World Health Organization, South-East Asia Regional Office
Maldives 2017
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
Page
No.
Impact of rouine immunizaion
EPI history
Page
No.
Towards measles eliminaion and rubella/congenital rubella
syndrome control
5
MCV1 and MCV2 coverage, measles and rubella cases, 1980-2016
Figure 7
11
Basic informaion 2016
Table 1
5
Table 7
11
Immunizaion schedule 2016
MCV supplementary immunizaion aciviies
Table 2
5
MCV1 coverage by district 2015
Figure 8
12
Naional immunizaion coverage 1980 - 2016
Figure 1
6
MCV1 coverage by district 2016
Figure 9
12
Immunizaion system highlights
Table 3
6
MCV2 coverage by district 2015
Figure 10
12
DTP3 coverage, diphtheria and pertussis cases 1980 - 2016
Figure 2
7
Figure 11
12
Reported cases of vaccine preventable diseases 2011 - 2016
MCV1 coverage by district 2016
Table 4
7
Immunity against measles – immunity proile by age in 2016
Figure 12
12
DTP-Hib-HepB3 coverage by district 2015
Figure 3
7
Subnaional risk assessment for measles and rubella
Figure 13
12
DTP-Hib-HepB3 coverage by district 2016
Figure 4
7
Sporadic and outbreak associated measles cases by month 2011 - 2016
Figure 14
13
Immunizaion status of conirmed (laboratory and Epi linked) measles outbreak
associated cases by age 2011 – 2016
Figure 15
13
Quality of ield and laboratory surveillance for measles and rubella 2012 - 2016
Table 8
14
Performance of laboratory surveillance 2012 - 2016
Table 9
14
WHO supported laboratory network for VPD surveillance
Figure 16
15
Page
No.
Maternal and neonatal tetanus eliminaion is sustained
TT2+ coverage and NT cases 1980 - 2016
Figure 5
8
Page
No.
Polio-free status is maintained
AFP surveillance indicators 2011 - 2016
Table 5
9
AFP cases 2011-2016
Figure 6
9
OPV supplementary immunizaion aciviies
Table 6
9
WHO South-East Asia Region
Maldives: atoll level map
Disclaimer: The boundaries and names shown and the designaions used on all the maps do not imply the expression of any opinion whatsoever on the part of the
World Health Organizaion concerning the legal status of any country, territory, city or area of its authoriies, or concerning the delimitaion of its froniers or boundaries.
4
Impact of routine immunization
Table 1: Basic information1 2016
EPI history
Total populaion
338,434
Division/Province/State/Region
-
Live births
6,592
Atoll/District
20
2
•
EPI launched in 1976
Children 10% drop-out rate for DTP-Hib-HepB1 to DTP-Hib-HepB3
no district
Source: WHO/UNICEF JRF, 2016
6
Figure 2: DTP3 coverage1, diphtheria and pertussis cases2, 1980-2016
DTP-Hib-HepB3 coverage by district
8
100
Figure 3: 2015
7
No. of cases
5
60
4
40
3
2
% Coverage
80
6
20
1
0
0
1980
1985
1990
1995
2000
2005
2010
2011
2012
2013
2014
2015
2016
Source: SEAR annual EPI reporing form, 2015 (administraive data)
Year
Diphtheria Cases
Pertussis Cases
DTP3 Coverage
WHO/UNICEF esimates of naional immunizaion coverage, July 2017 revision
WHO vaccine-preventable diseases: monitoring system 2016
1
2
Figure 4: 2016
Table 4: Reported cases of vaccine preventable diseases, 2011-2016
Year
Polio
Diphtheria
Pertussis
NT
(% of all Tetanus)
Measles
Rubella
Mumps
JE
CRS
2011
0
0
0
0
0
0
69
0
0
2012
0
0
0
0
0
0
14
0
0
2013
0
0
0
0
0
0
17
0
0
2014
0
0
0
0
0
0
0
0
0
2015
0
0
0
0
0
3
0
0
0
2016
0
0
0
0
0
0
0
0
0
Source: WHO/UNICEF JRF
ND=No data
Source: SEAR annual EPI reporing form, 2016 (administraive data)
90%
Maternal and neonatal tetanus elimination is sustained
Figure 5: TT2+ coverage1 and NT cases2, 1980-2016
5000
100
4000
80
3000
60
No data
2000
40
1000
20
0
0
1980
1985
1990
1995
2000
2005
2010
2011
2012
Year
NT Cases
WHO/UNICEF JRF, Country oicial esimates, 1980-2016
WHO vaccine-preventable diseases: monitoring system 2016
1
2
8
TT2+ Coverage
2013
2014
2015
2016
% Coverage
No. of cases
MNT eliminaion before 2000
Polio-free status is maintained
Table 5: AFP surveillance performance indicators, 2011-2016
Last laboratory-conirmed polio case due to WPV was reported in 1994.
Indicator
2011
2012
2013
2014
2015
2016
AFP cases
3
4
1
1
5
2
Wild poliovirus conirmed cases
0
0
0
0
0
0
Compaible cases
0
0
0
0
0
0
Non-polio AFP rate
3.40
4.55
1.08
1.12
5.60
2.11
Adequate stool specimen collecion percentage2
33%
75%
100%
100%
60%
0%
2
6
2
2
6
4
1
Total stool samples collected
% NPEV isolaion
0
0
0
0
0
0
% Timeliness of primary result reported3
0
100
100
100
0
100
Number of discarded AFP cases per 100,000 children under 15 years of age.
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.
1
2
Figure 6: AFP cases 2011-2016
2011 = 3 cases
2012 = 4 cases
+ 2013 = 1 case
2014 = 1 case
2015 = 5 cases
2016 = 2 cases
9
Table 6: OPV SIAs
Year
Anigen
Geographic
coverage
Target populaion
Coverage (%)
Target age
Round 1
Round 2
Round 1
Round 2
1997
OPV
NID
15 years
< 1 year
1-4 years
5-9 years
10-14 years
> 15 years
0
2011
2012
Immunized
Source: SEAR annual EPI reporing form (2011-2016)
2013
2014
2015
Not immunized/ unknown
2016
13
80%
2
80%
80%
Proporion of sub-naional
surveillance units reporing
to the naional level on ime
Genotypes
detected
Indicators
-
Proporion of atolls reporing
at least two discarded nonmeasles non-rubella cases
per 100,000 total populaion
Rubella
-
Discarded non-measles nonrubella incidence per 100,000
total populaion
0
0
ND
ND
ND
Proporion of all suspected
measles and rubella cases
that have had an adequate
invesigaion iniiated within
48 hours of noiicaion
0
0
2.6
2.9
2.9
Annual incidence of
conirmed rubella cases per
million total populaion
0
0
100
100
100
Annual incidence of
conirmed measles cases per
million total populaion
0
0
0
0
0
Discarded non-measles
non-rubella cases
0
0
0
0
0
EPI-linked
0
0
9
10
12
Lab-conirmed
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Measles
-
-
-
-
-
Clinically-conirmed
Case classiicaion (number)
Measles
EPI-linked
Target ➔
Lab-conirmed
0
0
0
0
0
0
0
0
0
0
9
0
0
No. of suspected measles
Table 8: Surveillance performance indicators for measles and rubella, 2012-2016
Year
2012
2013
2014
10
12
%
0
0
0
0
0
0
0
0
100
100
100
0
0
0
30
% Posiive cases
tested for viral
detecion
2015
No.
0
0
0
3
0
% Results within
4 days of receipt
ND=No data
%
0
0
0
0
0
14
Specimen
posiive for
rubella IgM
2016
No.
0
0
0
0
0
ND=No data
Specimen
posiive for
measles IgM
Source: SEAR annual EPI reporing form (2012-2016)
No (%)
0
0
9 (100%)
10 (100%)
12 (100%)
No (%)
0
0
9 (100%)
10 (100%)
12 (100%)
Serum specimen
received in
laboratory
within 5 days of
collecion
Table 9: Performance of laboratory surveillance, 2012-2016
Year
2013
2012
2014
2015
2016
Source: SEAR annual EPI reporing form (2012-2016)
Serum specimen
collected from
suspected
measles cases
0
0
100
100
11.92
Rubella
-
-
-
-
-
Figure 16: WHO supported laboratory network for VPD surveillance
Indira Gandhi Memorial Hospital
Naional measles and rubella laboratory
Source EPI Maldives, May 2015
15
For contact or feedback:
Naional Programme on Immunizaion and Travel Health
Health Protecion Agency, Ministry of Health, Male, Maldives Phone:
+960-3014495, Fax : +960-3014484
Email: nash@health.gov.mv, nash3118@gmail.com, www.health.gov.mv
Immunizaion and Vaccine Development (IVD)
WHO-SEARO, IP Estate, MG Marg, New Delhi 110002, India
Tel: +91 11 23370804, Fax: +91 11 23370251
Email: SearEpidata@who.int
www.searo.who.int/enity/immunizaion
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
Page
No.
Impact of rouine immunizaion
EPI history
Page
No.
Towards measles eliminaion and rubella/congenital rubella
syndrome control
5
MCV1 and MCV2 coverage, measles and rubella cases, 1980-2016
Figure 7
11
Basic informaion 2016
Table 1
5
Table 7
11
Immunizaion schedule 2016
MCV supplementary immunizaion aciviies
Table 2
5
MCV1 coverage by district 2015
Figure 8
12
Naional immunizaion coverage 1980 - 2016
Figure 1
6
MCV1 coverage by district 2016
Figure 9
12
Immunizaion system highlights
Table 3
6
MCV2 coverage by district 2015
Figure 10
12
DTP3 coverage, diphtheria and pertussis cases 1980 - 2016
Figure 2
7
Figure 11
12
Reported cases of vaccine preventable diseases 2011 - 2016
MCV1 coverage by district 2016
Table 4
7
Immunity against measles – immunity proile by age in 2016
Figure 12
12
DTP-Hib-HepB3 coverage by district 2015
Figure 3
7
Subnaional risk assessment for measles and rubella
Figure 13
12
DTP-Hib-HepB3 coverage by district 2016
Figure 4
7
Sporadic and outbreak associated measles cases by month 2011 - 2016
Figure 14
13
Immunizaion status of conirmed (laboratory and Epi linked) measles outbreak
associated cases by age 2011 – 2016
Figure 15
13
Quality of ield and laboratory surveillance for measles and rubella 2012 - 2016
Table 8
14
Performance of laboratory surveillance 2012 - 2016
Table 9
14
WHO supported laboratory network for VPD surveillance
Figure 16
15
Page
No.
Maternal and neonatal tetanus eliminaion is sustained
TT2+ coverage and NT cases 1980 - 2016
Figure 5
8
Page
No.
Polio-free status is maintained
AFP surveillance indicators 2011 - 2016
Table 5
9
AFP cases 2011-2016
Figure 6
9
OPV supplementary immunizaion aciviies
Table 6
9
WHO South-East Asia Region
Maldives: atoll level map
Disclaimer: The boundaries and names shown and the designaions used on all the maps do not imply the expression of any opinion whatsoever on the part of the
World Health Organizaion concerning the legal status of any country, territory, city or area of its authoriies, or concerning the delimitaion of its froniers or boundaries.
4
Impact of routine immunization
Table 1: Basic information1 2016
EPI history
Total populaion
338,434
Division/Province/State/Region
-
Live births
6,592
Atoll/District
20
2
•
EPI launched in 1976
Children 10% drop-out rate for DTP-Hib-HepB1 to DTP-Hib-HepB3
no district
Source: WHO/UNICEF JRF, 2016
6
Figure 2: DTP3 coverage1, diphtheria and pertussis cases2, 1980-2016
DTP-Hib-HepB3 coverage by district
8
100
Figure 3: 2015
7
No. of cases
5
60
4
40
3
2
% Coverage
80
6
20
1
0
0
1980
1985
1990
1995
2000
2005
2010
2011
2012
2013
2014
2015
2016
Source: SEAR annual EPI reporing form, 2015 (administraive data)
Year
Diphtheria Cases
Pertussis Cases
DTP3 Coverage
WHO/UNICEF esimates of naional immunizaion coverage, July 2017 revision
WHO vaccine-preventable diseases: monitoring system 2016
1
2
Figure 4: 2016
Table 4: Reported cases of vaccine preventable diseases, 2011-2016
Year
Polio
Diphtheria
Pertussis
NT
(% of all Tetanus)
Measles
Rubella
Mumps
JE
CRS
2011
0
0
0
0
0
0
69
0
0
2012
0
0
0
0
0
0
14
0
0
2013
0
0
0
0
0
0
17
0
0
2014
0
0
0
0
0
0
0
0
0
2015
0
0
0
0
0
3
0
0
0
2016
0
0
0
0
0
0
0
0
0
Source: WHO/UNICEF JRF
ND=No data
Source: SEAR annual EPI reporing form, 2016 (administraive data)
90%
Maternal and neonatal tetanus elimination is sustained
Figure 5: TT2+ coverage1 and NT cases2, 1980-2016
5000
100
4000
80
3000
60
No data
2000
40
1000
20
0
0
1980
1985
1990
1995
2000
2005
2010
2011
2012
Year
NT Cases
WHO/UNICEF JRF, Country oicial esimates, 1980-2016
WHO vaccine-preventable diseases: monitoring system 2016
1
2
8
TT2+ Coverage
2013
2014
2015
2016
% Coverage
No. of cases
MNT eliminaion before 2000
Polio-free status is maintained
Table 5: AFP surveillance performance indicators, 2011-2016
Last laboratory-conirmed polio case due to WPV was reported in 1994.
Indicator
2011
2012
2013
2014
2015
2016
AFP cases
3
4
1
1
5
2
Wild poliovirus conirmed cases
0
0
0
0
0
0
Compaible cases
0
0
0
0
0
0
Non-polio AFP rate
3.40
4.55
1.08
1.12
5.60
2.11
Adequate stool specimen collecion percentage2
33%
75%
100%
100%
60%
0%
2
6
2
2
6
4
1
Total stool samples collected
% NPEV isolaion
0
0
0
0
0
0
% Timeliness of primary result reported3
0
100
100
100
0
100
Number of discarded AFP cases per 100,000 children under 15 years of age.
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.
1
2
Figure 6: AFP cases 2011-2016
2011 = 3 cases
2012 = 4 cases
+ 2013 = 1 case
2014 = 1 case
2015 = 5 cases
2016 = 2 cases
9
Table 6: OPV SIAs
Year
Anigen
Geographic
coverage
Target populaion
Coverage (%)
Target age
Round 1
Round 2
Round 1
Round 2
1997
OPV
NID
15 years
< 1 year
1-4 years
5-9 years
10-14 years
> 15 years
0
2011
2012
Immunized
Source: SEAR annual EPI reporing form (2011-2016)
2013
2014
2015
Not immunized/ unknown
2016
13
80%
2
80%
80%
Proporion of sub-naional
surveillance units reporing
to the naional level on ime
Genotypes
detected
Indicators
-
Proporion of atolls reporing
at least two discarded nonmeasles non-rubella cases
per 100,000 total populaion
Rubella
-
Discarded non-measles nonrubella incidence per 100,000
total populaion
0
0
ND
ND
ND
Proporion of all suspected
measles and rubella cases
that have had an adequate
invesigaion iniiated within
48 hours of noiicaion
0
0
2.6
2.9
2.9
Annual incidence of
conirmed rubella cases per
million total populaion
0
0
100
100
100
Annual incidence of
conirmed measles cases per
million total populaion
0
0
0
0
0
Discarded non-measles
non-rubella cases
0
0
0
0
0
EPI-linked
0
0
9
10
12
Lab-conirmed
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Measles
-
-
-
-
-
Clinically-conirmed
Case classiicaion (number)
Measles
EPI-linked
Target ➔
Lab-conirmed
0
0
0
0
0
0
0
0
0
0
9
0
0
No. of suspected measles
Table 8: Surveillance performance indicators for measles and rubella, 2012-2016
Year
2012
2013
2014
10
12
%
0
0
0
0
0
0
0
0
100
100
100
0
0
0
30
% Posiive cases
tested for viral
detecion
2015
No.
0
0
0
3
0
% Results within
4 days of receipt
ND=No data
%
0
0
0
0
0
14
Specimen
posiive for
rubella IgM
2016
No.
0
0
0
0
0
ND=No data
Specimen
posiive for
measles IgM
Source: SEAR annual EPI reporing form (2012-2016)
No (%)
0
0
9 (100%)
10 (100%)
12 (100%)
No (%)
0
0
9 (100%)
10 (100%)
12 (100%)
Serum specimen
received in
laboratory
within 5 days of
collecion
Table 9: Performance of laboratory surveillance, 2012-2016
Year
2013
2012
2014
2015
2016
Source: SEAR annual EPI reporing form (2012-2016)
Serum specimen
collected from
suspected
measles cases
0
0
100
100
11.92
Rubella
-
-
-
-
-
Figure 16: WHO supported laboratory network for VPD surveillance
Indira Gandhi Memorial Hospital
Naional measles and rubella laboratory
Source EPI Maldives, May 2015
15
For contact or feedback:
Naional Programme on Immunizaion and Travel Health
Health Protecion Agency, Ministry of Health, Male, Maldives Phone:
+960-3014495, Fax : +960-3014484
Email: nash@health.gov.mv, nash3118@gmail.com, www.health.gov.mv
Immunizaion and Vaccine Development (IVD)
WHO-SEARO, IP Estate, MG Marg, New Delhi 110002, India
Tel: +91 11 23370804, Fax: +91 11 23370251
Email: SearEpidata@who.int
www.searo.who.int/enity/immunizaion