EPI factsheet: DPR Korea

World Health Organization• SEARO/FGL/IVD • 31 August 2016World Health Organization• SEARO/FGL/IVD • 31 August 2016 Immunization and Vaccine Development South-East Asia Region Immunization and Vaccine Development South-East Asia Region DPR Korea 2016 Immunization system highlights „ There is a comprehensive multi- year plan (cMYP) for immunization covering 2011-2015. „ A standing national technical advisory group on immunization (NTAGI) fully functional. „ A national system to monitor adverse events following immunization (AEFI) exists. „ A national policy for health care waste management including waste from immunization activities exists. „ All 210 districts have updated micro- plans that include activities to raise immunization coverage. „ All 210 districts have ³80% coverage for DTP-Hib-HepB3, ³90% coverage for MCV1. „ No district reported more than 10% drop-out rate from DTP-Hib-HepB1 to DTP-Hib-HepB3. „ A coverage evaluation survey (CES) is planned in the next 24 months. Source: WHO/UNICEF joint reporting form (JRF) 2015 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. Table 1: Basic information1 2015 Division/Province/State/Region 12 District 210 Population density (per sq. km) 202 Population living in urban areas 61% Population using improved drinking-water sources 98% Population using improved sanitation 82% Total expenditure on health as % of GDP – Births attended by skilled health personnel 100% Neonates protected at birth against NT 93% 1 SEAR annual EPI reporting form, 2015 and WHO, World Health Statistics 2015 Vaccine Age of administration BCG At birth HepB At birth DTP-Hib-HepB 6 weeks, 10 weeks, 14 weeks OPV 6 weeks, 10 weeks, 14 weeks IPV 14 weeks Measles 9 months and 15 months Td 3 months, 4 months Vitamin A 6 - 59 months EPI history „ EPI launched in 1980. „ Hepatitis B vaccine introduced in 2003. „ AD syringes introduced in 2003. „ Hepatitis B birth dose introduced in 2004. „ DTP-HepB vaccine introduced in 2006. „ Measles second dose introduced in 2008. „ Hib Pentavalent (DTP-Hib-HepB) vaccine introduced in 2012. „ IPV vaccine introduced in 2015 „ Type 2 component of OPV withdrawn on 18 April 2016 by switching from tOPV to bOPV Table 2: Immunization schedule, 2015 Source: cMYP 2011-2015 and EPI/MOPH Source: WHO/UNICEF joint reporting form (JRF) 2015 E P I F a c t S h E E t Total population 24 192 506 Live births (LB) 344 435 Children <1 year 340 520 Children <5 years 1 700 539 Children <15 years 5 186 693 Pregnant women 343 769 Women of child bearing age (15-49 years) 6 582 498 Neonatal mortality rate 14.9 (per 1 000 LB) Infant mortality rate 21.7 (per 1 000 LB) Under-five mortality rate 27.4 (per 1 000 LB) Maternal mortality ratio 87 (per 100 000 LB) Figure 10: Immunity against measles: Immunity profile by age in 2015* Figure 11: Immunity against measles: Immunity profile by age in 2016* Figure 13: Unimmunized confirmed (Lab and Epi linked) measles outbreak associated cases, by age, 2010–2015 * Modeled using MSP tool ver 2 based on coverage data up to 2015. Source: SEAR annual EPI reporting form (multiple years) * Modeled using MSP tool ver 2 assuming the schedule and measles containing vaccine (MCV) coverage remain unchanged and no SIAs in 2015 & 2016. Source: SEAR annual EPI reporting form (multiple years) Figure 12: Confirmed (Lab and Epi linked) measles outbreak associated cases, by age, 2010–2015 Table 8: Suspected sporadic and Outbreak associated measles and rubella cases, 2010–2015 Table 9: Quality of field and laboratory surveillance for measles and rubella, 2012–2015 Table 10: Performance of Laboratory Surveillance, 2012–2015 Source: Monthly VPD Reporting to WHO/SEARO # Only 1st quarter data for year 2014 *Laboratory confirmed & epidemiologically- linked Source: SEAR Annual EPI Reporting Form ND=No data Source: SEAR Annual EPI Reporting Form ND=No data Year Routine/sporadic cases Outbreak associated cases No. of suspected case No. of death No. of lab- confirmed measles cases No. of lab- confirmed rubella cases No. of suspected outbreak No. of Outbreak Investigated No. of case No. of death No. of measles outbreak* No. of confirmed measles case* No. of confirmed rubella outbreak* No. of confirmed rubella cases* 2010 0 0 0 0 0 0 0 0 0 0 0 0 2011 70 0 0 0 0 0 0 0 0 0 0 0 2012 66 0 0 1 0 0 0 0 0 0 0 0 2013 58 0 0 0 0 0 0 0 0 0 0 0 2014# 11 0 0 0 1 1 4 0 1 3 0 0 2015 132 0 0 0 0 0 0 0 0 0 0 0 Year No . o f S us pe ct ed M ea sl es Case classification (number) Indicators Measles Rubella Di sc ar de d n on -m ea sl es n on - ru be lla c as es An nu al in ci de nc e of c on fir m ed M ea sl es c as es p er m ill io n to ta l po pu la tio n An nu al in ci de nc e of c on fir m ed Ru be lla c as es p er m ill io n to ta l po pu la tio n Pr op or tio n of a ll su sp ec te d m ea sl es a nd ru be lla c as es th at h av e ha d an a de qu at e in ve st ig at io n in iti at ed w ith in 4 8 ho ur s of n ot ifi ca tio n Di sc ar de d no n- m ea sl es n on - ru be lla in ci de nc e pe r 1 00 ,0 00 to ta l p op ul at io n Pr op or tio n of s ub na tio na l ad m in is tra tiv e un its re po rti ng at le as t t w o di sc ar de d no n- m ea sl es n on -r ub el la c as es p er 10 0, 00 0 to ta l p op ul at io n Pr op or tio n of s ub -n at io na l su rv ei lla nc e un its re po rti ng to th e na tio na l l ev el o n tim e La b- co nfi rm ed Ep i-L in ke d Cl in ic al ly -c on fir m ed La b- co nfi rm ed Ep i-L in ke d Target  – – 80% 2 80% 80% 2012 66 1 0 0 0 0 65 0 0 100 0.27 0 100 2013 63 0 0 0 0 0 63 0 0 100 0.26 0 100 2014 135 3 0 0 0 0 132 0.12 0 100 0.53 0 100 2015 132 0 0 0 0 0 132 0 0 100 0.54 0 100 Year % Serum specimen collected from suspected measles cases Total Serum Specimen received in Laboratory % serum specimens tested Specimen Positive for Measles IgM Specimen Positive for Rubella IgM % Results within 4 of receipt % Outbreak tested for viral detection Genotypes detected No. % No. % Measles Rubella 2012 100 66 100 0 0 1 2% 100 2% ND ND 2013 100 63 100 0 0 0 0 100 0 ND ND 2014 100 135 100 3 2% 0 0 100 2% ND ND 2015 100 132 100 0 0 0 0 100 ND ND ND Central Hygiene Anti Epidemic Institution - National Polio Laboratory - National measles and rubella laboratory For contact or feedback: Expanded Program on Immunization Ministry of Public Health, Pyongyang, DPR Korea Phone: +850-2-3814077, Fax: +850-2-44104416 Email: bogon.moph@star-co.net.kp Figure 14: Laboratory Network Immunization 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/entity/immunization -10% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 Pe rce nt of po pu lat ion Age (in years) Susceptible Immune due to past infection Protected by SIAs Protected by routine vaccination with 2nd dose Protected by routine vaccination with 1st dose Protected by maternal antibodies -10% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 Pe rce nt of po pu lat ion Age (in years) Protected by maternal antibodies Protected by routine vaccination with 1st dose Protected by routine vaccination with 2nd dose Protected by SIAs Immune due to past infection Susceptible 0 1 2 3 2010 2011 2012 2013 2014 2015 <1 year 1-4 years 5-9 years 10-14 years 15+ years n=0 n=0 n=0 n=0 n=3 n=0 <1 year 1-4 years 5-9 years 10-14 years 15+ years 0 1 2 3 4 2010 2011 2012 2013 2014 2015 n=0 (100%) n=0 (100%) n=0 (100%) n=0 (100%) n=3 (100%) n=0 (100%) E P I F a c t S h E E t World Health Organization• SEARO/FGL/IVD • 31 August 2016 Immunization and Vaccine Development South-East Asia Region Figure 1: National immunization coverage, 1980–2015 Figure 7: MCV1 & MCV2 coverage1 and measles cases2, 1980–2015 Figure 2: DTP3 coverage1, diphtheria and pertussis cases2, 1980–2015 Figure 8: MCV1 coverage by province, 2015 Figure 4: TT2+ coverage1 and NT cases2, 1980–2015 Table 7: Districts with more than 95% MCV1 coverage Figure 6: Adequate stool specimen collection percentage by province, 2015 Source: WHO and UNICEF estimates of national immunization coverage, July 2016 revision 1 WHO and UNICEF estimates of national immunization coverage, July 2016 revision 2 WHO vaccine-preventable diseases: monitoring system 2016 Source: SEAR annual EPI reporting form, 2015 (administrative data) Source: WHO/UNICEF JRF 1 WHO and UNICEF estimates of national immunization coverage, July 2016 revision 2 WHO vaccine-preventable diseases: monitoring system 2016 Source: SEAR annual EPI reporting form, 2015 (administrative data) 1 Country official estimates, 1980-2015 2 WHO vaccine-preventable diseases: monitoring system 2016 Source: WHO/UNICEF JRF (multiple years) Figure 3: DTP-Hib-HepB3 coverage by province, 2015 Table 6: MCV supplementary immunization activities Figure 5: Non-polio AFP rate by province, 2015 Table 3: OPV and JE Supplementary immunization activities (SIA) Figure 9: Sporadic and outbreak associated measles cases* by month, 2010–2015 Year Antigen Activity Target population (age) Date of 1st round Date of 2nd round 1st round coverage (%) 2nd round coverage (%) 2000 OPV NID 2 147 929 (<5 yrs) Oct-00 Nov-00 99.6 99.7 2001 OPV NID 2 120 380 (<5 yrs) Oct-01 Nov-01 98.8 99.5 2002 OPV NID 2 098 940 (<5 yrs) Oct-02 Nov-02 99.7 99.8 2009-2010 JE Sub- national 1.5 million (12 to 23 months and 4 to 6 yrs) Jul-09 Jul-10 – 99.5 – Source: WHO/UNICEF JRF *Includes laboratory confirmed and epidemiologically linked cases Source: SEAR Monthly VPD reports Indicator 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 AFP cases 113 125 138 112 112 129 125 116 115 99 Wild polio confirmed cases 0 0 0 0 0 0 0 0 0 0 Compatible cases 0 0 0 0 0 0 0 0 0 0 AFP rate 1.86 1.95 2.15 1.95 1.95 2.25 2.18 2.02 2.00 1.72 Non-polio AFP rate1 1.86 1.95 2.15 1.95 1.95 2.25 2.18 2.02 2.00 1.72 Adequate stool specimen collection percentage2 99% 100% 100% 100% 99% 100% 100% 100% 100% 100% Total stool samples collected 237 258 280 220 245 270 269 226 184 156 % NPEV isolation 12 17 10 9 13 10 11 9 11 5 % Timeliness of primary result reported3 88 91 97 90 97 99 94 92 99 95 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 2005 to 2007 result reported within 28 days and 2008 onwards result reported within 14 days of sample received at laboratory. Table 5: Reported cases of vaccine preventable diseases, 2006-2015 Table 4: AFP surveillance performance indicators, 2006–2015 Source: WHO/UNICEF JRF ND=No data • The last laboratory confirmed polio case due to wild polio virus (WPV) was reported in 1996. Year Polio Diphtheria Pertussis Neonatal Tetanus (% of all Tetanus) Measles Rubella Mumps Japanese Encephalitis Congenital Rubella Syndrome 2006 0 0 409 0 0 101 176 0 0 2007 0 0 1 250 0 3 550 101 176 0 0 2008 0 0 395 0 82 82 67 124 0 2009 0 0 8 0 0 0 18 10 ND 2010 0 0 0 0 0 0 0 ND ND 2011 0 0 13 0 0 5 66 0 0 2012 0 0 8 0 0 1 11 0 0 2013 0 0 0 0 0 0 0 0 0 2014 0 0 0 0 3 0 0 0 0 2015 0 0 0 0 0 0 0 0 0 Year Vaccine, geographic coverage, target group Target Coverage Achieved 2007 M, nationwide, 6 month to 45 years 16 123 376 99.9 Year Number of districts % 2010 208 100 2011 208 100 2012 208 100 2013 209 100 2014 210 100 2015 210 100 0 20 40 60 80 100 0 200 400 600 800 1000 1200 1400 1600 1800 1980 1985 1990 1995 2000 2005 2010 2011 2012 2013 2014 2015 % C ov er ag e No . o f c as es Year Diphtheria Cases Pertussis Cases DTP3 Coverage <70% 70 % - 79 % 80% - 89% >90% 0 20 40 60 80 100 0 1 2 3 4 1980 1985 1990 1995 2000 2005 2010 2011 2012 2013 2014 2015 % C ov er ag e No . o f c as es Year NT cases TT2+ Coverage <1 1 – 1.99 >2 No non -polio AFP case < 60% 60% - 79% > 80% No AFP 0 20 40 60 80 100 0 500 1000 1500 2000 2500 3000 3500 4000 1980 1985 1990 1995 2000 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 % C ov er ag e No . o f c as es Year Measles MCV1 Coverage MCV2 Coverage <70% 70% - 79% 80% - 89% >90% 1 2 3 4 5 6 Ja n- 10 Ma r-1 0 Ma y- 10 Ju l-1 0 Se p- 10 No v- 10 Ja n- 11 Ma r-1 1 Ma y- 11 Ju l-1 1 Se p- 11 No v- 11 Ja n- 12 Ma r-1 2 Ma y- 12 Ju l-1 2 Se p- 12 No v- 12 Ja n- 13 Ma r-1 3 Ma y- 13 Ju l-1 3 Se p- 13 No v- 13 Ja n- 14 Ma r-1 4 Ma y- 14 Ju l-1 4 Se p- 14 No v- 14 Ja n- 15 Ma r-1 5 Ma y- 15 Ju l-1 5 Se p- 15 No v- 15 No . o f c as es Sporadic measles Outbreak associated measles 1980 1985 1990 1995 2000 2005 2010 2011 2012 2013 2014 2015 BCG 50 51 99 82 78 94 98 98 98 98 98 97 DTP3 50 55 98 64 56 79 93 94 96 93 93 96 OPV3 50 65 99 88 93 97 99 99 99 99 99 99 MCV1 29 38 98 67 78 96 99 99 99 99 99 98 0 20 40 60 80 100 % C ov er ag e • DPR Korea achieved the status of maternal and neonatal tetanus (MNT) elimination before 2000. E P I F a c t S h E E t World Health Organization• SEARO/FGL/IVD • 31 August 2016 Immunization and Vaccine Development South-East Asia Region Figure 1: National immunization coverage, 1980–2015 Figure 7: MCV1 & MCV2 coverage1 and measles cases2, 1980–2015 Figure 2: DTP3 coverage1, diphtheria and pertussis cases2, 1980–2015 Figure 8: MCV1 coverage by province, 2015 Figure 4: TT2+ coverage1 and NT cases2, 1980–2015 Table 7: Districts with more than 95% MCV1 coverage Figure 6: Adequate stool specimen collection percentage by province, 2015 Source: WHO and UNICEF estimates of national immunization coverage, July 2016 revision 1 WHO and UNICEF estimates of national immunization coverage, July 2016 revision 2 WHO vaccine-preventable diseases: monitoring system 2016 Source: SEAR annual EPI reporting form, 2015 (administrative data) Source: WHO/UNICEF JRF 1 WHO and UNICEF estimates of national immunization coverage, July 2016 revision 2 WHO vaccine-preventable diseases: monitoring system 2016 Source: SEAR annual EPI reporting form, 2015 (administrative data) 1 Country official estimates, 1980-2015 2 WHO vaccine-preventable diseases: monitoring system 2016 Source: WHO/UNICEF JRF (multiple years) Figure 3: DTP-Hib-HepB3 coverage by province, 2015 Table 6: MCV supplementary immunization activities Figure 5: Non-polio AFP rate by province, 2015 Table 3: OPV and JE Supplementary immunization activities (SIA) Figure 9: Sporadic and outbreak associated measles cases* by month, 2010–2015 Year Antigen Activity Target population (age) Date of 1st round Date of 2nd round 1st round coverage (%) 2nd round coverage (%) 2000 OPV NID 2 147 929 (<5 yrs) Oct-00 Nov-00 99.6 99.7 2001 OPV NID 2 120 380 (<5 yrs) Oct-01 Nov-01 98.8 99.5 2002 OPV NID 2 098 940 (<5 yrs) Oct-02 Nov-02 99.7 99.8 2009-2010 JE Sub- national 1.5 million (12 to 23 months and 4 to 6 yrs) Jul-09 Jul-10 – 99.5 – Source: WHO/UNICEF JRF *Includes laboratory confirmed and epidemiologically linked cases Source: SEAR Monthly VPD reports Indicator 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 AFP cases 113 125 138 112 112 129 125 116 115 99 Wild polio confirmed cases 0 0 0 0 0 0 0 0 0 0 Compatible cases 0 0 0 0 0 0 0 0 0 0 AFP rate 1.86 1.95 2.15 1.95 1.95 2.25 2.18 2.02 2.00 1.72 Non-polio AFP rate1 1.86 1.95 2.15 1.95 1.95 2.25 2.18 2.02 2.00 1.72 Adequate stool specimen collection percentage2 99% 100% 100% 100% 99% 100% 100% 100% 100% 100% Total stool samples collected 237 258 280 220 245 270 269 226 184 156 % NPEV isolation 12 17 10 9 13 10 11 9 11 5 % Timeliness of primary result reported3 88 91 97 90 97 99 94 92 99 95 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 2005 to 2007 result reported within 28 days and 2008 onwards result reported within 14 days of sample received at laboratory. Table 5: Reported cases of vaccine preventable diseases, 2006-2015 Table 4: AFP surveillance performance indicators, 2006–2015 Source: WHO/UNICEF JRF ND=No data • The last laboratory confirmed polio case due to wild polio virus (WPV) was reported in 1996. Year Polio Diphtheria Pertussis Neonatal Tetanus (% of all Tetanus) Measles Rubella Mumps Japanese Encephalitis Congenital Rubella Syndrome 2006 0 0 409 0 0 101 176 0 0 2007 0 0 1 250 0 3 550 101 176 0 0 2008 0 0 395 0 82 82 67 124 0 2009 0 0 8 0 0 0 18 10 ND 2010 0 0 0 0 0 0 0 ND ND 2011 0 0 13 0 0 5 66 0 0 2012 0 0 8 0 0 1 11 0 0 2013 0 0 0 0 0 0 0 0 0 2014 0 0 0 0 3 0 0 0 0 2015 0 0 0 0 0 0 0 0 0 Year Vaccine, geographic coverage, target group Target Coverage Achieved 2007 M, nationwide, 6 month to 45 years 16 123 376 99.9 Year Number of districts % 2010 208 100 2011 208 100 2012 208 100 2013 209 100 2014 210 100 2015 210 100 0 20 40 60 80 100 0 200 400 600 800 1000 1200 1400 1600 1800 1980 1985 1990 1995 2000 2005 2010 2011 2012 2013 2014 2015 % C ov er ag e No . o f c as es Year Diphtheria Cases Pertussis Cases DTP3 Coverage <70% 70 % - 79 % 80% - 89% >90% 0 20 40 60 80 100 0 1 2 3 4 1980 1985 1990 1995 2000 2005 2010 2011 2012 2013 2014 2015 % C ov er ag e No . o f c as es Year NT cases TT2+ Coverage <1 1 – 1.99 >2 No non -polio AFP case < 60% 60% - 79% > 80% No AFP 0 20 40 60 80 100 0 500 1000 1500 2000 2500 3000 3500 4000 1980 1985 1990 1995 2000 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 % C ov er ag e No . o f c as es Year Measles MCV1 Coverage MCV2 Coverage <70% 70% - 79% 80% - 89% >90% 1 2 3 4 5 6 Ja n- 10 Ma r-1 0 Ma y- 10 Ju l-1 0 Se p- 10 No v- 10 Ja n- 11 Ma r-1 1 Ma y- 11 Ju l-1 1 Se p- 11 No v- 11 Ja n- 12 Ma r-1 2 Ma y- 12 Ju l-1 2 Se p- 12 No v- 12 Ja n- 13 Ma r-1 3 Ma y- 13 Ju l-1 3 Se p- 13 No v- 13 Ja n- 14 Ma r-1 4 Ma y- 14 Ju l-1 4 Se p- 14 No v- 14 Ja n- 15 Ma r-1 5 Ma y- 15 Ju l-1 5 Se p- 15 No v- 15 No . o f c as es Sporadic measles Outbreak associated measles 1980 1985 1990 1995 2000 2005 2010 2011 2012 2013 2014 2015 BCG 50 51 99 82 78 94 98 98 98 98 98 97 DTP3 50 55 98 64 56 79 93 94 96 93 93 96 OPV3 50 65 99 88 93 97 99 99 99 99 99 99 MCV1 29 38 98 67 78 96 99 99 99 99 99 98 0 20 40 60 80 100 % C ov er ag e • DPR Korea achieved the status of maternal and neonatal tetanus (MNT) elimination before 2000. E P I F a c t S h E E t World Health Organization• SEARO/FGL/IVD • 31 August 2016 Immunization and Vaccine Development South-East Asia Region Figure 1: National immunization coverage, 1980–2015 Figure 7: MCV1 & MCV2 coverage1 and measles cases2, 1980–2015 Figure 2: DTP3 coverage1, diphtheria and pertussis cases2, 1980–2015 Figure 8: MCV1 coverage by province, 2015 Figure 4: TT2+ coverage1 and NT cases2, 1980–2015 Table 7: Districts with more than 95% MCV1 coverage Figure 6: Adequate stool specimen collection percentage by province, 2015 Source: WHO and UNICEF estimates of national immunization coverage, July 2016 revision 1 WHO and UNICEF estimates of national immunization coverage, July 2016 revision 2 WHO vaccine-preventable diseases: monitoring system 2016 Source: SEAR annual EPI reporting form, 2015 (administrative data) Source: WHO/UNICEF JRF 1 WHO and UNICEF estimates of national immunization coverage, July 2016 revision 2 WHO vaccine-preventable diseases: monitoring system 2016 Source: SEAR annual EPI reporting form, 2015 (administrative data) 1 Country official estimates, 1980-2015 2 WHO vaccine-preventable diseases: monitoring system 2016 Source: WHO/UNICEF JRF (multiple years) Figure 3: DTP-Hib-HepB3 coverage by province, 2015 Table 6: MCV supplementary immunization activities Figure 5: Non-polio AFP rate by province, 2015 Table 3: OPV and JE Supplementary immunization activities (SIA) Figure 9: Sporadic and outbreak associated measles cases* by month, 2010–2015 Year Antigen Activity Target population (age) Date of 1st round Date of 2nd round 1st round coverage (%) 2nd round coverage (%) 2000 OPV NID 2 147 929 (<5 yrs) Oct-00 Nov-00 99.6 99.7 2001 OPV NID 2 120 380 (<5 yrs) Oct-01 Nov-01 98.8 99.5 2002 OPV NID 2 098 940 (<5 yrs) Oct-02 Nov-02 99.7 99.8 2009-2010 JE Sub- national 1.5 million (12 to 23 months and 4 to 6 yrs) Jul-09 Jul-10 – 99.5 – Source: WHO/UNICEF JRF *Includes laboratory confirmed and epidemiologically linked cases Source: SEAR Monthly VPD reports Indicator 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 AFP cases 113 125 138 112 112 129 125 116 115 99 Wild polio confirmed cases 0 0 0 0 0 0 0 0 0 0 Compatible cases 0 0 0 0 0 0 0 0 0 0 AFP rate 1.86 1.95 2.15 1.95 1.95 2.25 2.18 2.02 2.00 1.72 Non-polio AFP rate1 1.86 1.95 2.15 1.95 1.95 2.25 2.18 2.02 2.00 1.72 Adequate stool specimen collection percentage2 99% 100% 100% 100% 99% 100% 100% 100% 100% 100% Total stool samples collected 237 258 280 220 245 270 269 226 184 156 % NPEV isolation 12 17 10 9 13 10 11 9 11 5 % Timeliness of primary result reported3 88 91 97 90 97 99 94 92 99 95 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 2005 to 2007 result reported within 28 days and 2008 onwards result reported within 14 days of sample received at laboratory. Table 5: Reported cases of vaccine preventable diseases, 2006-2015 Table 4: AFP surveillance performance indicators, 2006–2015 Source: WHO/UNICEF JRF ND=No data • The last laboratory confirmed polio case due to wild polio virus (WPV) was reported in 1996. Year Polio Diphtheria Pertussis Neonatal Tetanus (% of all Tetanus) Measles Rubella Mumps Japanese Encephalitis Congenital Rubella Syndrome 2006 0 0 409 0 0 101 176 0 0 2007 0 0 1 250 0 3 550 101 176 0 0 2008 0 0 395 0 82 82 67 124 0 2009 0 0 8 0 0 0 18 10 ND 2010 0 0 0 0 0 0 0 ND ND 2011 0 0 13 0 0 5 66 0 0 2012 0 0 8 0 0 1 11 0 0 2013 0 0 0 0 0 0 0 0 0 2014 0 0 0 0 3 0 0 0 0 2015 0 0 0 0 0 0 0 0 0 Year Vaccine, geographic coverage, target group Target Coverage Achieved 2007 M, nationwide, 6 month to 45 years 16 123 376 99.9 Year Number of districts % 2010 208 100 2011 208 100 2012 208 100 2013 209 100 2014 210 100 2015 210 100 0 20 40 60 80 100 0 200 400 600 800 1000 1200 1400 1600 1800 1980 1985 1990 1995 2000 2005 2010 2011 2012 2013 2014 2015 % C ov er ag e No . o f c as es Year Diphtheria Cases Pertussis Cases DTP3 Coverage <70% 70 % - 79 % 80% - 89% >90% 0 20 40 60 80 100 0 1 2 3 4 1980 1985 1990 1995 2000 2005 2010 2011 2012 2013 2014 2015 % C ov er ag e No . o f c as es Year NT cases TT2+ Coverage <1 1 – 1.99 >2 No non -polio AFP case < 60% 60% - 79% > 80% No AFP 0 20 40 60 80 100 0 500 1000 1500 2000 2500 3000 3500 4000 1980 1985 1990 1995 2000 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 % C ov er ag e No . o f c as es Year Measles MCV1 Coverage MCV2 Coverage <70% 70% - 79% 80% - 89% >90% 1 2 3 4 5 6 Ja n- 10 Ma r-1 0 Ma y- 10 Ju l-1 0 Se p- 10 No v- 10 Ja n- 11 Ma r-1 1 Ma y- 11 Ju l-1 1 Se p- 11 No v- 11 Ja n- 12 Ma r-1 2 Ma y- 12 Ju l-1 2 Se p- 12 No v- 12 Ja n- 13 Ma r-1 3 Ma y- 13 Ju l-1 3 Se p- 13 No v- 13 Ja n- 14 Ma r-1 4 Ma y- 14 Ju l-1 4 Se p- 14 No v- 14 Ja n- 15 Ma r-1 5 Ma y- 15 Ju l-1 5 Se p- 15 No v- 15 No . o f c as es Sporadic measles Outbreak associated measles 1980 1985 1990 1995 2000 2005 2010 2011 2012 2013 2014 2015 BCG 50 51 99 82 78 94 98 98 98 98 98 97 DTP3 50 55 98 64 56 79 93 94 96 93 93 96 OPV3 50 65 99 88 93 97 99 99 99 99 99 99 MCV1 29 38 98 67 78 96 99 99 99 99 99 98 0 20 40 60 80 100 % C ov er ag e • DPR Korea achieved the status of maternal and neonatal tetanus (MNT) elimination before 2000. World Health Organization• SEARO/FGL/IVD • 31 August 2016World Health Organization• SEARO/FGL/IVD • 31 August 2016 Immunization and Vaccine Development South-East Asia Region Immunization and Vaccine Development South-East Asia Region DPR Korea 2016 Immunization system highlights „ There is a comprehensive multi- year plan (cMYP) for immunization covering 2011-2015. „ A standing national technical advisory group on immunization (NTAGI) fully functional. „ A national system to monitor adverse events following immunization (AEFI) exists. „ A national policy for health care waste management including waste from immunization activities exists. „ All 210 districts have updated micro- plans that include activities to raise immunization coverage. „ All 210 districts have ³80% coverage for DTP-Hib-HepB3, ³90% coverage for MCV1. „ No district reported more than 10% drop-out rate from DTP-Hib-HepB1 to DTP-Hib-HepB3. „ A coverage evaluation survey (CES) is planned in the next 24 months. Source: WHO/UNICEF joint reporting form (JRF) 2015 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. Table 1: Basic information1 2015 Division/Province/State/Region 12 District 210 Population density (per sq. km) 202 Population living in urban areas 61% Population using improved drinking-water sources 98% Population using improved sanitation 82% Total expenditure on health as % of GDP – Births attended by skilled health personnel 100% Neonates protected at birth against NT 93% 1 SEAR annual EPI reporting form, 2015 and WHO, World Health Statistics 2015 Vaccine Age of administration BCG At birth HepB At birth DTP-Hib-HepB 6 weeks, 10 weeks, 14 weeks OPV 6 weeks, 10 weeks, 14 weeks IPV 14 weeks Measles 9 months and 15 months Td 3 months, 4 months Vitamin A 6 - 59 months EPI history „ EPI launched in 1980. „ Hepatitis B vaccine introduced in 2003. „ AD syringes introduced in 2003. „ Hepatitis B birth dose introduced in 2004. „ DTP-HepB vaccine introduced in 2006. „ Measles second dose introduced in 2008. „ Hib Pentavalent (DTP-Hib-HepB) vaccine introduced in 2012. „ IPV vaccine introduced in 2015 „ Type 2 component of OPV withdrawn on 18 April 2016 by switching from tOPV to bOPV Table 2: Immunization schedule, 2015 Source: cMYP 2011-2015 and EPI/MOPH Source: WHO/UNICEF joint reporting form (JRF) 2015 E P I F a c t S h E E t Total population 24 192 506 Live births (LB) 344 435 Children <1 year 340 520 Children <5 years 1 700 539 Children <15 years 5 186 693 Pregnant women 343 769 Women of child bearing age (15-49 years) 6 582 498 Neonatal mortality rate 14.9 (per 1 000 LB) Infant mortality rate 21.7 (per 1 000 LB) Under-five mortality rate 27.4 (per 1 000 LB) Maternal mortality ratio 87 (per 100 000 LB) Figure 10: Immunity against measles: Immunity profile by age in 2015* Figure 11: Immunity against measles: Immunity profile by age in 2016* Figure 13: Unimmunized confirmed (Lab and Epi linked) measles outbreak associated cases, by age, 2010–2015 * Modeled using MSP tool ver 2 based on coverage data up to 2015. Source: SEAR annual EPI reporting form (multiple years) * Modeled using MSP tool ver 2 assuming the schedule and measles containing vaccine (MCV) coverage remain unchanged and no SIAs in 2015 & 2016. Source: SEAR annual EPI reporting form (multiple years) Figure 12: Confirmed (Lab and Epi linked) measles outbreak associated cases, by age, 2010–2015 Table 8: Suspected sporadic and Outbreak associated measles and rubella cases, 2010–2015 Table 9: Quality of field and laboratory surveillance for measles and rubella, 2012–2015 Table 10: Performance of Laboratory Surveillance, 2012–2015 Source: Monthly VPD Reporting to WHO/SEARO # Only 1st quarter data for year 2014 *Laboratory confirmed & epidemiologically- linked Source: SEAR Annual EPI Reporting Form ND=No data Source: SEAR Annual EPI Reporting Form ND=No data Year Routine/sporadic cases Outbreak associated cases No. of suspected case No. of death No. of lab- confirmed measles cases No. of lab- confirmed rubella cases No. of suspected outbreak No. of Outbreak Investigated No. of case No. of death No. of measles outbreak* No. of confirmed measles case* No. of confirmed rubella outbreak* No. of confirmed rubella cases* 2010 0 0 0 0 0 0 0 0 0 0 0 0 2011 70 0 0 0 0 0 0 0 0 0 0 0 2012 66 0 0 1 0 0 0 0 0 0 0 0 2013 58 0 0 0 0 0 0 0 0 0 0 0 2014# 11 0 0 0 1 1 4 0 1 3 0 0 2015 132 0 0 0 0 0 0 0 0 0 0 0 Year No . o f S us pe ct ed M ea sl es Case classification (number) Indicators Measles Rubella Di sc ar de d n on -m ea sl es n on - ru be lla c as es An nu al in ci de nc e of c on fir m ed M ea sl es c as es p er m ill io n to ta l po pu la tio n An nu al in ci de nc e of c on fir m ed Ru be lla c as es p er m ill io n to ta l po pu la tio n Pr op or tio n of a ll su sp ec te d m ea sl es a nd ru be lla c as es th at h av e ha d an a de qu at e in ve st ig at io n in iti at ed w ith in 4 8 ho ur s of n ot ifi ca tio n Di sc ar de d no n- m ea sl es n on - ru be lla in ci de nc e pe r 1 00 ,0 00 to ta l p op ul at io n Pr op or tio n of s ub na tio na l ad m in is tra tiv e un its re po rti ng at le as t t w o di sc ar de d no n- m ea sl es n on -r ub el la c as es p er 10 0, 00 0 to ta l p op ul at io n Pr op or tio n of s ub -n at io na l su rv ei lla nc e un its re po rti ng to th e na tio na l l ev el o n tim e La b- co nfi rm ed Ep i-L in ke d Cl in ic al ly -c on fir m ed La b- co nfi rm ed Ep i-L in ke d Target  – – 80% 2 80% 80% 2012 66 1 0 0 0 0 65 0 0 100 0.27 0 100 2013 63 0 0 0 0 0 63 0 0 100 0.26 0 100 2014 135 3 0 0 0 0 132 0.12 0 100 0.53 0 100 2015 132 0 0 0 0 0 132 0 0 100 0.54 0 100 Year % Serum specimen collected from suspected measles cases Total Serum Specimen received in Laboratory % serum specimens tested Specimen Positive for Measles IgM Specimen Positive for Rubella IgM % Results within 4 of receipt % Outbreak tested for viral detection Genotypes detected No. % No. % Measles Rubella 2012 100 66 100 0 0 1 2% 100 2% ND ND 2013 100 63 100 0 0 0 0 100 0 ND ND 2014 100 135 100 3 2% 0 0 100 2% ND ND 2015 100 132 100 0 0 0 0 100 ND ND ND Central Hygiene Anti Epidemic Institution - National Polio Laboratory - National measles and rubella laboratory For contact or feedback: Expanded Program on Immunization Ministry of Public Health, Pyongyang, DPR Korea Phone: +850-2-3814077, Fax: +850-2-44104416 Email: bogon.moph@star-co.net.kp Figure 14: Laboratory Network Immunization 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/entity/immunization -10% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 Pe rce nt of po pu lat ion Age (in years) Susceptible Immune due to past infection Protected by SIAs Protected by routine vaccination with 2nd dose Protected by routine vaccination with 1st dose Protected by maternal antibodies -10% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 Pe rce nt of po pu lat ion Age (in years) Protected by maternal antibodies Protected by routine vaccination with 1st dose Protected by routine vaccination with 2nd dose Protected by SIAs Immune due to past infection Susceptible 0 1 2 3 2010 2011 2012 2013 2014 2015 <1 year 1-4 years 5-9 years 10-14 years 15+ years n=0 n=0 n=0 n=0 n=3 n=0 <1 year 1-4 years 5-9 years 10-14 years 15+ years 0 1 2 3 4 2010 2011 2012 2013 2014 2015 n=0 (100%) n=0 (100%) n=0 (100%) n=0 (100%) n=3 (100%) n=0 (100%) World Health Organization• SEARO/FGL/IVD • 31 August 2016World Health Organization• SEARO/FGL/IVD • 31 August 2016 Immunization and Vaccine Development South-East Asia Region Immunization and Vaccine Development South-East Asia Region DPR Korea 2016 Immunization system highlights „ There is a comprehensive multi- year plan (cMYP) for immunization covering 2011-2015. „ A standing national technical advisory group on immunization (NTAGI) fully functional. „ A national system to monitor adverse events following immunization (AEFI) exists. „ A national policy for health care waste management including waste from immunization activities exists. „ All 210 districts have updated micro- plans that include activities to raise immunization coverage. „ All 210 districts have ³80% coverage for DTP-Hib-HepB3, ³90% coverage for MCV1. „ No district reported more than 10% drop-out rate from DTP-Hib-HepB1 to DTP-Hib-HepB3. „ A coverage evaluation survey (CES) is planned in the next 24 months. Source: WHO/UNICEF joint reporting form (JRF) 2015 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. Table 1: Basic information1 2015 Division/Province/State/Region 12 District 210 Population density (per sq. km) 202 Population living in urban areas 61% Population using improved drinking-water sources 98% Population using improved sanitation 82% Total expenditure on health as % of GDP – Births attended by skilled health personnel 100% Neonates protected at birth against NT 93% 1 SEAR annual EPI reporting form, 2015 and WHO, World Health Statistics 2015 Vaccine Age of administration BCG At birth HepB At birth DTP-Hib-HepB 6 weeks, 10 weeks, 14 weeks OPV 6 weeks, 10 weeks, 14 weeks IPV 14 weeks Measles 9 months and 15 months Td 3 months, 4 months Vitamin A 6 - 59 months EPI history „ EPI launched in 1980. „ Hepatitis B vaccine introduced in 2003. „ AD syringes introduced in 2003. „ Hepatitis B birth dose introduced in 2004. „ DTP-HepB vaccine introduced in 2006. „ Measles second dose introduced in 2008. „ Hib Pentavalent (DTP-Hib-HepB) vaccine introduced in 2012. „ IPV vaccine introduced in 2015 „ Type 2 component of OPV withdrawn on 18 April 2016 by switching from tOPV to bOPV Table 2: Immunization schedule, 2015 Source: cMYP 2011-2015 and EPI/MOPH Source: WHO/UNICEF joint reporting form (JRF) 2015 E P I F a c t S h E E t Total population 24 192 506 Live births (LB) 344 435 Children <1 year 340 520 Children <5 years 1 700 539 Children <15 years 5 186 693 Pregnant women 343 769 Women of child bearing age (15-49 years) 6 582 498 Neonatal mortality rate 14.9 (per 1 000 LB) Infant mortality rate 21.7 (per 1 000 LB) Under-five mortality rate 27.4 (per 1 000 LB) Maternal mortality ratio 87 (per 100 000 LB) Figure 10: Immunity against measles: Immunity profile by age in 2015* Figure 11: Immunity against measles: Immunity profile by age in 2016* Figure 13: Unimmunized confirmed (Lab and Epi linked) measles outbreak associated cases, by age, 2010–2015 * Modeled using MSP tool ver 2 based on coverage data up to 2015. Source: SEAR annual EPI reporting form (multiple years) * Modeled using MSP tool ver 2 assuming the schedule and measles containing vaccine (MCV) coverage remain unchanged and no SIAs in 2015 & 2016. Source: SEAR annual EPI reporting form (multiple years) Figure 12: Confirmed (Lab and Epi linked) measles outbreak associated cases, by age, 2010–2015 Table 8: Suspected sporadic and Outbreak associated measles and rubella cases, 2010–2015 Table 9: Quality of field and laboratory surveillance for measles and rubella, 2012–2015 Table 10: Performance of Laboratory Surveillance, 2012–2015 Source: Monthly VPD Reporting to WHO/SEARO # Only 1st quarter data for year 2014 *Laboratory confirmed & epidemiologically- linked Source: SEAR Annual EPI Reporting Form ND=No data Source: SEAR Annual EPI Reporting Form ND=No data Year Routine/sporadic cases Outbreak associated cases No. of suspected case No. of death No. of lab- confirmed measles cases No. of lab- confirmed rubella cases No. of suspected outbreak No. of Outbreak Investigated No. of case No. of death No. of measles outbreak* No. of confirmed measles case* No. of confirmed rubella outbreak* No. of confirmed rubella cases* 2010 0 0 0 0 0 0 0 0 0 0 0 0 2011 70 0 0 0 0 0 0 0 0 0 0 0 2012 66 0 0 1 0 0 0 0 0 0 0 0 2013 58 0 0 0 0 0 0 0 0 0 0 0 2014# 11 0 0 0 1 1 4 0 1 3 0 0 2015 132 0 0 0 0 0 0 0 0 0 0 0 Year No . o f S us pe ct ed M ea sl es Case classification (number) Indicators Measles Rubella Di sc ar de d n on -m ea sl es n on - ru be lla c as es An nu al in ci de nc e of c on fir m ed M ea sl es c as es p er m ill io n to ta l po pu la tio n An nu al in ci de nc e of c on fir m ed Ru be lla c as es p er m ill io n to ta l po pu la tio n Pr op or tio n of a ll su sp ec te d m ea sl es a nd ru be lla c as es th at h av e ha d an a de qu at e in ve st ig at io n in iti at ed w ith in 4 8 ho ur s of n ot ifi ca tio n Di sc ar de d no n- m ea sl es n on - ru be lla in ci de nc e pe r 1 00 ,0 00 to ta l p op ul at io n Pr op or tio n of s ub na tio na l ad m in is tra tiv e un its re po rti ng at le as t t w o di sc ar de d no n- m ea sl es n on -r ub el la c as es p er 10 0, 00 0 to ta l p op ul at io n Pr op or tio n of s ub -n at io na l su rv ei lla nc e un its re po rti ng to th e na tio na l l ev el o n tim e La b- co nfi rm ed Ep i-L in ke d Cl in ic al ly -c on fir m ed La b- co nfi rm ed Ep i-L in ke d Target  – – 80% 2 80% 80% 2012 66 1 0 0 0 0 65 0 0 100 0.27 0 100 2013 63 0 0 0 0 0 63 0 0 100 0.26 0 100 2014 135 3 0 0 0 0 132 0.12 0 100 0.53 0 100 2015 132 0 0 0 0 0 132 0 0 100 0.54 0 100 Year % Serum specimen collected from suspected measles cases Total Serum Specimen received in Laboratory % serum specimens tested Specimen Positive for Measles IgM Specimen Positive for Rubella IgM % Results within 4 of receipt % Outbreak tested for viral detection Genotypes detected No. % No. % Measles Rubella 2012 100 66 100 0 0 1 2% 100 2% ND ND 2013 100 63 100 0 0 0 0 100 0 ND ND 2014 100 135 100 3 2% 0 0 100 2% ND ND 2015 100 132 100 0 0 0 0 100 ND ND ND Central Hygiene Anti Epidemic Institution - National Polio Laboratory - National measles and rubella laboratory For contact or feedback: Expanded Program on Immunization Ministry of Public Health, Pyongyang, DPR Korea Phone: +850-2-3814077, Fax: +850-2-44104416 Email: bogon.moph@star-co.net.kp Figure 14: Laboratory Network Immunization 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/entity/immunization -10% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 Pe rce nt of po pu lat ion Age (in years) Susceptible Immune due to past infection Protected by SIAs Protected by routine vaccination with 2nd dose Protected by routine vaccination with 1st dose Protected by maternal antibodies -10% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 Pe rce nt of po pu lat ion Age (in years) Protected by maternal antibodies Protected by routine vaccination with 1st dose Protected by routine vaccination with 2nd dose Protected by SIAs Immune due to past infection Susceptible 0 1 2 3 2010 2011 2012 2013 2014 2015 <1 year 1-4 years 5-9 years 10-14 years 15+ years n=0 n=0 n=0 n=0 n=3 n=0 <1 year 1-4 years 5-9 years 10-14 years 15+ years 0 1 2 3 4 2010 2011 2012 2013 2014 2015 n=0 (100%) n=0 (100%) n=0 (100%) n=0 (100%) n=3 (100%) n=0 (100%)