Expanded programme on Immunization (EPI) factsheet 2023: Bhutan

World Health Organization • SEARO/CDS/IVD • 31 October 2023 VACCINES PROTECT SUSTAIN. ACCELERATE. INNOVATE. EXPANDED PROGRAMME ON IMMUNIZATION (EPI) FACTSHEET 2023 BHUTAN Table 2: Basic information 2022 Table 3: Immunization schedule, 2022 Table 4: Immunization system highlights Total population1 763,249 Live births1 10,499 Children <1 year1 10,341 Children <5 years1 59,666 Children <15 years1 179,313 Pregnant women1 10,499 WCBA1 (15-49 years) 203,589 Neonatal mortality rate2 14.83 (per 1,000 LB) Infant mortality rate2 22.45 (per 1,000 LB) Under-five mortality rate2 26.69 (per 1,000 LB) Maternal mortality ratio2 60 (per 100,000 LB) Division/Province/State/Region 3 Dzongkhag/District 20 Gewog/Block 205 Sub-block/Ward 1,050 Village (approx.) 3,717 Population density (per sq. km)1 20 Population living in urban areas2 42.20% Population using at least basic drinking-water services2 99% Population using at least basic sanitation services4 95% Total expenditure on health as % of GDP2 3.41% Births attended by skilled health personnel2 99% Neonates protected at birth against NT2 90% Children not covered by immunization programme (zero dose children)3 189 1 SEAR annual EPI reporting form, 2022 2 Global Health Observatory (GHO) data http://apps.who.int/gho/ data accessed on 03 August 2023 3 DTP1 coverage from WHO and UNICEF estimates of immunization coverage and UN estimated under one population 4 Annual Health Bulletin 2022, MoH, Bhutan cMYP for immunization 2019-2023 NITAG fully functional Spending on vaccines financed by the government 78% Spending on routine immunization programme financed by the government ND Updated micro-plans that include activities to improve immunization coverage 20 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 National Health Survey 2012 >80% coverage for DTP-Hib-HepB3 20 districts (100%) >90% coverage for MCV1 19 districts (95%) >90% coverage for MCV2 19 districts (95%) >10% drop-out rate for DTP-Hib- HepB1 to DTP-Hib-HepB3 1 district (5%) Source: WHO/UNICEF JRF, 2022Figure 1: National immunization coverage, 2013-2022 Figure 16: Immunity against measles - immunity profile by age in 2022* Figure 20: Vaccination status of confirmed (laboratory, Epi linked and clinically compatible) measles cases, by age in 2021 and 2022 Figure 21: Vaccination status of confirmed (laboratory and Epi linked) rubella cases, by age in 2021 and 2022 Table 9: Summary of measles surveillance indicators, 2020-2022 Figure 22: Network of WHO supported surveillance and immunization medical officers and laboratories Figure 18: Confirmed measles cases* by month 2020-2022 Figure 17: Immunity against rubella through vaccination - immunity profile by age in 2022* Figure 19: Confirmed rubella cases* by month 2020-2022 *Modelled using WHO and UNICEF estimates and JRF (multiple years) and does not include immunity due to natural infection *Includes laboratory confirmed, epidemiologically linked and clinically compatible cases Source: SEAR measles case-based data *Includes laboratory confirmed and epidemiologically linked cases Source: SEAR measles case-based data *Modelled using MSP tool ver 2 Source: SEAR measles case-based data Source: SEAR measles case-based data For contact or feedback: Expanded Programme on Immunization Ministry of Health, Thimphu, Bhutan Tel: +975-2-332296, Fax: +975-2-332296 Email: tdawa@health.gov.bt www.health.gov.bt 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.who.int/southeastasia/health-topics/immunization Source: WHO and UNICEF estimates of immunization coverage Indicator Target 2020 2021 2022 Number of suspected measles cases 122 148 122 Confirmed measles cases 0 0 5 7 Lab confirmed 0 0 5 7 Epi-Linked 0 0 0 0 Clinically-compatible 0 0 0 0 Confirmed rubella cases 0 0 3 4 Lab confirmed 0 0 3 4 Epi-Linked 0 0 0 0 Discarded non-measles non-rubella cases 122 143 114 Percentage of suspected cases with adequate investigation initiated within 48 hours of notification ≥ 80% 95 100 88 Reporting rate of non-measles non-rubella cases to national level per 100,000 population ≥ 2 15.98 15.5 14.94 Percentage of second-level administrative units reporting at least 2 non-measles non-rubella cases per 100,00 population ≥ 80% ND ND 55 Percentage of surveillance units reporting measles and rubella data to the national level on time, even in the absence of cases ≥ 80% 100 ND 100 Percentage of specimens received at the laboratory within 5 days of collection ≥ 80% ND ND 61 Percentage of IgM results reported to the national public health authorities by the laboratory within 4 days of receipt of specimens ≥ 80% ND ND 71 Genotypes detected Measles ND D8 Rubella ND Vaccine Age of administration BCG Birth HepB Birth (within 24 hours) OPV Birth, 6 weeks, 10 weeks and 14 weeks DTP-Hib-HepB 6 weeks, 10 weeks and 14 weeks IPV 14 weeks, 8 months PCV 6 weeks, 10 weeks and 9 months MMR 9 months and 24 months DTP 24 months HPV Females 12 years and grade VI girls (two doses 6 months apart); HPV for boys Td 6 and 12 years; during pregnancy (at first contact and one month later) Vitamin A 6 months, 12 months, 18 months, 24 months, 30 months, 36 months, 42 months, 48 months and 54 months Source: WHO/UNICEF JRF, 2022 Public Health Laboratory • National measles/rubella laboratory • National Japanese encephalitis laboratory 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. Source: SEAR Annual EPI Reporting Form (multiple years) *Import or import related ND = No data Table 1: EPI History Year Milestone 1979 EPI launched on 15 November 1983 TT for pregnant women introduced 1997 HepB vaccine introduced 2003 DTP-HepB vaccine introduced 2003 AD syringes introduced 2006 MR vaccine introduced 2009 DTP-Hib-HepB vaccine introduced 2010 HPV vaccine for girls introduced 2012 HepB birth dose introduced 2012 TT vaccine replaced by Td vaccine 2015 IPV vaccine introduced 2016 tOPV to bOPV switched on 25 April 2016 MMR vaccine introduced 2017 Verification of endemic measles elimination 2019 PCV vaccine introduced in January 2019 Influenza vaccine introduced in November for following high risk groups: pregnant women, health workers, person with medical chronic condition, children 6 to 23 months and elderly population 65 years and above 2020 Introduction of HPV vaccine for boys 2021 Second dose IPV introduced in July Source: cMYP 2019-2023 and VPDP/MOH World Health Organization • SEARO/CDS/IVD • 31 October 2023 VACCINES PROTECT SUSTAIN. ACCELERATE. INNOVATE. Figure 2: DTP3 coverage1, diphtheria and pertussis cases2, 1980-2022 Table 5: Reported cases of vaccine preventable diseases, 2016-2022 Table 6: AFP surveillance performance indicators, 2016-2022 Figure 10: HepB3 and HepB birth dose immunization coverage1, 2000-2022 Figure 11: MCV1 & MCV2 coverage1 and measles, rubella cases2, 1980-2022 Table 7: OPV SIAs Table 8: MCV/MR SIAs Figure 3: TT2+ coverage1 and NT cases2, 1980-2022 1 WHO and UNICEF estimates of immunization coverage 2 WHO vaccine-preventable diseases: monitoring system 2022 1 Country official estimates, 1980-2022 2 WHO vaccine-preventable diseases: monitoring system 2022 Figure 4: 2021 DTP-Hib-HepB3 coverage by district Non-polio AFP rate by district Adequate stool specimen collection % by district MR1 coverage by district MR2 coverage by district Figure 5: 2022 Source: WHO/UNICEF JRF (multiple years) *Import and/or import related ND=No data Source: SEAR annual EPI reporting form, 2021 and 2022 (administrative data) Source: SEAR annual EPI reporting form, 2021 and 2022 (administrative data) Source: WHO/UNICEF JRF (multiple years) *Number of persons vaccinated Source: WHO/UNICEF JRF (multiple years) Year Polio Diphtheria Pertussis NT (% of all tetanus) Measles Rubella Mumps JE CRS 2016 0 0 4 0 45* 3 795 5 0 2017 0 0 15 0 66* 9 259 3 0 2018 0 0 8 0 18* 11 27 1 0 2019 0 1 2 0 2* 7 254 0 0 2020 0 0 0 0 0 0 214 0 0 2021 0 0 0 0 5 3 97 0 1 2022 0 0 0 0 7 4 ND 0 0 Indicator 2016 2017 2018 2019 2020 2021 2022 AFP cases 11 10 8 6 4 2 3 Wild poliovirus confirmed cases 0 0 0 0 0 0 0 Compatible cases 0 0 0 0 0 0 0 Non-polio AFP rate1 5.11 4.04 3.24 2.93 2.19 1.01 2.61 Adequate stool specimen collection percentage2 73% 80% 88% 83% 100% 50% 67% Total stool samples collected 20 8 14 12 8 4 5 % NPEV isolation 0 25 14 0 0 0 0 % Timeliness of primary result reported3 100 100 100 100 100 75 100 • Last clinically-confirmed polio case was reported in 1986 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 Results reported within 14 days of sample received at laboratory. 1 WHO and UNICEF estimates of immunization coverage 1 WHO and UNICEF estimates of immunization coverage 2 WHO vaccine-preventable diseases: monitoring system 2022 Figure 6: 2021 Figure 8: 2021Figure 7: 2022 Figure 9: 2022 Figure 12: 2021 Figure 14: 2021 Figure 15: 2022Figure 13: 2022 <1 1 – 1.99 >2 No non-polio AFP case <70% 70% - 79% 80% - 89% >90% <60% 60% - 79% >80% No AFP Year Antigen Geographic coverage Target age Target population Coverage (%) Round 1 Round 2 Round 1 Round 2 1995 OPV NID <5 years 80,336 99 100 1996-1997 OPV SNID <5 years 37,107 100 100 1997-1998 OPV SNID <5 years 37,465 100 100 1998-1999 OPV SNID <5 years 36,006 100 100 1999-2000 OPV SNID <5 years 36,541 100 100 2000-2001 OPV SNID <5 years 38,604 100 100 2001 OPV SNID <5 years 36,753 100 100 2002 OPV SNID <5 years 37,665 96 100 <80% 80% - 89% 90% - 94% > 95% Year Antigen Geographic coverage Target group Target Coverage 1995 M nationwide 9 months to 15 years 69,285 100% 2000 M nationwide 9 months to 15 years 214,128 100% 2006 MR nationwide 9 months to 14 years children and 15 years to 44 years women 338,040 98% 2016 MR subnational 418 100% 2017 MR nationwide 9 months to 40 years 267,280 98% 2018 MR subnational 9 months to 40 years 14,698* World Health Organization • SEARO/CDS/IVD • 31 October 2023 VACCINES PROTECT SUSTAIN. ACCELERATE. INNOVATE. Figure 2: DTP3 coverage1, diphtheria and pertussis cases2, 1980-2022 Table 5: Reported cases of vaccine preventable diseases, 2016-2022 Table 6: AFP surveillance performance indicators, 2016-2022 Figure 10: HepB3 and HepB birth dose immunization coverage1, 2000-2022 Figure 11: MCV1 & MCV2 coverage1 and measles, rubella cases2, 1980-2022 Table 7: OPV SIAs Table 8: MCV/MR SIAs Figure 3: TT2+ coverage1 and NT cases2, 1980-2022 1 WHO and UNICEF estimates of immunization coverage 2 WHO vaccine-preventable diseases: monitoring system 2022 1 Country official estimates, 1980-2022 2 WHO vaccine-preventable diseases: monitoring system 2022 Figure 4: 2021 DTP-Hib-HepB3 coverage by district Non-polio AFP rate by district Adequate stool specimen collection % by district MR1 coverage by district MR2 coverage by district Figure 5: 2022 Source: WHO/UNICEF JRF (multiple years) *Import and/or import related ND=No data Source: SEAR annual EPI reporting form, 2021 and 2022 (administrative data) Source: SEAR annual EPI reporting form, 2021 and 2022 (administrative data) Source: WHO/UNICEF JRF (multiple years) *Number of persons vaccinated Source: WHO/UNICEF JRF (multiple years) Year Polio Diphtheria Pertussis NT (% of all tetanus) Measles Rubella Mumps JE CRS 2016 0 0 4 0 45* 3 795 5 0 2017 0 0 15 0 66* 9 259 3 0 2018 0 0 8 0 18* 11 27 1 0 2019 0 1 2 0 2* 7 254 0 0 2020 0 0 0 0 0 0 214 0 0 2021 0 0 0 0 5 3 97 0 1 2022 0 0 0 0 7 4 ND 0 0 Indicator 2016 2017 2018 2019 2020 2021 2022 AFP cases 11 10 8 6 4 2 3 Wild poliovirus confirmed cases 0 0 0 0 0 0 0 Compatible cases 0 0 0 0 0 0 0 Non-polio AFP rate1 5.11 4.04 3.24 2.93 2.19 1.01 2.61 Adequate stool specimen collection percentage2 73% 80% 88% 83% 100% 50% 67% Total stool samples collected 20 8 14 12 8 4 5 % NPEV isolation 0 25 14 0 0 0 0 % Timeliness of primary result reported3 100 100 100 100 100 75 100 • Last clinically-confirmed polio case was reported in 1986 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 Results reported within 14 days of sample received at laboratory. 1 WHO and UNICEF estimates of immunization coverage 1 WHO and UNICEF estimates of immunization coverage 2 WHO vaccine-preventable diseases: monitoring system 2022 Figure 6: 2021 Figure 8: 2021Figure 7: 2022 Figure 9: 2022 Figure 12: 2021 Figure 14: 2021 Figure 15: 2022Figure 13: 2022 <1 1 – 1.99 >2 No non-polio AFP case <70% 70% - 79% 80% - 89% >90% <60% 60% - 79% >80% No AFP Year Antigen Geographic coverage Target age Target population Coverage (%) Round 1 Round 2 Round 1 Round 2 1995 OPV NID <5 years 80,336 99 100 1996-1997 OPV SNID <5 years 37,107 100 100 1997-1998 OPV SNID <5 years 37,465 100 100 1998-1999 OPV SNID <5 years 36,006 100 100 1999-2000 OPV SNID <5 years 36,541 100 100 2000-2001 OPV SNID <5 years 38,604 100 100 2001 OPV SNID <5 years 36,753 100 100 2002 OPV SNID <5 years 37,665 96 100 <80% 80% - 89% 90% - 94% > 95% Year Antigen Geographic coverage Target group Target Coverage 1995 M nationwide 9 months to 15 years 69,285 100% 2000 M nationwide 9 months to 15 years 214,128 100% 2006 MR nationwide 9 months to 14 years children and 15 years to 44 years women 338,040 98% 2016 MR subnational 418 100% 2017 MR nationwide 9 months to 40 years 267,280 98% 2018 MR subnational 9 months to 40 years 14,698* World Health Organization • SEARO/CDS/IVD • 31 October 2023 VACCINES PROTECT SUSTAIN. ACCELERATE. INNOVATE. Figure 2: DTP3 coverage1, diphtheria and pertussis cases2, 1980-2022 Table 5: Reported cases of vaccine preventable diseases, 2016-2022 Table 6: AFP surveillance performance indicators, 2016-2022 Figure 10: HepB3 and HepB birth dose immunization coverage1, 2000-2022 Figure 11: MCV1 & MCV2 coverage1 and measles, rubella cases2, 1980-2022 Table 7: OPV SIAs Table 8: MCV/MR SIAs Figure 3: TT2+ coverage1 and NT cases2, 1980-2022 1 WHO and UNICEF estimates of immunization coverage 2 WHO vaccine-preventable diseases: monitoring system 2022 1 Country official estimates, 1980-2022 2 WHO vaccine-preventable diseases: monitoring system 2022 Figure 4: 2021 DTP-Hib-HepB3 coverage by district Non-polio AFP rate by district Adequate stool specimen collection % by district MR1 coverage by district MR2 coverage by district Figure 5: 2022 Source: WHO/UNICEF JRF (multiple years) *Import and/or import related ND=No data Source: SEAR annual EPI reporting form, 2021 and 2022 (administrative data) Source: SEAR annual EPI reporting form, 2021 and 2022 (administrative data) Source: WHO/UNICEF JRF (multiple years) *Number of persons vaccinated Source: WHO/UNICEF JRF (multiple years) Year Polio Diphtheria Pertussis NT (% of all tetanus) Measles Rubella Mumps JE CRS 2016 0 0 4 0 45* 3 795 5 0 2017 0 0 15 0 66* 9 259 3 0 2018 0 0 8 0 18* 11 27 1 0 2019 0 1 2 0 2* 7 254 0 0 2020 0 0 0 0 0 0 214 0 0 2021 0 0 0 0 5 3 97 0 1 2022 0 0 0 0 7 4 ND 0 0 Indicator 2016 2017 2018 2019 2020 2021 2022 AFP cases 11 10 8 6 4 2 3 Wild poliovirus confirmed cases 0 0 0 0 0 0 0 Compatible cases 0 0 0 0 0 0 0 Non-polio AFP rate1 5.11 4.04 3.24 2.93 2.19 1.01 2.61 Adequate stool specimen collection percentage2 73% 80% 88% 83% 100% 50% 67% Total stool samples collected 20 8 14 12 8 4 5 % NPEV isolation 0 25 14 0 0 0 0 % Timeliness of primary result reported3 100 100 100 100 100 75 100 • Last clinically-confirmed polio case was reported in 1986 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 Results reported within 14 days of sample received at laboratory. 1 WHO and UNICEF estimates of immunization coverage 1 WHO and UNICEF estimates of immunization coverage 2 WHO vaccine-preventable diseases: monitoring system 2022 Figure 6: 2021 Figure 8: 2021Figure 7: 2022 Figure 9: 2022 Figure 12: 2021 Figure 14: 2021 Figure 15: 2022Figure 13: 2022 <1 1 – 1.99 >2 No non-polio AFP case <70% 70% - 79% 80% - 89% >90% <60% 60% - 79% >80% No AFP Year Antigen Geographic coverage Target age Target population Coverage (%) Round 1 Round 2 Round 1 Round 2 1995 OPV NID <5 years 80,336 99 100 1996-1997 OPV SNID <5 years 37,107 100 100 1997-1998 OPV SNID <5 years 37,465 100 100 1998-1999 OPV SNID <5 years 36,006 100 100 1999-2000 OPV SNID <5 years 36,541 100 100 2000-2001 OPV SNID <5 years 38,604 100 100 2001 OPV SNID <5 years 36,753 100 100 2002 OPV SNID <5 years 37,665 96 100 <80% 80% - 89% 90% - 94% > 95% Year Antigen Geographic coverage Target group Target Coverage 1995 M nationwide 9 months to 15 years 69,285 100% 2000 M nationwide 9 months to 15 years 214,128 100% 2006 MR nationwide 9 months to 14 years children and 15 years to 44 years women 338,040 98% 2016 MR subnational 418 100% 2017 MR nationwide 9 months to 40 years 267,280 98% 2018 MR subnational 9 months to 40 years 14,698* World Health Organization • SEARO/CDS/IVD • 31 October 2023 VACCINES PROTECT SUSTAIN. ACCELERATE. INNOVATE. EXPANDED PROGRAMME ON IMMUNIZATION (EPI) FACTSHEET 2023 BHUTAN Table 2: Basic information 2022 Table 3: Immunization schedule, 2022 Table 4: Immunization system highlights Total population1 763,249 Live births1 10,499 Children <1 year1 10,341 Children <5 years1 59,666 Children <15 years1 179,313 Pregnant women1 10,499 WCBA1 (15-49 years) 203,589 Neonatal mortality rate2 14.83 (per 1,000 LB) Infant mortality rate2 22.45 (per 1,000 LB) Under-five mortality rate2 26.69 (per 1,000 LB) Maternal mortality ratio2 60 (per 100,000 LB) Division/Province/State/Region 3 Dzongkhag/District 20 Gewog/Block 205 Sub-block/Ward 1,050 Village (approx.) 3,717 Population density (per sq. km)1 20 Population living in urban areas2 42.20% Population using at least basic drinking-water services2 99% Population using at least basic sanitation services4 95% Total expenditure on health as % of GDP2 3.41% Births attended by skilled health personnel2 99% Neonates protected at birth against NT2 90% Children not covered by immunization programme (zero dose children)3 189 1 SEAR annual EPI reporting form, 2022 2 Global Health Observatory (GHO) data http://apps.who.int/gho/ data accessed on 03 August 2023 3 DTP1 coverage from WHO and UNICEF estimates of immunization coverage and UN estimated under one population 4 Annual Health Bulletin 2022, MoH, Bhutan cMYP for immunization 2019-2023 NITAG fully functional Spending on vaccines financed by the government 78% Spending on routine immunization programme financed by the government ND Updated micro-plans that include activities to improve immunization coverage 20 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 National Health Survey 2012 >80% coverage for DTP-Hib-HepB3 20 districts (100%) >90% coverage for MCV1 19 districts (95%) >90% coverage for MCV2 19 districts (95%) >10% drop-out rate for DTP-Hib- HepB1 to DTP-Hib-HepB3 1 district (5%) Source: WHO/UNICEF JRF, 2022Figure 1: National immunization coverage, 2013-2022 Figure 16: Immunity against measles - immunity profile by age in 2022* Figure 20: Vaccination status of confirmed (laboratory, Epi linked and clinically compatible) measles cases, by age in 2021 and 2022 Figure 21: Vaccination status of confirmed (laboratory and Epi linked) rubella cases, by age in 2021 and 2022 Table 9: Summary of measles surveillance indicators, 2020-2022 Figure 22: Network of WHO supported surveillance and immunization medical officers and laboratories Figure 18: Confirmed measles cases* by month 2020-2022 Figure 17: Immunity against rubella through vaccination - immunity profile by age in 2022* Figure 19: Confirmed rubella cases* by month 2020-2022 *Modelled using WHO and UNICEF estimates and JRF (multiple years) and does not include immunity due to natural infection *Includes laboratory confirmed, epidemiologically linked and clinically compatible cases Source: SEAR measles case-based data *Includes laboratory confirmed and epidemiologically linked cases Source: SEAR measles case-based data *Modelled using MSP tool ver 2 Source: SEAR measles case-based data Source: SEAR measles case-based data For contact or feedback: Expanded Programme on Immunization Ministry of Health, Thimphu, Bhutan Tel: +975-2-332296, Fax: +975-2-332296 Email: tdawa@health.gov.bt www.health.gov.bt 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.who.int/southeastasia/health-topics/immunization Source: WHO and UNICEF estimates of immunization coverage Indicator Target 2020 2021 2022 Number of suspected measles cases 122 148 122 Confirmed measles cases 0 0 5 7 Lab confirmed 0 0 5 7 Epi-Linked 0 0 0 0 Clinically-compatible 0 0 0 0 Confirmed rubella cases 0 0 3 4 Lab confirmed 0 0 3 4 Epi-Linked 0 0 0 0 Discarded non-measles non-rubella cases 122 143 114 Percentage of suspected cases with adequate investigation initiated within 48 hours of notification ≥ 80% 95 100 88 Reporting rate of non-measles non-rubella cases to national level per 100,000 population ≥ 2 15.98 15.5 14.94 Percentage of second-level administrative units reporting at least 2 non-measles non-rubella cases per 100,00 population ≥ 80% ND ND 55 Percentage of surveillance units reporting measles and rubella data to the national level on time, even in the absence of cases ≥ 80% 100 ND 100 Percentage of specimens received at the laboratory within 5 days of collection ≥ 80% ND ND 61 Percentage of IgM results reported to the national public health authorities by the laboratory within 4 days of receipt of specimens ≥ 80% ND ND 71 Genotypes detected Measles ND D8 Rubella ND Vaccine Age of administration BCG Birth HepB Birth (within 24 hours) OPV Birth, 6 weeks, 10 weeks and 14 weeks DTP-Hib-HepB 6 weeks, 10 weeks and 14 weeks IPV 14 weeks, 8 months PCV 6 weeks, 10 weeks and 9 months MMR 9 months and 24 months DTP 24 months HPV Females 12 years and grade VI girls (two doses 6 months apart); HPV for boys Td 6 and 12 years; during pregnancy (at first contact and one month later) Vitamin A 6 months, 12 months, 18 months, 24 months, 30 months, 36 months, 42 months, 48 months and 54 months Source: WHO/UNICEF JRF, 2022 Public Health Laboratory • National measles/rubella laboratory • National Japanese encephalitis laboratory 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. Source: SEAR Annual EPI Reporting Form (multiple years) *Import or import related ND = No data Table 1: EPI History Year Milestone 1979 EPI launched on 15 November 1983 TT for pregnant women introduced 1997 HepB vaccine introduced 2003 DTP-HepB vaccine introduced 2003 AD syringes introduced 2006 MR vaccine introduced 2009 DTP-Hib-HepB vaccine introduced 2010 HPV vaccine for girls introduced 2012 HepB birth dose introduced 2012 TT vaccine replaced by Td vaccine 2015 IPV vaccine introduced 2016 tOPV to bOPV switched on 25 April 2016 MMR vaccine introduced 2017 Verification of endemic measles elimination 2019 PCV vaccine introduced in January 2019 Influenza vaccine introduced in November for following high risk groups: pregnant women, health workers, person with medical chronic condition, children 6 to 23 months and elderly population 65 years and above 2020 Introduction of HPV vaccine for boys 2021 Second dose IPV introduced in July Source: cMYP 2019-2023 and VPDP/MOH World Health Organization • SEARO/CDS/IVD • 31 October 2023 VACCINES PROTECT SUSTAIN. ACCELERATE. INNOVATE. EXPANDED PROGRAMME ON IMMUNIZATION (EPI) FACTSHEET 2023 BHUTAN Table 2: Basic information 2022 Table 3: Immunization schedule, 2022 Table 4: Immunization system highlights Total population1 763,249 Live births1 10,499 Children <1 year1 10,341 Children <5 years1 59,666 Children <15 years1 179,313 Pregnant women1 10,499 WCBA1 (15-49 years) 203,589 Neonatal mortality rate2 14.83 (per 1,000 LB) Infant mortality rate2 22.45 (per 1,000 LB) Under-five mortality rate2 26.69 (per 1,000 LB) Maternal mortality ratio2 60 (per 100,000 LB) Division/Province/State/Region 3 Dzongkhag/District 20 Gewog/Block 205 Sub-block/Ward 1,050 Village (approx.) 3,717 Population density (per sq. km)1 20 Population living in urban areas2 42.20% Population using at least basic drinking-water services2 99% Population using at least basic sanitation services4 95% Total expenditure on health as % of GDP2 3.41% Births attended by skilled health personnel2 99% Neonates protected at birth against NT2 90% Children not covered by immunization programme (zero dose children)3 189 1 SEAR annual EPI reporting form, 2022 2 Global Health Observatory (GHO) data http://apps.who.int/gho/ data accessed on 03 August 2023 3 DTP1 coverage from WHO and UNICEF estimates of immunization coverage and UN estimated under one population 4 Annual Health Bulletin 2022, MoH, Bhutan cMYP for immunization 2019-2023 NITAG fully functional Spending on vaccines financed by the government 78% Spending on routine immunization programme financed by the government ND Updated micro-plans that include activities to improve immunization coverage 20 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 National Health Survey 2012 >80% coverage for DTP-Hib-HepB3 20 districts (100%) >90% coverage for MCV1 19 districts (95%) >90% coverage for MCV2 19 districts (95%) >10% drop-out rate for DTP-Hib- HepB1 to DTP-Hib-HepB3 1 district (5%) Source: WHO/UNICEF JRF, 2022Figure 1: National immunization coverage, 2013-2022 Figure 16: Immunity against measles - immunity profile by age in 2022* Figure 20: Vaccination status of confirmed (laboratory, Epi linked and clinically compatible) measles cases, by age in 2021 and 2022 Figure 21: Vaccination status of confirmed (laboratory and Epi linked) rubella cases, by age in 2021 and 2022 Table 9: Summary of measles surveillance indicators, 2020-2022 Figure 22: Network of WHO supported surveillance and immunization medical officers and laboratories Figure 18: Confirmed measles cases* by month 2020-2022 Figure 17: Immunity against rubella through vaccination - immunity profile by age in 2022* Figure 19: Confirmed rubella cases* by month 2020-2022 *Modelled using WHO and UNICEF estimates and JRF (multiple years) and does not include immunity due to natural infection *Includes laboratory confirmed, epidemiologically linked and clinically compatible cases Source: SEAR measles case-based data *Includes laboratory confirmed and epidemiologically linked cases Source: SEAR measles case-based data *Modelled using MSP tool ver 2 Source: SEAR measles case-based data Source: SEAR measles case-based data For contact or feedback: Expanded Programme on Immunization Ministry of Health, Thimphu, Bhutan Tel: +975-2-332296, Fax: +975-2-332296 Email: tdawa@health.gov.bt www.health.gov.bt 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.who.int/southeastasia/health-topics/immunization Source: WHO and UNICEF estimates of immunization coverage Indicator Target 2020 2021 2022 Number of suspected measles cases 122 148 122 Confirmed measles cases 0 0 5 7 Lab confirmed 0 0 5 7 Epi-Linked 0 0 0 0 Clinically-compatible 0 0 0 0 Confirmed rubella cases 0 0 3 4 Lab confirmed 0 0 3 4 Epi-Linked 0 0 0 0 Discarded non-measles non-rubella cases 122 143 114 Percentage of suspected cases with adequate investigation initiated within 48 hours of notification ≥ 80% 95 100 88 Reporting rate of non-measles non-rubella cases to national level per 100,000 population ≥ 2 15.98 15.5 14.94 Percentage of second-level administrative units reporting at least 2 non-measles non-rubella cases per 100,00 population ≥ 80% ND ND 55 Percentage of surveillance units reporting measles and rubella data to the national level on time, even in the absence of cases ≥ 80% 100 ND 100 Percentage of specimens received at the laboratory within 5 days of collection ≥ 80% ND ND 61 Percentage of IgM results reported to the national public health authorities by the laboratory within 4 days of receipt of specimens ≥ 80% ND ND 71 Genotypes detected Measles ND D8 Rubella ND Vaccine Age of administration BCG Birth HepB Birth (within 24 hours) OPV Birth, 6 weeks, 10 weeks and 14 weeks DTP-Hib-HepB 6 weeks, 10 weeks and 14 weeks IPV 14 weeks, 8 months PCV 6 weeks, 10 weeks and 9 months MMR 9 months and 24 months DTP 24 months HPV Females 12 years and grade VI girls (two doses 6 months apart); HPV for boys Td 6 and 12 years; during pregnancy (at first contact and one month later) Vitamin A 6 months, 12 months, 18 months, 24 months, 30 months, 36 months, 42 months, 48 months and 54 months Source: WHO/UNICEF JRF, 2022 Public Health Laboratory • National measles/rubella laboratory • National Japanese encephalitis laboratory 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. Source: SEAR Annual EPI Reporting Form (multiple years) *Import or import related ND = No data Table 1: EPI History Year Milestone 1979 EPI launched on 15 November 1983 TT for pregnant women introduced 1997 HepB vaccine introduced 2003 DTP-HepB vaccine introduced 2003 AD syringes introduced 2006 MR vaccine introduced 2009 DTP-Hib-HepB vaccine introduced 2010 HPV vaccine for girls introduced 2012 HepB birth dose introduced 2012 TT vaccine replaced by Td vaccine 2015 IPV vaccine introduced 2016 tOPV to bOPV switched on 25 April 2016 MMR vaccine introduced 2017 Verification of endemic measles elimination 2019 PCV vaccine introduced in January 2019 Influenza vaccine introduced in November for following high risk groups: pregnant women, health workers, person with medical chronic condition, children 6 to 23 months and elderly population 65 years and above 2020 Introduction of HPV vaccine for boys 2021 Second dose IPV introduced in July Source: cMYP 2019-2023 and VPDP/MOH