World Health Organization, South-East Asia Regional Office
Bhutan 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
5
Basic informaion 2016
MCV1 and MCV2 coverage, measles and rubella cases, 1980-2016
Table 1
5
Immunizaion schedule 2016
MCV supplementary immunizaion aciviies
Table 2
5
Naional immunizaion coverage 1980 - 2016
Figure 1
6
Immunizaion system highlights
Table 3
6
DTP3 coverage, diphtheria and pertussis cases 1980 - 2016
Figure 2
7
Reported cases of vaccine preventable diseases 2011 - 2016
Table 4
7
DTP-Hib-HepB3 coverage by district 2015
Figure 3
7
DTP-Hib-HepB3 coverage by district 2016
Figure 4
7
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
Non-polio AFP rate by district 2015
Figure 6
9
Non-polio AFP rate by district 2016
Figure 7
9
Adequate stool specimen collecion percentage by district 2015
Figure 8
10
Adequate stool specimen collecion percentage by district 2016
Figure 9
10
OPV supplementary immunizaion aciviies
Table 6
10
Page
No.
Towards measles eliminaion and rubella/congenital rubella
syndrome control
Figure 10
11
Table 7
11
MCV1 coverage by district 2015
Figure 11
12
MCV1 coverage by district 2016
Figure 12
12
MCV2 coverage by district 2015
Figure 13
12
MCV1 coverage by district 2016
Figure 14
12
Immunity against measles – immunity proile by age in 2016
Figure 15
12
Subnaional risk assessment for measles and rubella
Figure 16
12
Sporadic and outbreak associated measles cases by month 2011 - 2016
Figure 17
13
Immunizaion status of conirmed (laboratory and Epi linked) measles outbreak
associated cases by age 2011 – 2016
Figure 18
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 19
15
WHO South-East Asia Region
Bhutan: district 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
757,042
Division/Province/State/Region
-
Live births
12,869
Dzongkhag/District
20
205
•
EPI launched on 15 November 1979
Children 10% drop-out rate for DTP-Hib-HepB1 to DTP-Hib-HepB3
1 district (5%)
Source: WHO/UNICEF JRF, 2016
6
Figure 2: DTP3 coverage1, diphtheria and pertussis cases2, 1980-2016
DTP-Hib-HepB3 coverage by district
464
Figure 3: 2015
100
300
80
200
60
150
40
100
% Coverage
No. of cases
250
20
50
Source: SEAR annual EPI reporing form, 2015 (administraive data)
0
0
1980
1985
1990
1995
2000
2005
2010
2011
2012
2013
2014
2015
2016
Year
Diphtheria Cases
Pertussis Cases
DTP3 Coverage
Figure 4: 2016
WHO/UNICEF esimates of naional immunizaion coverage, July 2017 revision
WHO vaccine-preventable diseases: monitoring system 2016
1
2
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
10
3
262
3
ND
2012
0
0
0
0
1
2
198
0
0
2013
0
0
0
0
0
6
20
0
0
2014
0
0
0
0
0
0
206
2
0
2015
0
0
12
0
11
1
620
5
0
2016
0
0
4
0
45
3
795
5
0
Source: WHO/UNICEF JRF, (muliple years)
ND=No data
7
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
MNT eliminaion before 2000
4.5
100
4.0
No. of cases
3.0
60
2.5
2.0
40
1.5
1.0
0.5
20
No
data
0.0
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
80
3.5
Polio-free status is maintained
Table 5: AFP surveillance performance indicators, 2011-2016
Last clinically-conirmed polio case was reported in 1986.
Indicator
2011
2012
2013
2014
2015
2016
AFP cases
6
10
10
11
9
11
Wild poliovirus conirmed cases
0
0
0
0
0
0
Compaible cases
0
0
0
0
0
0
2.74
5.14
4.52
4.84
4.18
5.11
83%
70%
80%
73%
67%
73%
7
21
11
22
16
20
0
0
0
9
0
0
71
100
100
100
100
100
Non-polio AFP rate1
Adequate stool specimen collecion percentage
2
Total stool samples collected
% NPEV isolaion
% Timeliness of primary result reported
3
Number of discarded AFP cases per 100,000 children under 15 years of age.
2
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
Non-polio AFP rate by district
Figure 6: 2015
Figure 7: 2016
© WHO/Bhutan/S Bahadur
2
No non-polio AFP case
9
Adequate stool specimen collection % by district
Figure 8: 2015
Figure 9: 2016
80%
No AFP
Table 6: OPV SIAs
Year
Vaccine
Geographic
coverage
Target populaion
Coverage (%)
Target age
Round 1
Round 2
Round 1
Round 2
1995
OPV
NID
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
5
Basic informaion 2016
MCV1 and MCV2 coverage, measles and rubella cases, 1980-2016
Table 1
5
Immunizaion schedule 2016
MCV supplementary immunizaion aciviies
Table 2
5
Naional immunizaion coverage 1980 - 2016
Figure 1
6
Immunizaion system highlights
Table 3
6
DTP3 coverage, diphtheria and pertussis cases 1980 - 2016
Figure 2
7
Reported cases of vaccine preventable diseases 2011 - 2016
Table 4
7
DTP-Hib-HepB3 coverage by district 2015
Figure 3
7
DTP-Hib-HepB3 coverage by district 2016
Figure 4
7
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
Non-polio AFP rate by district 2015
Figure 6
9
Non-polio AFP rate by district 2016
Figure 7
9
Adequate stool specimen collecion percentage by district 2015
Figure 8
10
Adequate stool specimen collecion percentage by district 2016
Figure 9
10
OPV supplementary immunizaion aciviies
Table 6
10
Page
No.
Towards measles eliminaion and rubella/congenital rubella
syndrome control
Figure 10
11
Table 7
11
MCV1 coverage by district 2015
Figure 11
12
MCV1 coverage by district 2016
Figure 12
12
MCV2 coverage by district 2015
Figure 13
12
MCV1 coverage by district 2016
Figure 14
12
Immunity against measles – immunity proile by age in 2016
Figure 15
12
Subnaional risk assessment for measles and rubella
Figure 16
12
Sporadic and outbreak associated measles cases by month 2011 - 2016
Figure 17
13
Immunizaion status of conirmed (laboratory and Epi linked) measles outbreak
associated cases by age 2011 – 2016
Figure 18
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 19
15
WHO South-East Asia Region
Bhutan: district 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
757,042
Division/Province/State/Region
-
Live births
12,869
Dzongkhag/District
20
205
•
EPI launched on 15 November 1979
Children 10% drop-out rate for DTP-Hib-HepB1 to DTP-Hib-HepB3
1 district (5%)
Source: WHO/UNICEF JRF, 2016
6
Figure 2: DTP3 coverage1, diphtheria and pertussis cases2, 1980-2016
DTP-Hib-HepB3 coverage by district
464
Figure 3: 2015
100
300
80
200
60
150
40
100
% Coverage
No. of cases
250
20
50
Source: SEAR annual EPI reporing form, 2015 (administraive data)
0
0
1980
1985
1990
1995
2000
2005
2010
2011
2012
2013
2014
2015
2016
Year
Diphtheria Cases
Pertussis Cases
DTP3 Coverage
Figure 4: 2016
WHO/UNICEF esimates of naional immunizaion coverage, July 2017 revision
WHO vaccine-preventable diseases: monitoring system 2016
1
2
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
10
3
262
3
ND
2012
0
0
0
0
1
2
198
0
0
2013
0
0
0
0
0
6
20
0
0
2014
0
0
0
0
0
0
206
2
0
2015
0
0
12
0
11
1
620
5
0
2016
0
0
4
0
45
3
795
5
0
Source: WHO/UNICEF JRF, (muliple years)
ND=No data
7
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
MNT eliminaion before 2000
4.5
100
4.0
No. of cases
3.0
60
2.5
2.0
40
1.5
1.0
0.5
20
No
data
0.0
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
80
3.5
Polio-free status is maintained
Table 5: AFP surveillance performance indicators, 2011-2016
Last clinically-conirmed polio case was reported in 1986.
Indicator
2011
2012
2013
2014
2015
2016
AFP cases
6
10
10
11
9
11
Wild poliovirus conirmed cases
0
0
0
0
0
0
Compaible cases
0
0
0
0
0
0
2.74
5.14
4.52
4.84
4.18
5.11
83%
70%
80%
73%
67%
73%
7
21
11
22
16
20
0
0
0
9
0
0
71
100
100
100
100
100
Non-polio AFP rate1
Adequate stool specimen collecion percentage
2
Total stool samples collected
% NPEV isolaion
% Timeliness of primary result reported
3
Number of discarded AFP cases per 100,000 children under 15 years of age.
2
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
Non-polio AFP rate by district
Figure 6: 2015
Figure 7: 2016
© WHO/Bhutan/S Bahadur
2
No non-polio AFP case
9
Adequate stool specimen collection % by district
Figure 8: 2015
Figure 9: 2016
80%
No AFP
Table 6: OPV SIAs
Year
Vaccine
Geographic
coverage
Target populaion
Coverage (%)
Target age
Round 1
Round 2
Round 1
Round 2
1995
OPV
NID