Epi presesentation for gavi
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  • 1. Immunization Services in Myanmar Data as of 15 Sep 2012 1
  • 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
  • 3. Routine immunization coverage(1980-2011) 100 90 % Coverage 80 70 60 50 40 30 20 10 0 1980 1985 1990 1995 2000 2005 2006 2007 2008 2009 2010 2011 BCG 9 45 95 90 88 76 85 89 88 93 93 93 DTP3 4 16 88 84 82 80 91 97 98 99 99 86 3 88 84 87 82 92 96 98 99 99 90 68 82 84 80 89 95 98 99 99 88 OPV3 MCV1
  • 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
  • 7. DTP3 coverage and Diphtheria and Pertussis cases, 1990-2012 DPT3 Coverage and Diphtheria and Pertussis Cases, 1990-2012 6000 100 90 4882 80 70 4000 3000 50 2455 40 2000 1592 1745 30 1379 20 873 1000 10 5 13 35 19 3 2007 2008 2009 40 74 17 2 2012 3 13 2011 48 2010 100 18 35 50 61 12 19 1 2006 49 38 2005 34 18 2004 120 46 22 5 2003 1995 1994 1993 1992 1991 0 15 2002 28 2001 85 2000 92 1999 44 1998 110 1997 331 1996 181 1990 Cases 60 % Coverage 5000 0 Year Diphtheria Cases Pertussis Cases DPT Coverage Data as of 15 Sep 2012
  • 8. Reported Diphtheria cases 2011-2012 1 Dot = 1 case 2011 (7 cases) 2012 (17 cases) Data as of 15 Sep 2012
  • 9. TT2+ coverage1 and NT cases( 1990-2012) Reported Neonatal Tetanus cases and reported TT2 coverage Myanmar 1990-2012 200 100 189 80 TT2+ 150 96 100 93 87 75 75 61 59 50 66 48 47 46 40 72 49 49 35 41 34 25 20 32 23 19 Cases 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 0 1991 0 TT2+ Coverage Data as of 15 Sep 2012 %Coverage 60 1990 Cases 125
  • 10. Routine Measles Immunization Coverage and Reported Measles Cases Myanmar, 1990-2012 Measles SIA 18000 2012 2007 2002-2004 16368 100 90 16000 80 14000 70 10000 50 8000 40 6243 6000 3883 4000 30 4437 ** 3530 2692 189 19 71 40 2 1168 15 20 2519 1700 2000 29 6 1684 1057 2 2046 1926 1465 23 792 845 58 22 2 ** 736 830 46 13 12 1329 314 10 1 760 4 10 1088 333 329 337 9 3 0 1 7 16 Cases Deaths ** Laboratory confirmed measles cases only from Measles case based surveillance Routine Coverage 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 0 1988 0 Coverage 60 1987 No. of cases 12000
  • 11. Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 600 500 400 Case based surveillance Trends of Measles Cases by Month Myanmar, 2006-2012 Measles SIA (2007) Measles SIA (2012) Targeted - 6,104,592 (9m-5yrs Children) Targeted – 6,432,064 (9m-5yrs Children) Immunized - 5721726 (94%) Immunized – 6267535 (97%) 700 300 200 100 0 2006 2007 2008 2009 2010 2011 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
  • 15. EPI Updates in 2012 15
  • 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.
  • 22. Communication - Community demand generating approach - Media workshop (The last week of October 2012)
  • 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