India factsheet 2020: expanded programme on Immunization (EPI)

World Health Organization • SEARO/CDS/IVD • 15 July 2020 Table 1: Basic information1 2019 Table 2: Immunization schedule, 2019 Table 3: Immunization system highlights EPI HISTORy • EPI launched in 1978 with DTP, OPV and BCG vaccines • TT immunization of pregnant women introduced in 1983 • EPI termed Universal Immunization Programme (UIP) in 1985 • MCV introduced in 1985 • HepB piloted in 2002 and made universal in 2011 • MCV2 introduced 2010 onward • Pentavalent introduced in two states in 2011 and gradually expanded to all states by 2015 • First dose of JE vaccine at 9 to 12 months introduced in 2006 and second dose at 16 to 24 months introduced in 2013 in JE endemic districts • Multi-dose open vial policy for vaccines introduced in 2013 • IPV introduced in six states in 2015 and expanded to all states in 2016 • Rotavirus vaccine introduced in four states in 2016, nationwide expansion in 2019 • tOPV to bOPV switch on 25 April 2016 • Rubella vaccine introduced at subnational level from February 2017 and expanded to all states by 2019 • PCV introduced in 2017 now expanded to Bihar Himachal Pradesh, Haryana, Madhya Pradesh, Rajasthan and Uttar Pradesh • TT replaced by Td in 2019 Source: cMYP 2018-2022 and EPI/MoHFW FACTSHEET 2020 ExPAnDED PROgRAmmE On ImmunIzATIOn (EPI) InDIA Total population1 1,340,018,117 Live births1 27,192,790 Children <1 year1 26,297,590 Children <5 years1 153,673,454 Children <15 years1 440,835,286 Pregnant women1 29,913,500 Women of child bearing age1 (15-49 years) 251,600,000 Neonatal mortality rate2 22.7 (per 1,000 LB) Infant mortality rate2 29.9 (per 1,000 LB) Under-five mortality rate2 36.6 (per 1,000 LB) Maternal mortality ratio2 145 (per 100,000 LB) Division/Province/State/Region 36 District 704 Block 6,714 Population density1 (per sq. km) 382 Population living in urban areas2 34.8% Population using at least basic drinking- water services2 94% Population using at least basic sanitation services2 72% Total expenditure on health as % of GDP2 3.5% Births attended by skilled health personnel2 81% Neonates protected at birth 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 2018-2022 NTAGI Fully functional Spending on vaccines financed by the government 99.7% Spending on routine immunization programme financed by the government 99.8% Updated micro-plans that include activities to improve immunization coverage 704 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 National Family Health Survey-4 2015-16 >80% coverage for DTP-Hib-HepB3 539 districts (67%) >90% coverage for MCV1 384 districts (55%) >90% coverage for MCV2 208 districts (30%) >10% drop-out rate for DTP-Hib- HepB1 to DTP-Hib-HepB3 59 districts (8%) Last case of WPV 2011 Polio vaccination policy for travelers to and from polio endemic/infected countries introduced 2014 Mission Indradhanush to immunize all children against seven VPDs ongoing since April 2015 MNTE validation 2015 Source: WHO/UNICEF 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 HepB Birth OPV Birth, 6 weeks, 10 weeks, 14 weeks and 16 to 24 months Rotavirus 6 weeks, 10 weeks and 14 weeks 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 vaccine 9 to 12 months and 16 to 24 months (JE endemic districts) Td 10 years, 16 years and 2 doses/ booster for pregnant women PCV 6 weeks, 14 weeks and 9 months (sub national) Vitamin A 9 doses at 9 months, 16-18 months then 6 monthly till the age of 5 years Source: JRF 2019 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 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 state Figure 5: 2019 a Excludes three type 2 VDPV b Excludes two type 2 VDPV c Excludes one type 2 VDPV 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 0a 6,094 46,706 492(10%) 24,977 4,870 ND 1,657 ND 2015 0b 2,365 25,206 491 (22%) 25,488 3,252 ND 1,620 ND 2016 0c 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 35 (0.5%) 10,430 3,404 ND 2,496 237 <70% 70% - 79% 80% - 89% >90% Source: WHO/UNICEF JRF (multiple years) and EPI/MOHFW ND=No data 320109 184368 112416 36 States and Union Territories have achieved MNT elimination status by May 2015 National: 89.0% National: 91.0% Table 5: AFP surveillance performance indicators, 2014-2019 Table 7: OPV SIAs non-polio AFP rate by district % of Adequate stool specimen collection by district Source: WHO/UNICEF JRF (multiple years) and EPI/MOHFW Indicator 2014 2015 2016 2017 2018 2019 AFP cases 53,933 46,970 46,500 39,128 35,990 40,613 Wild poliovirus confirmed cases 0 0 0 0 0 0 Compatible cases 20 11 15 37 16 18 Non-polio AFP rate1 10.77 10.78 10.60 8.92 8.11 9.01 Adequate stool specimen collection percentage2 87% 86% 87% 86% 86% 87% Total stool samples collected 105,939 91,868 91,031 72,555 70,510 79,712 Percentage of NPEV isolation 18 15 15 16 15 13 Percentage of timeliness of primary result reported3 97 97 97 94 98 93 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 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 2015 OPV NID <5 years 167,393,125 168,041,923 97 97 2015 OPV SNID <5 years 71,249,633 49,182,923 99 98 2015 OPV SNID <5 years 22,481,343 21,594,303 98 98 2016 tOPV NID <5 years 166,295,895 166,701,651 97 97 2016 tOPV Mop up and SNID <5 years 1,868,674 45,348,418 94 96 2016 bOPV SNID <5 years 70,836,203 6,9849,220 98 98 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 Table 6: Environmental surveillance sites for polio detection in 2018 and 2019 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 8 46 1496 78 430 301 9 1 1 4 1 577 2019 9 52 1607 98 479 316 0 0 2 0 0 624 Figure 6: 2018 National: 8.11 National: 9.01 National: 86% National: 87% Figure 7: 2019 Figure 8: 2018 Figure 9: 2019 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 state mCV2 coverage by state Source: SEAR annual EPI reporting form, 2018 and 2019 (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, 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 % 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 MRCV subnational 9 months to 15 years 183,848,000 96% 2019 MRCV subnational 9 months to 15 years 196,350,491 99% National: 83.6% National: 72.0%National: 95.0% National: 84.0% 114036 161216 Figure 12: 2019 Figure 13: 2018 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 and Epi linked) 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 For contact or feedback: Expanded Programme on Immunization Ministry of Health and Family Welfare (MOHFW), New Delhi, India Tel/Fax : +91-11-23062728, Email: riindia2015@gmail.com 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 <1 yr 1-4 yrs 5-9 yrs 10-14 yrs 15-24 yrs 25-29 yrs 40+yrs Unknown <1 yr 1-4 yrs 5-9 yrs 10-14 yrs 15-24 yrs 25-29 yrs 40+yrs Unknown <1 yr 1-4 yrs 5-9 yrs 10-14 yrs 15-24 yrs 25-29 yrs 40+yrs Unknown<1 yr 1-4 yrs 5-9 yrs 10-14 yrs 15-24 yrs 25-29 yrs 40+yrs Unknown Indicator Target 2017 2018 2019 Number of suspected measles cases 45,773 52,308 28,246 Confirmed measles cases 0 13,401 19,474 10,430 Lab confirmed 0 3,467 4,914 4,608 Epi-Linked 0 9,003 13,147 3,136 Clinically-compatible 0 931 1,413 2,686 Confirmed rubella cases 0 2,856 2,328 3,404 Lab confirmed 0 833 924 2,024 Epi-Linked 0 2,023 1,404 1,380 Discarded non-measles non-rubella cases 1,711 7,209 13,854 Percentage of suspected cases with adequate investigation initiated within 48 hours of notification ≥ 80% 83.5 81 87 Reporting rate of non-measles non-rubella cases to national level per 100,000 population ≥ 2 0.1 0.5 1.01 Percentage of second-level administrative units reporting at least 2 non-measles non-rubella cases per 100 000 population ≥ 80% ND ND 15 Percentage of surveillance units reporting measles and rubella data to the national level on time, even in the absence of cases ≥ 80% 92.2 90 94 Percentage of specimens received at the laboratory within 5 days of collection ≥ 80% 100 92 88 Percentage of IgM results reported to the national public health authorities by the laboratory within 4 days of receipt of specimens ≥ 80% 81 31 84 Genotypes detected Measles D4,D8 D4,D8 B3, D4, D8 Rubella 2B 2B - 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