Expanded programme on Immunization (EPI) factsheet 2019: Thailand

World Health Organization • SEARO/FGL/IVD • 31 October 2019 THAILAnD FAcTSHEET 2019 ExpAnDED pROGRAmmE On ImmunIzATIOn (EpI) Table 1: Basic information 2018 Table 2: Immunization schedule, 2018 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 Source: cMYP 2017-2021 and EPI/MOPH Disclimer: 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. Total population1 66,413,979 Live births1 666,109 Children <1 year1 589,954 Children <5 years1 3,314,100 Children <15 years1 11,153,397 Pregnant women1 589,954 Women of child bearing age1 (WCBA) (15-49 years) 16,778,039 Neonatal mortality rate2 5.3 (per 1,000 LB) Infant mortality rate2 8.2 (per 1,000 LB) Under-five mortality rate2 9.5 (per 1,000 LB) Maternal mortality ratio2 20 (per 100,000 LB) Division/Province/State/Region 77 District 928 Sub-district 7,425 Village 74,948 Population density1 (per sq. km) 129.43 Population living in urban areas2 49.2% Population using at least basic drinking- water services2 98% Population using at least basic sanitation services2 95% Total expenditure on health as % of GDP2 3.8% Births attended by skilled health personnel2 99% Neonates protected at birth NT2 98% 1 SEAR annual EPI reporting form, 2018 2 WHO, Global Health Observatory (GHO) data http://apps.who.int/gho/data accessed on 19 May 2019 Vaccine Age of administration BCG Birth HepB Birth and 1 month (new-born from HepB carrier mother) DTP-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 (Sukhothai and Phetchabun provinces) Source: WHO/UNICEF JRF 2018 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 71 provinces (92%) >90% coverage for MCV1 44 provinces (57%) >90% coverage for MCV2 33 provinces (43%) >10% drop-out rate for DTP-HepB1 to DTP- HepB3 no data Source: WHO/UNICEF JRF, 2018Figure 1: National immunization coverage, 1980-2018 Source: WHO and UNICEF estimates of immunization coverage, July 2019 revision Figure 2: DTP3 coverage1, diphtheria and pertussis cases2, 1980-2018 Table 4: reported cases of vaccine preventable diseases, 2013-2018 Figure 3: TT2+ coverage1 and NT cases2, 1980-2018 1 WHO and UNICEF estimates of immunization coverage, July 2019 revision 2 WHO vaccine-preventable diseases: monitoring system 2019 19 18 48 20 25 33 1 Country official estimates, 1980-2018 2 WHO vaccine-preventable diseases: monitoring system 2019 Figure 4: 2017 DTP-hepB3 coverage by Province Figure 5: 2018 Source: WHO/UNICEF JRF (multiple years) ND=No data Source: SEAR annual EPI reporting form, 2017 and 2018 (administrative data) year Polio Diphtheria Pertussis NT (% of all tetanus) Measles rubella Mumps JE Crs 2013 0 28 24 2 (2%) 2,641 539 5,907 59 0 2014 0 19 14 2 (2%) 146 152 3,704 31 ND 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%) 1,946 34 17 28 0 2018 0 90 79 65 (0%) 6,035 64 2,061 19 0 <70% 70% - 79% 80% - 89% >90% MNT elimination in 1995 Table 5: AFP surveillance performance indicators, 2013-2018 Table 6: oPV sIAs Non-polio AFP rate by district Adequate stool specimen collection % by district Source: NCCPE reports and WHO/UNICEF JRF (multiple years) * Thai children <5 yrs and foreign children <15 yrs. Indicator 2013 2014 2015 2016 2017 2018 AFP cases 235 238 183 246 198 241 Wild poliovirus confirmed cases 0 0 0 0 0 0 Compatible cases 0 0 0 0 0 0 Non-polio AFP rate1 1.80 1.97 1.36 1.95 1.71 2.02 Adequate stool specimen collection percentage2 70% 79% 65% 75% 68% 68% Total stool samples collected 444 450 345 464 364 467 % NPEV isolation 5 5 3 8.4 6.6 5.2 % Timeliness of primary result reported3 100 100 100 100 100 100 • 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: 2017 Figure 7: 2018 Figure 9: 2018 <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 - # Provinces # sites # samples tested sL1 sL3 sL1 + sL3 VDPV NPEV 2 3 102 2 2 0 0 13 Figure 8: 2017 Figure 10: Environmental surveillance sites for polio detection in 2018 Note : SL1: Sabin like type 1; SL3: Sabin like type 3; VDPV: Vaccine Derived Polio Virus; NPEV: Non Polio Etero Virus Vaccines Protect SUSTAIN. ACCELERATE. INNOVATE. World Health Organization • SEARO/FGL/IVD • 31 October 2019 Figure 11: MCV1 & MCV2 coverage1 and measles, rubella cases2, 1980-2018 Table 7: MCV sIAs MCV1 coverage by district MCV2 coverage by district Source: SEAR annual EPI reporting form, 2017 and 2018 (administrative data) Source: WHO/UNICEF JRF (multiple years) 1 WHO and UNICEF estimates of immunization coverage, July 2019 revision 2 WHO vaccine-preventable diseases: monitoring system 2019 Figure 12: 2017 Figure 14: 2017 Figure 15: 2018Figure 13: 2018 <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 197,777 62 16795 32156 29244 Figure 16: Immunity against measles - immunity profile by age in 2018* Figure 18: sub-national risk assessment - measles and rubella Figure 17: Immunity against rubella through vaccination - immunity profile by age in 2018* Figure 19: sporadic and outbreak associated measles cases* by month 2016-2018 *Modeled using WHO and UNICEF estimates and JRF (multiple years) and does not include immunity due to natural infection *Includes laboratory confirmed and epidemiologically linked cases Source: SEAR Monthly VPD reports *Modeled using MSP tool ver 2 Very High Risk High Risk Medium Low Not Available Vaccines Protect SUSTAIN. ACCELERATE. INNOVATE. Figure 20: Vaccination status of confirmed (laboratory, epi-linked and clinically compatible) measles cases, by age in 2018 Table 8: surveillance performance indicator for measles and rubella, 2013-2018 Table 9: Performance of laboratory surveillance, 2013-2018 Figure 21: Network of laboratories year No. of suspected Measles Case classification (number) Indicators Measles rubella D is ca rd ed n on - m ea sl es n on -ru be lla ca se s A nn ua l i nc id en ce o f co nf ir m ed M ea sl es ca se s pe r m ill io n to ta l po pu la ti on A nn ua l i nc id en ce o f co nf ir m ed r ub el la ca se s pe r m ill io n to ta l po pu la ti on Pr op or ti on o f a ll su sp ec te d m ea sl es an d ru be lla c as es t ha t ha ve h ad a n ad eq ua te in ve st ig at io n in it ia te d w it hi n 48 h ou rs o f no ti fic at io n D is ca rd ed n on - m ea sl es n on -ru be lla in ci de nc e pe r 10 0, 00 0 to ta l p op ul at io n Pr op or ti on o f pr ov in ce s re po rt in g at le as t tw o di sc ar de d no n- m ea sl es no n- ru be lla c as es pe r 10 0, 00 0 to ta l po pu la ti on Pr op or ti on o f s ub - na ti on al s ur ve ill an ce un it s re po rt in g to t he na ti on al le ve l o n ti m e La b- co nf ir m ed Ep i-L in ke d Cl in ic al ly - co nf ir m ed La b- co nf ir m ed Ep i-L in ke d Target  - - 80% 2 80% 80% 2013 2,641 325 2 1,819 50 0 405 5.07 0.78 26.98 0.63 6.58 ND 2014 1,184 75 3 68 21 1 300 1.2 0.34 ND 0.46 3.95 ND 2015 1015 59 3 92 34 14 377 0.95 0.73 ND 0.58 9.21 ND 2016 1,422 743 91 170 7 0 411 11.36 0.11 93.53 0.63 9.09 ND 2017 2,943 1,545 401 929 27 7 34 29.89 0.63 64 0.05 ND ND 2018 7,205 3,610 1,860 565 49 15 1097 91.0 0.96 ND 1.65 ND ND Source: SEAR Annual EPI Reporting Form (multiple years) ND=No data Source: SEAR Annual EPI Reporting Form (multiple years) ND=No data Source: SEAR measles case-based data National Institute of health, Nonthaburi - Regional reference polio laboratory - Regional reference measles & rubella laboratory - JE national laboratory sub-national measles & rubella laboratories (13) 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.searo.who.int/entity/immunization year serum specimen collected from suspected measles cases serum specimen received in laboratory within 5 days of collection specimen positive for measles IgM specimen positive for rubella IgM % results within 4 days of receipt Genotypes detected No. (%) No. (%) No. % No. % Measles rubella 2013 ND ND ND ND ND ND ND ND ND 2014 444 (37) 302 (73) 75 18 21 5.1 92.1 B3 ND 2015 555 (55) 335 (66.2) 61 12.1 36 7.1 94.5 H1 2B 2016 1,135 (80) 625 (55) 651 57.4 7 0.6 98.8 B3, D8, H1 ND 2017 2,419 (82) 2,419 (100) 1,407 58.2 27 1.1 99.5 B3, D8, H1 ND 2018 6,256 (87) 3,868 (75.1) 3,389 43.8 48 0.8 99.0 ND ND