Expanded programme on immunization (EPI): Thailand 2021 Factsheet

World Health Organization • SEARO/CDS/IVD • 31 August 2021 ExpAnDED pROgRAmmE On ImmunIzAtIOn (EpI) Table 1: Basic information 2020 Table 2: Immunization schedule, 2020 Table 3: Immunization system highlights EPI hIsTory • EPI launched in 1977 • 1977 - BCG for newborns, DTP for infants at 2 and 4 months • 1982 - OPV introduction, DTP 3rd dose for infants at 6 months • 1984 - MCV for 9-12 months infants • 1986 - Rubella vaccine for 6th grade girls • 1991 - DTP 4th dose for infants 1.5-2 years • 1992 - HepB vaccine scaled up nation-wide • 1993 - Rubella vaccine for 1st grade students • 1996 - MCV for 1st grade students • 1997 - MCV and rubella vaccine were substituted by MMR for students • 2000 - JE_Inacted vaccine introduced countrywide • 2000 - DTP 5th dose introduced for children aged 4 years • 2004 - Influenza vaccine introduced for HCWs • 2008 - Influenza vaccine introduced for high risk adults • 2008 - DTP-HepB vaccine introduced • 2010 - MCV vaccine substituted with MMR for 9-12 months infants • IPV introduced in 2015 • tOPV to bOPV switched on 29 April 2016 • JE live attenuated vaccine started in 2013 in 8 provinces then expanded to cover 29 Provinces in 2015 and the whole country in 2016 • HPV vaccine provided to girl students of grade 5 and 6 through a pilot project in Pranakhonsri Ayuthaya Province in 2014 and countrywide in 2017 • Age of MMR2 changed to children 2.5 years in 2014 and launched the campaign to cover the gap in the age between 2.5-7 years in 2015 • Rotavirus vaccine provided to 2, 4 and 6 months children through a pilot project in Sukhothai and Phetchabun Province • In 2019, DTP-Hib-HepB vaccine introduced Source: cMYP 2017-2021 and EPI/MOPH 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. ThaIland Total population1 66,186,727 Live births1 587,368 Children <1 year1 577,133 Children <5 years1 3,266,259 Children <15 years1 11,174,613 Pregnant women1 ND Women of child bearing age1 (WCBA) (15-49 years) 16,666,199 Neonatal mortality rate2 5.3 (per 1,000 LB) Infant mortality rate2 7.7 (per 1,000 LB) Under-five mortality rate2 9.0 (per 1,000 LB) Maternal mortality ratio2 37 (per 100,000 LB) Division/Province/State/Region 77 District 928 Sub-district 8,335 Village 74,948 Population density1 (per sq. km) ND Population living in urban areas2 55.80% Population using at least basic drinking- water services2 100% Population using at least basic sanitation services2 99% Total expenditure on health as % of GDP2 4.12% Births attended by skilled health personnel2 99% Neonates protected at birth NT2 98% 1 SEAR annual EPI reporting form, 2020 2 WHO, Global Health Observatory (GHO) data http://apps.who. int/gho/data accessed on 01 August 2021 cMYP for immunization 2017-2021 NTAGI fully functional Spending on vaccines financed by the government No data Spending on routine immunization programme financed by the government No data Updated micro-plans that include activities to improve immunization coverage 928 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 Coverage survey for routine and school- based immunization 2018 ≥80% coverage for DTP-HepB3 73 provinces (95%) ≥90% coverage for MCV1 50 provinces (65%) ≥90% coverage for MCV2 43 provinces (56%) ≥10% drop-out rate for DTP-HepB1 to DTP- HepB3 no data Source: WHO/UNICEF JRF, 2020 Figure 1: national immunization coverage, 1980-2020 Source: WHO and UNICEF estimates of immunization coverage Vaccine age of administration BCG Birth HepB Birth and 1 month (new-born from HepB carrier mother) DTP-Hib-HepB 2 months, 4 months and 6 months OPV 2 months, 4 months, 6 months, 1.5 years and 4 years IPV 4 months MMR 9 Months and 2.5 years DTP 1.5 years and 4 years Td School children in grade VI (12 years) and pregnant women at 1st contact, +1 month, +6 months (depending on vaccination history) JE_LiveAtd 1 year and 2.5 years HPV Grade 5 girls (2 doses – 6 months apart) Rotavirus 2 months, 4 months and 6 months Men ACWY- 135_conj 9 months to 55 years (pilgrims from Thailand is the main target group, Thai travellers need to go to epidemic area: Africa, SA and the students in dormitory such as; USA/UK MR Healthcare workers and all University students of first-year in Faculty of Medical and Public Health Yellow Fever (YF) >=9 months old travellers Source: WHO/UNICEF JRF, 2020 FacTshEET 2021 Figure 2: dTP3 coverage1, diphtheria and pertussis cases2, 1980-2020 Table 4: reported cases of vaccine preventable diseases, 2015-2020 Figure 3: TT2+/dT2+ coverage1 and nT cases2, 1980-2020 1 WHO and UNICEF estimates of immunization coverage 2 WHO vaccine-preventable diseases: monitoring system 2020 1 Country official estimates, 1980-2020 2 WHO vaccine-preventable diseases: monitoring system 2020 Figure 4: 2019 dTP-hib-hepB3 coverage by district Figure 5: 2020 Source: WHO/UNICEF JRF (multiple years) Source: SEAR annual EPI reporting form, 2019 and 2020 (administrative data) year Polio diphtheria Pertussis nT (% of all tetanus) Measles rubella Mumps JE crs 2015 0 19 51 0 (0%) 154 240 3,121 23 0 2016 0 16 84 61 (0%) 652 7 23 21 0 2017 0 5 55 68 (0%) 1946 34 17 28 0 2018 0 90 79 65 (0%) 6,035 64 2,061 19 0 2019 0 70 99 1 (2%) 5,412 142 2,553 4 0 2020 0 79 90 33 (0%) 803 195 4 33 0 <70% 70% - 79% 80% - 89% >90% Table 5: aFP surveillance performance indicators, 2015-2020 Table 7: oPV sIas non-polio aFP rate by district adequate stool specimen collection % by district * Thai children <5 yrs and foreign children <15 yrs Source: WHO/UNICEF JRF (multiple years) Indicator 2015 2016 2017 2018 2019 2020 AFP cases 183 246 215 243 277 164 Wild poliovirus confirmed cases 0 0 0 0 0 0 Compatible cases 0 0 0 0 0 0 Non-polio AFP rate1 1.56 2.13 1.64 2.03 2.22 1.13 Adequate stool specimen collection percentage2 65% 75% 67% 68% 71% 67% Total stool samples collected 357 482 416 480 538 333 % NPEV isolation 2.8 8.3 5.8 5 5.6 2.7 % Timeliness of primary result reported3 100 100 100 100 100 99 The last laboratory confirmed polio case due to WPV was reported in April 1997 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. Figure 6: 2019 Figure 8: 2019 Figure 9: 2020 <1 1 – 1.99 >2 No non-polio AFP case <60% 60% - 79% >80% No AFP year antigen Target age Target population coverage (%) round 1 round 2 round 1 round 2 2000 OPV <5 years 5,320,365 5,350,859 >95 >95 2001 OPV <5 years 4,228,841 4,235,472 >95 >95 2002 OPV <5 years 3,253,754 3,259,466 >95 >95 2003 OPV <5 years 3,090,113 3,104,156 >95 >95 2004 OPV <5 years 3,202,447 3,085,319 >95 >95 2006 OPV <5 years 2,275,235 2,279,229 >95 >95 2007 OPV <5 years 2,385,009 2,385,460 >93 >93 2008 OPV <5 years 2,356,691 2,374,596 >95 >95 2009 OPV <5 years 2,465,626 2,481,614 >95 >95 2010 OPV <5 years 1,976,446 2,012,534 97 96 2011 OPV <5 years 1,173,775 1,181,487 94 >95 2012 OPV <5 years 951,795 819,037 95 95 2013 OPV <5 years 269,903 278,345 96 97 2014* OPV <5 years 613,939 - 94 - 2015* OPV <5 years 617,027 - 87 - 2019 OPV <5 years 168,107 171,067 96 93 Figure 7: 2020 Table 6: Environmental surveillance sites for polio detection, 2018 - 2020 Note: SL1: Sabin like type 1; SL2: Sabin like type 2; SL3: Sabin like type 3; VDPV: Vaccine Derived Polio Virus; NPEV: Non Polio Entero Virus SL2 was isolated due to contamination of bOPV year # Provinces # sites # samples tested Isolation sl1 sl3 sl1+sl3 sl2 sl1+sl2 sl1+sl2+sl3 sl2+sl3 VdPV nPEV 2018 2 2 101 2 2 13 2019 4 7 135 11 12 2 91 2020 3 6 132 0 3 73 World Health Organization • SEARO/CDS/IVD • 31 August 2021 VACCInES PROtECt SUSTAIN. ACCELERATE. INNOVATE. Figure 10: hepB3 and hepB birth dose immunization coverage1, 2000-2020 Figure 11: McV1 & McV2 coverage1 and measles, rubella cases2, 1980-2020 Table 8: McV/Mr sIas Mr1 coverage by district Mr2 coverage by district Source: SEAR annual EPI reporting form, 2019 and 2020 (administrative data) Source: WHO/UNICEF JRF (multiple years) 1 WHO and UNICEF estimates of immunization coverage 1 WHO and UNICEF estimates of immunization coverage 2 WHO vaccine-preventable diseases: monitoring system 2020 Figure 12: 2019 Figure 15: 2020 <80% 80% - 89% 90% - 94% > 95% year antigen Geographic coverage Target group Target coverage (%) 2002 M Subnational outbreak response & campaign ND ND 2015 MR nationwide 2.5 to 7 years 2,541,544 88% 2018 MR subnational 9 months to 5 years 47,562 79% 2019 MMR subnational 1-7 years 224,256 65% 2019 MR subnational school children 7-12 years 398,028 79% Figure 13: 2020 Figure 14: 2019 Figure 16: Immunity against measles - immunity profile by age in 2020* Figure 18: confirmed measles cases* by month 2018-2020 Figure 17: Immunity against rubella through vaccination - immunity profile by age in 2020* Figure 19: confirmed rubella cases* by month 2018-2020 *Modeled 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 *Modeled using MSP tool ver 2 Vaccines Protect SUSTAIN. ACCELERATE. INNOVATE. Figure 20: Vaccination status of confirmed (laboratory, Epi linked and clinically compatible) measles cases, by age in 2019 and 2020 Figure 21: Vaccination status of confirmed (laboratory and Epi linked) rubella cases, by age in 2019 and 2020 Table 9: summary of measles surveillance indicators, 2018-2020 Figure 22 : network of Who supported surveillance and immunization medical officers and laboratories Source: SEAR measles case-based data Source: SEAR Annual EPI Reporting Form (multiple years) ND=No data Source: SEAR measles case-based data Indicator Target 2018 2019 2020 Number of suspected measles cases 7,141 9,255 1,906 Confirmed measles cases 0 6,042 5,412 802 Lab confirmed 0 3,614 3,617 337 Epi-Linked 0 1,862 749 111 Clinically-compatible 0 566 1,001 354 Confirmed rubella cases 0 72 142 195 Lab confirmed 0 57 142 51 Epi-Linked 0 15 0 144 Discarded non-measles non-rubella cases 1,099 3,713 911 Percentage of suspected cases with adequate investigation initiated within 48 hours of notification ≥ 80% 79.31 94.48 98.01 Reporting rate of non-measles non-rubella cases to national level per 100,000 population ≥ 2 1.7 5.58 1.4 Percentage of second-level administrative units reporting at least 2 non-measles non-rubella cases per 100,00 population ≥ 80% 29.87 50.65 18.18 Percentage of surveillance units reporting measles and rubella data to the national level on time, even in the absence of cases ≥ 80% ND ND ND Percentage of specimens received at the laboratory within 5 days of collection ≥ 80% 66.8 71.72 88.46 Percentage of IgM results reported to the national public health authorities by the laboratory within 4 days of receipt of specimens ≥ 80% 99.3 98.4 98.4 Genotypes detected Measles B3, D8, H1 B3, D8, H1 D8 Rubella 1E 1a,1E 1E For contact or feedback: chief, Vaccine Preventable disease section Ministry of Public Health, Nonthaburi, Thailand Tel: +66-2-5903196, Fax + 66-2-9659152 Email: vaccine.ddc@gmail.com, http://dvpd.ddc.moph.go.th 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 national Institute of health, nonthaburi - Regional reference polio laboratory - Regional reference measles & rubella laboratory - JE national laboratory sub-national measles & rubella laboratories (13)