Expanded Programme on Immunization (EPI)

Timor-Leste 217 Expanded Programme on Immunization (EPI) FACT SHEET

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

Contents Impact of routine immunization EPI history 5 Basic information 216 Table 1 5 Immunization schedule 216 Table 2 5 National immunization coverage 198-216 Figure 1 6 Immunization system highlights Table 3 6 DTP3 coverage, diphtheria and pertussis cases 198-216 Figure 2 7 Reported cases of vaccine preventable diseases 211-216 Table 4 7 DTP-Hib-HepB3 coverage by district 215 Figure 3 7 DTP-Hib-HepB3 coverage by district 216 Figure 4 7 Maternal and neonatal tetanus elimination is sustained TT2+ coverage and NT cases 198-216 Figure 5 8 Polio-free status is maintained Page No. Page No. Page No. AFP surveillance indicators 211-216 Table 5 9 Non-polio AFP rate by district 215 Figure 6 9 Non-polio AFP rate by district 216 Figure 7 9 Adequate stool specimen collection percentage by district 215 Figure 8 1 Adequate stool specimen collection percentage by district 216 Figure 9 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, 198-216 Figure 1 11 MCV supplementary immunization activities Table 7 11 MCV1 coverage by district 215 Figure 11 12 MCV1 coverage by district 216 Figure 12 12 MCV2 coverage by district 215 Figure 13 12 MCV1 coverage by district 216 Figure 14 12 Immunity against measles immunity profile by age in 216 Figure 15 12 Subnational risk assessment for measles and rubella Figure 16 12 Sporadic and outbreak associated measles cases by month 211-216 Figure 17 13 Immunization status of confirmed (laboratory and Epi linked) measles outbreak associated cases by age 211 216 Figure 18 13 Quality of field and laboratory surveillance for measles and rubella 212-216 Table 8 14 Performance of laboratory surveillance 212-216 Table 9 14 WHO supported laboratory network for VPD surveillance Figure 19 15

WHO South-East Asia Region Timor-Leste: district 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

Impact of routine immunization Table 1: Basic information 1 216 EPI history EPI started in 1978 EPI re-structured in March 2 DTP-HepB vaccine introduced in 27 DTP-Hib-HepB) vaccine introduced in 212 MR vaccine introduced in Feb 216 Second dose of MR introduced in Feb 216 HepB birth dose introduced in Feb 216 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) 154,65 Neonatal mortality rate 22.3 (per 1, LB) Infant mortality rate 44.7 (per 1, LB) Under-five mortality rate 52.6 (per 1, LB) Maternal mortality ratio 215 (per 1, LB) 1 SEAR annual EPI reporting form, 216 and WHO, World Health Statistics 216 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 7% 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% DPT/DT vaccine (booster dose) introduced in Feb 216 IPV introduced in Feb 216 topv to bopv switched on 18 April 216. Source: cmyp 216-22 and EPI/MOH Table 2: Immunization schedule, 216 Vaccine Age of administration BCG Birth OPV Birth, 6 weeks, 1 weeks and 14 weeks DTP-Hib-HepB 6 weeks, 1 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 years Source: WHO/UNICEF JRF, 216 5

Figure 1: National immunization coverage, 198-216 1 8 % Coverage 6 4 2 22 24 26 28 21 214 215 216 BCG 75 72 74 85 79 84 84 85 DTP3 54 57 63 79 72 77 76 85 OPV 38 57 62 79 72 76 75 83 MCV1 56 55 61 73 66 74 7 78 Source: WHO/UNICEF estimates of national immunization coverage, July 217 revision Table 3: Immunization system highlights cmyp for immunization 216-22 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 (1%) National policy for health care waste management including waste from immunization activities National system to monitor AEFI Most recent EPI CES in place in place EPI CES Dili municipality and 12 other municipalities 215 >8% coverage for DTP-Hib-HepB3 13 districts (1%) >9% coverage for MCV1 7 districts (54%) >1% drop-out rate for DTP-Hib-HepB1 to DTP-Hib-HepB3 no district Source: WHO/UNICEF JRF, 216 6

Figure 2: DTP3 coverage 1, diphtheria and pertussis cases 2, 198-216 3 1 DTP-Hib-HepB3 coverage by district 25 8 No. of cases 2 15 1 6 4 % Coverage Figure 3: 215 5 2 22 24 26 28 21 211 Year 212 213 214 215 216 Source: SEAR annual EPI reporting form, 215 (administrative data) 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, 211-216 Year Polio Diphtheria Pertussis NT (% of all tetanus) Measles Rubella Mumps JE CRS 211 4 2 (67%) 82 212 4 (4%) 16 8 Source: SEAR annual EPI reporting form, 216 (administrative data) 213 1 1 (9%) 4 ND 5 ND 214 2 47 1 215 1 5 48 5 ND 216 6 2 8 1 Source: WHO/UNICEF JRF (211-216) ND=No data <7% 7% - 79% 8% - 89% > 9% 7

Maternal and neonatal tetanus elimination is sustained Figure 5: TT2+ coverage 1 and NT cases 2, 198-216 MNT elimination in 212 1 1 8 8 No. of cases 6 4 6 4 % Coverage 2 2 22 24 26 28 21 211 212 213 214 215 216 Year WHO/Timor-Leste/S Singh 1 WHO/UNICEF JRF, Country official estimates, 198-216 2 WHO vaccine-preventable diseases: monitoring system 216 NT Cases TT2+ Coverage 8

Polio-free status is maintained Table 5: AFP surveillance performance indicators, 211-216 Indicator 211 212 213 214 215 216 AFP cases 5 5 3 1 Wild poliovirus confirmed cases Compatible cases Non-polio AFP rate 1 1. 1.61.59. 1.87 Adequate stool specimen collection percentage 2 4% 2% 67% 5 Total stool samples collected 5 5 4 - % NPEV isolation - % Timeliness of primary result reported 3 1 68 1-1 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 district Figure 6: 215 Figure 7: 216 WHO/Timor-Leste/S Singh <1 1 1.99 >2 No non-polio AFP case 9

Adequate stool specimen collection % by district Figure 8: 215 Figure 9: 216 <6% 6% - 79% >8% No AFP Table 6: OPV SIAs Year Vaccine Geographic coverage Target age Target population Coverage (%) Round 1 Round 2 Round 1 Round 2 25 OPV NID <5 years 177,713 93 12 215* OPV NID <5 years 522,943-96 - * During MR vaccination campaign. Source: WHO/UNICEF JRF 1

Towards measles elimination and rubella/crs control Figure 1: MCV1 and MCV2 coverage 1, measles and rubella cases 2, 198-216 Table 7: MCV SIAs 12 763 1 Year Antigen Geographic coverage Target group Target Coverage % 1 8 23 M nationwide 9 to 59 months 128,318 99 No. of cases 8 6 4 2 No data 22 24 26 28 21 211 212 213 214 215 216 6 4 2 % Coverage 26 M nationwide 29 M nationwide 211 M nationwide 6 months to 14 years 9 to 59 months 6 months to 14 years 39,687 4 167,136 76 494,427 92 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 216 215 MR nationwide 6 months to 14 years 51,832 97 Source: WHO/UNICEF JRF, (multiple years) 11

MCV1 coverage by district Figure 15: Immunity against measles - immunity profile by age in 216* 1% Figure 11: 215 Source: SEAR annual EPI reporting form, 215 (administrative data) Percent of population 8% 6% 4% 2% Figure 12: 216 MCV2 coverage by district Source: SEAR annual EPI reporting form, 216 (administrative data) % 1 2 3 4 5 6 7 8 9 1 11 12 13 14 15 16 17 18 19 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 in 216. Figure 16: Sub-national risk assessment -measles and rubella Figure 13: 215 Source: SEAR annual EPI reporting form, 215 (administrative data) Figure 14 : 216 Very high risk High risk Medium risk Low risk Not available Source: SEAR annual EPI reporting form, 216 (administrative data) <8% 8% - 89% 9% - 94% >95% 12 Source: developed using WHO risk assessment tool based on JRF & ARF data base

Figure 17: Sporadic and outbreak associated measles cases* by month 211-216 4 35 No of cases 3 25 2 15 Sporadic measles Outbreak associated measles 1 5 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 *Includes laboratory confirmed and epidemiologically linked cases Source: SEAR Monthly VPD reports Figure 18: Immunization status of confirmed (laboratory and EPI linked) measles outbreak associated cases, by age, 211-216 2 18 16 14 12 1 8 6 4 2 WHO/Timor-Leste/S Singh 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 211 212 213 214 215 216 Immunized Not immunized/ unknown Source: SEAR annual EPI reporting form (211-216) 13

Table 8: Surveillance performance indicators for measles and rubella, 212-216 Case classification (number) Indicators Year No. of suspected measles Lab-confirmed Measles EPI-linked Clinically-confirmed Lab-confirmed Rubella EPI-linked Discarded non-measles nonrubella 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 nonrubella incidence per 1, total population Proportion of districts reporting at least two discarded non-measles nonrubella cases per 1, total population Proportion of sub-national surveillance units reporting to the national level on time Target - - 8% 2 8% 8% 212 28 4 15 9 16.54 4.35 11.31.78 1 213 5 1 4 4.24 4.24 1 214 47 26 5 1 16 21..83 1 1.25 15 1 215 48 6 15 4 18 5. 4.16 75 1.83 15 1 216 132 2 13 9 121 15.1 68.1 1 8.4 ND 1 Source: SEAR annual EPI reporting form (212-216) ND=No data Table 9: Performance of laboratory surveillance, 212-216 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 13 (46%) 13 (1%) 4 31 213 1 (25%) 1 (1%) 1 1 1 214 43 (91%) 43 (1%) 26 72 1 2.77 1 215 34 (71%) 34 (1%) 6 18 5 15 1 216 119 (9%) 119 (1%) 2 1.7 9 7.6 1 Source: SEAR annual EPI reporting form (212-216) ND=No data Genotypes detected 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 Immunization Ministry of Health, Dilli, Timor-Leste Tel: +67-77351964, Fax: +67-72597 Email: mmausiry@gmail.com www.moh.gov.tl Immunization and Vaccine Development (IVD) WHO-SEARO, IP Estate, MG Marg, New Delhi 112, India Tel: +91 11 233784, Fax: +91 11 2337251 Email: SearEpidata@who.int www.searo.who.int/entity/immunization