World Health Organization• SEARO/FHR/IVD • 29 August 2012 Immunization andVaccine Development

South-East Asia Region

Bangladesh 2011

Bangladesh lies within the broad delta formed by the rivers Ganges and Brahmaputra with an area of approximately 147,570 square kilometers bordered by Bay of Bengal on the south; by India on the west, northwest and east; and by Myanmar on the southeast.

Bangladesh is a home of 150 millions people and annual population growth rate is 1.4. Twenty-eight percent population lives in urban areas. There is decreasing trend in average family size from 4.8 to 4.4 in last two censuses 2001 and 2011. Moreover, the majority of the population is Muslim making up about 90% of the population, Hindus constitute about 9% and the remaining are Buddhist and Christian. The expanded programme on immunization (EPI) in Bangladesh was launched on April 7, 1979 with the 6 conventional vaccines; BCG, DPT, OPV and measles. Because vaccination centers were few and were located mainly in health care facilities in urban areas, the EPI coverage remained less than 2% till 1984. In 1985, government of Bangladesh committed to the global universal child immunization initiative, and began a phase-wise implementation of EPI from 1985 to 1990. Immunization was made available to all target groups by 1990.

Source: Comprehensive multi-year plan 2011-2016 and WHO, world health statistics 2012

Table 1: Basic information1 2011Division/Province/State/Region 7

District 64

Upazilla/Sub-district 482

City Corporation 6

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

81%

Population using improved sanitation 56%

Total expenditure on health as % of GDP 3.4

Literacy rate among adults aged >15 years 56%

Births attended by skilled health personnel 27%

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

Measles 38 weeks

TT +15 Years (WCBA 15-49 Yrs), + 1 month, + 6 months, + 1 year, + 1 year

Vitamin A 38 weeks

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 Plan to introduce MR and MCV2 (2012),

Pneumococcal (2013), Rotavirus (2014) and HepB birth dose (2014).

Source: cMYP 2011-2016

Immunization system highlights

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

n All 64 districts have updated micro-plans that include activities to raise immunization coverage.

n A standing technical advisory group on immunization is available. It has formal written terms of reference.

n The effective vaccine management (EVM) assessment was conducted in April 2011. Cold chain equipment inventory was updated in 2011.

n Out of 64 districts, 51 (80%) had >80% coverage for DTP3 and 33 (52%) had >90% coverage for MCV1.

n No district reported more than 10% drop-out rate DTP1 to DTP3.

n EPI coverage evaluation survey was conducted in 2011. An EPI coverage evaluation survey is planned in the next 24 months.

n Vaccine wastage rates 2011: BCG=85.3%, DTP-Hib-HepB=1.2%, OPV=32.5%, MCV=71.6% and TT=35.7%.

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

n A national system to monitor adverse events following immunization (AEFI) is available. 1,178 AEFI were reported and 44 events were categorized as “serious” in 2011.

n 29% of all spending on vaccine was government financed.

n 37% of all spending on routine immunization was government financed.

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

Total population 150,461,611

Live births 3,927,048

Children <1 year 3,773,433

Children <5 years 19,409,548

Children <15 years 59,191,598

Pregnant women 5,266,156

Women of child bearing age (15-49 years)

37,164,018

Crude birth rate (per 1000 population)2

22.6

Neonates protected at birth against NT

93%

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, 2011 and WHO, world health statistics 20122 BDHS 2011 (preliminary report) and EPI Bangladesh

Table 2: Immunization schedule, 2011

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.

Source: WHO/UNICEF joint reporting form (JRF) 2011

E P I F a c t S h E E t

World Health Organization• SEARO/FHR/IVD • 29 August 2012

Source: WHO/UNICEF estimates, 2012

Figure 2: DTP3 coverage1, diphtheria and pertussis cases2, 1980-2011

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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Diphtheria cases Pertussis cases DTP3 coverage

12,436 23,897 4,879

1 WHO/UNICEF estimates, 20122 WHO vaccine-preventable diseases: monitoring system 2012 global summary

1 WHO/UNICEF estimates, 20122 WHO vaccine-preventable diseases: monitoring system 2012 global summary

Source: EPI Coverage evaluation survey, 2011

Source: EPI Coverage evaluation survey, 2011

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Measles cases MCV1 coverage

25,934

Figure 4: MCV1 coverage1 and measles cases2, 1980-2011

Figure 1: National immunization coverage, 1980-2011

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

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BCG 2 86 93 95 97 96 92 90 94 94 95

DTP3 2 69 69 83 96 93 95 95 96 95 96

Pol3 2 69 69 84 96 93 95 95 96 95 96

MCV 1 65 79 72 94 92 95 96 98 94 96

1980 1985 1990 1995 2000 2005 2006 2007 2008 2009 2010 2011

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

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

Immunization andVaccine Development

South-East Asia Region

MCV supplementary immunization activities• The first phase of catch-up measles campaign

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

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

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

• Bangladesh has a plan to conduct measles-rubella campaign in 2013 targeting 58,659,692 children aged 9 months to 15 years.

1 Country official estimates, 1980-20112 WHO vaccine-preventable diseases: monitoring system 2012 global summary

Table 3: OPV supplementary immunization activities, 2006-2011

Figure 7: Network of WHO supported surveillance medical officers and laboratories, 2011

Year Activity Target population (< 5 years)

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

2nd round coverage (%)

2006 NID 22,804,311 16-Apr-06 13-May-06 102 102

2006 NID 23,083,686 11-Jun-06 6-Aug-06 102 102

2006 SNID 1,528,576 14-Oct-06 - 101 -

2006 NID 23,499,840 25-Nov-06 23-Dec-06 102 101

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

Figure 6: TT2+ coverage1 and NT cases2, 1980-2011

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 2 September 2012)

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World Health Organization• SEARO/FHR/IVD • 29 August 2012 Immunization andVaccine Development

South-East Asia Region

E P I F a c t S h E E t

Indicator 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

AFP cases 1,365 1,128 1,301 1,458 1,619 1,844 1,790 1,502 1,537 1610

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

Compatibles 0 0 2 0 2 0 0 0 0 0

AFP rate 2.70 2.03 2.31 2.66 2.91 3.25 3.1 2.61 2.63 2.72

Non-polio AFP rate1 2.70 2.03 2.31 2.66 2.87 3.25 3.1 2.61 2.63 2.72

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

Total stool samples collected 2,666 2,200 2,523 2,846 3,185 3,611 4,276 3,403 3,412 3,578

% NPEV 28.0 23.0 20.0 20.0 14.8 15.0 23.1 19.4 19.4 18.0

% Timeliness of primary result reported3 100 99 100 100 98 100 95 97 98 931 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 Neonatal Tetanus (% of all Tetanus)

Measles Rubella Mumps Japanese Encephalitis

2002 0 73 587 1,036 336 (32%) 3,484 - ND -

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

Table 5: Reported cases of vaccine preventable diseases, 2002-2011

Table 4: AFP surveillance performance indicators, 2002-2011

Figure 8: Non-polio AFP rate by district, 2011 Figure 9: Adequate stool collection rate by district, 2011

Data as of 15 July 2012

For contact or feedback:

Expanded Program on ImmunizationMinistry of Health, Dhaka, Bangladesh

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

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

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

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

Email: epidata@searo.who.int, www.searo.who.int/vaccine

Source: WHO/UNICEF JRF ND=No data

• 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.

Non-polio AFP rate = 2.72< 1 1 – 1.99 > 2 No non-polio AFP case-

Adequate stool collection rate = 95%< 60% 60% – 79% > 80% No AFP case– >