Maldives 2011

World Health Organization• SEARO/FHR/IVD • 29 August 2012 Immunization andVaccine Development

South-East Asia Region

Maldives is an archipelago in the Indian ocean situated on the equator at approximately 7° north to 0° south latitudes and between 72° to 73° eastern longitudes consisting of 1,192 low-lying coral islands that form a chain about

823 km long and 130 wide within an area of 90,000 square kilometers of which land area is only 300 square kilometers and only 196 islands are inhabited. The average island is small with a land area of 58 hectares. Maldives is a home of three hundred thousand people and annual population growth rate is 1.5 (2000-2010). Forty percent population lives in urban areas. National expanded programme on immunization (EPI) was begun in 1976. Despite of challenges and hardship, Maldives was able to achieve universal childhood immunization (UCI) in 1988 almost two years ahead of the target 1990.

Source: Comprehensive multi-year plan 2009-2013 and WHO, world health statistics 2012

Table 1: Basic information1 2011Division/Province/State/Region 7

Atoll/District 20

City 2

Island (inhabited) 196

Total Islands 1192

Population density (per sq. km) 1053

Population living in urban areas 40%

Population using improved drinking-water sources

98%

Population using improved sanitation 97%

Total expenditure on health as % of GDP 6.4

Literacy rate among adults aged >15 years 98

Births attended by skilled health personnel 95%

Vaccine Age of administration

BCG At birth

OPV Birth, 6 weeks, 10 weeks, 14 weeks

HepB Birth, 6 weeks, 10 weeks

DTP 6 weeks, 10 weeks, 14 weeks

Measles 9 months

MMR 18 months

TT 15 to 45 years CBAW, +1 month, +6 months, +1 year, +1 year

DT 5 years

Vitamin A 9 months, 18 months, 24 months and +6 months

Influenza +15 years pilgrims

Men ACWY +15 years pilgrims

YF +18 years travellers

EPI historyn Launched on 1976 and made available to

all target groups by 1988.n Hepatitis B introduced in 1993.n Meningococcus introduced in 2004

(high-risk groups)n MR introduced in 2006n MMR introduced in 2007.n Plan to introduce DTP-Hib-HepB in 2012.

Source: cMYP 2009-2013

Immunization system highlights

n There is a comprehensive multi-year plan (cMYP) for immunization covering 2009-2013.

n All 20 Atolls have updated micro-plans that include activities to improve immunization coverage.

n A standing technical advisory group on immunization is available. It has formal written terms of reference.

n Cold chain equipment inventory was updated in 2011.

n All Atolls have >80% coverage for DTP3, >90% coverage for MCV1 and >80% coverage for TT2+ in pregnant women.

n No district reported more than 10% drop-out rate DTP1 to DTP3.

n Demographic health survey was conducted in 2009. A coverage survey is planned in the next 24 months.

n Vaccine wastage rates 2011: BCG=75%, DTP=45%, OPV=28%, MCV=26% and TT=40%.

n A national policy for health care waste management including waste from immunization activities is available.

n A national system to monitor adverse events following immunization (AEFI) is available. 22 AEFI were reported and no event was categorized as “serious” in 2011.

n 100% of all spending on vaccine was government financed.

n 100% of all spending on routine immunization was government financed.

n The latest AFP/VPD surveillance and EPI review was completed in 2006. Next VPD surveillance review is planned for 2012.

n For intensification of routine immunization in 2012, Maldives has a plan to reach high-risk areas, migrant/un-reached population and low performing areas.

Total population 325,135

Live births 7,478

Children <1 year 7,395

Children <5 years 30,568

Children <15 years 87,635

Pregnant women 7,478

Women of child bearing age (15-44 years)

79,893

Crude birth rate (per 1000 population)

16.8

Neonates protected at birth against NT

95%

Neonatal mortality rate 9 (per 1000 LB)

Infant mortality rate 14 (per 1000 LB)

Under-five mortality rate 15 (per 1000 LB)

Maternal mortality ratio 60 (per 100000 LB) 1 SEAR Annual EPI Reporting Form, 2011 and WHO, World Health Statistics, 2012.

Table 2: Immunization schedule, 2011

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.

Source: WHO/UNICEF joint reporting form (JRF) 2011

E P I F a c t S h E E t

World Health Organization• SEARO/FHR/IVD • 29 August 2012

Source: WHO/UNICEF estimates, 2012

Figure 2: DTP3 coverage1, diphtheria and pertussis cases2, 1980-2011

Figure 3: DTP3 coverage by atoll, 2011

Figure 5: MCV1 coverage by atoll, 2011

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1 WHO/UNICEF estimates, 20122 WHO vaccine-preventable diseases: monitoring system 2012 global summary

1 WHO/UNICEF estimates, 20122 WHO vaccine-preventable diseases: monitoring system 2012 global summary

Source: SEAR annual EPI reporting form, 2011 (administrative data)

Source: SEAR annual EPI reporting form, 2011 (administrative data)

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1980 1985 1990 1995 2000 2005 2006 2007 2008 2009 2010 2011

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Measles cases MCV1 coverage

<70% 70% - 79% 80% - 89% > 90%

<70% 70% - 79% 80% - 89% > 90%

Figure 4: MCV1 coverage1 and measles cases2, 1980-2011

Figure 1: National immunization coverage, 1980-2011

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BCG 7 45 99 99 99 99 99 99 99 99 97 98

DTP3 4 28 94 94 98 98 98 98 98 98 96 96

OPV3 4 28 94 97 98 98 98 98 98 98 97 96

MCV1 47 96 96 99 97 97 97 97 98 97 96

1980 1985 1990 1995 2000 2005 2006 2007 2008 2009 2010 2011

Immunization andVaccine Development

South-East Asia Region

1 Country official estimates, 1980-20112 WHO vaccine-preventable diseases: monitoring system 2012 global summary

Table 3: Supplementary immunization activities, 1997-2011

Figure 7: Network of laboratories, 2011

Figure 6: TT2+ coverage1 and NT cases2, 1980-2011

Source: NCCPE report and WHO/UNICEF JRF

• Maldivesachievedthematernalneonataltetanus(MNT)eliminationstatusbefore2000.

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1980 1985 1990 1995 2000 2005 2006 2007 2008 2009 2010 2011Year

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NT cases TT2+ coverage

Indira Gandhi Memorial Hospital - National measles/rubella laboratory

Invasive bacterial diseases (IBD) laboratory- Indira Gandhi Memorial Hospital- ADK Hospital

Rotavirus laboratory- Medical Research Institute (Colombo, Sri Lanka)

Source: EPI Maldives, August 2012

Year Antigen Activity Target population (age)Dates by SIA round Coverage (%) by round

First Second First Second

1997/98 OPV NID 40,000 (<5 yrs) 18-Dec-97 18-Jan-98 43 40

1998/99 OPV NID 39,000 (<5 yrs) 18-Dec-98 18-Jan-99 41 44

1999/00 OPV NID 38,000 (<5 yrs) 18-Dec-99 18-Jan-00 47 50

2000/01 OPV NID 37,500 (<5 yrs) 18-Dec-00 18-Jan-01 53 53

2001/02 OPV SNID 35,000 (<5 yrs) 18-Dec-01 18-Jan-02 29 14

2003-2005 No SIAs reported

2005 MR NID 144,997 (6 to 25 yrs men and 6 to 35 women)

4-Dec-05 - 82 -

2006 MR NID 144,997 (6 to 25 yrs men and 6 to 35 women)

May-Jun 2006 - 85 -

2007 MMR NID 29,529 (4 to 6 yrs) Apr-Dec 2007 - 56 -

2008-2011 No SIAs reported

World Health Organization• SEARO/FHR/IVD • 29 August 2012 Immunization andVaccine Development

South-East Asia Region

E P I F a c t S h E E t

Indicator 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

AFP cases 4 1 0 1 1 0 0 4 4 3

Wild polio 0 0 0 0 0 0 0 0 0 0

Compatibles 0 0 0 0 0 0 0 0 0 0

AFP rate 3.28 0.97 0 0.97 1.04 0 0 4.40 4.53 3.40

Non-polio AFP rate1 3.28 0.97 0 0 1.04 0 0 4.40 4.53 3.40

Adequate stool collection rate2 25% 100% 0 0 100% 0 0 50% 50% 33%

Total stool samples collected 5 2 0 0 2 0 0 6 4 2

% NPEV 0 0 0 0 0 0 0 0 0 0

% Timeliness of primary result reported3 100 0 0 0 0 0 0 100 100 0

1 Number of discarded AFP cases per 100,000 children under 15 years of age.2 Percent with 2 specimens 24 hours apart and within 14 days of paralysis onset.3 2002 to 2007 result reported within 28 days and 2008 onwards result reported within 14 days of sample received at laboratory.

Year Polio Diphtheria Pertussis Total Tetanus Neonatal Tetanus (% of all Tetanus)

Measles Rubella Mumps Japanese Encephalitis

2002 ND ND ND ND ND 926 ND ND -

2003 ND ND ND ND ND 77 81 ND -

2004 ND 0 ND ND ND 37 ND 44 -

2005 0 0 0 0 0 1,395 3 5,410 -

2006 0 0 0 0 0 47 0 5,349 ND

2007 0 0 0 0 0 20 ND 341 ND

2008 0 0 0 0 0 2 ND 114 ND

2009 0 0 0 0 0 6 0 71 0

2010 0 0 0 0 0 0 4 50 0

2011 0 0 0 3 0 0 1 69 0

Table 5: Reported cases of vaccine preventable diseases, 2002-2011

Table 4: AFP surveillance performance indicators, 2002-2011

Figure 8: Acute flaccid paralysis (AFP) cases, 2009-2011

Data as of 30 July 2012

For contact or feedback:

Expanded Program on Immunization (EPI) Centre for Community Health and Disease Control,

Ministry of Health, Male, Maldives.

Tel: +960-3014498, Fax : +960-3014484

Email: thimna@health.gov.mv, www.health.gov.mv

Immunization and Vaccine Development (IVD)WHO-SEARO, IP Estate, MG Marg, New Delhi 110002, India

Tel: +91 11 23370804, Fax: +91 11 23370251

Email: epidata@searo.who.int, www.searo.who.int/vaccine

Source: WHO/UNICEF JRF ND=No data

• Lastlaboratory-confirmedpoliocasewasreportedin1994.

2009 = 4 AFP cases

2010 = 4 AFP cases

2011 = 3 AFP cases