Expanded progrAmme on immunization (EPI): Sri Lanka 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 1978 • Inactivated JE vaccine introduced in 1988 and live JE vaccine nationwide in 2011 • Rubella vaccine introduced in 1996. • Vitamin A supplementation added in 2000 • MR vaccine and aTd vaccine introduced in 2001 • HepB vaccine introduced in 2003 • DTP-Hib-HepB vaccine introduced in 2008 • MMR vaccine introduced in 2011 • IPV introduced in 2015 • tOPV to bOPV switched on 30 April 2016 Source: cMYP 2017-2022 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. FacTshEET 2021 srI laNKa Total population1 22,034,594 Live births1 313,754 Children <1 year1 352,554 Children <5 years1 1,872,940 Children <15 years1 5,134,060 Pregnant women1 342,128 WCBA1 (15-49 years) 8,750,000 Neonatal mortality rate2 4.3 (per 1,000 LB) Infant mortality rate2 6.1 (per 1,000 LB) Under-five mortality rate2 7.1 (per 1,000 LB) Maternal mortality ratio2 36 (per 100,000 LB) Division/Province/State/Region 9 District 26 Medical officer of health (MOH) areas 357 Population density1 (per sq. km) 341 Population living in urban areas2 18.80% Population using at least basic drinking- water services2 92% Population using at least basic sanitation services2 94% Total expenditure on health as % of GDP2 3.50% 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 DTP-Hib-HepB 2 months, 4 months and 6 months OPV 2 months, 4 months, 6 months, 18 months and 5 years IPV (fIPV) 2 months and 4 months JE_LiveAtd 1 year MMR 9 months and 3 years DTP 18 months DT 5 years aTd 12 years TT Pregnant women (2 doses in 1st pregnancy and 1 dose in subsequent 3 pregnancies) HPV females, in Grade 6 at schools, on completion of 10 years, 2 dose schedule in 6 months interval Vitamin A 6 - 36 months (every 6 months) Typhoid fever polysaccha- ride vaccine high risk categories, food handlers, based on transmission pattern and data, districts are selected to provide vaccination YF (Yellow fever) vaccine travellers to Yellow Fever (YF) endemic countries Source: WHO/UNICEF JRF, 2020 cMYP for immunization 2017-2021 NTAGI fully functional Spending on vaccines financed by the government 95% Spending on routine immunization programme financed by the government no data* Updated micro-plans that include activities to improve immunization coverage 26 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 EPI coverage survey, Puttalam district-2017 ≥80% coverage for DTP-Hib- HepB3 26 districts (100%) ≥90% coverage for MCV1 26 districts (100%) ≥90% coverage for MCV2 26 districts (100%) ≥10% drop-out rate for DTP-Hib- HepB1 to DTP-Hib-HepB3 none Source: WHO/UNICEF JRF, 2020 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 0 107 0 1,568 9 338 17 0 2016 0 0 54 0 112 0 311 20 0 2017 0 0 0 0 1* 1 252 23 0 2018 0 0 12 0 1* 0 290 29 0 2019 0 0 5 0 49* 0 248 19 0 2020 0 0 1 0 2 0 170 31 0 <70% 70% - 79% 80% - 89% >90% Table 5: aFP surveillance performance indicators, 2015-2020 Table 6: oPV sIas Non-polio aFP rate by district adequate stool specimen collection % by district Source: WHO/UNICEF JRF (multiple years) Indicator 2015 2016 2017 2018 2019 2020 AFP cases 70 65 70 63 80 50 Wild poliovirus confirmed cases 0 0 0 0 0 0 Compatible cases 0 0 0 0 0 0 Non-polio AFP rate1 1.35 1.2 1.29 1.17 1.34 0.97 Adequate stool specimen collection percentage2 77% 85% 84% 92% 82% 88% Total stool samples collected 137 104 142 121 129 106 % NPEV isolation 10 3.8 0.7 5 5.6 2.8 % Timeliness of primary result reported3 89 81 98 99 100 99 • The last laboratory confirmed polio case due to WPV was reported in November 1993 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: 2019 Figure 8: 2019 Figure 9: 2020 <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 1997 OPV NID <5 years 1,838,465 97 95 1998 OPV NID <5 years 1,856,850 92 88 1999 OPV NID <5 years 2,320,556 93 93 2000 OPV NID <5 years 634,999 93 93 2001 OPV SNID <5 years 514,821 96 91 2002 OPV SNID <5 years 272,559 98 97 2003 OPV SNID <5 years 536,269 97 98 Figure 7: 2020 World Health Organization • SEARO/CDS/IVD • 31 August 2021 VACCInES PROtECt SUSTAIN. ACCELERATE. INNOVATE. Figure 10: hepB3 and hepB birth dose immunization coverage1, 2000-2020 Figure 11: 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) 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 12: 2019 Figure 15: 2020 <80% 80% - 89% 90% - 94% > 95% year antigen Geographic coverage Target group Target coverage (%) 2003 M 2 districts 10 to 15 years 1,987,847 95% 2004 MR nationwide 16 to 20 years 1,890,326 72% 2013 M nationwide 6 to 12 months 176,587 96% Figure 13: 2020 Figure 14: 2019 Figure 16: Immunity against measles - immunity profile by age in 2020* Figure 18: confirmed measles cases* by month 2018-2020 Figure 17: Immunity against rubella through vaccination - immunity profile by age in 2020* Figure 19: 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 20: Vaccination status of confirmed (laboratory, Epi linked and clinically compatible) measles cases, by age in 2019 and 2020 Figure 21: Vaccination status of confirmed (laboratory and Epi linked) rubella cases, by age in 2019 and 2020 Table 9: summary of measles surveillance indicators, 2018-2020 Figure 22 : 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 Indicator Target 2018 2019 2020 Number of suspected measles cases 166 386 ND Confirmed measles cases 0 1 49 ND Lab confirmed 0 1* 49* ND Epi-Linked 0 0 0 ND Clinically-compatible 0 0 0 ND Confirmed rubella cases 0 0 0 ND Lab confirmed 0 0 0 ND Epi-Linked 0 0 0 ND Discarded non-measles non-rubella cases 165 332 ND Percentage of suspected cases with adequate investigation initiated within 48 hours of notification ≥ 80% 98 94 ND Reporting rate of non-measles non-rubella cases to national level per 100,000 population ≥ 2 0.8 1.5 ND Percentage of second-level administrative units reporting at least 2 non-measles non-rubella cases per 100,00 population ≥ 80% 12 27 ND Percentage of surveillance units reporting measles and rubella data to the national level on time, even in the absence of cases ≥ 80% 92 99 ND Percentage of specimens received at the laboratory within 5 days of collection ≥ 80% 88 82 ND Percentage of IgM results reported to the national public health authorities by the laboratory within 4 days of receipt of specimens ≥ 80% 73 51 ND Genotypes detected Measles H1 D8 ND Rubella ND ND ND For contact or feedback: Expanded Programme on Immunization Ministry of Health, Colombo, Sri Lanka Tel: +94 11 2695112; Fax: +94-11-2696583 Email: deepagamage@gmail.com, www.health.gov.lk 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 Medical research Institute, colombo • National polio laboratory • National measles and rubella laboratory • National Japanese encephalitis laboratory • Rotavirus laboratory lady ridgeway hospital, colombo • Invasive bacterial disease laboratory