epi presesentation for gavi
TRANSCRIPT
Data as of 15 Sep 2012
Immunization Services in Myanmar
1
Presentation outline
• Immunization and VPD status in Myanmar
• EPI Updates in 2012
• Upcoming events in late 2012 and onwards
• Future Plan in 2013 onwards
2
0
10
20
30
40
50
60
70
80
90
100
% C
over
age
BCG 9 45 95 90 88 76 85 89 88 93 93 93
DTP3 4 16 88 84 82 80 91 97 98 99 99 86
OPV3 3 88 84 87 82 92 96 98 99 99 90
MCV1 68 82 84 80 89 95 98 99 99 88
1980 1985 1990 1995 2000 2005 2006 2007 2008 2009 2010 2011
Routine immunization coverage(1980-2011)
Data as of 15 Sep 2012
OPV supplementary immunization activities, 2001-2011
Year NID/ SNID
TargetPopulation(<5 years)
Coverage (%) by round
First Second
2001/2002 NID 6,116,532 97 982002/2003 NID 6,251,093 97 972003/2004 SNID 771,081 95 992005 SNID 337,085 121 1272006 SNID 104,572 100 1002006 SNID 2,037,606 97 972007 SNID 415,554 116 1012007 SNID 2,416,960 102 992007 NID 7,207,399 98 982008 SNID 1,825,117 99 -2009 NID 7,394,415 98 1002010 SNID 2,229,394 98 1002011 SNID 2,925,709 98 99
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Measles supplementary immunization activities
Year Region Coverage
1995 Sub- National 95%
1997 Sub- National 96%
2002 Sub- National 88%
2003 Sub- National 90%
2004 Sub- National 76%
2007 National 94%
2012 National 97%
Data as of 15 Sep 2012
Tetanus Toxoid Supplementary Immunization Activities
in high risked townshipsYear Activity Achievement
1999-2006 187 High Risk Townships(3 Rounds) 6.74 Millions WCBA> 80% Coverage
2007-2008 87 Townships 2.58 Million WCBA88% Coverage
2009 7 Townships 0.16 Million WCBA96.5 % Coverage
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Data as of 15 Sep 2012
Current EPI Schedule in Myanmar
Age Vaccines
At Birth BCG, HepB ( Hospital births)
6 weeks DPT -1, OPV -1, HepB
10 weeks DPT -2, OPV -2, HepB
14 weeks DPT -3, OPV-3, HepB
9 months Measles - 1
Penta-1 + OPV-1
Penta-2 + OPV-2
Penta-3 + OPV-3
2 month
4 month
6 month
18 month
New EPI Schedule after New Vaccines Introduction
Measles - 2
Data as of 15 Sep 2012
DTP3 coverage and Diphtheria and Pertussis cases, 1990-2012
DPT3 Coverage and Diphtheria and Pertussis Cases, 1990-2012
181 110 44 92 85 28 15 5 22 18 38 18 50 12 1 4 3 5 3 19 4 7 17
4882
2455
1379
15921745
873
331
120 46 34 49 1008 13 13 5 3 0 4 2196135
0
1000
2000
3000
4000
5000
6000
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Year
Cas
es
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90
100
% C
ove
rag
e
Diphtheria Cases Pertussis Cases DPT Coverage
Data as of 15 Sep 2012
Reported Diphtheria cases 2011-2012
1 Dot = 1 case
2011 (7 cases)
2012 (17 cases)
Data as of 15 Sep 2012
TT2+ coverage1 and NT cases( 1990-2012)
46
189
96
125
87
75
59
47
75
93
6166
72
48 49
3541
49
2534
19
3223
0
50
100
150
20019
90
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
0
20
40
60
80
100
Cases TT2+ Coverage
%C
ove
rag
e
Reported Neonatal Tetanus cases and reported TT2 coverage Myanmar 1990-2012
Ca
se
s
TT2+
3883
6243
4437
1700
2692
3530
11681684
10571465
792 845
2519
736 8301329
314760
1088
333 329 337
2046 1926
189 19 71 40 2 15 29 6 2 23 58 22 2 46 13 12 10 1 4 9 3 1 7
16368
1600
2000
4000
6000
8000
10000
12000
14000
16000
18000
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
No
. o
f ca
ses
0
10
20
30
40
50
60
70
80
90
100
Cases Deaths Routine Coverage
Co
vera
ge
Routine Measles Immunization Coverage and Reported Measles CasesMyanmar, 1990-2012
** Laboratory confirmed measles cases only from Measles case based surveillance
** **
Measles SIA
2002-2004 2007 2012
Trends of Measles Cases by MonthMyanmar, 2006-2012
0
100
200
300
400
500
600
700
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
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
2006 2007 2008 2009 2010 2011 2012
Measles SIA (2007)
Targeted - 6,104,592 (9m-5yrs Children)
Immunized - 5721726 (94%)
Measles SIA (2012)
Targeted – 6,432,064 (9m-5yrs Children)
Immunized – 6267535 (97%)
Ca
se
ba
se
d s
urv
eil
lan
ce
Routine Measles coverage
<60%
60%-79%
>=80%
Vaccination status of measles cases
Confirmed Measles cases Age group
Grand Total
Vaccination Status 0-11 Months 1-4 Years 5-9 Years 10-14
Years 15+ Years Unknown
1 - Yes 20 176 166 129 94 4 5892 - No 160 349 322 172 193 18 12149 - Unknown 4 48 56 56 76 3 243(blank) 1 1Grand Total 184 573 544 357 363 26 2047
Measles Cases by State and RegionMyanmar, 2010-2012
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Recent History of Polio Cases in Myanmar 2007,2010,2012
2007
P1 WPV cases Rakhine = 11 Onset of last case = 31-5-2007
P1 VDPV casesYangon = 1Kayin = 1Bago (East) = 1Mon = 1Onset of last case = 06-12-2007
2010
P2 VDPV caseMandalayDate of Onset = 06-12-2010
Source: CEU, DOH, Ministry of Health
2012
P1 VDPV case Northern Shan StateLaukkaing Township Date of onset = 29-5-2012
Pocket areas for routine immunizationSilent areas for AFP reportingBorder areas with migrationCultural barriers, Security barriers
EPI Updates in 2012
15
2012 - Year of Intensification of Routine Immunization
• Launching ceremony (12-9-12)- attended by – HE Union Minister for Health – National Health Committee– Partners– INGOs– NGOs– Related government departments– Media
• IRI campaign • Advocacy to States/ Regional governments (planning)
Phase 1 (84 Townships) Phase 2 (117 Townships)
179 Townships had RHC with DTP3 < 80% in 2011.
Reason for un vaccinated children at RHC Cat.1 Physically/ geographically hard to reach 16%Cat.2 Mobile population/ socially hard to reach population 26%Cat.3 Midwife vacancy/ absent/ imbalance proportion of MW 19%Cat.4 Weak community participation/ involvement 0%Cat.5 Security limitation 6%Cat.6 DPT Vaccine shortage 15%Cat.7 High target/ low birth rate 16%Cat.8 Other 3%
Source- CEPI
Strengthening RI is Strengthening RI is National PrioritiesNational Priorities
NoName of village/ Ward
Distance from S/C
Mode of travel to village/ Ward
Immunization Strategies
Total Target
Reason for Uncovered
/Unreached
Monthly routine (Fixed,
Outreach &
Mobile)
RECUncovered
/ Unreached
Service delivery- MOH have asked grass root level to explore any uncovered for assistance since 2010-2011.
Therefore IRI is the opportunity to encourage them to explore the unreached and to get help from the higher levels.
Strengthening RI is our PriorityStrengthening RI is our Priority
All areas of programme had been discussed.Some changes are- • New schedule for feasible microplanning and vaccine
administration• National prioritized NUV and booster doses depending on
resources• Immunization card policy at school entry
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National Policy and Strategy Workshop onImmunization and VPD Surveillance (August 2012)
Cold chain management
1. Effective Vaccine management (EVM) assessment in November 2011- CC improvement plan
2. Temperature mapping study (August 2012)3. Temperature monitoring study (August- November 2012)4. Effective vaccine management training to all sub-depot
(cold stores) (September 2012) 1. Planned cold chain functioning in all health care facilities for
least defect before New vaccine introduction.2. Planned CC policy workshop at the end of 2012.
Capacity building
1. Strengthening AEFI surveillance and National level workshop (26 to 30 April 2012) (New guideline- in progress)
2. Building national capacity for evidence-based decision makingNCIP Workshop- (9 to 11 July 2012)
3. Mid Level Manager training- national level(1 to 5 July 2012)
4. Mid Level Manager training- States/ regional level• One- third of Township Medical Officers are newly
recruited.
Communication
- Community demand generating approach- Media workshop (The last week of October 2012)
Finding evidence
1. Sub-national immunization coverage survey after November 2012 (After introduction of Pentavalent vaccine)
2. Sero-surveillance for Polio and Measles in high risk townships (in process)
3. Impact study after introduction of Hib containing vaccine (planning)
4. Sentinel surveillance for NUV ( planning)
Others
1. National Mass Measles follow up Campaign (March 2012)97% coverage of 6-4 millions (9 months to 5 years)
2. Introduction of Hib containing pentavalent vaccine3. Introduction of second dose of measles