2. Presentation outline
• Immunization and VPD status in Myanmar
• EPI Updates in 2012
• Upcoming events in late 2012 and onwards
• Future Plan in 2013 onwards
2
4. Measles supplementary
OPV supplementary immunization
immunization activities
activities, 2001-2011
Year
Year
1995
1997
2001/2002
2002
2002/2003
2003/2004
2003
2005
2006 2004
2006 2007
2007
2007 2012
2007
2008
2009
2010
2011
Region Target
NID/
Population
Sub- National
SNID
(<5 years)
Sub- National
NID
6,116,532
NID Sub- National 6,251,093
SNID Sub- National 771,081
SNID
337,085
SNID Sub- National 104,572
SNID National 2,037,606
SNID
415,554
SNID National 2,416,960
NID
7,207,399
SNID
1,825,117
NID
7,394,415
SNID
2,229,394
SNID
2,925,709
Coverage (%) by round
Coverage
First 95%
Second
96%
97
98
88%
97
97
95
99
90%
121
127
76%
100
100
97
97
94%
116
101
97%
102
99
98
98
99
98
100
98Data as of 15 Sep 2012
100
4
98
99
5. Tetanus Toxoid Supplementary Immunization Activities
Year
in high risked townships
Activity
Achievement
1999-2006
187 High Risk Townships(3 Rounds)
6.74 Millions WCBA
> 80% Coverage
2007-2008
87 Townships
2.58 Million WCBA
88% Coverage
2009
7 Townships
0.16 Million WCBA
96.5 % Coverage
Data as of 15 Sep 2012
5
6. Current after New Vaccines Introduction
New EPI Schedule EPI Schedule in Myanmar
Age
Vaccines
At Birth
BCG, HepB ( Hospital births)
6 weeks
2 month
DPT -1, OPV -1, HepB
10month
4 weeks
DPT -2, OPV -2, HepB
14month
6 weeks
DPT -3, OPV-3, HepB
9 months
Measles - 1
18 month
Measles - 2
Penta-1 + OPV-1
Penta-2 + OPV-2
Penta-3 + OPV-3
Data as of 15 Sep 2012
12. Measles Cases by State and Region
Myanmar, 2010-2012
Confirmed Measles
cases
Vaccination Status
1 - Yes
2 - No
9 - Unknown
(blank)
Grand Total
Age group
0-11
1-4 Years 5-9 Years
Months
20
176
166
160
349
322
4
48
56
184
573
Routine Measles coverage
<60%
60%-79%
>=80%
Vaccination status of measles cases
544
10-14
15+ Years Unknown
Years
129
94
4
172
193
18
56
76
3
1
357
363
26
Grand
Total
589
1214
243
1
2047
13. Recent History of Polio Cases in Myanmar
2007,2010,2012
2007
2010
2012
P1 WPV cases
Rakhine = 11
Onset of last case = 31-5-2007
P1 VDPV cases
Yangon
= 1
Kayin
= 1
Bago (East) = 1
Mon
= 1
Onset of last case = 06-12-2007
Source: CEU, DOH, Ministry of Health
P2 VDPV case
Mandalay
Date of Onset = 06-12-2010
P1 VDPV case
Northern Shan State
Laukkaing Township
Date of onset = 29-5-2012
13
14. Pocket areas for routine immunization
Silent areas for AFP reporting
Border areas with migration
Cultural barriers, Security barriers
16. 2012 - Year of Intensification of Routine Immunization
• Launching ceremony (12-9-12)- attended by
– HE Union Minister for Health
– National Health Committee
– Partners
– INGOs
– 1 (84
PhaseNGOsTownships)
– Related government departments
179 Townships had RHC with DTP3 < 80% in 2011.
– Media
Phase 2 (117 Townships)
• IRI campaign
• Advocacy to States/ Regional governments (planning)
17. Reason for un vaccinated children at RHC
Cat.1
Cat.2
Cat.3
Cat.4
Cat.5
Cat.6
Cat.7
Cat.8
Source- CEPI
Physically/ geographically hard to reach
Mobile population/ socially hard to reach population
Midwife vacancy/ absent/ imbalance proportion of MW
Weak community participation/ involvement
Security limitation
DPT Vaccine shortage
High target/ low birth rate
Other
16%
26%
19%
0%
6%
15%
16%
3%
18. Strengthening RI is
National Priorities
Service deliveryMOH have asked grass root level to explore any uncovered for assistance
since 2010-2011.
Immunization Strategies
No
Name of
village/
Ward
Distance
from S/C
Mode of
travel to
village/
Ward
Monthly
routine
(Fixed,
Outreach
&
Mobile)
REC
Uncovered
/
Unreached
Total
Target
Reason for
Uncovered
/
Unreached
Therefore IRI is the opportunity to encourage them to explore the unreached
and to get help from the higher levels.
19. Strengthening RI is our Priority
National Policy and Strategy Workshop on
Immunization and VPD Surveillance (August 2012)
All areas of programme had been discussed.
Some changes are• New schedule for feasible microplanning and vaccine
administration
• National prioritized NUV and booster doses depending on
resources
• Immunization card policy at school entry
19
20. Cold chain management
1. Effective Vaccine management (EVM) assessment in
November 2011- CC improvement plan
2. Temperature mapping study (August 2012)
3. Temperature monitoring study (August- November 2012)
4. Effective vaccine management training to all sub-depot
(cold stores) (September 2012)
1. Planned cold chain functioning in all health care facilities for
least defect before New vaccine introduction.
2. Planned CC policy workshop at the end of 2012.
21. Capacity building
1. Strengthening AEFI surveillance and National level workshop
(26 to 30 April 2012) (New guideline- in progress)
2. Building national capacity for evidence-based decision making
NCIP Workshop- (9 to 11 July 2012)
3. Mid Level Manager training- national level
(1 to 5 July 2012)
4. Mid Level Manager training- States/ regional level
•
One- third of Township Medical Officers are newly
recruited.
23. Finding evidence
1. Sub-national immunization coverage survey after
November 2012 (After introduction of Pentavalent
vaccine)
2. Sero-surveillance for Polio and Measles in high risk
townships (in process)
3. Impact study after introduction of Hib containing
vaccine (planning)
4. Sentinel surveillance for NUV ( planning)
24. Others
1. National Mass Measles follow up Campaign (March
2012)
97% coverage of 6-4 millions (9 months to 5 years)
2. Introduction of Hib containing pentavalent vaccine
3. Introduction of second dose of measles
