World Health Organization• SEARO/FHR/IVD • 30 August 2013 Immunization andVaccine Development

South-East Asia Region

Bangladesh 2012

Table 1: Basic information1 2012

Division/Province/State/Region 7

District 64

Upazilla/Sub-district 482

City Corporation 10

Union 4,498

Ward 13,494

Sub-Block 108,000

Population density (per sq. km) 1015

Population living in urban areas 28%

Population using improved drinking-water sources

83%

Population using improved sanitation 55%

Total expenditure on health as % of GDP 3.7

Literacy rate among adults aged >15 years 57%

Births attended by skilled health personnel 31%

Neonates protected at birth against NT 94%

Vaccine Age of administration

BCG At birth

DTP-Hib-HepB 6 weeks, 10 weeks, 14 weeks

OPV 6 weeks, 10 weeks, 14 weeks, 38 weeks

MCVMR-38 weeks and +15 years female, Measles-15 months (October 2012)

TTFemales 15 to 49 years (5 doses with an interval of + 1 month, + 6 months, + 1 year and + 1 year with preceding dose)

Vitamin A 6 - 59 months

EPI historyn Launched on 07 April 1979 and made

available to all target groups by 1990.n Vitamin A supplementation started in 1990.n TT5 dose for WCBA started in 1993.n HepB started in 2003.n AD syringes introduced in 2004.n DTP-Hib-HepB introduced in 2009.n MR and measles second dose in 2012.

Source: cMYP 2011-2016

Immunization system highlights

n There is a comprehensive multi-year plan (cMYP) for immunization covering 2011-2016.

n A standing technical advisory group on immunization with formal written terms of reference exists.

n 37% spending on vaccines financed by the government. In addition, 42% spending on routine immunization financed by the government.

n A national policy for health care waste management including waste from immunization activities exists.

n All 64 districts and 8 (of 10) city corporations have updated micro-plans that include activities to raise immunization coverage.

n For intensification of routine immunization in 2012, activities in low performing 32 districts and 4 city corporations have been conducted.

n Out of 64 districts, all (100%) districts had >80% coverage for DTP-Hib-HepB3 and 59 (92%) had >90% coverage for MCV1.

n No district reported more than 10% drop-out rate DTP-Hib-HepB1 to DTP-Hib-HepB3.

n An EPI coverage evaluation survey is planned in 2013.

n The latest AFP/VPD surveillance and EPI review was completed in March 2012.

n DTP-Hib-HepB post-introduction evaluation was completed in March 2012.

n Vaccine wastage rates 2012: BCG=85.8%, DTP-Hib-HepB=3.6%, OPV=33.7%, MCV=65.8% and TT=39.3%.

n A national system to monitor adverse events following immunization (AEFI) exists.

n Bangladesh plans to introduce Pneumococcal (2013), Rotavirus (2014) and HepB birth dose (2014).

Total population 151,824,245

Live births (LB) 3,431,228

Children <1 year 3,283,685

Children <5 years 15,941,546

Children <15 years 52,531,189

Pregnant women 3,431,228

Women of child bearing age (15-49 years)

40,537,074

Neonatal mortality rate2 32 (per 1000 LB)

Infant mortality rate2 43 (per 1000 LB)

Under-five mortality rate2 53 (per 1000 LB)

Maternal mortality ratio2 194 (per 100000 LB)

1 SEAR annual EPI reporting form, 2012 and WHO, World Health Statistics 20132 BDHS 2011 and EPI Bangladesh

Table 2: Immunization schedule, 2012

Source: WHO/UNICEF joint reporting form (JRF) 2012

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.

E P I F A C T S H E E T

World Health Organization• SEARO/FHR/IVD • 30 August 2013

Source: WHO/UNICEF estimates, 2013

Figure 2: DTP3 coverage1, diphtheria and pertussis cases2, 1980-2012

Figure 3: DTP-Hib-HepB3 coverage by age 23 months among 12-23 months children, 2011

Figure 5: MCV1 coverage by age 23 months among 12-23 months children, 2011

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2389712436 4879

1 WHO/UNICEF estimates, 20132 WHO vaccine-preventable diseases: monitoring system 2013 global summary

1 WHO/UNICEF estimates, 20132 WHO vaccine-preventable diseases: monitoring system 2013 global summary

Source: EPI Coverage evaluation survey, 2011

Source: EPI Coverage evaluation survey, 2011

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25,934

Figure 4: MCV1 coverage1 and measles cases2, 1980-2012

Figure 1: National immunization coverage, 1980-2012

Note: DTP-Hib-HepB introduced in 2009 (2003-2008 DTP-HepB)

1980 1985 1990 1995 2000 2005 2006 2007 2008 2009 2010 2011 2012BCG 2 86 93 95 97 96 92 90 94 94 95 95DTP3 2 69 69 83 96 93 95 95 96 95 96 96Pol3 2 69 69 84 96 93 95 95 96 95 96 96MCV 1 65 79 72 94 92 95 96 98 94 96 96

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<70% 70% - 79% 80% - 89% > 90%

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Immunization andVaccine Development

South-East Asia Region

Measles supplementary immunization activities• The first phase of the catch-up measles

campaign began in 2005 targeting 1,481,321 children aged 9 months up to 10 years. The coverage was 93%.

• The second phase of the catch-up measles campaign completed in 2006 targeting 34,199,590 children aged 9 months up to 10 years. The coverage was 100%.

• A measles follow-up campaign was conducted in 2010 targeting 18,136,066 children aged 9 months up to 5 years. The coverage was 100%.

• Bangladesh has a plan to conduct measles-rubella campaign in November 2013 targeting 51,671,466 children aged 9 months up to 15 years.

1 Country official estimates, 1980-20122 WHO vaccine-preventable diseases: monitoring system 2013 global summary

Table 3: OPV supplementary immunization activities (SIA), 2007-2012

Figure 7: Network of WHO supported surveillance medical officers and laboratories, 2012

Year Activity Target population (< 5 years)

Date of 1st round Date of 2nd round 1st round coverage (%)

2nd round coverage (%)

2007 NID 23,860,574 3-Mar-07 8-Apr-07 101 101

2007 SNID 1,865,659 20-May-07 1-Jul-07 101 101

2007 NID 23,918,744 27-Oct-07 8-Dec-07 102 101

2008-2009 NID 24,043,956 29-Nov-08 3-Jan-09 101 101

2010 NID 21,252,571 10-Jan-10 - 102 -

2010 NID* 20,924,847 14-Feb-10 - 100 -

2011 NID 22,151,269 8-Jan-11 - 102 -

2011 NID 22,320,803 - 12-Feb-11 - 101

2012 NID 22,019,556 7-Jan-2012 - 101 -

2012 NID 22,073,699 - 11-Feb-2012 - 101

Figure 6: TT2+ coverage1 and NT cases2, 1980-2012

Source: WHO/UNICEF JRF

• Bangladeshachievedthestatusofmaternalneonataltetanus(MNT)eliminationin2008.

* One dose OPV given during measles follow-up campaign

Surveillance medical officer (SMO) = 28

Institute of Public Health - National polio laboratory - National measles/rubella laboratory - National Japanese encephalitis laboratory

Invasive Bacterial Disease Laboratories - Dhaka Shishu Hospital - Chittagong Maa-O-Shishu Hospital - Kumudini Women’s Medical College

Data WHO-IVD Bangladesh (as of August 2013)

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World Health Organization• SEARO/FHR/IVD • 30 August 2013 Immunization andVaccine Development

South-East Asia Region

E P I F A C T S H E E T

Indicator 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

AFP cases 1,128 1,301 1,458 1,619 1,844 1,790 1,502 1,537 1,610 1,567

Wild polio 0 0 0 18 0 0 0 0 0 0

Compatibles 0 2 0 2 0 0 0 0 0 0

AFP rate 2.03 2.31 2.66 2.91 3.25 3.1 2.61 2.63 3.11 2.98

Non-polio AFP rate1 2.03 2.31 2.66 2.87 3.25 3.1 2.61 2.63 3.11 2.98

Adequate stool collection rate2 89% 90% 92% 93% 92% 92% 94% 95% 95% 96%

Total stool samples collected 2,200 2,523 2,846 3,185 3,611 4,276 3,403 3,412 3,578 3,412

% NPEV 23.0 20.0 20.0 14.8 15.0 23.1 19.4 19.4 18.0 13.8

% Timeliness of primary result reported3 99 100 100 98 100 95 97 98 93 881 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 2002 to 2007 result reported within 28 days and 2008 onwards result reported within 14 days of sample received at laboratory.

Year Polio Diphtheria Pertussis Total Tetanus (incl. NT)

Neonatal Tetanus(% of all Tetanus)

Measles Rubella Mumps Japanese Encephalitis

2003 0 78 332 715 390 (55%) 4,067 - ND -

2004 0 117 140 1,897 748 (39%) 9,743 347 ND -

2005 0 125 125 1,388 341 (25%) 25,935 9,229 ND -

2006 18 35 46 1,235 257 (21%) 6,192 3,418 ND -

2007 0 86 87 1,034 206 (20%) 2,924 13,226 ND 204

2008 0 43 33 943 152 (16%) 2,660 5,526 ND 702

2009 0 23 16 791 121 (15%) 718 13,076 ND 15

2010 0 27 17 710 117 (16%) 788 12,963 ND 15

2011 0 11 44 644 98 (15%) 5,625 5,631 ND 103

2012 0 16 13 614 109 (18%) 1,986 3,245 NR 52

Table 5: Reported cases of vaccine preventable disease, 2003-2012

Table 4: AFP surveillance performance indicators, 2003-2012

Figure 8: Non-polio AFP rate by district, 2012 Figure 9: Adequate stool collection rate by district, 2012

Data as of 07 Aug 2013

For contact or feedback:

Expanded Program on ImmunizationMinistry of Health and Family Welfare, Dhaka, Bangladesh

Tel: +880-2-9880530, 8821910-03, Fax: +880-2-8821914

Email: tajulepi@yahoo.com, www.dghs.gov.bd

• Last indigenous wild polio virus (WPV1) was reported from Dhaka district in August 2000.• Last imported wild polio virus (WPV1) was reported from Habiganj district in November 2006.

Adequate stool collection rate = 96%< 60% 60% – 79% > 80%– >

Non-polio AFP rate = 2.98< 1 1 – 1.99 > 2

Immunization and Vaccine Development (IVD)WHO-SEARO, IP Estate, MG Road, New Delhi 110002, India

Tel: +91 11 23370804, Fax: +91 11 23370251

Email: SEAREpidata@who.int, www.searo.who.int/topics/immunization

Source: WHO/UNICEF JRF ND=No data