Expanded programme on Immunization (EPI) factsheet 2019: Maldives

World Health Organization • SEARO/FGL/IVD • 31 October 2019 MALDIVES FActSHEEt 2019 ExpAnDED pROGRAMME On IMMunIzAtIOn (EpI) Table 1: Basic information 2018 Table 2: Immunization schedule, 2018 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 Source: cMYP 2015-2019 and EPI/MOH 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 338,434 Live births1 6,508 Children <1 year1 6,609 Children <5 years1 35,712 Children <15 years1 93,478 Pregnant women1 7,156 Women of child bearing age1 WCBA (15-49 years) 97,772 Neonatal mortality rate2 4.5 (per 1,000 LB) Infant mortality rate2 6.8 (per 1,000 LB) Under-five mortality rate2 7.9 (per 1,000 LB) Maternal mortality ratio2 68 per 100,000 LB) Division/Province/State/Region 6 Atoll/District 20 City 2 Island (inhabited) 187 Total Islands 1,192 Population density1 (per sq. km) 1,392 Population living in urban areas2 39% Population using at least basic drinking-water services2 98% Population using at least basic sanitation services2 96% Total expenditure on health as % of GDP2 9.5% Births attended by skilled health personnel2 96% Neonates protected at birth against NT2 99% 1 SEAR annual EPI reporting form, 2018 2 WHO, Global Health Observatory (GHO) data http://apps.who.int/gho/data accessed on 31 May 2018 Vaccine Age of administration BCG Birth HepB Birth DTP-Hib-HepB 2 months, 4 months and 6 months OPV 2 months, 4 months, 6 months and 15+years pilgrims DTP booster 4 years IPV 6 months MR 9 months MMR 18 months Td Females 15 years ( 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 pilgrims 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, 2018 Table 3: Immunization system highlights cMYP for immunization 2015-2019 NTAGI fully functional Spending on vaccines financed by the government 100% Spending on routine immunization pro- gramme 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, 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 1 Country official estimates, 1980-2018 2 WHO vaccine-preventable diseases: monitoring system 2019 Figure 4: 2017 DTP-hib-hepB3 coverage by district Figure 5: 2018 Source: SEAR annual EPI reporting form, 2017 and 2018 (administrative data) Source: WHO/UNICEF JRF (multiple years) *Import and/or import related year Polio Diphtheria Pertussis NT (% of all tetanus) Measles rubella Mumps JE Crs 2013 0 0 0 0 0 0 17 0 0 2014 0 0 0 0 0 0 0 0 0 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 <70% 70% - 79% 80% - 89% >=90% MNT elimination before 2000 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 Table 5: AFP surveillance performance indicators, 2013-2018 Table 6: oPV sIAs Figure 6: Acute Flaccid Paralysis (AFP) cases 2013-2018 Source: NCCPE report and WHO/UNICEF JRF Indicator 2013 2014 2015 2016 2017 2018 AFP cases 1 1 5 2 7 7 Wild poliovirus confirmed cases 0 0 0 0 0 0 Compatible cases 0 0 0 0 0 0 Non-polio AFP rate1 1.08 1.12 5.60 2.11 7.40 7.40 Adequate stool specimen collection per-centage2 100% 100% 60% 0% 71% 43% Total stool samples collected 2 2 6 4 6 9 % NPEV isolation 0 0 0 0 0 0 % Timeliness of primary result reported3 100 100 0 100 100 89 • 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 2005 to 2007 result reported within 28 days and 2008 onwards result reported within 14 days of sample received at laboratory. Vaccines Protect SUSTAIN. ACCELERATE. INNOVATE. World Health Organization • SEARO/FGL/IVD • 31 October 2019 Figure 7: MCV1 & MCV2 coverage1 and measles, rubella cases2, 1980-2018 Table 7: MCV sIAs MCV1 coverage by district MCV2 coverage by district 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 Source: SEAR annual EPI reporting form 2017 and 2018 (administrative data) 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 Figure 8: 2017 Figure 10: 2017Figure 9: 2018 Figure 11: 2018 <80% 80% - 89% 90% - 94% > 95% Figure 12: Immunity against measles - immunity profile by age in 2018* Figure 13: Immunity against rubella through vaccination - immunity profile by age in 2018* Figure 14: sub-national risk assessment - measles and rubella Figure 15: sporadic and outbreak associated measles cases* by month 2013-2018 *Includes laboratory confirmed and epidemiologically linked cases Source: SEAR Monthly VPD reports * Modeled using MSP tool ver 2. *Modeled using WHO and UNICEF estimates and JRF (multiple years) and does not include immunity due to natural infection Very High Risk High Risk Medium Risk Low Risk Not Available Vaccines Protect SUSTAIN. ACCELERATE. INNOVATE. Table 8: surveillance performance indicator for measles and rubella, 2013-2018 Figure 16: Vaccination status of confirmed (laboratory, epi-linked and clinically compatible) measles cases, by age in 2018 Table 9: Performance of laboratory surveillance, 2013-2018 Figure 17: Laboratory network 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 no n- ru be lla in ci de nc e pe r 10 0, 00 0 to ta l po pu la ti on 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 0 0 0 0 0 0 0 0 0 0 0 0 0 2014 9 0 0 0 0 0 9 0 0 100 2.6 ND 100 2015 10 0 0 0 0 0 10 0 0 100 2.9 ND 100 2016 12 0 0 0 0 0 12 0 0 100 2.9 ND 11.92 2017 66 1* 0 0 1 0 64 2.95 2.95 100 18.9 ND 100 2018 32 1* 0 0 0 0 31 2.95 0 100 8.86 ND 100 Source: SEAR Annual EPI Reporting Form *Import and/or import related ND=No data Source: SEAR Annual EPI Reporting Form ND=No data Source: SEAR measles case-based data Source EPI Maldives Indira Gandhi Memorial hospital National measles and rubella laboratory 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.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 0 0 0 0 0 0 0 - - 2014 9 (100) 9 (100) 0 0 0 0 100 - - 2015 10 (100) 10 (100) 0 0 3 30 100 - - 2016 12 (100) 12 (100) 0 0 0 0 100 - - 2017 66 (100) 66 (100) 1 1.5 1 1.5 100 D8 ND 2018 32 (100) 32 (100) 1 0.03 0 0 100 D8 -