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Data as of 15 Sep 2012 Immunization Services in Myanmar 1

Epi presesentation for gavi

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Page 1: Epi presesentation for gavi

Data as of 15 Sep 2012

Immunization Services in Myanmar

1

Page 2: Epi presesentation for gavi

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

Page 3: Epi presesentation for gavi

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)

Page 4: Epi presesentation for gavi

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

4

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%

Page 5: Epi presesentation for gavi

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

5

Page 6: Epi presesentation for gavi

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

Page 7: Epi presesentation for gavi

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

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2002

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2011

2012

Year

Cas

es

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% C

ove

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Diphtheria Cases Pertussis Cases DPT Coverage

Page 8: Epi presesentation for gavi

Data as of 15 Sep 2012

Reported Diphtheria cases 2011-2012

1 Dot = 1 case

2011 (7 cases)

2012 (17 cases)

Page 9: Epi presesentation for gavi

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

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2012

0

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Cases TT2+ Coverage

%C

ove

rag

e

Reported Neonatal Tetanus cases and reported TT2 coverage Myanmar 1990-2012

Ca

se

s

TT2+

Page 10: Epi presesentation for gavi

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

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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

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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

Page 11: Epi presesentation for gavi

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

Page 12: Epi presesentation for gavi

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

Page 13: Epi presesentation for gavi

13

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

Page 14: Epi presesentation for gavi

Pocket areas for routine immunizationSilent areas for AFP reportingBorder areas with migrationCultural barriers, Security barriers

Page 15: Epi presesentation for gavi

EPI Updates in 2012

15

Page 16: Epi presesentation for gavi

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.

Page 17: Epi presesentation for gavi

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

Page 18: Epi presesentation for gavi

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.

Page 19: Epi presesentation for gavi

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

19

National Policy and Strategy Workshop onImmunization and VPD Surveillance (August 2012)

Page 20: Epi presesentation for gavi

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.

Page 21: Epi presesentation for gavi

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.

Page 22: Epi presesentation for gavi

Communication

- Community demand generating approach- Media workshop (The last week of October 2012)

Page 23: Epi presesentation for gavi

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)

Page 24: Epi presesentation for gavi

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