Expanded programme on Immunization (EPI) factsheet 2023: India

World Health Organization • SEARO/CDS/IVD • 31 October 2023 VACCINES PROTECT SUSTAIN. ACCELERATE. INNOVATE. EXPANDED PROGRAMME ON IMMUNIZATION (EPI) FACTSHEET 2023 INDIA Table 2: Basic information, 2022Table 1: EPI History Table 3: Immunization schedule, 2022 Table 4: Immunization system highlights Total population1 1,379,752,250 Live births1 20,987,726 Children <1 year1 26,403,088 Children <5 years1 ND Children <15 years1 ND Pregnant women1 29,939,610 Women of child bearing age1 (15-49 years) ND Neonatal mortality rate2 19.12 (per 1,000 LB) Infant mortality rate2 25.49 (per 1,000 LB) Under-five mortality rate2 30.62 (per 1,000 LB) Maternal mortality ratio2 103 (per 100,000 LB) Division/Province/State/Region 36 District 757 Block 7,636 Population density1 (per sq. km) 382 Population living in urban areas2 34.80% Population using at least basic drinking- water services2 93% Population using at least basic sanitation services2 78% Total expenditure on health as % of GDP2 1.08% Births attended by skilled health personnel2 89% Neonates protected at birth against NT2 90% Children not covered by immunization programme (zero dose children)3 1,125,995 1 SEAR annual EPI reporting form, 2022 2 WHO, 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 Year Milestone 1978 EPI launched with DTP, OPV, BCG and typhoid vaccines 1983 TT immunization of pregnant women introduced 1985 MCV (measles vaccine-standalone) introduced 2002-11 HepB piloted in 2002 and made universal in 2011 2010 MCV2 introduced 2011-15 Pentavalent (introduced in two states in 2011 and gradually expanded to all states by 2015) 2006-13 First dose of JE vaccine introduced in 2006 and second dose introduced in 2013 in JE endemic districts 2013 Multi-dose vial policy for vaccines introduced 2015-16 IPV introduced in six states in 2015 and expanded to all states in 2016 2016 tOPV to bOPV switched on 25 April 2016-19 Rotavirus vaccine introduced in four states in 2016, nationwide expansion in 2019 2017-19 Rubella containing Vaccine (RCV) introduced through Measles-Rubella vaccine (MR Vaccine) at subnational level from February 2017 and expanded to all states by 2019 2017 PCV introduced, now expanded to Bihar, Himachal Pradesh, Haryana, Madhya Pradesh, Rajasthan and Uttar Pradesh 2019 TT replaced by Td Source: cMYP 2018-2022 and EPI/MoHFW cMYP for immunization 2018-2022 NTAGI fully functional Spending on vaccines financed by the government 100% Spending on routine immunization programme financed by the government 100% Updated micro-plans that include activities to improve immunization coverage 757 (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 Family Health Survey-5 2021 >80% coverage for DTP-Hib-HepB3 608 districts (80%) >90% coverage for MCV1 444 districts (59%) >90% coverage for MCV2 350 districts (46%) >10% drop-out rate for DTP-Hib- HepB1 to DTP-Hib-HepB3 38 districts (5%) Polio vaccination policy for travelers to and from polio endemic/infected countries introduced 2014 Mission Indradhanush to immunize all children against eleven VPDs ongoing since Dec-14 Source: WHO/UNICEF JRF, 2022 Figure 1: National immunization coverage, 2013-2022 Source: WHO and UNICEF estimates of immunization coverage Vaccine Age of administration BCG 0-1 year HepB Birth OPV Birth, 6 weeks, 10 weeks, 14 weeks and 16 to 24 months IPV 6 weeks and 14 weeks DTP-Hib-HepB 6 weeks, 10 weeks and 14 weeks DTP 16 to 24 months and 5-6 years MR 9 to 12 months and 16 to 24 months JE_live_Atd 9 to 12 months and 16 to 24 months (select JE endemic districts) JE_Inactd 9 to 12 months and 16 to 24 months (select JE endemic districts) Td 10 years, 16 years and 2 doses/ booster for pregnant women Vitamin A 9 months, 18 months, 24 months, 30 months, 36 months and 42 months PCV 6 weeks, 14 weeks and 9 months Rotavirus 6 weeks, 10 weeks and 14 weeks Source: WHO/UNICEF JRF, 2022 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. 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 10: Summary of measles surveillance indicators, 2020-2022 Figure 22: Network of WHO supported surveillance 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 Annual EPI Reporting Form (multiple years) ND=No data Source: SEAR measles case-based data For contact or feedback: Expanded Programme on Immunization Ministry of Health and Family Welfare (MOHFW), New Delhi, India Tel/Fax : +91-11-23062728, Email: pradeephaldar@yahoo.co.in www.mohfw.nic.in 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 Indicator Target 2020 2021 2022 Number of suspected measles cases 17,949 33,436 112,185 Confirmed measles cases 0 5,511 5,903 43,410 Lab confirmed 0 2,565 1,872 14,017 Epi-Linked 0 630 451 21,670 Clinically-compatible 0 2,316 3,580 7,723 Confirmed rubella cases 0 1,398 1,681 2,554 Lab confirmed 0 1,295 1,637 2,474 Epi-Linked 0 102 44 80 Discarded non-measles non-rubella cases 11,019 25,851 65,926 Percentage of suspected cases with adequate investigation initiated within 48 hours of notification ≥ 80% 88.7 92 94 Reporting rate of non-measles non-rubella cases to national level per 100,000 population ≥ 2 0.79 1.81 4.63 Percentage of second-level administrative units reporting at least 2 non-measles non-rubella cases per 100,000 population ≥ 80% 11 42 87 Percentage of surveillance units reporting measles and rubella data to the national level on time, even in the absence of cases ≥ 80% 94 93 94 Percentage of specimens received at the laboratory within 5 days of collection ≥ 80% 66 81 87 Percentage of IgM results reported to the national public health authorities by the laboratory within 4 days of receipt of specimens ≥ 80% 66 94 87 Genotypes detected Measles B3,D4, D8 D8 D8 Rubella Source: WHO/NPSP Surveillance medical officers Laboratories: Polio Measles/rubella Polio and Measles/rubella Japanese encephalitis IBD and Rotavirus reference Lab Diphtheria/Pertussis Measles/rubella, Diphtheria/Pertussis Polio, Measles/rubella, Diphtheria/ Pertussis 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 Table 8: OPV 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 Figure 5: 2022 a Excludes one type 2 VDPV Source: SEAR annual EPI reporting form, 2021 and 2022 (administrative data) Source: WHO/UNICEF JRF (multiple years) Year Polio Diphtheria Pertussis NT (% of all tetanus) Measles Rubella Mumps JE CRS 2016 0a 3,380 37,274 227 (6%) 18,663 11,027 ND 1,627 25 2017 0 5,293 23,766 295 (6%) 13,401 2,856 ND 2,043 76 2018 0 8,788 13,208 129 (2%) 19,474 2,328 ND 1,707 ND 2019 0 9,622 11,875 95 (1.3%) 10,544 3,466 ND 2,496 237 2020 0 3,485 12,566 162 (13.5%) 5,511 1,398 ND 718 ND 2021 0 1,768 593 81 (6.5%) 5,700 1,675 758 489 ND 2022 0 3,286 4,362 65 (100%) 43,410 2,554 6 1,271 210 Indicator 2016 2017 2018 2019 2020 2021 2022 AFP cases 46,499 39,127 35,990 40,613 21,164 25,422 30,225 Wild poliovirus confirmed cases 0 0 0 0 0 0 0 Compatible cases 15 37 16 22 11 10 13 Non-polio AFP rate1 10.6 8.92 8.11 9.1 4.6 5.6 6.58 Adequate stool specimen collection percentage2 87% 86% 86% 87% 82% 86% 88% Total stool samples collected 91,031 72,555 70,510 79,041 40,298 49,279 59,102 % NPEV isolation 15 16 15 13 11 9 13 % Timeliness of primary result reported3 97 94 98 93 94 96 97 • The last polio case due to WPV was reported on 13 January 2011 from West Bengal 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 1 – 1.99 >2 No AFP case <70% 70% - 79% 80% - 89% >90% <60% 60% - 79% >80% No AFP case Year Antigen Geographic coverage Target age Target population Coverage (%) Round 1 Round 2 Round 1 Round 2 2017 bOPV NID <5 years 170,000,000 170,000,000 97 97 2017 bOPV SNID <5 years 70,600,000 70,600,000 98 98 2018 bOPV NID <5 years 164,333,904 166,963,605 98 98 2018 bOPV SNID <5 years 69,984,609 30,640,071 98 98 2019 bOPV NID <5 years 165,000,000 - 97 - 2019 bOPV SNID <5 years 71,000,000 71,000,000 98 98 2020 bOPV NID <5 years 165,000,000 - 98 - 2020 bOPV SNID <5 years 32,800,000 33,570,000 97 98 2021 bOPV NID <5 years 163,700,000 168,041,923 97.2 - 2021 bOPV SNID <5 years 71,249,633 33,146,000 97.4 - 2021 bOPV SNID <5 years 22,481,343 35,338,000 97.5 - 2022 bOPV NID <5 years 163,695,998 - 96.8 - 2022 bOPV SNID <5 years 35,361,794 - 97.1 - 2022 bOPV SNID <5 years 71,924,126 - 96.7 -Source: WHO/UNICEF JRF (multiple years) ND=No data Table 7: Environmental surveillance sites for polio detection, 2019 - 2022 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 2019 9 52 1,607 98 480 318 0 0 0 0 0 540 2020 11 56 1,258 59 328 285 0 0 0 0 0 415 2021 13 58 1,533 87 336 206 0 0 0 0 0 683 2022 14 63 1,739 81 373 224 0 0 0 0 1 803 Figure 6: 2021 Figure 7: 2022 Figure 8: 2021 Figure 9: 2022 Figure 10: HepB3 and HepB birth dose immunization coverage1, 2000-2022 Figure 11: MCV1 & MCV2 coverage1 and measles, rubella cases2, 1980-2022 Table 9: MCV/MR SIAs MR1 coverage by province MR2 coverage by province Source: SEAR annual EPI reporting form, 2021 and 2022 (administrative data) *as a part of emergency health response to floods in Tamil Nadu 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 2022 Figure 12: 2021 Figure 15: 2022 <80% 80% - 89% 90% - 94% > 95% Year Antigen Geographic Coverage Target group Target Coverage (%) 2010 MCV subnational 9 months to 10 years 13,845,686 87% 2011 MCV subnational 9 months to 10 years 40,167,580 90% 2012 MCV subnational 9 months to 10 years 76,730,639 92% 2015* MCV subnational 1 to 15 years 890,070 2017 MCV subnational 9 months to 15 years 60,223,836 98% 2018 MR subnational 9 months to 15 years 183,848,000 96% 2019 MR subnational 9 months to 15 years 196,350,491 99% Figure 13: 2022 Figure 14: 2021 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 Table 8: OPV 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 Figure 5: 2022 a Excludes one type 2 VDPV Source: SEAR annual EPI reporting form, 2021 and 2022 (administrative data) Source: WHO/UNICEF JRF (multiple years) Year Polio Diphtheria Pertussis NT (% of all tetanus) Measles Rubella Mumps JE CRS 2016 0a 3,380 37,274 227 (6%) 18,663 11,027 ND 1,627 25 2017 0 5,293 23,766 295 (6%) 13,401 2,856 ND 2,043 76 2018 0 8,788 13,208 129 (2%) 19,474 2,328 ND 1,707 ND 2019 0 9,622 11,875 95 (1.3%) 10,544 3,466 ND 2,496 237 2020 0 3,485 12,566 162 (13.5%) 5,511 1,398 ND 718 ND 2021 0 1,768 593 81 (6.5%) 5,700 1,675 758 489 ND 2022 0 3,286 4,362 65 (100%) 43,410 2,554 6 1,271 210 Indicator 2016 2017 2018 2019 2020 2021 2022 AFP cases 46,499 39,127 35,990 40,613 21,164 25,422 30,225 Wild poliovirus confirmed cases 0 0 0 0 0 0 0 Compatible cases 15 37 16 22 11 10 13 Non-polio AFP rate1 10.6 8.92 8.11 9.1 4.6 5.6 6.58 Adequate stool specimen collection percentage2 87% 86% 86% 87% 82% 86% 88% Total stool samples collected 91,031 72,555 70,510 79,041 40,298 49,279 59,102 % NPEV isolation 15 16 15 13 11 9 13 % Timeliness of primary result reported3 97 94 98 93 94 96 97 • The last polio case due to WPV was reported on 13 January 2011 from West Bengal 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 1 – 1.99 >2 No AFP case <70% 70% - 79% 80% - 89% >90% <60% 60% - 79% >80% No AFP case Year Antigen Geographic coverage Target age Target population Coverage (%) Round 1 Round 2 Round 1 Round 2 2017 bOPV NID <5 years 170,000,000 170,000,000 97 97 2017 bOPV SNID <5 years 70,600,000 70,600,000 98 98 2018 bOPV NID <5 years 164,333,904 166,963,605 98 98 2018 bOPV SNID <5 years 69,984,609 30,640,071 98 98 2019 bOPV NID <5 years 165,000,000 - 97 - 2019 bOPV SNID <5 years 71,000,000 71,000,000 98 98 2020 bOPV NID <5 years 165,000,000 - 98 - 2020 bOPV SNID <5 years 32,800,000 33,570,000 97 98 2021 bOPV NID <5 years 163,700,000 168,041,923 97.2 - 2021 bOPV SNID <5 years 71,249,633 33,146,000 97.4 - 2021 bOPV SNID <5 years 22,481,343 35,338,000 97.5 - 2022 bOPV NID <5 years 163,695,998 - 96.8 - 2022 bOPV SNID <5 years 35,361,794 - 97.1 - 2022 bOPV SNID <5 years 71,924,126 - 96.7 -Source: WHO/UNICEF JRF (multiple years) ND=No data Table 7: Environmental surveillance sites for polio detection, 2019 - 2022 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 2019 9 52 1,607 98 480 318 0 0 0 0 0 540 2020 11 56 1,258 59 328 285 0 0 0 0 0 415 2021 13 58 1,533 87 336 206 0 0 0 0 0 683 2022 14 63 1,739 81 373 224 0 0 0 0 1 803 Figure 6: 2021 Figure 7: 2022 Figure 8: 2021 Figure 9: 2022 Figure 10: HepB3 and HepB birth dose immunization coverage1, 2000-2022 Figure 11: MCV1 & MCV2 coverage1 and measles, rubella cases2, 1980-2022 Table 9: MCV/MR SIAs MR1 coverage by province MR2 coverage by province Source: SEAR annual EPI reporting form, 2021 and 2022 (administrative data) *as a part of emergency health response to floods in Tamil Nadu 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 2022 Figure 12: 2021 Figure 15: 2022 <80% 80% - 89% 90% - 94% > 95% Year Antigen Geographic Coverage Target group Target Coverage (%) 2010 MCV subnational 9 months to 10 years 13,845,686 87% 2011 MCV subnational 9 months to 10 years 40,167,580 90% 2012 MCV subnational 9 months to 10 years 76,730,639 92% 2015* MCV subnational 1 to 15 years 890,070 2017 MCV subnational 9 months to 15 years 60,223,836 98% 2018 MR subnational 9 months to 15 years 183,848,000 96% 2019 MR subnational 9 months to 15 years 196,350,491 99% Figure 13: 2022 Figure 14: 2021 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 Table 8: OPV 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 Figure 5: 2022 a Excludes one type 2 VDPV Source: SEAR annual EPI reporting form, 2021 and 2022 (administrative data) Source: WHO/UNICEF JRF (multiple years) Year Polio Diphtheria Pertussis NT (% of all tetanus) Measles Rubella Mumps JE CRS 2016 0a 3,380 37,274 227 (6%) 18,663 11,027 ND 1,627 25 2017 0 5,293 23,766 295 (6%) 13,401 2,856 ND 2,043 76 2018 0 8,788 13,208 129 (2%) 19,474 2,328 ND 1,707 ND 2019 0 9,622 11,875 95 (1.3%) 10,544 3,466 ND 2,496 237 2020 0 3,485 12,566 162 (13.5%) 5,511 1,398 ND 718 ND 2021 0 1,768 593 81 (6.5%) 5,700 1,675 758 489 ND 2022 0 3,286 4,362 65 (100%) 43,410 2,554 6 1,271 210 Indicator 2016 2017 2018 2019 2020 2021 2022 AFP cases 46,499 39,127 35,990 40,613 21,164 25,422 30,225 Wild poliovirus confirmed cases 0 0 0 0 0 0 0 Compatible cases 15 37 16 22 11 10 13 Non-polio AFP rate1 10.6 8.92 8.11 9.1 4.6 5.6 6.58 Adequate stool specimen collection percentage2 87% 86% 86% 87% 82% 86% 88% Total stool samples collected 91,031 72,555 70,510 79,041 40,298 49,279 59,102 % NPEV isolation 15 16 15 13 11 9 13 % Timeliness of primary result reported3 97 94 98 93 94 96 97 • The last polio case due to WPV was reported on 13 January 2011 from West Bengal 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 1 – 1.99 >2 No AFP case <70% 70% - 79% 80% - 89% >90% <60% 60% - 79% >80% No AFP case Year Antigen Geographic coverage Target age Target population Coverage (%) Round 1 Round 2 Round 1 Round 2 2017 bOPV NID <5 years 170,000,000 170,000,000 97 97 2017 bOPV SNID <5 years 70,600,000 70,600,000 98 98 2018 bOPV NID <5 years 164,333,904 166,963,605 98 98 2018 bOPV SNID <5 years 69,984,609 30,640,071 98 98 2019 bOPV NID <5 years 165,000,000 - 97 - 2019 bOPV SNID <5 years 71,000,000 71,000,000 98 98 2020 bOPV NID <5 years 165,000,000 - 98 - 2020 bOPV SNID <5 years 32,800,000 33,570,000 97 98 2021 bOPV NID <5 years 163,700,000 168,041,923 97.2 - 2021 bOPV SNID <5 years 71,249,633 33,146,000 97.4 - 2021 bOPV SNID <5 years 22,481,343 35,338,000 97.5 - 2022 bOPV NID <5 years 163,695,998 - 96.8 - 2022 bOPV SNID <5 years 35,361,794 - 97.1 - 2022 bOPV SNID <5 years 71,924,126 - 96.7 -Source: WHO/UNICEF JRF (multiple years) ND=No data Table 7: Environmental surveillance sites for polio detection, 2019 - 2022 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 2019 9 52 1,607 98 480 318 0 0 0 0 0 540 2020 11 56 1,258 59 328 285 0 0 0 0 0 415 2021 13 58 1,533 87 336 206 0 0 0 0 0 683 2022 14 63 1,739 81 373 224 0 0 0 0 1 803 Figure 6: 2021 Figure 7: 2022 Figure 8: 2021 Figure 9: 2022 Figure 10: HepB3 and HepB birth dose immunization coverage1, 2000-2022 Figure 11: MCV1 & MCV2 coverage1 and measles, rubella cases2, 1980-2022 Table 9: MCV/MR SIAs MR1 coverage by province MR2 coverage by province Source: SEAR annual EPI reporting form, 2021 and 2022 (administrative data) *as a part of emergency health response to floods in Tamil Nadu 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 2022 Figure 12: 2021 Figure 15: 2022 <80% 80% - 89% 90% - 94% > 95% Year Antigen Geographic Coverage Target group Target Coverage (%) 2010 MCV subnational 9 months to 10 years 13,845,686 87% 2011 MCV subnational 9 months to 10 years 40,167,580 90% 2012 MCV subnational 9 months to 10 years 76,730,639 92% 2015* MCV subnational 1 to 15 years 890,070 2017 MCV subnational 9 months to 15 years 60,223,836 98% 2018 MR subnational 9 months to 15 years 183,848,000 96% 2019 MR subnational 9 months to 15 years 196,350,491 99% Figure 13: 2022 Figure 14: 2021 World Health Organization • SEARO/CDS/IVD • 31 October 2023 VACCINES PROTECT SUSTAIN. ACCELERATE. INNOVATE. EXPANDED PROGRAMME ON IMMUNIZATION (EPI) FACTSHEET 2023 INDIA Table 2: Basic information, 2022Table 1: EPI History Table 3: Immunization schedule, 2022 Table 4: Immunization system highlights Total population1 1,379,752,250 Live births1 20,987,726 Children <1 year1 26,403,088 Children <5 years1 ND Children <15 years1 ND Pregnant women1 29,939,610 Women of child bearing age1 (15-49 years) ND Neonatal mortality rate2 19.12 (per 1,000 LB) Infant mortality rate2 25.49 (per 1,000 LB) Under-five mortality rate2 30.62 (per 1,000 LB) Maternal mortality ratio2 103 (per 100,000 LB) Division/Province/State/Region 36 District 757 Block 7,636 Population density1 (per sq. km) 382 Population living in urban areas2 34.80% Population using at least basic drinking- water services2 93% Population using at least basic sanitation services2 78% Total expenditure on health as % of GDP2 1.08% Births attended by skilled health personnel2 89% Neonates protected at birth against NT2 90% Children not covered by immunization programme (zero dose children)3 1,125,995 1 SEAR annual EPI reporting form, 2022 2 WHO, 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 Year Milestone 1978 EPI launched with DTP, OPV, BCG and typhoid vaccines 1983 TT immunization of pregnant women introduced 1985 MCV (measles vaccine-standalone) introduced 2002-11 HepB piloted in 2002 and made universal in 2011 2010 MCV2 introduced 2011-15 Pentavalent (introduced in two states in 2011 and gradually expanded to all states by 2015) 2006-13 First dose of JE vaccine introduced in 2006 and second dose introduced in 2013 in JE endemic districts 2013 Multi-dose vial policy for vaccines introduced 2015-16 IPV introduced in six states in 2015 and expanded to all states in 2016 2016 tOPV to bOPV switched on 25 April 2016-19 Rotavirus vaccine introduced in four states in 2016, nationwide expansion in 2019 2017-19 Rubella containing Vaccine (RCV) introduced through Measles-Rubella vaccine (MR Vaccine) at subnational level from February 2017 and expanded to all states by 2019 2017 PCV introduced, now expanded to Bihar, Himachal Pradesh, Haryana, Madhya Pradesh, Rajasthan and Uttar Pradesh 2019 TT replaced by Td Source: cMYP 2018-2022 and EPI/MoHFW cMYP for immunization 2018-2022 NTAGI fully functional Spending on vaccines financed by the government 100% Spending on routine immunization programme financed by the government 100% Updated micro-plans that include activities to improve immunization coverage 757 (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 Family Health Survey-5 2021 >80% coverage for DTP-Hib-HepB3 608 districts (80%) >90% coverage for MCV1 444 districts (59%) >90% coverage for MCV2 350 districts (46%) >10% drop-out rate for DTP-Hib- HepB1 to DTP-Hib-HepB3 38 districts (5%) Polio vaccination policy for travelers to and from polio endemic/infected countries introduced 2014 Mission Indradhanush to immunize all children against eleven VPDs ongoing since Dec-14 Source: WHO/UNICEF JRF, 2022 Figure 1: National immunization coverage, 2013-2022 Source: WHO and UNICEF estimates of immunization coverage Vaccine Age of administration BCG 0-1 year HepB Birth OPV Birth, 6 weeks, 10 weeks, 14 weeks and 16 to 24 months IPV 6 weeks and 14 weeks DTP-Hib-HepB 6 weeks, 10 weeks and 14 weeks DTP 16 to 24 months and 5-6 years MR 9 to 12 months and 16 to 24 months JE_live_Atd 9 to 12 months and 16 to 24 months (select JE endemic districts) JE_Inactd 9 to 12 months and 16 to 24 months (select JE endemic districts) Td 10 years, 16 years and 2 doses/ booster for pregnant women Vitamin A 9 months, 18 months, 24 months, 30 months, 36 months and 42 months PCV 6 weeks, 14 weeks and 9 months Rotavirus 6 weeks, 10 weeks and 14 weeks Source: WHO/UNICEF JRF, 2022 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. 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 10: Summary of measles surveillance indicators, 2020-2022 Figure 22: Network of WHO supported surveillance 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 Annual EPI Reporting Form (multiple years) ND=No data Source: SEAR measles case-based data For contact or feedback: Expanded Programme on Immunization Ministry of Health and Family Welfare (MOHFW), New Delhi, India Tel/Fax : +91-11-23062728, Email: pradeephaldar@yahoo.co.in www.mohfw.nic.in 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 Indicator Target 2020 2021 2022 Number of suspected measles cases 17,949 33,436 112,185 Confirmed measles cases 0 5,511 5,903 43,410 Lab confirmed 0 2,565 1,872 14,017 Epi-Linked 0 630 451 21,670 Clinically-compatible 0 2,316 3,580 7,723 Confirmed rubella cases 0 1,398 1,681 2,554 Lab confirmed 0 1,295 1,637 2,474 Epi-Linked 0 102 44 80 Discarded non-measles non-rubella cases 11,019 25,851 65,926 Percentage of suspected cases with adequate investigation initiated within 48 hours of notification ≥ 80% 88.7 92 94 Reporting rate of non-measles non-rubella cases to national level per 100,000 population ≥ 2 0.79 1.81 4.63 Percentage of second-level administrative units reporting at least 2 non-measles non-rubella cases per 100,000 population ≥ 80% 11 42 87 Percentage of surveillance units reporting measles and rubella data to the national level on time, even in the absence of cases ≥ 80% 94 93 94 Percentage of specimens received at the laboratory within 5 days of collection ≥ 80% 66 81 87 Percentage of IgM results reported to the national public health authorities by the laboratory within 4 days of receipt of specimens ≥ 80% 66 94 87 Genotypes detected Measles B3,D4, D8 D8 D8 Rubella Source: WHO/NPSP Surveillance medical officers Laboratories: Polio Measles/rubella Polio and Measles/rubella Japanese encephalitis IBD and Rotavirus reference Lab Diphtheria/Pertussis Measles/rubella, Diphtheria/Pertussis Polio, Measles/rubella, Diphtheria/ Pertussis World Health Organization • SEARO/CDS/IVD • 31 October 2023 VACCINES PROTECT SUSTAIN. ACCELERATE. INNOVATE. EXPANDED PROGRAMME ON IMMUNIZATION (EPI) FACTSHEET 2023 INDIA Table 2: Basic information, 2022Table 1: EPI History Table 3: Immunization schedule, 2022 Table 4: Immunization system highlights Total population1 1,379,752,250 Live births1 20,987,726 Children <1 year1 26,403,088 Children <5 years1 ND Children <15 years1 ND Pregnant women1 29,939,610 Women of child bearing age1 (15-49 years) ND Neonatal mortality rate2 19.12 (per 1,000 LB) Infant mortality rate2 25.49 (per 1,000 LB) Under-five mortality rate2 30.62 (per 1,000 LB) Maternal mortality ratio2 103 (per 100,000 LB) Division/Province/State/Region 36 District 757 Block 7,636 Population density1 (per sq. km) 382 Population living in urban areas2 34.80% Population using at least basic drinking- water services2 93% Population using at least basic sanitation services2 78% Total expenditure on health as % of GDP2 1.08% Births attended by skilled health personnel2 89% Neonates protected at birth against NT2 90% Children not covered by immunization programme (zero dose children)3 1,125,995 1 SEAR annual EPI reporting form, 2022 2 WHO, 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 Year Milestone 1978 EPI launched with DTP, OPV, BCG and typhoid vaccines 1983 TT immunization of pregnant women introduced 1985 MCV (measles vaccine-standalone) introduced 2002-11 HepB piloted in 2002 and made universal in 2011 2010 MCV2 introduced 2011-15 Pentavalent (introduced in two states in 2011 and gradually expanded to all states by 2015) 2006-13 First dose of JE vaccine introduced in 2006 and second dose introduced in 2013 in JE endemic districts 2013 Multi-dose vial policy for vaccines introduced 2015-16 IPV introduced in six states in 2015 and expanded to all states in 2016 2016 tOPV to bOPV switched on 25 April 2016-19 Rotavirus vaccine introduced in four states in 2016, nationwide expansion in 2019 2017-19 Rubella containing Vaccine (RCV) introduced through Measles-Rubella vaccine (MR Vaccine) at subnational level from February 2017 and expanded to all states by 2019 2017 PCV introduced, now expanded to Bihar, Himachal Pradesh, Haryana, Madhya Pradesh, Rajasthan and Uttar Pradesh 2019 TT replaced by Td Source: cMYP 2018-2022 and EPI/MoHFW cMYP for immunization 2018-2022 NTAGI fully functional Spending on vaccines financed by the government 100% Spending on routine immunization programme financed by the government 100% Updated micro-plans that include activities to improve immunization coverage 757 (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 Family Health Survey-5 2021 >80% coverage for DTP-Hib-HepB3 608 districts (80%) >90% coverage for MCV1 444 districts (59%) >90% coverage for MCV2 350 districts (46%) >10% drop-out rate for DTP-Hib- HepB1 to DTP-Hib-HepB3 38 districts (5%) Polio vaccination policy for travelers to and from polio endemic/infected countries introduced 2014 Mission Indradhanush to immunize all children against eleven VPDs ongoing since Dec-14 Source: WHO/UNICEF JRF, 2022 Figure 1: National immunization coverage, 2013-2022 Source: WHO and UNICEF estimates of immunization coverage Vaccine Age of administration BCG 0-1 year HepB Birth OPV Birth, 6 weeks, 10 weeks, 14 weeks and 16 to 24 months IPV 6 weeks and 14 weeks DTP-Hib-HepB 6 weeks, 10 weeks and 14 weeks DTP 16 to 24 months and 5-6 years MR 9 to 12 months and 16 to 24 months JE_live_Atd 9 to 12 months and 16 to 24 months (select JE endemic districts) JE_Inactd 9 to 12 months and 16 to 24 months (select JE endemic districts) Td 10 years, 16 years and 2 doses/ booster for pregnant women Vitamin A 9 months, 18 months, 24 months, 30 months, 36 months and 42 months PCV 6 weeks, 14 weeks and 9 months Rotavirus 6 weeks, 10 weeks and 14 weeks Source: WHO/UNICEF JRF, 2022 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. 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 10: Summary of measles surveillance indicators, 2020-2022 Figure 22: Network of WHO supported surveillance 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 Annual EPI Reporting Form (multiple years) ND=No data Source: SEAR measles case-based data For contact or feedback: Expanded Programme on Immunization Ministry of Health and Family Welfare (MOHFW), New Delhi, India Tel/Fax : +91-11-23062728, Email: pradeephaldar@yahoo.co.in www.mohfw.nic.in 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 Indicator Target 2020 2021 2022 Number of suspected measles cases 17,949 33,436 112,185 Confirmed measles cases 0 5,511 5,903 43,410 Lab confirmed 0 2,565 1,872 14,017 Epi-Linked 0 630 451 21,670 Clinically-compatible 0 2,316 3,580 7,723 Confirmed rubella cases 0 1,398 1,681 2,554 Lab confirmed 0 1,295 1,637 2,474 Epi-Linked 0 102 44 80 Discarded non-measles non-rubella cases 11,019 25,851 65,926 Percentage of suspected cases with adequate investigation initiated within 48 hours of notification ≥ 80% 88.7 92 94 Reporting rate of non-measles non-rubella cases to national level per 100,000 population ≥ 2 0.79 1.81 4.63 Percentage of second-level administrative units reporting at least 2 non-measles non-rubella cases per 100,000 population ≥ 80% 11 42 87 Percentage of surveillance units reporting measles and rubella data to the national level on time, even in the absence of cases ≥ 80% 94 93 94 Percentage of specimens received at the laboratory within 5 days of collection ≥ 80% 66 81 87 Percentage of IgM results reported to the national public health authorities by the laboratory within 4 days of receipt of specimens ≥ 80% 66 94 87 Genotypes detected Measles B3,D4, D8 D8 D8 Rubella Source: WHO/NPSP Surveillance medical officers Laboratories: Polio Measles/rubella Polio and Measles/rubella Japanese encephalitis IBD and Rotavirus reference Lab Diphtheria/Pertussis Measles/rubella, Diphtheria/Pertussis Polio, Measles/rubella, Diphtheria/ Pertussis