Myanmar factsheet 2020: expanded programme on Immunization (EPI)

World Health Organization • SEARO/CDS/IVD • 15 July 2020 Table 1: Basic information 2019 Table 2: Immunization schedule, 2019 Table 3: Immunization system highlights EPI HISTORy • EPI launched in 1978 • OPV and MCV introduced in 1987 • AD syringes introduced in 2002 • HepB vaccine introduced in 2003 • MCV2 introduced partially in 2008 and made available nationwide in 2012 • DTP-Hib-HepB vaccine introduced in 2012 • MR vaccine introduced in 2015 • IPV introduced in 2015 • tOPV to bOPV switched on 29 Apr 2016 • PCV introduced in July 2016 • JE vaccine introduced in January 2018 Source: cMYP 2017-2021 and EPI/MOH 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. FACTSHEET 2020 ExPAnDED PROgRAmmE On ImmunIzATIOn (EPI) myAnmAR Total population1 53,286,494 Live births 1 981,223 Children <1 year1 968,376 Children <5 years1 4,483,542 Children <15 years1 13,271,916 Pregnant women1 1,030,634 WCBA (15-49 years) 13,480,090 Neonatal mortality rate2 23.1 (per 1,000 LB) Infant mortality rate2 36.8 (per 1,000 LB) Under-five mortality rate2 46.2 (per 1,000 LB) Maternal mortality ratio2 250 (per 100,000 LB) Division/Province/State/Region 17 Township/District 330/69 City/Town 396 Village 67,285 Population density1 (per sq. km) 153 Population living in urban areas2 36.9% Population using at least basic drinking- water services2 91% Population using at least basic sanitation services2 74% Total expenditure on health as % of GDP2 4.7% Births attended by skilled health personnel2 60% Neonates protected at birth against NT2 90% 1 SEAR annual EPI reporting form, 2019 2 WHO, Global Health Observatory (GHO) data http://apps.who. int/gho/data accessed on 06 June 2020 cMYP for immunization 2017 -2021 NTAGI fully functional Spending on vaccines financed by the government 29% Spending on routine immunization programme financed by the government 26% Updated micro-plans that include activities to improve immunization coverage 330 districts (100%) National policy for health care waste management including waste from immunization activities Yes National system to monitor AEFI in place Most recent EPI CES Demographic and Health Survey 2015- 2016 >80% coverage for DTP-Hib-HepB3 278 districts (84%) >90% coverage for MCV1 92 districts (28%) >90% coverage for MCV2 46 districts (14%) >10% drop-out rate for DTP-Hib- HepB1 to DTP-Hib-HepB3 30 districts (9%) Source: WHO/UNICEF joint reporting form (JRF) 2019 Figure 1: national immunization coverage, 1980-2019 Source: WHO and UNICEF estimates of immunization coverage, July 2020 revision Vaccine Age of administration BCG Birth to 2 months HepB Birth DTP-Hib-HepB 2 months, 4 months and 6 months OPV 2 months, 4 months and 6 months IPV 4 months MR 9 months and 18 months Td During pregnancy (at first contact and 4 weeks later) PCV 2 months, 4 months and 6 months JE_LiveAtd 9 months Vitamin A 6-59 months Source: WHO/UNICEF JRF 2019 Figure 2: DTP3 coverage1, diphtheria and pertussis cases2, 1980-2019 Table 4: Reported cases of vaccine preventable diseases, 2014-2019 Figure 3: TT2+ coverage1 and nT cases2, 1980-2019 1 WHO and UNICEF estimates of immunization coverage, July 2020 revision 2 WHO vaccine-preventable diseases: monitoring system 2020 1 Country official estimates, 1980-2019 2 WHO vaccine-preventable diseases: monitoring system 2020 Figure 4: 2018 DTP-Hib-HepB3 coverage by district Figure 5: 2019 a Excludes two type 2 cVDPVs b Excludes six type 1 VDPV Source: WHO/UNICEF JRF (multiple years) ND=No data Source: SEAR annual EPI reporting form, 2018 and 2019 (administrative data) year Polio Diphtheria Pertussis nT (% of all tetanus) measles Rubella mumps JE CRS 2014 0 29 5 32 (44%) 122 30 ND 50 ND 2015 0a 87 5 30 (ND) 6 34 ND 113 ND 2016 0 136 2 21 (11%) 269 10 ND 393 ND 2017 0 68 4 20 (33%) 1,293 6 ND 442 0 2018 0 127 28 22 (38%) 1,389 13 ND 126 8 2019 0b 22 30 25 (43%) 5,252 28 ND 115 0 <70% 70% - 79% 80% - 89% >90% 26878 26878 MNT elimination in 2010 Table 5: AFP surveillance performance indicators, 2014-2019 Table 7: OPV SIAs non-polio AFP rate by district Adequate stool specimen collection % by district Source: WHO/UNICEF JRF (multiple years) Indicator 2014 2015 2016 2017 2018 2019 AFP cases 389 336 466 396 335 420 Wild poliovirus confirmed cases 0 0 0 0 0 0 Compatible cases 0 0 0 0 0 0 Non-polio AFP rate1 1.82 2.34 3.34 2.94 2.50 3.11 Adequate stool specimen collection percentage2 96% 93% 96% 95% 94% 90% Total stool samples collected 772 672 931 794 663 839 % NPEV isolation 13 13 12 14 13 10 % Timeliness of primary result reported3 94 95 96 93 96 97 • Last polio case due to indigenous WPV reported from Rakhine province in February 2000. • Last polio case due to imported WPV reported from Rakhine province in May 2007. 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 Result reported within 14 days of sample received at laboratory. Figure 6: 2018 Figure 8: 2018 Figure 9: 2019 <1 1 – 1.99 >2 No non-polio AFP case <60% 60% - 79% >80% No AFP year Antigen geographic coverage Target age Target population Coverage (%) Round 1 Round 2 Round 1 Round 2 2002 OPV NID <5 years 6,251,093 97 97 2003 OPV SNID <5 years 771,081 95 99 2005 OPV SNID <5 years 321,850 99 100 2006 OPV SNID <5 years 2,037,606 97 97 2007 OPV SNID <5 years 2,416,960 102 99 2007 OPV NID <5 years 7,207,399 98 98 2008 OPV SNID <5 years 1,825,117 99 - 2009 OPV NID <5 years 7,394,415 98 100 2010 OPV SNID <5 years 2,229,394 98 100 2011 OPV SNID <5 years 2,925,709 98 99 2012 OPV SNID <5 years 281,026 99 101 2013 OPV SNID <5 years 335,860 97 97 2015 OPV SNID <5 years 367,972 97 - 2016 OPV Mop-up SNID <5 years 3,017,377 96 99 2016 OPV Mop-up NID <5 years 4,908,837 99 99 2017 bOPV Mop-up <5 years 372,833 94 89 2019 bOPV ORI <5 years 305,313 95 2019 bOPV subnational <5 years 629,950 88 2019 bOPV Subnational 0-5 years 6 months 1,231,369 91 Figure 7: 2019 Table 6: Environmental surveillance sites for polio detection in 2018 and 2019 Note: SL1: Sabin like type 1; SL3: Sabin like type 3; VDPV: Vaccine Derived Polio Virus; NPEV: Non Polio Entero Virus year # Provinces # sites # samples tested Isolation SL1 SL3 SL1+SL3 VDPV nPEV 2018 2 3 59 0 5 0 0 17 2019 2 3 12 0 2 0 0 2 VACCInES PROTECT SUSTAIN. ACCELERATE. INNOVATE. World Health Organization • SEARO/CDS/IVD • 15 July 2020 Figure 10: mCV1 & mCV2 coverage1 and measles cases2, 1980-2019 Table 8: mCV SIAs mCV1 coverage by province mCV2 coverage by province Source: SEAR annual EPI reporting form, 2018 and 2019 (administrative data) Source: WHO/UNICEF JRF (multiple years) 1 WHO and UNICEF estimates of immunization coverage, July 2020 revision 2 WHO vaccine-preventable diseases: monitoring system 2020 Figure 11: 2018 Figure 14: 2019 <80% 80% - 89% 90% - 94% > 95% year Antigen geographic Coverage Target group Target Coverage % 2007 M nationwide 9 to 59 months 6,056,000 94 2012 M follow-up 9 to 59 months 6,432,064 97 2015 MR nationwide 9 months to 15 years 13,958,963 94 2019 MR subnational 9 months to 15 years 604,230 92 2019 MR subnational 9 months - 5 Years 6 months 4234002 96 Figure 12: 2019 Figure 13: 2018 21457 Figure 15: Immunity against measles - immunity profile by age in 2019* Figure 17: Confirmed measles cases* by month, 2017-2019 Figure 16: Immunity against rubella through vaccination - immunity profile by age in 2019* Figure 18: Confirmed rubella cases* by month, 2017-2019 *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 Ja n- 17 Fe b- 17 M ar -1 7 A pr -1 7 M ay -1 7 Ju n- 17 Ju l-1 7 A ug -1 7 Se p- 17 O ct -1 7 N ov -1 7 D ec -1 7 Ja n- 18 Fe b- 18 M ar -1 8 A pr -1 8 M ay -1 8 Ju n- 18 Ju l-1 8 A ug -1 8 Se p- 18 O ct -1 8 N ov -1 8 D ec -1 8 Ja n- 19 Fe b- 19 M ar -1 9 A pr -1 9 M ay -1 9 Ju n- 19 Ju l-1 9 A ug -1 9 Se p- 19 O ct -1 9 N ov -1 9 D ec -1 9 Ja n- 17 Fe b- 17 M ar -1 7 A pr -1 7 M ay -1 7 Ju n- 17 Ju l-1 7 A ug -1 7 Se p- 17 O ct -1 7 N ov -1 7 D ec -1 7 Ja n- 18 Fe b- 18 M ar -1 8 A pr -1 8 M ay -1 8 Ju n- 18 Ju l-1 8 A ug -1 8 Se p- 18 O ct -1 8 N ov -1 8 D ec -1 8 Ja n- 19 Fe b- 19 M ar -1 9 A pr -1 9 M ay -1 9 Ju n- 19 Ju l-1 9 A ug -1 9 Se p- 19 O ct -1 9 N ov -1 9 D ec -1 9 VACCInES PROTECT SUSTAIN. ACCELERATE. INNOVATE. Figure 19: Vaccination status of confirmed (laboratory, Epi linked and clinically compatible) measles cases by age in 2018 and 2019 Figure 20: Vaccination status of confirmed (laboratory, Epi linked and clinically compatible) rubella cases by age in 2018 and 2019 Table 9: Summary of measles surveillance indicators, 2017-2019 Figure 21: network of WHO supported surveillance medical officers and laboratories for VPD surveillance 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 2017 2018 2019 Number of suspected measles cases 1,757 1,985 6,539 Confirmed measles cases 0 1,293 1,389 5,252 Lab confirmed 0 1,012 974 3,493 Epi-Linked 0 205 367 1,190 Clinically-compatible 0 76 48 569 Confirmed rubella cases 0 6 13 28 Lab confirmed 0 6 13 28 Epi-Linked 0 0 0 0 Discarded non-measles non-rubella cases 458 583 1,259 Percentage of suspected cases with adequate investigation initiated within 48 hours of notification ≥ 80% ND 75 96 Reporting rate of non-measles non-rubella cases to national level per 100,000 population ≥ 2 0.96 1.11 2.58 Percentage of second-level administrative units reporting at least 2 non-measles non-rubella cases per 100 000 population ≥ 80% 12 12 60 Percentage of surveillance units reporting measles and rubella data to the national level on time, even in the absence of cases ≥ 80% 96 95 95 Percentage of specimens received at the laboratory within 5 days of collection ≥ 80% 91 93 93 Percentage of IgM results reported to the national public health authorities by the laboratory within 4 days of receipt of specimens ≥ 80% 98 98 74 Genotypes detected Measles H1 D8, H1, B3 D8, H1 Rubella ND ND ND For contact or feedback: Director (Epidemiology) Director (EPI), ministry of Health and Sports Nay Pyi Taw, Myanmar, Tel: +95 67 420925 Email: toethiriaung@mohs.gov.mm, htarhtarlin@mohs.gov.mm www.moh.gov.mm 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 Health laboratory • National polio laboratory • National measles and rubella laboratory • National Japanese encephalitis laboratory Sub National Measles and rubella laboratory Public Health Laboratory, Mandalay Rotavirus laboratory • Department of Medical Research National Surveillance Coordinator = 1 Regional Surveillance Officer = 17