Expanded progrAmme on immunization (EPI): Maldives 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 1976 • HepB vaccine introduced in 1993 • MMR vaccine introduced in 2007 • DTP-Hib-HepB vaccine started at national level in 2013 • TT vaccine replaced by Td vaccine in 2015 • IPV introduced in 2015 • tOPV to bOPV switched on 18 April 2016 • Verification of endemic measles elimination in 2017 • MCV1 replaced with MR at 9 months in 2017 • DTP booster vaccine introduced in December 2018 • HPV vaccine introduced in March 2019 Sorce: cMYP 2020-2024 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. MaldIvEs Total population1 515,696 Live births1 6,183 Children <1 year1 8,853 Children <5 years1 42,220 Children <15 years1 105,119 Pregnant women1 6,150 Women of child bearing age1 WCBA (15-49 years) 106,798 Neonatal mortality rate2 4.9 (per 1,000 LB) Infant mortality rate2 6.5 (per 1,000 LB) Under-five mortality rate2 7.6 (per 1,000 LB) Maternal mortality ratio2 53 per 100,000 LB) Division/Province/State/Region 3 Atoll/District 20 City 2 Island (inhabited) 187 Total Islands 1,192 Population density1 (per sq. km) 1,801 Population living in urban areas2 50.20% Population using at least basic drinking- water services2 100% Population using at least basic sanitation services2 99% Total expenditure on health as % of GDP2 14% Births attended by skilled health personnel2 100% Neonates protected at birth against NT2 99% 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 Figure 1: National immunization coverage, 1980-2020 Source: WHO and UNICEF estimates of immunization coverage vaccine age of administration BCG Birth HepB Birth DTP-Hib-HepB 2 months, 4 months and 6 months DTP booster 4 years OPV 2 months, 4 months, 6 months and 15+years pilgrims IPV 6 months MR 9 months MMR 18 months Td Females 15 years and pregnant women (5 doses with intervals of +1 month, +6 months, +1 year and +1 year with preceding dose) HPV 10 years (2 doses 6 months apart) Men ACWY- 135 conj 15+years travellers Yellow fever 15+years travellers Vitamin A 9 - 42 months (9 months, 18 months, 24 months, 30 months, 36 months and 42 months Source: WHO/UNICEF JRF 2020 cMYP for immunization 2020-2024 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 20 atolls (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 DHS 2017 ≥80% coverage for DTP-Hib-HepB3 20 atolls (100%) ≥90% coverage for MCV1 20 atolls (100%) ≥90% coverage for MCV2 20 atolls (100%) ≥10% drop-out rate for DTP-Hib-HepB1 to DTP-Hib-HepB3 none 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+ 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) * Import and/or import related 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 0 0 0 0 3 0 0 0 2016 0 0 0 0 0 0 0 0 0 2017 0 0 0 0 1* 1 6 0 0 2018 0 0 1 0 1* 0 0 0 0 2019 0 0 0 0 0 2 0 0 0 2020 0 0 0 0 15 1 2 0 0 <70% 70% - 79% 80% - 89% >90% Table 5: aFP surveillance performance indicators, 2015-2020 Table 6: oPv sIas Figure 6: acute Flaccid Paralysis (aFP) cases 2016-2020 Source: WHO/UNICEF JRF (multiple years) Indicator 2015 2016 2017 2018 2019 2020 AFP cases 5 2 7 7 8 4 Wild poliovirus confirmed cases 0 0 0 0 0 0 Compatible cases 0 0 0 0 0 0 Non-polio AFP rate1 5.6 2.11 7.4 7.4 6.34 3.17 Adequate stool specimen collection percentage2 60% 0% 71% 43% 63% 75% Total stool samples collected 6 4 6 9 6 4 % NPEV isolation 0 0 0 0 0 0 % Timeliness of primary result reported3 0 100 100 89 100 100 • Last laboratory-confirmed polio case due to WPV was reported in 1994 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. year antigen Geographic coverage Target age Target population coverage (%) round 1 round 2 round 1 round 2 1997 OPV NID <5 years 40,000 43 40 1998 OPV NID <5 years 39,000 41 44 1999 OPV NID <5 years 38,000 47 50 2000 OPV NID <5 years 37,500 53 53 2001 OPV SNID <5 years 35,000 101 29 2016 = 2 cases 2017 = 7 cases 2018 = 7 cases 2019 = 8 cases 2020 = 4 cases World Health Organization • SEARO/CDS/IVD • 31 August 2021 VACCInES PROtECt SUSTAIN. ACCELERATE. INNOVATE. Figure 7: hepB3 and hepB birth dose immunization coverage1, 2000-2020 Figure 8: Mcv1 & Mcv2 coverage1 and measles, rubella cases2, 1980-2020 Table 7: 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) 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 9: 2019 Figure 12: 2020 <80% 80% - 89% 90% - 94% > 95% year antigen Geographic coverage Target group Target coverage % 2005 MR 2 districts 6 to 25 years (males) and 6 to 35 years (females) 144,997 82 2006 MR nationwide 6 to 25 years (males) and 6 to 35 years (females) 144,997 85 2007 MMR nationwide 4 to 6 years 29,529 56 2017 MR Nationwide 8 years to 14 years 2,129 77 2017 MR Nationwide 15 years to 25 years 61,835 76 2020 MR Nationwide 18 months to 40 years 170,000 2.8 Figure 10: 2020 Figure 11: 2019 Figure 13: Immunity against measles - immunity profile by age in 2020* Figure 15: confirmed measles cases* by month 2018-2020 Figure 14: Immunity against rubella through vaccination - immunity profile by age in 2020* Figure 16: 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 17: vaccination status of confirmed (laboratory, Epi linked and clinically compatible) measles cases, by age in 2019 and 2020 Figure 18: vaccination status of confirmed (laboratory and Epi linked) rubella cases, by age in 2019 and 2020 Table 8: summary of measles surveillance indicators, 2018-2020 Figure 19: 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) * Import or import related ND=No data Source: SEAR measles case-based data Indicator Target 2018 2019 2020 Number of suspected measles cases 35 67 250 Confirmed measles cases 0 1 0 15 Lab confirmed 0 1* 0 14 Epi-Linked 0 0 0 0 Clinically-compatible 0 0 0 1 Confirmed rubella cases 0 0 0 1 Lab confirmed 0 0 0 1 Epi-Linked 0 0 0 0 Discarded non-measles non-rubella cases 34 67 234 Percentage of suspected cases with adequate investigation initiated within 48 hours of notification ≥ 80% 17 12 94 Reporting rate of non-measles non-rubella cases to national level per 100,000 population ≥ 2 9.34 18.4 45.38 Percentage of second-level administrative units reporting at least 2 non-measles non-rubella cases per 100,00 population ≥ 80% ND ND ND Percentage of surveillance units reporting measles and rubella data to the national level on time, even in the absence of cases ≥ 80% 100 100 100 Percentage of specimens received at the laboratory within 5 days of collection ≥ 80% 77 88 98 Percentage of IgM results reported to the national public health authorities by the laboratory within 4 days of receipt of specimens ≥ 80% 29 55 95 Genotypes detected Measles D8 D8 D8 Rubella - - 1a For contact or feedback: National Programme on Immunization and Travel vaccine Health Protection Agency, Ministry of Health, Male, Maldives. Phone: +960-3014495, Fax : +960-3014484 Email: nash@health.gov.mv, www.health.gov.mv 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 Indira Gandhi Memorial hospital National measles and rubella laboratory