Draft version for the SEAR-ITAG 5-9 June 5 All data provisional as of May 5 Timor Leste 4 Immunization system highlights There is a comprehensive multi-year plan (cmyp) for immunization covering 3-5. 8% spending on vaccines financed by the government. 39% spending on routine immunization programme financed by the government. A national policy for health care waste management including waste from immunization activities exists. Timor Leste achieved maternal neonatal tetanus (MNT) elimination status in. All 3 districts have updated micro-plans that include activities to raise immunization coverage. Out of 3 districts, 7 (54%) districts had >8% coverage for DTP-Hib- HepB3 and (5%) districts had >9% coverage for MCV. (5%) districts reported more than % drop-out rate DTP-Hib-HepB to DTP- Hib-HepB3. Food and Nutrition survey, which includes immunization coverage by municipality, was conducted in 3. EPI coverage surveys in four municipalities are planned in 5-6. A national system to monitor adverse events following immunization (AEFI) exists. Table : Basic information 4 Total population,, Live births (LB) 43,94 Children < year 4,35 Children <5 years 9,34 Children <5 years 5,594 Pregnant women 48,36 Women of child bearing age (5-49 years) Neonatal mortality rate Infant mortality rate Under-five mortality rate Maternal mortality ratio Vaccine BCG OPV DTP-Hib- HepB Measles TT Vitamin A Age of administration Birth to year Birth to weeks, 6 weeks, weeks, 4 weeks 6 weeks, weeks, 4 weeks 9 months 5,46 4 (per, LB) 48 (per, LB) 57 (per, LB) 7 (per, LB) SEAR annual EPI reporting form, 4 and WHO, World Health Statistics 4 National statistic directorate (census ) Table : Immunization schedule, 4 Females 5-49 years (st pregnancy contact, + month, +6 months, + year, + year) 6 36 months Source: WHO/UNICEF joint reporting form (JRF) 4 Division/Province/State/Region - Municipality 3 Postos/Sub-district 65 Sucos/Village 44 Population density (per sq. km) 7 Population living in urban areas 9% Population using improved drinking-water sources 7% Population using improved sanitation 39% Total expenditure on health as % of GDP 4.6% Births attended by skilled health personnel 9% Neonates protected at birth against NT 8% EPI history EPI started in 978. EPI re-structured in March. DTP-HepB introduced in 7. Hib Pentavalent (DTP-Hib-HepB) introduced in. Plan to introduce DT and DTP for 5 years children in September 5. Plan to introduce IPV and MR in September 5. Source: cmyp 3-5 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 or of its authorities, or concerning the delimitation of its frontiers or boundaries. World Health Organization SEARO/FHR/IVD July 5 Immunization and Vaccine Development South-East Asia Region
EPI FACT SHEET Figure : National immunization coverage, -4 8 6 4 BCG DTP3 OPV3 MCV 4 6 8 3 4 75 7 74 85 7 68 7 8 79 54 57 63 79 7 67 83 8 77 38 57 6 79 7 66 83 8 76 56 55 6 73 66 6 73 7 74 Figure : DTP3 coverage, diphtheria and pertussis, -4 3 5 5 5 4 6 8 3 4 Diphtheria Cases Pertussis Cases DTP3 Coverage WHO/UNICEF coverage estimates 3, for 4 Country Official estimate used WHO vaccine-preventable diseases: monitoring system 4 & JRF 4. 8 6 4 Source: WHO/UNICEF coverage estimates. Figure 3: DTP-Hib-HepB3 coverage, 4 Figure 4: TT+ coverage and NT, 98-4 8 8 6 4 6 4 4 6 8 3 4 NT TT+ Coverage <7% 7% - 79% 8% - 89% > 9% Country official estimates, 98-4 WHO vaccine-preventable diseases: monitoring system 4 global summary & JRF 4. Source: SEAR annual EPI reporting form, 4 (administrative data) Table 3: OPV supplementary immunization activities (SIA), 997-4 Activity Target population (<5 years) Date of st round Date of nd round st round coverage (%) nd round coverage (%) 5 NID 77,73 (<5 yrs) Aug-5 Sep-5 93 Source: WHO/UNICEF JRF World Health Organization SEARO/FHR/IVD July 5
Table 4: AFP surveillance performance indicators, 5-4 Indicator 5 6 7 8 9 3 4 AFP 4 3 5 5 3 Wild poliovirus confirmed Compatible AFP rate.9.4.49.6...6.59 Non-polio AFP rate.46....6.59 Adequate stool specimen collection percentage 5% 33% % 4% % 67% Total stool samples collected 4 4 5 5 4 % NPEV isolation 5 % Timeliness of primary result reported 3 68 Number of discarded AFP per, children under 5 years of age. Percent with specimens, 4 hours apart and within 4 days of paralysis onset. 3 5 to 7 result reported within 8 days and 8 onwards result reported within 4 days of sample received at laboratory. Figure 5: Non-polio AFP rate by district, 4 Figure 6: Adequate stool specimen collection percentage by district, 4 <.99 > No non-polio AFP case Source: Weekly Acute Flaccid Paralysis (AFP) data Note: Three AFP are pending for classification < 6% 6% 79% Source: Weekly Acute Flaccid Paralysis (AFP) data > 8% No AFP Table 5: Reported of vaccine preventable diseases, 5-4 Polio Diphtheria Pertussis Neonatal Tetanus (% of all Tetanus) Measles Rubella Mumps Japanese Encephalitis Congenital Rubella Syndrome 5 6 3-6 6 8 9 ND ND - ND 7 4 (67%) 8 4 (67%) 9 (%) 3 7 (78%) 5 ND ND 4 (67%) 8 4 (4%) 6 8 3 (9%) 4 ND 5 ND 4 (%) 47 Source: WHO/UNICEF JRF ND=No data
Figure 7: MCV coverage and, -4 Figure 8: MCV coverage by district, 4 8 8 6 4 6 4 4 6 8 3 4 Measles Cases MCV Coverage MCV coverage WHO/UNICEF coverage estimates. WHO vaccine-preventable diseases: monitoring system 4 & JRF 4. <7% 7% - 79% 8% - 89% > 9% Source: SEAR annual EPI reporting form, 4 (administrative data) Table 6: MCV supplementary immunization activities Table 7: Districts with more than 95% MCV coverage 3 6 9 Vaccine, geographic coverage, target group M, nationwide, 9 months to 59 years M, nationwide, 6 months to 4 years M, nationwide, 9 months to 5 years M, nationwide, 6 months to 4 years Target Coverage Achieved 8,38 99% 39,687 4% 67,36 76% 494,47 9% Number of districts % 5 3 4 5 Source: WHO/UNICEF JRFs Source: WHO/UNICEF JRF (multiple years) Figure 9: Sporadic and outbreak associated * by month and Measles SIA coverage, -4 3 MR SIA (9%) 5 5 5 Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan-3 Feb-3 Mar-3 Apr-3 May-3 Jun-3 Jul-3 Aug-3 Sep-3 Oct-3 Nov-3 Dec-3 Jan-4 Feb-4 Mar-4 Apr-4 May-4 Jun-4 Jul-4 Aug-4 Sep-4 Oct-4 Nov-4 Dec-4 Sporadic Outbreak associated *Includes laboratory confirmed and epidemiologically linked Source: SEAR Monthly VPD reports Immunization and Vaccine Development South-East Asia Region
Figure : Immunity against : Immunity profile by age in 5* Percent of population % 9% 8% 7% 6% 5% 4% 3% % % % 3 4 5 6 7 8 9 3 4 5 6 7 8 9 Age (in years) Protected by maternal antibodies Protected by routine vaccination with nd dose Unprotected by vaccination * Based on coverage data for up to 4. Source: Modeled using MSP tool ver Protected by routine vaccination with st dose Protected by SIAs Figure : Immunity against : Immunity profile by age in 6* Percent of population % 8% 6% 4% % % 3 4 5 6 7 8 9 3 4 5 6 7 8 9 Age (in years) Protected by maternal antibodies Protected by routine vaccination with st dose Protected by routine vaccination with nd dose Protected by SIAs Immune due to past infection Susceptible * Assuming the schedule and coverage of st dose of Measles containing vaccine is unchanged in 5; a Measles campaign in 5 targeting age group 6 months to 5 years and the nd dose of is introduced at the age of 8 months in 5 after the campaign. Source: Modeled using MSP tool ver Figure : Confirmed (Lab and Epi linked) outbreak associated, by age, -4 Figure 3: Unimmunized confirmed (Lab and Epi linked) outbreak associated, by age, -4 4 35 3 5 5 5 n= n=8 n= n= n=46 3 4 4 35 3 5 5 5 NA ND NA NA n=8 (39%) 3 4 < year -4 years 5-9 years -4 years 5+ years < year -4 years 5-9 years -4 years 5+ years Source: SEAR annual EPI reporting form (multiple years) * For the breakup of 5-9 and -4 years age groups are combined in one Source: SEAR annual EPI reporting form (multiple years) Table 8: Suspected sporadic and Outbreak associated and rubella, -4 Routine/sporadic Outbreak associated suspected case death labconfirmed labconfirmed rubella suspected outbreak Outbreak Investigated case death outbreak* confirmed case* confirmed rubella outbreak* confirmed rubella * 5 8 8 78 3 4 4 47 5 33 Source: Monthly VPD Reporting to WHO/SEARO * Laboratory confirmed & epidemiologically- linked
EPI FACT SHEET Table 9: Quality of field and laboratory surveillance for and rubella, -4 Case classification (number) Indicators Suspected Measles Lab-confirmed Measles Epi-Linked Clinically-confirmed Rubella Lab-confirmed Epi-Linked Discarded non- non-rubella Annual incidence of confirmed Measles per million total population Annual incidence of confirmed Rubella per million total population Proportion of all suspected and rubella that have had an adequate investigation initiated within 48 hours of notification Discarded non- non-rubella incidence per, total population Proportion of subnational administrative units reporting at least two discarded non- non-rubella per, total population Proportion of sub-national surveillance units reporting to the national level on time Target - - 8% 8% 8% 8 4 5 9 6.54 4.35.3.78 3 5 4 4.4 4.4 4 47 6 4 6 4.8.83.4 Source: SEAR Annual EPI Reporting Form, 4 ND=No data Table : Performance of Laboratory Surveillance, -4 % Serum specimen collected from suspected Total Serum Specimen received in Laboratory % serum specimens tested Specimen Positive for Measles IgM Specimen Positive for Rubella IgM % Results within 4 of receipt % Outbreak tested for viral detection Genotypes detected No. % No. % Measles Rubella 46 3 4 3 3 5 4 9.49 43 6 6.3 Source: SEAR Annual EPI Reporting Form, 4 ND=No data Figure 4: Network of laboratories, 4 National Health Laboratory, Dili - National and rubella laboratory - National Japanese encephalitis laboratory For contact or feedback: Expanded Program on Immunization Ministry of Health, Dilli, Timor Leste Tel: +67-7597, Fax : +67-7597 Email: wairisi@yahoo.com.au www.moh.gov.tl Immunization and Vaccine Development (IVD) WHO-SEARO, IP Estate, MG Marg, New Delhi, India Tel: +9 33784, Fax: +9 3375 Email: SEAREpidata@who.int, www.searo.who.int/entity/immunization World Health Organization SEARO/FHR/IVD July 5 Immunization and Vaccine Development South-East Asia Region