AEFI Most recent EPI CES no data in place in place Basic Health Survey 213, District Coverage Survey in 1 provinces and 31 districts 215 >8% coverage for DTP-Hib-HepB3 375 districts (73%) >9% coverage for MCV1 263 districts (51%) >1% drop-out rate for DTP-Hib-HepB1 to DTP-Hib-HepB3 55 districts (11%) Assessment of vaccine hesitancy at national level 213 Source: WHO/UNICEF JRF, 216 6

7 Figure 2: DTP3 coverage 1, diphtheria and pertussis cases 2, DTP-Hib-HepB3 coverage by province Figure 3: 215 No. of cases % Coverage 2 2 Source: SEAR annual EPI reporting form, 215 (administrative data) Year Diphtheria Cases Pertussis Cases DTP3 Coverage 1 WHO/UNICEF estimates of national immunization coverage, July 217 revision 2 WHO vaccine-preventable diseases: monitoring system 216 Figure 4: 216 Table 4: Reported cases of vaccine preventable diseases, Year Polio Diphtheria Pertussis NT (% of all Tetanus) Measles Rubella Mumps JE CRS , (54%) 21,893 1,959 ND ND ND 212 1,192 ND 16 15,489 1,2 ND ND ND , (35%) 8,419 2,355 ND ND ND ,82 75 (7%) 12,943 3,542 ND 72 ND (ND) 9, ND (6%) 6,962 1,238 ND Source: WHO/UNICEF JRF (multiple years) ND=No data Source: SEAR annual EPI reporting form, 216 (administrative data) <7% 7% - 79% 8% - 89% >9% 7

8 Maternal and neonatal tetanus elimination is sustained Figure 5: TT2+ coverage 1 and NT cases 2, MNT elimination in May No. of cases % Coverage Year NT Cases TT2+ Coverage WHO/Indonesia 1 WHO/UNICEF JRF, Country official estimates, WHO vaccine-preventable diseases: monitoring system 216 8

9 Polio-free status is maintained Table 5: AFP surveillance performance indicators, The last polio case due to WPV was reported from Tenggara district, Aceh on 2 February 26. Indicator AFP cases 1,72 1,951 1,963 1,765 1,428 1,398 Wild poliovirus confirmed cases Compatible cases Non-polio AFP rate Adequate stool specimen collection percentage 2 91% 92% 88% 89% 92% 87% Total stool samples collected 3,386 3,828 3,826 3,424 2,81 2,683 % NPEV isolation % Timeliness of primary result reported Number of discarded AFP cases per 1, children under 15 years of age. 2 Percent with 2 specimens, at least 24 hours apart and within 14 days of paralysis onset. 3 Results reported within 14 days of sample received at laboratory. Non-polio AFP rate by province Figure 6: 215 Figure 7: 216 WHO/Indonesia < >2 No non-polio AFP case 9

10 Figure 8: Environmental surveillance sites for poliovirus detection Adequate stool specimen collection % by province Figure 9: 215 Yogyakarta - 1 site Jakarta - 1 site West Java - 1 site Figure 1: 216 Table 6: OPV SIAs Year Antigen Geographic coverage Target age Target population Coverage (%) Round 1 Round 2 Round 1 Round 2 22 OPV NID <5 years 2,31, OPV NID <5 years 23,426, OPV NID <5 years 23,62, OPV NID <5 years 23,62, OPV SNID <5 years 4,523,187 6,45, OPV SNID <5 years 12,517, OPV SNID* <5 years 2,52, OPV SNID* <5 years 4,322, OPV SNID* <5 years 13,958, OPV NID <5 years 23,721,4 22,883,91 96 * During measles campaign Source: WHO/UNICEF JRF (multiple years) <6% 6% - 79% >8% No AFP 1

11 Towards measles elimination and rubella/crs control Figure 11: MCV1 and MCV2 coverage 1, measles and rubella cases 2, No. of cases Year Measles Cases Rubella MCV1 Coverage MCV2 Coverage 1 WHO/UNICEF estimates of national immunization coverage, July 217 revision 2 WHO vaccine-preventable diseases: monitoring system % Coverage Table 7: MCV SIAs Year Antigen Geographic Coverage Target group Target Coverage % 2 M Subnational 6 to 12 years 6,665, M Subnational 6 to 12 years 1,3, M Subnational 6 to 12 years 2,18, M Subnational 26 M Subnational 6 months to 15 years 6 months to 5 years 5,515, ,978, M Subnational 6 to 12 years 3,161, M Subnational 6 months to 12 years 2,692, M Subnational 6 to 12 years 2,569, M Subnational 6 to 59 months 14,916, M Subnational 1 to 3 years 11, M Subnational 21 M Subnational 211 M Subnational 216 M nationwide Source: WHO/UNICEF JRF (multiple years) 9 to 59 months 9 to 59 months 9 to 59 months 9 to 59 months 1,763, ,619, ,843, ,222,

12 MCV1 coverage by province Figure 12: 215 Source: SEAR annual EPI reporting form, 215 (administrative data) Figure 13: 216 Figure 16: Immunity against measles - immunity profile by age in 216* Percent of population 1% 8% 6% 4% 2% Source: SEAR annual EPI reporting form, 216 (administrative data) MCV2 coverage by province Figure 14: 215 % Age (in years) Protected by maternal antibodies Protected by routine vaccination with 1st dose Protected by routine vaccination with 2nd dose Protected by SIAs Immune due to past infection Susceptible * Modeled using MSP tool ver 2 assuming the schedule and MCV coverage remain unchanged and Measles SIAs in 18 high risk districts in 216. Figure 17: Sub-national risk assessment - measles and rubella Source: SEAR annual EPI reporting form, 215 (administrative data) Figure 15 : 216 Source: SEAR annual EPI reporting form, 216 (administrative data) Very high risk High risk Medium risk Low risk Not available Source: developed using WHO risk assessment tool based on JRF & ARF data base <8% 8% - 89% 9% - 94% >95% 12

13 Figure 18: Sporadic and outbreak associated measles cases* by month and No of cases Sporadic measles Outbreak associated measles 1 Jan-11 Mar-11 May-11 Jul-11 Sep-11 Nov-11 Jan-12 Mar-12 May-12 Jul-12 Sep-12 Nov-12 Jan-13 Mar-13 *Includes laboratory confirmed and epidemiologically linked cases Source: SEAR Monthly VPD reports May-13 Figure 19: Immunization status of confirmed (laboratory and EPI linked) measles outbreak associated cases, by age, < 1 year 1-4 years 5-9 years 1-14 years > 15 years < 1 year 1-4 years 5-9 years 1-14 years > 15 years < 1 year 1-4 years 5-9 years 1-14 years > 15 years < 1 year 1-4 years 5-9 years 1-14 years > 15 years < 1 year 1-4 years 5-9 years 1-14 years > 15 years < 1 year 1-4 years 5-9 years 1-14 years > 15 years Jul-13 Sep-13 Nov-13 Jan-14 Mar-14 May-14 Jul-14 Sep-14 Nov-14 Jan-15 Mar-15 May-15 Jul-15 Sep-15 Nov-15 Jan-16 Mar-16 May-16 Jul-16 Sep-16 Nov-16 WHO/Indonesia Immunized Not immunized/ unknown Source: SEAR annual EPI reporting form ( ) 13

14 Table 8: Surveillance performance indicators for measles and rubella, Case classification (number) Indicators Year No. of suspected measles Lab-confirmed Measles EPI-linked Clinically-confirmed Lab-confirmed Rubella EPI-linked Discarded non-measles non-rubella cases Annual incidence of confirmed measles cases per million total population Annual incidence of confirmed rubella cases per million total population Proportion of all suspected measles and rubella cases that have had an adequate investigation initiated within 48 hours of notification Discarded non-measles non-rubella incidence per 1, total population Proportion of provinces reporting at least two discarded non-measles non-rubella cases per 1, total population Proportion of sub-national surveillance units reporting to the national level on time Target - - 8% 2 8% 8% , ND ND 1,565 ND 1, ND.61 ND , ND ND 742 ND 1, ND.54 ND ,943 2,241 ND ND 96 ND 2, ND 1.3 ND , ND ND 826 ND 1, ND.57 ND ,11 2,541 ND 5,495 1,193 ND 2, ND.96 ND ND Source: SEAR annual EPI reporting form ( ) ND=No data Table 9: Performance of laboratory surveillance, Year Serum specimen collected from suspected measles cases Serum specimen received in laboratory within 5 days of collection Specimen positive for measles IgM Specimen positive for rubella IgM % Results within 4 days of receipt % Positive cases tested for viral detection No (%) No (%) No. % No. % Measles Rubella 212 4,657 (25) 4,657 (25) 43 1% % 68 ND ND ND 213 5,169 (45) 5,169 (45) 996 2% 1,42 25% 97 ND ND ND 214 8,448 (69) 8,448 (69) 5,194 62% 1,14 36% 6 2 ND ND ,68 (83) 11,68 (83) 2,511 22% 4,239 47% 4 ND ND ND ,939 15,939 4,946 41% 1,899 16% 57 3 ND ND Source: SEAR annual EPI reporting form ( ) ND=No data Genotypes detected 14

15 Figure 2: WHO supported laboratory network for VPD surveillance Polio, measles & rubella laboratories National Institute of Health Research and Development (NIHRD), Jakarta Biofarma, Bandung Public Health Laboratory, Surabaya Measles & rubella laboratories Public Health Laboratory, Yogyakarta Public Health Laboratory, Palembang Public Health Laboratory, Makassar Public Health Laboratory, Jakarta Japanese encephalitis laboratories NIHRD, Jakarta Public Health Laboratory, Denpasar Source: EPI Indonesia 15

16 For contact or feedback: Expanded Programme on Immunization Ministry of Health, Jakarta, Indonesia Tel : , Fax: primayosephine@yahoo.com Immunization and Vaccine Development (IVD) WHO-SEARO, IP Estate, MG Marg, New Delhi 112, India Tel: , Fax: SearEpidata@who.int