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Acronyms
AD Auto disable
AEFI Adverse events following immunization
AFP Acute flaccid paralysis
BCG Bacillus Calmette-Guérin vaccine
CES Coverage evaluation survey
cMYP Comprehensive multi-year plan
CRS Congenital rubella syndrome
DHS Demographic health survey
DT Diphtheria tetanus toxoid, pediatric
DTP Diphtheria – tetanus – pertussis vaccine
DTP-Hib-HepB Pentavalent vaccine
DTP-Hib-HepB3 3rd dose pentavalent vaccine
EPI Expanded programme on immunization
GDP Gross domestic product
HCW Health care worker
HepB Hepatitis B vaccine
Hib Haemophilus influenzae type b
HPV Human papilloma virus
IgM Immunoglobulin M
IPV Inactivated poliovirus vaccine
JE Japanese encephalitis
JE_Live-Atd JE live attenuated vaccine
JRF WHO UNICEF joint reporting form
LB Live birth
M Measles
MCV1 First dose measles containing vaccine
MCV2 Second dose measles containing vaccine
MICS Multiple indicator cluster survey
MMR Measles mumps rubella vaccine
MNT Maternal and neonatal tetanus
MR Measles rubella vaccine
NCIP National committee on immunization practices
NID National immunization day
NTAGI National technical advisory group on immunization
NPEV Non-polio enterovirus
NT Neonatal tetanus
OPV Oral poliovirus vaccine
bOPV Bivalent OPV
tOPV Trivalent OPV
PCV Pneumococcal conjugate vaccine
SEAR WHO South-East Asia Region
SIA Supplementary immunization activities
SNID Subnational immunization day
Td Tetanus diphtheria toxoid; older children, adults
TT Tetanus toxoid
TT2+ 2 or more doses TT
VDPV Vaccine derived poliovirus
VPD Vaccine preventable diseases
WCBA Women of child bearing age
WPV Wild poliovirus
Contents
Impact of routine immunization Page No.
EPI history 5
Basic information 2016 Table 1 5
Immunization schedule 2016 Table 2 5
National immunization coverage 1980 - 2016 Figure 1 6
Immunization 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
Towards measles elimination and rubella/congenital rubella syndrome control
Page No.
MCV1 and MCV2 coverage, measles and rubella cases, 1980-2016 Figure 10 11
MCV supplementary immunization activities 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 profile by age in 2016 Figure 15 12
Subnational risk assessment for measles and rubella Figure 16 12
Sporadic and outbreak associated measles cases by month 2011 - 2016 Figure 17 13
Immunization status of confirmed (laboratory and Epi linked) measles outbreak associated cases by age 2011 – 2016 Figure 18 13
Quality of field 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
Maternal and neonatal tetanus elimination is sustained Page No.
TT2+ coverage and NT cases 1980 - 2016 Figure 5 8
Polio-free status is maintained Page No.
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 collection percentage by district 2015 Figure 8 10
Adequate stool specimen collection percentage by district 2016 Figure 9 10
OPV supplementary immunization activities Table 6 10
WHO South-East Asia Region
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 of its authorities, or concerning the delimitation of its frontiers or boundaries.
Timor-Leste: district level map
4
EPI history
• EPI started in 1978
• EPI re-structured in March 2000
• DTP-HepB vaccine introduced in 2007
• DTP-Hib-HepB) vaccine introduced in 2012
• MR vaccine introduced in Feb 2016
• Second dose of MR introduced in Feb 2016
• HepB birth dose introduced in Feb 2016
• DPT/DT vaccine (booster dose) introduced in Feb 2016
• IPV introduced in Feb 2016
• tOPV to bOPV switched on 18 April 2016 .
Source: cMYP 2016-2020 and EPI/MOH
Table 1: Basic information1 2016
Total population 1,231,262
Live births 35,426
Children <1 year 33,548
Children <5 years 176,377
Children <15 years 493,795
Pregnant women 38,969
WCBA (15-49 years) 154,605
Neonatal mortality rate 22.3 (per 1,000 LB)
Infant mortality rate 44.7 (per 1,000 LB)
Under-five mortality rate 52.6 (per 1,000 LB)
Maternal mortality ratio 215 (per 100,000 LB)1SEAR annual EPI reporting form, 2016 and WHO, World Health Statistics 2016
Division/Province/State/Region -
Municipalities 13
Postos/Sub-district 65
Sucos/Village 442
Population density (per sq. km) 71
Population living in urban areas 32%
Population using improved drinking-water sources 70%
Population using improved sanitation 39%
Total expenditure on health as % of GDP 1.4%
Births attended by skilled health personnel 21%
Neonates protected at birth against NT 81%
Table 2: Immunization schedule, 2016
Vaccine Age of administration
BCG Birth
OPV Birth, 6 weeks, 10 weeks and 14 weeks
DTP-Hib-HepB 6 weeks, 10 weeks and 14 weeks
MR 9 months and 18 months
TT Females 15 to 49 years (1st pregnancy contact, +1 month, +6 months, +1 year, +1 year)
Vitamin A 6 to 36 months (with 6 months interval)
IPV 14 weeks
DT 6 yearsSource: WHO/UNICEF JRF, 2016
Impact of routine immunization
5
Figure 1: National immunization coverage, 1980-2016
% C
over
age
0
20
40
60
80
100
Source: WHO/UNICEF estimates of national immunization coverage, July 2017 revision
Table 3: Immunization system highlights
cMYP for immunization 2016-2020
NTAGI fully functional
Spending on vaccines financed by the government 76%
Spending on routine immunization programme financed by the government 39%
Updated micro-plans that include activities to improve immunization coverage 13 districts (100%)
National policy for health care waste management including waste from immunization activities in place
National system to monitor AEFI in place
Most recent EPI CES EPI CES Dili municipality and 12 other municipalities 2015
>80% coverage for DTP-Hib-HepB3 13 districts (100%)
>90% coverage for MCV1 7 districts (54%)
>10% drop-out rate for DTP-Hib-HepB1 to DTP-Hib-HepB3 no district
Source: WHO/UNICEF JRF, 2016
2002 2004 2006 2008 2010 2014 2015 2016BCG 75 72 74 85 79 84 84 85DTP3 54 57 63 79 72 77 76 85OPV 38 57 62 79 72 76 75 83MCV1 56 55 61 73 66 74 70 78
6
Figure 3: 2015
Figure 4: 2016
Source: SEAR annual EPI reporting form, 2016 (administrative data)
Source: SEAR annual EPI reporting form, 2015 (administrative data)
Figure 2: DTP3 coverage1, diphtheria and pertussis cases2, 1980-2016
Year
Diphtheria Cases Pertussis Cases DTP3 Coverage
% C
over
age
No.
of c
ases
2016201520142013201220112010200820062002 20040
5
10
15
20
25
30
0
20
40
60
80
100
1WHO/UNICEF estimates of national immunization coverage, July 2017 revision2WHO vaccine-preventable diseases: monitoring system 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 4 2 (67%) 802 0 0 0 0
2012 0 0 0 4 (40%) 16 8 0 0 0
2013 0 1 0 1 (9%) 4 0 ND 5 ND
2014 0 2 0 0 47 1 0 0 0
2015 0 1 5 0 48 5 ND 0 0
2016 0 0 6 0 2 8 0 1 0
Source: WHO/UNICEF JRF (2011-2016) ND=No data
DTP-Hib-HepB3 coverage by district
<70% 70% - 79% 80% - 89% > 90%
7
% C
over
age
No.
of c
ases
Year
NT Cases TT2+ Coverage
0
2
4
6
8
10
0
20
40
60
80
100
2002 2004 2006 2008 2010 2011 2012 2013 2014 2015 2016
Figure 5: TT2+ coverage1 and NT cases2, 1980-2016
1 WHO/UNICEF JRF, Country official estimates, 1980-20162WHO vaccine-preventable diseases: monitoring system 2016
Maternal and neonatal tetanus elimination is sustained
MNT elimination in 2012
© WHO/Timor-Leste/S Singh
8
Table 5: AFP surveillance performance indicators, 2011-2016
Indicator 2011 2012 2013 2014 2015 2016
AFP cases 0 5 5 3 0 10
Wild poliovirus confirmed cases 0 0 0 0 0 0
Compatible cases 0 0 0 0 0 0
Non-polio AFP rate1 0 1.00 1.61 0.59 0.00 1.87
Adequate stool specimen collection percentage2 0 40% 20% 67% 0 50
Total stool samples collected 0 5 5 4 0 -
% NPEV isolation 0 0 0 0 0 -
% Timeliness of primary result reported3 0 100 68 100 0 -1Number of discarded AFP cases per 100,000 children under 15 years of age. 2Percent with 2 specimens, at least 24 hours apart and within 14 days of paralysis onset.3Results reported within 14 days of sample received at laboratory.
Figure 6: 2015 Figure 7: 2016
Polio-free status is maintained
Non-polio AFP rate by district
<1 1 – 1.99
>2 No non-polio AFP case
© WHO/Timor-Leste/S Singh
9
Table 6: OPV SIAs
Year Vaccine Geographic coverage Target age
Target population Coverage (%)
Round 1 Round 2 Round 1 Round 2
2005 OPV NID <5 years 177,713 93 102
2015* OPV NID <5 years 522,943 - 96 -
* During MR vaccination campaign.Source: WHO/UNICEF JRF
Adequate stool specimen collection % by district
Figure 9: 2016Figure 8: 2015
<60% 60% - 79%
>80% No AFP
10
Towards measles elimination and rubella/CRS control
Figure 10: MCV1 and MCV2 coverage1, measles and rubella cases2, 1980-2016
Measles Cases Rubella MCV1 Coverage MCV2 Coverage
763
% C
over
age
No.
of c
ases
Year
0
20
40
60
80
100
120
0
20
40
60
80
100
2002 2004 2006 2008 2010 2011 2012 2013 2014 2015 2016
No data
1WHO/UNICEF estimates of national immunization coverage, July 2017 revision2WHO vaccine-preventable diseases: monitoring system 2016
Table 7: MCV SIAs
Year Antigen Geographic coverage Target group Target Coverage
%
2003 M nationwide 9 to 59 months 128,318 99
2006 M nationwide 6 months to 14 years 390,687 40
2009 M nationwide 9 to 59 months 167,136 76
2011 M nationwide 6 months to 14 years 494,427 92
2015 MR nationwide 6 months to 14 years 501,832 97
Source: WHO/UNICEF JRF, (multiple years)
11
0%
20%
40%
60%
80%
100%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Per
cent
of p
opul
atio
n
Age (in years)Protected by maternal antibodies Protected by routine vaccination with 1st doseProtected by routine vaccination with 2nd dose Protected by SIAsImmune due to past infection Susceptible
Figure 15: Immunity against measles - immunity profile by age in 2016*
* Modeled using MSP tool ver 2 assuming the schedule and MCV coverage remain unchanged in 2016.
<80% 80% - 89% 90% - 94% >95%
Source: SEAR annual EPI reporting form, 2016 (administrative data)
Figure 12: 2016
Figure 11: 2015
Source: SEAR annual EPI reporting form, 2015 (administrative data)
Figure 14 : 2016
Figure 13: 2015
Source: SEAR annual EPI reporting form, 2016 (administrative data)
Source: SEAR annual EPI reporting form, 2015 (administrative data)
Figure 16: Sub-national risk assessment -measles and rubella
MCV1 coverage by district
MCV2 coverage by district
Source: developed using WHO risk assessment tool based on JRF & ARF data base
Very high riskHigh riskMedium riskLow riskNot available
12
Figure 17: Sporadic and outbreak associated measles cases* by month 2011-2016
Sporadic measles
Outbreak associated measles
No
of c
ases
0
5
10
15
20
25
30
35
40
Dec-
16No
v-16
Oct-1
6Se
p-16
Aug-
16Ju
l-16
Jun-
16M
ay-1
6Ap
r-16
Mar
-16
Feb-
16Ja
n-16
Dec-
15No
v-15
Oct-1
5Se
p-15
Aug-
15Ju
l-15
Jun-
15M
ay-1
5Ap
r-15
Mar
-15
Feb-
15Ja
n-15
Dec-
14No
v-14
Oct-1
4Se
p-14
Aug-
14Ju
l-14
Jun-
14M
ay-1
4Ap
r-14
Mar
-14
Feb-
14Ja
n-14
Dec-
13No
v-13
Oct-1
3Se
p-13
Aug-
13Ju
l-13
Jun-
13M
ay-1
3Ap
r-13
Mar
-13
Feb-
13Ja
n-13
Dec-
12No
v-12
Oct-1
2Se
p-12
Aug-
12Ju
l-12
Jun-
12M
ay-1
2Ap
r-12
Mar
-12
Feb-
12
*Includes laboratory confirmed and epidemiologically linked casesSource: SEAR Monthly VPD reports
Figure 18: Immunization status of confirmed (laboratory and EPI linked) measles outbreak associated cases, by age, 2011-2016
2011 2012 2013 2014 2015 2016Immunized Not immunized/ unknown
0
2
4
6
8
10
12
14
16
18
20
> 1
5 ye
ars
10-1
4 ye
ars
5-9
year
s1-
4 ye
ars
< 1
yea
r>
15
year
s10
-14
year
s5-
9 ye
ars
1-4
year
s<
1 y
ear
> 1
5 ye
ars
10-1
4 ye
ars
5-9
year
s1-
4 ye
ars
< 1
yea
r>
15
year
s10
-14
year
s5-
9 ye
ars
1-4
year
s<
1 y
ear
> 1
5 ye
ars
10-1
4 ye
ars
5-9
year
s1-
4 ye
ars
< 1
yea
r>
15
year
s10
-14
year
s5-
9 ye
ars
1-4
year
s
Source: SEAR annual EPI reporting form (2011-2016)
© WHO/Timor-Leste/S Singh
13
Table 8: Surveillance performance indicators for measles and rubella, 2012-2016
Year
No.
of s
uspe
cted
mea
sles
Case classification (number) Indicators
Measles Rubella
Disc
arde
d no
n-m
easle
s non
-ru
bella
cas
es
Annu
al in
cide
nce
of
confi
rmed
mea
sles c
ases
per
m
illio
n to
tal p
opul
ation
Annu
al in
cide
nce
of
confi
rmed
rube
lla c
ases
per
m
illio
n to
tal p
opul
ation
Prop
ortio
n of
all
susp
ecte
d m
easle
s and
rube
lla c
ases
th
at h
ave
had
an a
dequ
ate
inve
stiga
tion
initi
ated
with
in
48 h
ours
of n
otific
ation
Disc
arde
d no
n-m
easle
s non
-ru
bella
inci
denc
e pe
r 100
,000
to
tal p
opul
ation
Prop
ortio
n of
dist
ricts
re
porti
ng a
t lea
st tw
o di
scar
ded
non-
mea
sles n
on-
rube
lla c
ases
per
100
,000
to
tal p
opul
ation
Prop
ortio
n of
sub-
natio
nal
surv
eilla
nce
units
repo
rting
to
the
natio
nal l
evel
on
time
Lab-
confi
rmed
EPI-l
inke
d
Clin
ical
ly-c
onfir
med
Lab-
confi
rmed
EPI-l
inke
d
Target ➔ - - 80% 2 80% 80%
2012 28 4 0 15 0 0 9 16.54 4.35 11.31 0.78 0 100
2013 5 1 0 4 0 0 0 4.24 0 4.24 0 0 100
2014 47 26 0 5 1 0 16 21.0 0.83 100 1.25 15 100
2015 48 6 0 15 4 0 18 5.0 4.16 75 1.83 15 100
2016 132 2 0 130 9 0 121 15.1 68.1 100 8.4 ND 100Source: SEAR annual EPI reporting form (2012-2016) ND=No data
Year
Seru
m sp
ecim
en
colle
cted
from
su
spec
ted
mea
sles c
ases
Seru
m sp
ecim
en
rece
ived
in
labo
rato
ry
with
in 5
day
s of
colle
ction
Spec
imen
po
sitive
for
mea
sles I
gM
Spec
imen
po
sitive
for
rube
lla Ig
M
% R
esul
ts w
ithin
4
days
of r
ecei
pt
% P
ositi
ve c
ases
te
sted
for v
iral
dete
ction
Geno
type
s de
tect
ed
No (%) No (%) No. % No. % Measles Rubella
2012 13 (46%) 13 (100%) 4 31 0 0 0 0 0 0
2013 1 (25%) 1 (100%) 1 100 0 0 100 0 0 0
2014 43 (91%) 43 (100%) 26 72 1 2.77 100 0 0 0
2015 34 (71%) 34 (100%) 6 18 5 15 100 0 0 0
2016 119 (90%) 119 (100%) 2 1.7 9 7.6 100 0 0 0Source: SEAR annual EPI reporting form (2012-2016) ND=No data
Table 9: Performance of laboratory surveillance, 2012-2016
14
Figure 19: WHO supported laboratory network for VPD surveillance
National Health Laboratory, Dili• National measles and rubella laboratory• National Japanese encephalitis laboratory
15
For contact or feedback:Expanded Programme on ImmunizationMinistry of Health, Dilli, Timor-LesteTel: +670-77351964, Fax: +670-7250097Email: [email protected]
Immunization and Vaccine Development (IVD)WHO-SEARO, IP Estate, MG Marg, New Delhi 110002, IndiaTel: +91 11 23370804, Fax: +91 11 23370251Email: [email protected]/entity/immunization