DPR Korea 4 Immunization system highlights There is a comprehensive multiyear plan (cmyp) for immunization covering -5. A standing national technical advisory group on immunization (NTAGI) with formal written terms of reference exists. A national system to monitor adverse events following immunization (AEFI) exists. Table : Basic information 4 Total population 4,759, Live births (LB) 4,458 Children < year 7,95 Children <5 years,698,664 Children <5 years 5,,9 Pregnant women 4,794 Women of child bearing age (5-49 years) 6,578,987 Division/Province/State/Region District Population density (per sq. km) Population living in urban areas 6% Population using improved drinking-water sources 98% Population using improved sanitation 8% Total expenditure on health as % of GDP - A national policy for health care waste management including waste from immunization activities exists. A national seasonal influenza vaccination policy does not exist. DPR Korea achieved the status of maternal neonatal tetanus (MNT) elimination before. Neonatal mortality rate 6 (per, LB) Births attended by skilled health personnel % Infant mortality rate (per, LB) Neonates protected at birth against NT 9% Under-five mortality rate 9 (per, LB) Maternal mortality ratio 87 (per, LB) SEAR annual EPI reporting form, 4 and WHO, World Health Statistics 4 8% spending on vaccines financed by the government. 4% spending on routine immunization financed by the government. All districts have >8% coverage for DTP-Hib-HepB, >9% coverage for MCV. No district reported more than % drop-out rate from DTP-Hib- HepB to DTP-Hib-HepB. A coverage evaluation survey (CES) is planned in the next 4 months. IPV introduced in April 5. Table : Immunization schedule, 4 Vaccine Age of administration BCG At birth HepB At birth DTP-Hib-HepB 6 weeks, weeks, 4 weeks OPV 6 weeks, weeks, 4 weeks Measles 9 months and 5 months Td months, 4 months Source: WHO/UNICEF joint reporting form (JRF) 4 EPI history Vaccine production unit was set up in 946. EPI launched in 98. Hepatitis B introduced in. AD syringes introduced in. Hepatitis B birth dose introduced in 4. DTP-HepB introduced in 6. MCV introduced in 8. Hib Pentavalent (DTP-Hib-HepB) introduced in. Source: cmyp -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, 98-4 8 6 4 98 985 99 995 5 4 BCG 5 5 99 8 78 94 98 98 98 98 98 DTP 5 55 98 64 56 79 9 94 96 9 9 OPV 5 65 99 88 9 97 99 99 99 99 99 MCV 9 8 98 67 78 96 99 99 99 99 99 Source: WHO/UNICEF coverage estimates. Figure : DTP coverage, diphtheria and pertussis, 98-4 8 6 4 8 6 4 98 985 99 995 5 4 Diphtheria Cases Pertussis Cases DTP Coverage WHO/UNICEF coverage estimates. WHO vaccine-preventable diseases: monitoring system 4 & JRF 4. 8 6 4 Figure : DTP-Hib-HepB coverage by province, 4 Figure 4: TT+ coverage and NT, 98-4 4 98 985 99 995 5 4 NT TT+ coverage 8 6 4 <7% 7% - 79% 8% - 89% > 9% Source: SEAR annual EPI reporting form, 4 (administrative data) Country official estimates, 98-4 WHO vaccine-preventable diseases: monitoring system 4 & JRF 4. Table : OPV and JE Supplementary immunization activities (SIA) Antigen Activity Target population (age) Date of st round Date of nd round st round coverage (%) nd round coverage (%) OPV NID,47,99 (<5 years) Oct- Nov- 99.6 99.7 OPV NID,,8 (<5 years) Oct- Nov- 98.8 99.5 OPV NID,98,94 (<5 years) Oct- Nov- 99.7 99.8 9- JE Subnational.5 million ( to months and 4 to 6 years) Jul-9 Jul- - 99.5 - Source: WHO/UNICEF JRF World Health Organization SEARO/FHR/IVD July 5
Table 4: AFP surveillance performance indicators, 5-4 The last laboratory confirmed polio case due to wild polio virus (WPV) was reported in 996. Indicator 5 6 7 8 9 4 AFP 85 5 8 9 5 6 5 Wild poliovirus confirmed Compatible AFP rate.7.86.95.5.95.95.5.8.. Non-polio AFP rate.7.86.95.5.95.95.5.8.. Adequate stool specimen collection percentage 96% 99% % % % 99% % % % % Total stool samples collected 7 7 58 8 45 7 69 6 84 % NPEV isolation 5 7 9 9 % Timeliness of primary result reported 95 88 9 97 9 97 99 94 9 99 Number of discarded AFP per, children under 5 years of age. Percent with specimens, 4 hours apart and within 4 days of paralysis onset. 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 province, 4 Figure 6: Adequate stool specimen collection percentage entage by province, 4 <.99 > No non-polio AFP case < 6% 6% 79% > 8% No AFP Table 5: Reported of vaccine preventable disease, 5-4 Polio Diphtheria Pertussis Neonatal Tetanus (% of all Tetanus) Measles Rubella Mumps Japanese Encephalitis Congenital Rubella Syndrome 5 49 87 ND 6 49 76 7,5,55 76 8 95 8 8 67 4 9 8 8 ND ND ND 5 66 8 4 Source: WHO/UNICEF JRF ND=No data
Figure 7: MCV & MCV coverage and, 98-4 Figure 8: MCV coverage by province, 4 4 5 5 5 5 98 985 99 995 5 6 7 8 9 4* Measles Cases MCV Coverage MCV coverage 8 6 4 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 7 Vaccine, geographic coverage, target group M, nationwide, 6 month to 45 years Source: WHO/UNICEF JRFs Target Coverage Achieved Coverage (%) 6,,76 99.9 95 Number of districts % 8 8 8 9 4 Source: WHO/UNICEF JRF (multiple years) Figure 9: Sporadic and outbreak associated * by month and MR SIA coverage, -4 5 9 7 5 No monthly VPD report since Mar-4 - 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- Feb- Mar- Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- 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 and WHO/UNICEF coverage estimates revision (July 4). 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% % % % % 4 5 6 7 8 9 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 * Based on coverage and SIA data up to 4 Source: Modeled using MSP tool ver Figure : Immunity against : Immunity profile by age in 6* Percent of population % 9% 8% 7% 6% 5% 4% % % % % 4 5 6 7 8 9 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 routine coverage for st and nd dose of Measles containing vaccine stays constant 99% at current vaccination schedules Source: Modeled using MSP tool ver Figure : Confirmed (Lab and Epi linked) outbreak associated, by age, -4 Figure : Unimmunized confirmed (Lab and Epi linked) outbreak associated, by age, -4 4 n= n= n= n= n=4 4 n= n= n= n= n= (%) (%) (%) (%) (75%) 4 < year -4 years 5-9 years -4 years 5+ years 4 < year -4 years 5-9 years -4 years 5+ years Source: SEAR annual EPI reporting form (multiple years) 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 * 7 66 58 4 # 4 Source: Monthly VPD Reporting to WHO/SEARO, # Data up to March 4 only. No monthly VPD report since March 4 * 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% 66 65.7 6 6.6 4 5..5 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 66 % % % ND ND 6 % % % ND ND 4 5 % % % ND ND Source: SEAR Annual EPI Reporting Form, 4 ND=No data Figure 4: Laboratory Network Central Hygiene Anti Epidemic Institution - National polio laboratory - National & rubella laboratory For contact or feedback: Expanded Program on Immunization Ministry of Public Health, Pyongyang, DPR Korea Phone: +85--8477, Fax: +85--44446 Email: bogon.moph@star-co.net.kp Immunization and Vaccine Development (IVD) WHO-SEARO, IP Estate, MG Marg, New Delhi, India Tel: +9 784, Fax: +9 75 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