Timor-Leste 2017
Acronyms
AD Auto disable
AEFI Adverse events following immunization
AFP Acute flaccid paralysis
BCG Bacillus Calmette-Guérin vaccine
CES Coverage evaluation survey
cMYP Comprehensive multi-year plan
CRS Congenital rubella syndrome
DHS Demographic health survey
DT Diphtheria tetanus toxoid, pediatric
DTP Diphtheria – tetanus – pertussis vaccine
DTP-Hib-HepB Pentavalent vaccine
DTP-Hib-HepB3 3rd dose pentavalent vaccine
EPI Expanded programme on immunization
GDP Gross domestic product
HCW Health care worker
HepB Hepatitis B vaccine
Hib Haemophilus influenzae type b
HPV Human papilloma virus
IgM Immunoglobulin M
IPV Inactivated poliovirus vaccine
JE Japanese encephalitis
JE_Live-Atd JE live attenuated vaccine
JRF WHO UNICEF joint reporting form
LB Live birth
M Measles
MCV1 First dose measles containing vaccine
MCV2 Second dose measles containing vaccine
MICS Multiple indicator cluster survey
MMR Measles mumps rubella vaccine
MNT Maternal and neonatal tetanus
MR Measles rubella vaccine
NCIP National committee on immunization practices
NID National immunization day
NTAGI National technical advisory group on immunization
NPEV Non-polio enterovirus
NT Neonatal tetanus
OPV Oral poliovirus vaccine
bOPV Bivalent OPV
tOPV Trivalent OPV
PCV Pneumococcal conjugate vaccine
SEAR WHO South-East Asia Region
SIA Supplementary immunization activities
SNID Subnational immunization day
Td Tetanus diphtheria toxoid; older children, adults
TT Tetanus toxoid
TT2+ 2 or more doses TT
VDPV Vaccine derived poliovirus
VPD Vaccine preventable diseases
WCBA Women of child bearing age
Contents
Impact of rouine immunizaion
Page
No.
EPI history 5
Basic informaion 2016 Table 1 5
Immunizaion schedule 2016 Table 2 5
Naional immunizaion coverage 1980 - 2016 Figure 1 6
Immunizaion system highlights Table 3 6
DTP3 coverage, diphtheria and pertussis cases 1980 - 2016 Figure 2 7
Reported cases of vaccine preventable diseases 2011 - 2016 Table 4 7
DTP-Hib-HepB3 coverage by district 2015 Figure 3 7
DTP-Hib-HepB3 coverage by district 2016 Figure 4 7
Towards measles eliminaion and rubella/congenital rubella
syndrome control
Page
No.
MCV1 and MCV2 coverage, measles and rubella cases, 1980-2016 Figure 10 11
MCV supplementary immunizaion aciviies Table 7 11
MCV1 coverage by district 2015 Figure 11 12
MCV1 coverage by district 2016 Figure 12 12
MCV2 coverage by district 2015 Figure 13 12
MCV1 coverage by district 2016 Figure 14 12
Immunity against measles – immunity proile by age in 2016 Figure 15 12
Subnaional risk assessment for measles and rubella Figure 16 12
Sporadic and outbreak associated measles cases by month 2011 - 2016 Figure 17 13
Immunizaion status of conirmed (laboratory and Epi linked) measles outbreak
associated cases by age 2011 – 2016 Figure 18 13
Quality of ield and laboratory surveillance for measles and rubella 2012 - 2016 Table 8 14
Performance of laboratory surveillance 2012 - 2016 Table 9 14
WHO supported laboratory network for VPD surveillance Figure 19 15
Maternal and neonatal tetanus eliminaion is sustained
Page
No.
TT2+ coverage and NT cases 1980 - 2016 Figure 5 8
Polio-free status is maintained
Page
No.
AFP surveillance indicators 2011 - 2016 Table 5 9
Non-polio AFP rate by district 2015 Figure 6 9
Non-polio AFP rate by district 2016 Figure 7 9
Adequate stool specimen collecion percentage by district 2015 Figure 8 10
Adequate stool specimen collecion percentage by district 2016 Figure 9 10
WHO South-East Asia Region
EPI history
• EPI started in 1978
• EPI re-structured in March 2000 • DTP-HepB vaccine introduced
in 2007
• DTP-Hib-HepB) vaccine
introduced in 2012
• MR vaccine introduced in
Feb 2016
• Second dose of MR introduced
in Feb 2016
• HepB birth dose introduced in
Feb 2016
• DPT/DT vaccine (booster dose)
introduced in Feb 2016
• IPV introduced in Feb 2016 • tOPV to bOPV switched on
18 April 2016 .
Source: cMYP 2016-2020 and EPI/MOH
Table 1:
Basic information
12016
Total populaion 1,231,262
Live births 35,426
Children <1 year 33,548
Children <5 years 176,377
Children <15 years 493,795
Pregnant women 38,969
WCBA (15-49 years) 154,605
Neonatal mortality rate 22.3 (per 1,000 LB)
Infant mortality rate 44.7 (per 1,000 LB)
Under-ive mortality rate 52.6 (per 1,000 LB)
Maternal mortality raio 215 (per 100,000 LB)
1SEAR annual EPI reporing form, 2016 and WHO, World Health Staisics 2016
Division/Province/State/Region
-Municipaliies 13
Postos/Sub-district 65
Sucos/Village 442
Populaion density (per sq. km) 71
Populaion living in urban areas 32%
Populaion using improved
drinking-water sources 70%
Populaion using improved sanitaion 39%
Total expenditure on health as % of GDP 1.4%
Births atended by skilled health personnel 21%
Neonates protected at birth against NT 81%
Table 2:
Immunization schedule, 2016
Vaccine Age of administraionBCG Birth
OPV Birth, 6 weeks, 10 weeks and 14 weeks
DTP-Hib-HepB 6 weeks, 10 weeks and 14 weeks
MR 9 months and 18 months
TT Females 15 to 49 years (1st pregnancy contact, +1 month, +6 months, +1 year, +1 year)
Vitamin A 6 to 36 months (with 6 months interval)
IPV 14 weeks
DT 6 years
Source: WHO/UNICEF JRF, 2016
Figure 1:
National immunization coverage, 1980-2016
Source: WHO/UNICEF esimates of naional immunizaion coverage, July 2017 revision
Table 3:
Immunization system highlights
cMYP for immunizaion 2016-2020
NTAGI fully funcional
Spending on vaccines inanced by the government 76%
Spending on rouine immunizaion programme inanced by the government 39%
Updated micro-plans that include aciviies to improve immunizaion coverage 13 districts (100%)
Naional policy for health care waste management including waste from immunizaion aciviies in place
Naional system to monitor AEFI in place
Most recent EPI CES EPI CES Dili municipality and 12 other
municipaliies 2015
>80% coverage for DTP-Hib-HepB3 13 districts (100%)
>90% coverage for MCV1 7 districts (54%)
>10% drop-out rate for DTP-Hib-HepB1 to DTP-Hib-HepB3 no district
Source: WHO/UNICEF JRF, 2016
2002 2004 2006 2008 2010 2014 2015 2016
BCG 75 72 74 85 79 84 84 85
DTP3 54 57 63 79 72 77 76 85
OPV 38 57 62 79 72 76 75 83
MCV1 56 55 61 73 66 74 70 78
Figure 3:
2015
Figure 4:
2016
Source: SEAR annual EPI reporing form, 2016 (administraive data) Source: SEAR annual EPI reporing form, 2015 (administraive data)
Figure 2:
DTP3 coverage
1, diphtheria and pertussis cases
2, 1980-2016
Year
Diphtheria Cases Pertussis Cases DTP3 Coverage
%
1WHO/UNICEF esimates of naional immunizaion coverage, July 2017 revision 2WHO vaccine-preventable diseases: monitoring system 2016
Table 4:
Reported cases of vaccine preventable diseases, 2011-2016
Year Polio Diphtheria Pertussis NT(% of all tetanus) Measles Rubella Mumps JE CRS
2011 0 0 4 2 (67%) 802 0 0 0 0
Source: WHO/UNICEF JRF (2011-2016) ND=No data
DTP-Hib-HepB3 coverage by district
%
NT Cases TT2+ Coverage
0
2002 2004 2006 2008 2010 2011 2012 2013 2014 2015 2016
Figure 5:
TT2+ coverage
1and NT cases
2, 1980-2016
1 WHO/UNICEF JRF, Country oicial esimates, 1980-2016 2WHO vaccine-preventable diseases: monitoring system 2016
Maternal and
neonatal tetanus elimination is sustained
MNT eliminaion in 2012
© WHO/Timor-Leste/S Singh
Table 5:
AFP surveillance performance indicators, 2011-2016
Indicator 2011 2012 2013 2014 2015 2016
AFP cases 0 5 5 3 0 10
Wild poliovirus conirmed cases 0 0 0 0 0 0
Compaible cases 0 0 0 0 0 0
Non-polio AFP rate1 0 1.00 1.61 0.59 0.00 1.87
Adequate stool specimen collecion percentage2 0 40% 20% 67% 0 50
Total stool samples collected 0 5 5 4 0
-% NPEV isolaion 0 0 0 0 0
-% Timeliness of primary result reported3 0 100 68 100 0
-1Number of discarded AFP cases per 100,000 children under 15 years of age.
2Percent with 2 specimens, at least 24 hours apart and within 14 days of paralysis onset. 3Results reported within 14 days of sample received at laboratory.
Figure 6:
2015
Figure 7:
2016
Polio-free
status is maintained
Non-polio AFP rate by district
<1 1 – 1.99
>2 No non-polio AFP case
Table 6:
OPV SIAs
Year Vaccine Geographic
coverage Target age
Target populaion Coverage (%)
Round 1 Round 2 Round 1 Round 2
2005 OPV NID <5 years 177,713 93 102
2015* OPV NID <5 years 522,943 - 96
-* During MR vaccinaion campaign. Source: WHO/UNICEF JRF
Adequate stool specimen collection % by district
Figure 9:
2016
Figure 8:
2015
<60% 60% - 79%
>80% No AFP
Towards
measles elimination and rubella/CRS control
Figure 10:
MCV1 and MCV2 coverage
1, measles and rubella cases
2, 1980-2016
Measles Cases Rubella MCV1 Coverage MCV2 Coverage
763
% Coverage
No. of cases
Year
2002 2004 2006 2008 2010 2011 2012 2013 2014 2015 2016 No
data
1WHO/UNICEF esimates of naional immunizaion coverage, July 2017 revision 2WHO vaccine-preventable diseases: monitoring system 2016
Table 7:
MCV SIAs
Year Anigen Geographic
coverage Target group Target
Coverage %
2003 M naionwide 9 to 59
months 128,318 99
2006 M naionwide 6 months to
14 years 390,687 40
2009 M naionwide 9 to 59
months 167,136 76
2011 M naionwide 6 months to
14 years 494,427 92
2015 MR naionwide 6 months to
14 years 501,832 97
0%
Percent of population
Age (in years)
Protected by maternal antibodies Protected by routine vaccination with 1st dose
Protected by routine vaccination with 2nd dose Protected by SIAs
Immune due to past infection Susceptible
Figure 15:
Immunity against measles - immunity profile by age in 2016*
* Modeled using MSP tool ver 2 assuming the schedule and MCV coverage remain unchanged in 2016.
<80% 80% - 89% 90% - 94% >95%
Source: SEAR annual EPI reporing form, 2016 (administraive data)
Figure 12:
2016
Figure 11:
2015
Source: SEAR annual EPI reporing form, 2015 (administraive data)
Figure 14 :
2016
Figure 13:
2015
Source: SEAR annual EPI reporing form, 2016 (administraive data)
Source: SEAR annual EPI reporing form, 2015 (administraive data)
Figure 16:
Sub-national risk assessment -measles and rubella
MCV1 coverage by district
MCV2 coverage by district
Source: developed using WHO risk assessment tool based on JRF & ARF data base
Figure 17:
Sporadic and outbreak associated measles cases* by month 2011-2016
Sporadic measles
Outbreak associated measles
No of cases
0
*Includes laboratory conirmed and epidemiologically linked cases Source: SEAR Monthly VPD reports
Figure 18:
Immunization status of confirmed (laboratory and EPI linked) measles
outbreak associated cases, by age, 2011-2016
2011 2012 2013 2014 2015 2016
0
> 15 years
10-14 years
5-9 years
1-4 years
< 1 year
> 15 years
10-14 years
5-9 years
1-4 years
< 1 year
> 15 years
10-14 years
5-9 years
1-4 years
< 1 year
> 15 years
10-14 years
5-9 years
1-4 years
< 1 year
> 15 years
10-14 years
5-9 years
1-4 years
< 1 year
> 15 years
10-14 years
5-9 years
1-4 years
Table 8:
Surveillance performance indicators for measles and rubella, 2012-2016
Year
No. of suspected measles
Case classiic
Discarded measles non-rubella cases
Annual incidence of
conirmed measles cases per million total populaion
Annual incidence of
conirmed rubella cases per million total populaion Proporion of all suspected
measles and rubella cases that have had an adequate
invesigaion iniiated within 48 hours of noiicaion
Discarded measles
non-rubella incidence per 100,000 total populaion
Proporion of districts reporing at least two
discarded measles
non-rubella cases per 100,000 total populaion
Proporion of sub-naional surveillance units reporing to the naional level on ime Lab-conirmed
AR annual EPI reporing f
orm (2012-2016)
ND=No dat
a
Year
Serum specimen collected from suspected measles cases
Serum specimen received in laboratory
within 5 days of collecion
Specimen
posiive for
measles IgM
Specimen
posiive for
rubella IgM
% Results within 4 days of receipt
% Posiive cases
tested for viral
detecion
AR annual EPI reporing f
orm (2012-2016)
ND=No dat
a
Table 9:
Performance of laboratory surveillance, 2012-2016
Figure 19:
WHO supported laboratory network for VPD surveillance
Naional Health Laboratory, Dili
For contact or feedback:
Expanded Programme on Immunizaion Ministry of Health, Dilli, Timor-Leste Tel: +670-77351964, Fax: +670-7250097 Email: mmausiry@gmail.com
www.moh.gov.tl
Immunizaion 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
