DPR Korea 2011

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

South-East Asia Region

The Democratic Peoples’ Republic of Korea (DPRK) lies in the north eastern part of Asia, covering 122,762 square kilometers and has land borders with China and Russia to the North with a demilitarized zone to the south. The country is administratively

divided into 10 provinces and 208 cities or counties. DPRK is the home of 24 millions people and annual growth rate is 0.6 (2000-2010). Sixty percent population live in urban areas. The country had set up vaccine production unit in 1946 and had developed capacities of producing ten different vaccines including those against tuberculosis, poliomyelitis, tetanus, diphtheria, pertussis, measles and Japanese encephalitis. However, due to certain factors including natural disasters, vaccine production stopped or was ceased in some cases since 1995. Since 1997, WHO and UNICEF are providing assistance to strengthen national expanded programme on immunization (EPI).

Source: Comprehensive multi-year plan 2011-2015 and WHO, world health statistics 2012.

Table 1: Basic information1 2011Division/Province/State/Region 10

County/District 208

Population density (per sq km) 202

Population living in urban areas 60%

Population using improved drinking-water sources

98%

Population using improved sanitation 80%

Total expenditure on health as % of GDP -

Literacy rate among adults aged >15 years 100%

Births attended by skilled health personnel 100%

Vaccine Age of administration

BCG At birth

HepB At birth

DTPHepB 6 weeks, 10 weeks, 14 weeks

OPV 6 weeks, 10 weeks, 14 weeks

Measles 9 months and 15 months

TT 3 months, 4 months (of pregnancy)

Vitamin A 6-59 months

EPI historyn Launched in 1980 and made available to

all target groups by 1990.n Hepatitis B introduced in 2003.n AD syringes introduced in 2003.n Hepatitis B birth dose introduced in 2004.n DTP-HepB introduced in 2006.n MCV2 introduced in 2008.n Plan to introduce DTP-Hib-HepB in 2012.

Source: cMYP 2011-2015

Immunization system highlights

n There is a comprehensive multi-year plan (cMYP) for immunization covering 2011-2015.

n Cold chain equipment inventory was updated in 2010.

n All districts have >80% coverage for DTP-HepB3, >90% coverage for MCV1 and >80% coverage for TT2+ in pregnant women.

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

n Multiple indicator cluster survey (MICS) was conducted in 2009. No coverage survey is planned in the next 24 months.

n Vaccine wastage rates 2011: BCG=75%, DTP=30%, DTP-HepB=30%, OPV=15%, MCV=30% and TT=20%.

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

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

n A follow-up on the 2008 AFP/VPD surveillance and EPI review was completed in 2009.

n For intensification of routine immunization in 2012, DPR Korea has a plan to reach high-risk areas, migrant/un-reached population and low performing areas.

Total population 24,345,000

Live births 350,568

Children <1 year 344,651

Children <5 years 1,703,918

Children <15 years 5,456,347

Pregnant women 356,896

Women of child bearing age (15-49 years)

6,517,376

Crude birth rate (per 1000 population)

14.3

Neonates protected at birth against NT

91%

Neonatal mortality rate 18 (per 1000 LB)

Infant mortality rate 26 (per 1000 LB)

Under-five mortality rate 33 (per 1000 LB)

Maternal mortality ratio 81 (per 100000 LB)1 SEAR annual EPI reporting form, 2011 and WHO, world health statistics, 2012

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-HepB3 coverage by province, 2011

Figure 5: MCV1 coverage by province, 2011

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

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Diphtheria cases Pertussis cases DTP3 coverage

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: SEAR annual EPI reporting form, 2011 (administrative data)

Source: SEAR annual EPI reporting form, 2011 (administrative data)

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

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Measles cases MCV1 coverage

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

Figure 1: National immunization coverage, 1980-2011

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over

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BCG 50 51 99 82 78 94 96 96 97 98 98 98

DTP3 50 55 98 64 56 79 89 92 92 93 93 94

OPV3 50 65 99 88 93 97 98 99 98 98 99 99

MCV1 29 38 98 67 78 96 96 99 98 98 99 99

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

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

Table 3: Supplementary immunization activities, 2000-2011

Figure 7: Network of laboratories

Year Antigen Activity Target population (age) Date of 1st round Date of 2nd round 1st round coverage (%)

2nd round coverage (%)

2000 OPV NID 2,147,929 (<5 yrs) Oct-00 Nov-00 99.6 99.7

2001 OPV NID 2,120,380 (<5 yrs) Oct-01 Nov-01 98.8 99.5

2000/2001 Vitamin A NID 1,962,600 (6 M to <5 yrs) Oct-00 Oct-01 102.0 99.5

2002 OPV NID 2,098,940 (<5 yrs) Oct-02 Nov-02 99.7 99.8

2002 Vitamin A NID 1,789,704 (6 M to <5 yrs) Oct-02 Nov-02 99.96 99.95

2007 Measles NID6,102,733 (6M to 15 yrs)

10,020,643 (16 to 45 yrs)Mar-07 - 99.91 -

2008 Vitamin A NID 2,061,494 (6 M to <5 yrs) Mar-08 Nov-08 99 99

2009 Vitamin A NID 1,539,308 (6 M to <5 yrs) May-09 Nov-09 99 99

2009-2010 JE SNID1.5 million (12 to 23

months and 4 to 6 yrs) Jul-09Jul-10

- 99.5 -

2010 Vitamin A NID 1,549,782 (6 M to <5 yrs) May-10 Nov-10 99.6 99.5

2011 Vitamin A NID 1,554,518 (6 M to <5 yrs) May-11 Nov-11 100 99.6

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

Source: NCCPE reports and WHO/UNICEF JRF

• DPRKoreaachievedthestatusofmaternalandneonataltetanus(MNT)eliminationbefore2000.

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

Year

Case

s

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over

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NT cases TT2+ coverage

Central Hygiene Anti Epidemic Station - National polio laboratory - National measles & rubella laboratory

ND=No data

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 71 77 72 85 113 125 138 112 112 129

Wild polio 0 0 0 0 0 0 0 0 0 0

Compatibles 0 0 0 0 0 0 0 0 0 0

AFP rate 1.11 1.15 1.07 1.27 1.86 1.95 2.15 1.95 1.95 2.25

Non-polio AFP rate1 1.11 1.15 1.07 1.27 1.86 1.95 2.15 1.95 1.95 2.25

Adequate stool collection rate2 97% 96% 94% 96% 99% 100% 100% 100% 99% 100

Total stool samples collected 142 148 141 172 237 258 280 220 245 270

% NPEV 14 12 13 15 12 17 10 9 13 10

% Timeliness of primary result reported3 96 95 94 95 88 91 97 90 97 99

1 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 0 1,087 0 0 0 520 2,710 -

2003 0 0 1,084 0 0 0 520 2,710 -

2004 0 0 1,930 0 0 0 507 2,050 -

2005 0 0 493 0 0 0 123 187 -

2006 0 0 409 0 0 0 101 176 0

2007 0 0 1,250 0 0 3,550 101 176 0

2008 0 0 395 0 0 82 82 67 124

2009 0 0 8 0 0 0 0 18 10

2010 0 0 0 0 0 0 0 0 ND

2011 0 0 13 0 0 0 5 66 0

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 province, 2011 Figure 9: Adequate stool collection rate by province, 2011

Data as of 30 July 2012

For contact or feedback:

Expanded Program on Immunization Ministry of Public Health, Pyongyang, DPR Korea

Tel: +850-2-3814077, Fax: +850-2-44104416

Email: bogon.moph@star-co.net.kp

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

• Thelastlaboratoryconfirmedpoliocasewasreportedin1996.

Non-polio AFP rate = 2.25< 1 1 – 1.99 > 2 No non-polio AFP case

--

Adequate stool collection rate = 100%< 60% 60% – 79% > 80% No AFP case– >