Bangladesh 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 Table 3: Immunization system highlights EPI HISTORy • EPI launched on 07 April 1979 • TT5 dose for WCBA started in 1993 • HepB vaccine introduced in 2003 • AD syringes introduced in 2004 • Pentavalent vaccine introduced in 2009 • MR vaccine and measles vaccine second dose introduced in 2012 • PCV introduced in 2015 • tOPV to bOPV switched on 23 April 2016 and IPV to fIPV switched on November 2017 • HPV demonstration projects launched on 16 April 2016 in 4 upazillas and 1 zone under Gazipur district which was completed in 2017 • TT switched to Td on March 2019 Source: cMYP 2018-2022 and EPI/MOHFW 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) BAngLADESH Total population1 167,836,821 Live births1 3,408,614 Children <1 year1 3,262,044 Children <5 years1 16,026,457 Children <15 years1 48,991,359 Pregnant women1 3,749,475 Women of child bearing age1 (WCBA) (15-49 years) 46,987,746 Neonatal mortality rate3 30.0 (per 1,000 LB) Infant mortality rate3 38.0 (per 1,000 LB) Under-five mortality rate3 45.0 (per 1,000 LB) Maternal mortality ratio3 165 (per 100,000 LB) Division/Province/State/Region 8 District 64 Upazilla/Sub-district 489 City Corporation 12 Union 4,587 Ward (EPI) 13,761 Sub-Block (EPI) 110,088 Population density1 (per sq. km) 1,137 Population living in urban areas2 38% Population using at least basic drinking- water services3 98.1% Population using at least basic sanitation services3 81.5% Total expenditure on health as % of GDP2 2.3% Births attended by skilled health personnel (BDHS 2017-2018) 52.7% Coverage Evaluation Survey 2019 (Unpublished) 94.6% 1 SEAR annual EPI reporting form, 2019 2 WHO, Global Health Observatory (GHO) data http://apps.who.int/gho/data accessed on 06 June 2020 3 Sample Vital Registration System 2019, Bangladesh Bureau of Statistics Vaccine Age of administration BCG Birth DTP-Hib-HepB 6 weeks, 10 weeks and 14 weeks OPV 6 weeks, 10 weeks and 14 weeks PCV 6 weeks, 10 weeks and 14 weeks IPV 6 weeks and 14 weeks MR 9 months and 15 months Td Females 15 - 49 years (5 doses with an interval of + 1 month, + 6 months, + 1 year and + 1 year with preceding dose) Vitamin A 6 to 59 months Source: WHO/UNICEF JRF, 2019 cMYP for immunization 2018-2022 NITAG fully func- tional Spending on vaccines financed by the government 38% Spending on routine immunization pro- gramme financed by the government 39% Updated micro-plans that include activities to improve immunization coverage 64 districts (100%) National policy for health care waste management including waste from immu- nization activities in place National system to monitor AEFI in place Most recent EPI CES EPI CES 2019 >80% coverage for DTP-Hib-HepB3 63 districts (98%) >90% coverage for MCV1 62 districts (97%) >90% coverage for MCV2 62 districts (97%) >10% drop-out rate for DTP-Hib-HepB1 to DTP-Hib-HepB3 One district Source: WHO/UNICEF JRF, 2019 Figure 1: national immunization coverage, 1980-2019 Note: Penta replaced DPT in 2009, MCV1 replaced MR1 in 2012 Source: WHO and UNICEF estimates of immunization coverage, July 2020 revision 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 N o. o f ca se s N o. o f ca se s % C ov er ag e % C ov er ag e 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 * 8372 probable cases reported among the migrants in Cox’s Bazar out of which 293 are confirmed cases **135 confirmed measles and 2 rubella cases reported among the migrants in Cox’s Bazar Source: Coverage evaluation survey 2019Source: SEAR annual EPI reporting form 2018 (administrative data) year Polio Diphtheria Pertussis nT (% of all tetanus) measles Rubella mumps JE CRS 2014 0 13 12 105 (19%) 289 381 ND 183 98 2015 0 6 11 117 (21%) 240 189 ND 76 121 2016 0 2 1 110 (25%) 972 165 ND 1,294 146 2017 0 5 0 96 (27%) 4,001 299 ND 19 202 2018 0 36* 3 85 (37%) 2,263 308 ND 96 194 2019 0 14 12 49 (42%) 5,827** 176 ND 86 160 <70% 70% - 79% 80% - 89% >90% Source: WHO/UNICEF JRF (multiple years) ND=No data Table 5: AFP surveillance performance indicators, 2014-2019 Table 7: OPV SIAs non-polio AFP rate by district Adequate stool specimen collection % by district * One dose OPV given during MR campaign Source: WHO/UNICEF JRF (multiple years) Indicator 2014 2015 2016 2017 2018 2019 AFP cases 1,478 1,413 1,437 1,361 1,404 1,429 Wild poliovirus confirmed cases 0 0 0 0 0 0 Vaccine derived poliovirus cases 0 0 0 0 0 0 Compatible cases 0 0 0 0 0 0 Non-polio AFP rate1 2.74 2.78 2.85 2.73 2.84 2.92 Adequate stool specimen collection percentage2 98% 97% 99% 99% 99% 100% Total stool samples collected 3,094 3,008 2,865 2,703 2,796 2,854 % NPEV isolation 22.6 20.4 21.3 19 16.3 19.7 % Timeliness of primary result reported3 97 98 98 88 97 97 • Last polio case due to indigenous WPV reported from Dhaka district in August 2000 • Last polio case due to imported WPV reported from Sunamganj district in November 2006 • Environmental surveillance started in 2015 and is currently functioning at 8 sites 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: 2018 Figure 8: 2018Figure 7: 2019 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 2011 tOPV NID <5 years 22,151,269 22,320,803 102 101 2012 OPV NID <5 years 22,019,556 22,073,699 101 101 2013 tOPV NID <5 years 20,530,418 101 - 2014 OPV NID* <5 years 20,631,077 99 - 2016 tOPV Mop-up SNID <5 years 114,979 115,355 101 101 2016 bOPV Mop-up SNID <5 years 118,272 98 - 2017 bOPV Mop-up SNID <5 years 47,165 153 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 In 2019, one sample from each of the 12 sites were collected following a clinical trail by icddr,b in collaboration with CDC Atlanta year # Provinces # sites # samples tested SL1 SL3 SL1+ SL3 VDPV nPEV 2018 2 8 124 2 12 2 0 72 2019 2 20 161 11 35 1 0 63 VACCInES PROTECT SUSTAIN. ACCELERATE. INNOVATE. World Health Organization • SEARO/CDS/IVD • 15 July 2020 Figure 10: mCV1 & mCV2 coverage1 and measles, rubella cases2, 1980-2019 Table 8: mCV/mR SIAs mR1 coverage by district mR2 coverage by district Source: SEAR Annual EPI reporting form 2018 administrative data for the year 2018 and 2019 data from coverage evaluation survey 2019 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 Note: MCV1 and MCV2 replaced MR1 and MR2 in 2012 Figure 11: 2018 Figure 13: 2018 Figure 14: 2019Figure 12: 2019 <80% 80% - 89% 90% - 94% > 95% year Antigen geographic Coverage Target group Target Coverage % 2005 MCV 2 districts 9 months to 10 years 1,481,321 93 2006 MCV nationwide 9 months to 10 years 34,199,590 100 2010 MCV nationwide 9 months to 5 years 18,136,066 100 2014 MR nationwide 9 months to 15 years 52,745,231 102 2016 MR subnational 9 months to <5 years 99,489 101 2017 MR subnational 9 months to <5 years 1,556,818 100 2017 MR subnational 6 months to <15 years 121,530 112 14000 12000 10000 8000 6000 4000 2000 0 100 80 60 40 20 0 N o. o f ca se s % C ov er ag e 1980 1985 1990 1995 2000 2005 2010 2015 2016 2017 2018 2019 Figure 15: Immunity against measles - iimmunity profile by age in 2019* Figure 16: Immunity against rubella through vaccination - immunity profile by age in 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 *Modeled using MSP tool ver 2 Figure 18: Confirmed rubella cases* by month, 2017-2019 *Includes laboratory confirmed and epidemiologically linked cases Source: SEAR measles case-based data 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 Figure 17: Confirmed measles cases* by month, 2017-2019 900 800 700 600 500 400 300 200 100 0 N u m b e r o f c a s e s 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. Indicator Target 2017 2018 2019 Number of suspected measles cases 8,025 6,662 11,632 Confirmed measles cases 0 4,001 2,263 5,827 Lab confirmed 0 2,612 1,688 4,073 Epi-Linked 0 982 448 802 Clinically-compatible 0 407 127 952 Confirmed rubella cases 0 299 308 176 Lab confirmed 0 240 286 176 Epi-Linked 0 59 22 - Discarded non-measles non-rubella cases 3,725 4,091 5,629 Percentage of suspected cases with adequate investigation initiated within 48 hours of notification ≥ 80% 94 92 96 Reporting rate of non-measles non-rubella cases to national level per 100,000 population ≥ 2 2.3 2.5 3.4 Percentage of second-level administrative units reporting at least 2 non-measles non-rubella cases per 100 000 population ≥ 80% 60 72 93 Percentage of surveillance units reporting measles and rubella data to the national level on time, even in the absence of cases ≥ 80% 98 97 99 Percentage of specimens received at the laboratory within 5 days of collection ≥ 80% 99 100 92 Percentage of IgM results reported to the national public health authorities by the laboratory within 4 days of receipt of specimens ≥ 80% 69 93 86 Genotypes detected Measles ND B3, D8 B3,D8 Rubella ND - - 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 and immunization medical officers and laboratories Source: SEAR measles case-based data Source: SEAR Annual EPI Reporting Form (multiple years) ND=No data Source: SEAR measles case-based data Institute of Public Health - National polio laboratory - National measles/rubella laboratory - National japanese encephalitis Invasive Bacterial Disease Laboratories - Dhaka Shishu Hospital - Chittagong Maa-O-Shishu Hospital - Kumudini Women’s Medical College - Shishu Shasthaya Foundation (SSF) Surveillance and Immunization Medical Officer (SIMO) = 61 Emergency Immunization Coordinator (E-IC) = 1 Divisional Coordinator (DC) = 7 Emergency Surveillance and Immunization Medical Officer (E-SIMO) = 3 For contact or feedback: Expanded Programme on Immunization Ministry of Health and Family Welfare, Dhaka, Bangladesh Tel: +880-2-9880530, 8821910-03, Fax: +880-2-8821914 Email: pm.epi.esd@ld.dghs.gov.bd, www.dghs.gov.bd 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