World Health Organization• SEARO/FGL/IVD • 31 August 2016World Health Organization• SEARO/FGL/IVD • 31 August 2016 Immunization andVaccine Development

South-East Asia Region

Immunization andVaccine Development

South-East Asia Region

Bangladesh 2016

Immunization system highlights

� There is a comprehensive multi-year plan (cMYP) for immunization covering 2014-2018.

� A standing national technical advisory group on immunization (NTAGI) fully functional.

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

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

� An EPI coverage evaluation survey (CES) was conducted in 2015. Another CES is planned in the next 24 months.

� 27% spending on vaccines financed by the government.

� 29% spending on routine immunization programme financed by the government.

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

� All 64 districts had >80% coverage for DTP-Hib-HepB3 and >90% coverage for MCV1.

� HPV demonstration launched on 16 April 2016 in 4 Upzila and 1 Zone under Gazipur district targeting school going girls of grade 5 and out of school girls of the age 10 years.

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.

Table 1: Basic information1 2015Division/Province/State/Region 7

District 64

Upazilla/Sub-district 489

City Corporation 11

Union 4 498

Ward 13 494

Sub-Block 108 000

Population density (per sq. km) 1 074

Population living in urban areas 33%

Population using improved drinking-water sources

85%

Population using improved sanitation 57%

Total expenditure on health as % of GDP 3.5%

Births attended by skilled health personnel 44%

Neonates protected at birth against NT 94%

Total population 158 435 598

Live births (LB) 3 228 362

Children <1 year 3 089 542

Children <5 years 15 686 321

Children <15 years 50 916 899

Pregnant women 3 551 198

Women of child bearing age (15-49 years)

43 380 414

Neonatal mortality rate 24.2 (per 1 000 LB)

Infant mortality rate 33.2 (per 1 000 LB)

Under-five mortality rate 41.1 (per 1 000 LB)

Maternal mortality ratio 170 (per 100 000 LB)

1 SEAR annual EPI reporting form, 2015 and WHO, World Health Statistics 2015

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

PCV 6 weeks, 10 weeks, 18 weeks

IPV 14 weeks

MR 38 weeks, 15 months

Measles 15 months

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

EPI history � EPI Launched on 07 April 1979. � TT5 dose for WCBA started in 1993. � HepB vaccine introduced in 2003. � AD syringes introduced in 2004. � Hib Pentavalent (DTP-Hib-HepB) vaccine

introduced in 2009. � MR vaccine and measles second dose

introduced in 2012. � Pneumococcal conjugate vaccine introduced

in 2015. � IPV introduced in 2015. � Type 2 component of OPV withdrawn on 23

April 2016 by switching from tOPV to bOPV.

Table 2: Immunization schedule, 2015

Source: cMYP 2011-2016 and EPI/MOHFWSource: WHO/UNICEF joint reporting form (JRF) 2015

Source: WHO/UNICEF joint reporting form (JRF) 2015

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

Figure 12: Confirmed (Lab and Epi linked) measles outbreak associated cases, by age, 2010–2015

Figure 10: Immunity against measles: Immunity profile by age in 2015*

Figure 13: Unimmunized confirmed (Lab and Epi linked)measles outbreak associated cases, by age, 2010–2015

Figure 14: Network of WHO supported surveillance medical officers and laboratories

Figure 11: Immunity against measles: Immunity profile by age in 2016*

*Modeled using MSP tool ver 2 based on coverage data up to 2015.

Source: SEAR annual EPI reporting form (multiple years)

*Modeled using MSP tool ver 2 assuming the schedule and measles containing vaccine (MCV) coverage remain unchanged and no SIAs in 2015 & 2016.

Source: SEAR annual EPI reporting form (multiple years)

Routine/sporadic cases Outbreak associated cases

Year No. of suspected

case

No. of death

No. of lab-confirmed

measles cases

No. of lab-confirmed

rubella cases

No. of suspected

outbreak

No. of Outbreak

Investigated

No. of case

No. of death

No. of measles

outbreak*

No. of confirmed

measles case*

No. of confirmed

rubella outbreak*

No. of confirmed

rubella cases*

2010 1 534 5 43 496 217 217 13 666 0 0 0 193 12 467

2011 2 993 1 1 445 267 333 333 11 863 11 91 2 802 89 4 744

2012 1 764 0 560 161 185 185 6 756 1 33 1 092 66 2 683

2013 1 095 0 55 230 146 146 4 230 0 7 156 87 2 787

2014 1 668 0 97 176 71 71 1 368 0 9 178 11 166

2015 2 470 0 129 130 68 68 922 0 4 78 3 48

Source: Monthly VPD Reporting to WHO/SEARO * Laboratory confirmed & epidemiologically- linked

Table 8: Suspected sporadic and Outbreak associated measles and rubella cases, 2010–2015

Table 9: Quality of field and laboratory surveillance for measles and rubella, 2012–2015

Year

No. o

f Sus

pect

ed M

easl

es

Case classification (number) Indicators

Measles Rubella

Disc

arde

d no

n-m

easl

es n

on-

rube

lla c

ases

Annu

al in

cide

nce

of

confi

rmed

Mea

sles

cas

es p

er

mill

ion

tota

l pop

ulat

ion

Annu

al in

cide

nce

of

confi

rmed

Rub

ella

cas

es p

er

mill

ion

tota

l pop

ulat

ion

Prop

ortio

n of

all

susp

ecte

d m

easl

es a

nd ru

bella

cas

es

that

hav

e ha

d an

ade

quat

e in

vest

igat

ion

initi

ated

with

in

48 h

ours

of n

otifi

catio

n

Disc

arde

d no

n-m

easl

es

non-

rube

lla in

cide

nce

per

100,

000

tota

l pop

ulat

ion

Prop

ortio

n of

sub

natio

nal

adm

inis

trativ

e un

its re

porti

ng

at le

ast t

wo

disc

arde

d no

n-m

easl

es n

on-r

ubel

la c

ases

pe

r 100

,000

tota

l pop

ulat

ion

Prop

ortio

n of

sub

-nat

iona

l su

rvei

llanc

e un

its re

porti

ng

to th

e na

tiona

l lev

el o

n tim

e

Lab-

confi

rmed

Epi-L

inke

d

Clin

ical

ly-c

onfir

med

Lab-

confi

rmed

Epi-L

inke

d

Target – – 80% 2 80% 80%

2012 8 289 715 1 077 599 481 2 592 2 825 11.8 20.2 87 1.9 30 85

2013 5 229 77 123 325 633 2 337 1 728 1.3 19.3 88 1.1 19 85

2014 3 039 143 143 175 223 158 2 138 1.8 2.4 90 1.4 17 89

2015 3 415 158 80 64 152 37 2 880 1.5 1.2 92 1.8 37 92

Source: SEAR Annual EPI Reporting Form, 2015 ND=No data

Table 10: Performance of Laboratory Surveillance, 2012–2015

Year

% Serum specimen collected from

suspected measles cases

Total Serum Specimen

received in Laboratory

% serum specimens

tested

Specimen Positive for Measles IgM

Specimen Positive for Rubella IgM

% Results within 4 of

receipt

% Outbreak tested for

viral detection

Genotypes detected

No. % No. % Measles Rubella

2012 31 2 590 99 714 28% 481 26% 32 ND ND ND

2013 33 1 748 99 77 4% 634 38% 82 ND ND ND

2014 67 2 042 99 143 7% 223 12% 99 0 B3 ND

2015 83 2 839 100 158 6% 152 6% 87 ND ND ND

Source: SEAR Annual EPI Reporting Form, 2015 ND=No data

For contact or feedback: Expanded Program on ImmunizationMinistry of Health and Family Welfare, Dhaka, BangladeshTel: +880-2-9880530, 8821910-03, Fax: +880-2-8821914Email: tajulepi@yahoo.com, www.dghs.gov.bd

Immunization and Vaccine Development (IVD)WHO-SEARO, IP Estate, MG Marg, New Delhi 110002, IndiaTel: +91 11 23370804, Fax: +91 11 23370251Email: SearEpidata@who.int, www.searo.who.int/entity/immunization

0%10%20%30%40%50%60%70%80%90%

100%

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

Perce

nt of

popu

lation

Age (in years)Susceptible Immune due to past infectionProtected by SIAs Protected by routine vaccination with 2nd doseProtected by routine vaccination with 1st dose Protected by maternal antibodies

0%10%20%30%40%50%60%70%80%90%

100%

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

Perce

nt of

popu

lation

Age (in years)Protected by maternal antibodies Protected by routine vaccination with 1st doseProtected by routine vaccination with 2nd dose Protected by SIAsImmune due to past infection Susceptible

050

100150200250300350400450500

2010 2011 2012 2013 2014 2015<1 year 1-4 years 5-9 years 10-14 years 15+ years

n=0 n=2802 n=1092 n=156 n=178 n=78956 949

050

100150200250300350400450500

2010 2011 2012 2013 2014 2015<1 year 1-4 years 5-9 years 10-14 years 15+ years

n=0 n=1212 n=459 n=57 n=78 n=12(0%) (43%) (42%) (37%) (44%) (15%)

Institute of Public Health - National polio laboratory

- National measles/rubella laboratory

- National Japanese encephalitis laboratory

- Dhaka Shishu Hospital- Chittagong Maa-O-Shishu Hospital- Kumudini Women’s Medical College

Invasive Bacteria

Surveillance Medical Officer (SMO) = 30Divisional Coordinator (DC) = 5

Data WHO-IVD Bangladesh (as of May 2016)

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

World Health Organization• SEARO/FGL/IVD • 31 August 2016 Immunization andVaccine Development

South-East Asia Region

Table 3: OPV supplementary immunization activities (SIA)

Figure 3: DTP-Hib-HepB3 valid coverage by 23 months by district, 2015

Figure 5: Non-polio AFP rate by district, 2015

Table 6: MCV supplementary immunization activities

Figure 7: MCV1 & MCV2 coverage1 and measles cases2, 1980–2015

Figure 9: Sporadic and outbreak associated measles cases* by month and MR SIA coverage, 2010–2015

Figure 4: TT2+ coverage1 and NT cases2, 1980–2015

Figure 6: Adequate stool specimen collection percentage by district, 2015

Table 7: Districts with more than 95% MCV1 coverage

Figure 8: MCV1 valid coverage by 23 months by district, 2015

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-12 – 101 –

2012 NID 22 073 699 – 11-Feb-12 – 101

2013 NID 20 530 418 21-Dec-13 – 101 –

2014 NID* 20 631 077 25-Jan-14 – 99 –

2016 Mop-up 114 979 23-Jan-16 – 101 –

2016 Mop-up 115 355 – 27-Feb-16 – 101

Source: WHO/UNICEF JRF * One dose OPV given during MCV campaign

Indicator 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

AFP cases 1 619 1 844 1 790 1 502 1 537 1 610 1 567 1 412 1 478 1 413

Wild poliovirus confirmed cases 18 0 0 0 0 0 0 0 0 0

Compatible cases 2 0 0 0 0 0 0 0 0 0

AFP rate 2.91 3.25 3.1 2.61 2.63 3.11 2.98 2.65 2.74 2.78

Non-polio AFP rate1 2.87 3.25 3.1 2.61 2.63 3.11 2.98 2.65 2.74 2.78

Adequate stool specimen collection percentage2 93% 92% 92% 94% 95% 95% 96% 96% 98% 97%

Total stool samples collected 3 185 3 611 4 276 3 403 3 412 3 578 3 412 3 132 3 094 3 008

% NPEV isolation 14.8 15.0 23.1 19.4 19.4 18.0 13.8 18.8 22.6 20.4

% Timeliness of primary result reported3 98 100 95 97 98 93 88 97 97 98

Year Vaccine, geographic coverage, target group

Target Coverage Achieved

2005 M, two districts, 9 months to 10 years 1 481 321 93%

2006 M, nationwide, 9 months to 10 years 34 199 590 100%

2010 M, nationwide, 9 months to 5 years 18 136 066 100%

2014 MR, nationwide, 9 months to 15 years 52 745 231 102%

Year Number of districts %

2010 28 44

2011 26 41

2012 54 84

2013 49 77

2014 49 77

2015 64 100

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 2005 to 2007 result reported within 28 days and 2008 onwards result reported within 14 days of sample received at laboratory.

1 WHO and UNICEF estimates of national immunization coverage, July 2016 revision2 WHO vaccine-preventable diseases: monitoring system 2016

1 Country official estimates, 1980-20152 WHO vaccine-preventable diseases: monitoring system 2016

Source: WHO and UNICEF estimates of national immunization coverage, July 2016 revision

Source: CES 2015 (provisional data)

*Includes laboratory confirmed and epidemiologically linked casesSource: SEAR Monthly VPD reports

Source: WHO/UNICEF JRFs

1 WHO and UNICEF estimates of national immunization coverage, July 2016 revision2 WHO vaccine-preventable diseases: monitoring system 2016

Source: WHO/UNICEF JRF (multiple years)

Source: CES 2015 (provisional data)

Table 4: AFP surveillance performance indicators, 2006–2015• Last polio case due to indigenous wild polio virus (WPV) was reported from Dhaka district in August 2000.• Last polio case due to imported wild polio virus (WPV) was reported from Sunamganj district in November 2006

• Bangladesh achieved the status of maternal neonatal tetanus (MNT) elimination in 2008.

Figure 1: National immunization coverage, 1980–2015 Figure 2: DTP3 coverage1, diphtheria and pertussis cases2, 1980–2015

Year Polio Diphtheria Pertussis Neonatal Tetanus (% of all Tetanus)

Measles Rubella Mumps Japanese Encephalitis

Congenital Rubella Syndrome

2006 18 35 46 257 (21%) 6 192 3 418 ND ND ND

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

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

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

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

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

2012 0 16 13 109 (18%) 1 986 3 245 ND 52 20

2013 0 2 1 108 (21%) 237 3 034 ND 23 34

2014 0 13 12 105 (19%) 289 381 ND 183 98

2015 0 6 11 117(21%) 240 189 ND 76 89

Table 5: Reported cases of vaccine preventable disease, 2006–2015

Source: WHO/UNICEF JRF ND=No data

1980 1985 1990 1995 2000 2005 2010 2011 2012 2013 2014 2015BCG 2 86 93 94 97 98 99 98 98 98 98DTP3 2 69 69 82 93 94 96 94 94 94 94Pol3 2 69 69 83 94 94 96 94 94 94 94MCV 1 65 79 74 88 88 93 88 88 88 88

0

20

40

60

80

100

% C

over

age

0

20

40

60

80

100

0200400600800

100012001400160018002000

1980 1985 1990 1995 2000 2005 2010 2011 2012 2013 2014 2015

% C

over

age

No. o

f cas

es

YearDiphtheria Cases Pertussis Cases DTP3 Coverage

12436 23897 4879

<70% 70%–79% 80%–89% > 90%

0

20

40

60

80

100

0

200

400

600

800

1000

1200

1980 1985 1990 1995 2000 2005 2010 2011 2012 2013 2014 2015

% C

over

age

No. o

f cas

es

YearNT cases TT2+ Coverage

<1 1–1.99 > No non-polio AFP case 2 <60% 60%–79% > No AFP 80

0

20

40

60

80

100

0

2000

4000

6000

8000

10000

12000

1980 1985 1990 1995 2000 2005 2010 2011 2012 2013 2014 2015

% C

over

age

No. o

f cas

es

YearMeasles Cases MCV1 Coverage MCV2 Coverage

25934

<70% 70%–79% 80%–89% > 90%

0

100

200

300

400

500

600

700

800

900

Jan-

10Ma

r-10

May-1

0Ju

l-10

Sep-

10No

v-10

Jan-

11Ma

r-11

May-1

1Ju

l-11

Sep-

11No

v-11

Jan-

12Ma

r-12

May-1

2Ju

l-12

Sep-

12No

v-12

Jan-

13Ma

r-13

May-1

3Ju

l-13

Sep-

13No

v-13

Jan-

14Ma

r-14

May-1

4Ju

l-14

Sep-

14No

v-14

Jan-

15Ma

r-15

May-1

5Ju

l-15

Sep-

15No

v-15

No. o

f cas

es

Sporadic measles Outbreak associated measles

M SIA (100%) MR SIA (102%)

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

World Health Organization• SEARO/FGL/IVD • 31 August 2016 Immunization andVaccine Development

South-East Asia Region

Table 3: OPV supplementary immunization activities (SIA)

Figure 3: DTP-Hib-HepB3 valid coverage by 23 months by district, 2015

Figure 5: Non-polio AFP rate by district, 2015

Table 6: MCV supplementary immunization activities

Figure 7: MCV1 & MCV2 coverage1 and measles cases2, 1980–2015

Figure 9: Sporadic and outbreak associated measles cases* by month and MR SIA coverage, 2010–2015

Figure 4: TT2+ coverage1 and NT cases2, 1980–2015

Figure 6: Adequate stool specimen collection percentage by district, 2015

Table 7: Districts with more than 95% MCV1 coverage

Figure 8: MCV1 valid coverage by 23 months by district, 2015

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-12 – 101 –

2012 NID 22 073 699 – 11-Feb-12 – 101

2013 NID 20 530 418 21-Dec-13 – 101 –

2014 NID* 20 631 077 25-Jan-14 – 99 –

2016 Mop-up 114 979 23-Jan-16 – 101 –

2016 Mop-up 115 355 – 27-Feb-16 – 101

Source: WHO/UNICEF JRF * One dose OPV given during MCV campaign

Indicator 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

AFP cases 1 619 1 844 1 790 1 502 1 537 1 610 1 567 1 412 1 478 1 413

Wild poliovirus confirmed cases 18 0 0 0 0 0 0 0 0 0

Compatible cases 2 0 0 0 0 0 0 0 0 0

AFP rate 2.91 3.25 3.1 2.61 2.63 3.11 2.98 2.65 2.74 2.78

Non-polio AFP rate1 2.87 3.25 3.1 2.61 2.63 3.11 2.98 2.65 2.74 2.78

Adequate stool specimen collection percentage2 93% 92% 92% 94% 95% 95% 96% 96% 98% 97%

Total stool samples collected 3 185 3 611 4 276 3 403 3 412 3 578 3 412 3 132 3 094 3 008

% NPEV isolation 14.8 15.0 23.1 19.4 19.4 18.0 13.8 18.8 22.6 20.4

% Timeliness of primary result reported3 98 100 95 97 98 93 88 97 97 98

Year Vaccine, geographic coverage, target group

Target Coverage Achieved

2005 M, two districts, 9 months to 10 years 1 481 321 93%

2006 M, nationwide, 9 months to 10 years 34 199 590 100%

2010 M, nationwide, 9 months to 5 years 18 136 066 100%

2014 MR, nationwide, 9 months to 15 years 52 745 231 102%

Year Number of districts %

2010 28 44

2011 26 41

2012 54 84

2013 49 77

2014 49 77

2015 64 100

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 2005 to 2007 result reported within 28 days and 2008 onwards result reported within 14 days of sample received at laboratory.

1 WHO and UNICEF estimates of national immunization coverage, July 2016 revision2 WHO vaccine-preventable diseases: monitoring system 2016

1 Country official estimates, 1980-20152 WHO vaccine-preventable diseases: monitoring system 2016

Source: WHO and UNICEF estimates of national immunization coverage, July 2016 revision

Source: CES 2015 (provisional data)

*Includes laboratory confirmed and epidemiologically linked casesSource: SEAR Monthly VPD reports

Source: WHO/UNICEF JRFs

1 WHO and UNICEF estimates of national immunization coverage, July 2016 revision2 WHO vaccine-preventable diseases: monitoring system 2016

Source: WHO/UNICEF JRF (multiple years)

Source: CES 2015 (provisional data)

Table 4: AFP surveillance performance indicators, 2006–2015• Last polio case due to indigenous wild polio virus (WPV) was reported from Dhaka district in August 2000.• Last polio case due to imported wild polio virus (WPV) was reported from Sunamganj district in November 2006

• Bangladesh achieved the status of maternal neonatal tetanus (MNT) elimination in 2008.

Figure 1: National immunization coverage, 1980–2015 Figure 2: DTP3 coverage1, diphtheria and pertussis cases2, 1980–2015

Year Polio Diphtheria Pertussis Neonatal Tetanus (% of all Tetanus)

Measles Rubella Mumps Japanese Encephalitis

Congenital Rubella Syndrome

2006 18 35 46 257 (21%) 6 192 3 418 ND ND ND

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

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

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

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

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

2012 0 16 13 109 (18%) 1 986 3 245 ND 52 20

2013 0 2 1 108 (21%) 237 3 034 ND 23 34

2014 0 13 12 105 (19%) 289 381 ND 183 98

2015 0 6 11 117(21%) 240 189 ND 76 89

Table 5: Reported cases of vaccine preventable disease, 2006–2015

Source: WHO/UNICEF JRF ND=No data

1980 1985 1990 1995 2000 2005 2010 2011 2012 2013 2014 2015BCG 2 86 93 94 97 98 99 98 98 98 98DTP3 2 69 69 82 93 94 96 94 94 94 94Pol3 2 69 69 83 94 94 96 94 94 94 94MCV 1 65 79 74 88 88 93 88 88 88 88

0

20

40

60

80

100

% C

over

age

0

20

40

60

80

100

0200400600800

100012001400160018002000

1980 1985 1990 1995 2000 2005 2010 2011 2012 2013 2014 2015

% C

over

age

No. o

f cas

es

YearDiphtheria Cases Pertussis Cases DTP3 Coverage

12436 23897 4879

<70% 70%–79% 80%–89% > 90%

0

20

40

60

80

100

0

200

400

600

800

1000

1200

1980 1985 1990 1995 2000 2005 2010 2011 2012 2013 2014 2015

% C

over

age

No. o

f cas

es

YearNT cases TT2+ Coverage

<1 1–1.99 > No non-polio AFP case 2 <60% 60%–79% > No AFP 80

0

20

40

60

80

100

0

2000

4000

6000

8000

10000

12000

1980 1985 1990 1995 2000 2005 2010 2011 2012 2013 2014 2015

% C

over

age

No. o

f cas

es

YearMeasles Cases MCV1 Coverage MCV2 Coverage

25934

<70% 70%–79% 80%–89% > 90%

0

100

200

300

400

500

600

700

800

900

Jan-

10Ma

r-10

May-1

0Ju

l-10

Sep-

10No

v-10

Jan-

11Ma

r-11

May-1

1Ju

l-11

Sep-

11No

v-11

Jan-

12Ma

r-12

May-1

2Ju

l-12

Sep-

12No

v-12

Jan-

13Ma

r-13

May-1

3Ju

l-13

Sep-

13No

v-13

Jan-

14Ma

r-14

May-1

4Ju

l-14

Sep-

14No

v-14

Jan-

15Ma

r-15

May-1

5Ju

l-15

Sep-

15No

v-15

No. o

f cas

es

Sporadic measles Outbreak associated measles

M SIA (100%) MR SIA (102%)

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

World Health Organization• SEARO/FGL/IVD • 31 August 2016 Immunization andVaccine Development

South-East Asia Region

Table 3: OPV supplementary immunization activities (SIA)

Figure 3: DTP-Hib-HepB3 valid coverage by 23 months by district, 2015

Figure 5: Non-polio AFP rate by district, 2015

Table 6: MCV supplementary immunization activities

Figure 7: MCV1 & MCV2 coverage1 and measles cases2, 1980–2015

Figure 9: Sporadic and outbreak associated measles cases* by month and MR SIA coverage, 2010–2015

Figure 4: TT2+ coverage1 and NT cases2, 1980–2015

Figure 6: Adequate stool specimen collection percentage by district, 2015

Table 7: Districts with more than 95% MCV1 coverage

Figure 8: MCV1 valid coverage by 23 months by district, 2015

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-12 – 101 –

2012 NID 22 073 699 – 11-Feb-12 – 101

2013 NID 20 530 418 21-Dec-13 – 101 –

2014 NID* 20 631 077 25-Jan-14 – 99 –

2016 Mop-up 114 979 23-Jan-16 – 101 –

2016 Mop-up 115 355 – 27-Feb-16 – 101

Source: WHO/UNICEF JRF * One dose OPV given during MCV campaign

Indicator 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

AFP cases 1 619 1 844 1 790 1 502 1 537 1 610 1 567 1 412 1 478 1 413

Wild poliovirus confirmed cases 18 0 0 0 0 0 0 0 0 0

Compatible cases 2 0 0 0 0 0 0 0 0 0

AFP rate 2.91 3.25 3.1 2.61 2.63 3.11 2.98 2.65 2.74 2.78

Non-polio AFP rate1 2.87 3.25 3.1 2.61 2.63 3.11 2.98 2.65 2.74 2.78

Adequate stool specimen collection percentage2 93% 92% 92% 94% 95% 95% 96% 96% 98% 97%

Total stool samples collected 3 185 3 611 4 276 3 403 3 412 3 578 3 412 3 132 3 094 3 008

% NPEV isolation 14.8 15.0 23.1 19.4 19.4 18.0 13.8 18.8 22.6 20.4

% Timeliness of primary result reported3 98 100 95 97 98 93 88 97 97 98

Year Vaccine, geographic coverage, target group

Target Coverage Achieved

2005 M, two districts, 9 months to 10 years 1 481 321 93%

2006 M, nationwide, 9 months to 10 years 34 199 590 100%

2010 M, nationwide, 9 months to 5 years 18 136 066 100%

2014 MR, nationwide, 9 months to 15 years 52 745 231 102%

Year Number of districts %

2010 28 44

2011 26 41

2012 54 84

2013 49 77

2014 49 77

2015 64 100

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 2005 to 2007 result reported within 28 days and 2008 onwards result reported within 14 days of sample received at laboratory.

1 WHO and UNICEF estimates of national immunization coverage, July 2016 revision2 WHO vaccine-preventable diseases: monitoring system 2016

1 Country official estimates, 1980-20152 WHO vaccine-preventable diseases: monitoring system 2016

Source: WHO and UNICEF estimates of national immunization coverage, July 2016 revision

Source: CES 2015 (provisional data)

*Includes laboratory confirmed and epidemiologically linked casesSource: SEAR Monthly VPD reports

Source: WHO/UNICEF JRFs

1 WHO and UNICEF estimates of national immunization coverage, July 2016 revision2 WHO vaccine-preventable diseases: monitoring system 2016

Source: WHO/UNICEF JRF (multiple years)

Source: CES 2015 (provisional data)

Table 4: AFP surveillance performance indicators, 2006–2015• Last polio case due to indigenous wild polio virus (WPV) was reported from Dhaka district in August 2000.• Last polio case due to imported wild polio virus (WPV) was reported from Sunamganj district in November 2006

• Bangladesh achieved the status of maternal neonatal tetanus (MNT) elimination in 2008.

Figure 1: National immunization coverage, 1980–2015 Figure 2: DTP3 coverage1, diphtheria and pertussis cases2, 1980–2015

Year Polio Diphtheria Pertussis Neonatal Tetanus (% of all Tetanus)

Measles Rubella Mumps Japanese Encephalitis

Congenital Rubella Syndrome

2006 18 35 46 257 (21%) 6 192 3 418 ND ND ND

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

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

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

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

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

2012 0 16 13 109 (18%) 1 986 3 245 ND 52 20

2013 0 2 1 108 (21%) 237 3 034 ND 23 34

2014 0 13 12 105 (19%) 289 381 ND 183 98

2015 0 6 11 117(21%) 240 189 ND 76 89

Table 5: Reported cases of vaccine preventable disease, 2006–2015

Source: WHO/UNICEF JRF ND=No data

1980 1985 1990 1995 2000 2005 2010 2011 2012 2013 2014 2015BCG 2 86 93 94 97 98 99 98 98 98 98DTP3 2 69 69 82 93 94 96 94 94 94 94Pol3 2 69 69 83 94 94 96 94 94 94 94MCV 1 65 79 74 88 88 93 88 88 88 88

0

20

40

60

80

100

% C

over

age

0

20

40

60

80

100

0200400600800

100012001400160018002000

1980 1985 1990 1995 2000 2005 2010 2011 2012 2013 2014 2015

% C

over

age

No. o

f cas

es

YearDiphtheria Cases Pertussis Cases DTP3 Coverage

12436 23897 4879

<70% 70%–79% 80%–89% > 90%

0

20

40

60

80

100

0

200

400

600

800

1000

1200

1980 1985 1990 1995 2000 2005 2010 2011 2012 2013 2014 2015

% C

over

age

No. o

f cas

es

YearNT cases TT2+ Coverage

<1 1–1.99 > No non-polio AFP case 2 <60% 60%–79% > No AFP 80

0

20

40

60

80

100

0

2000

4000

6000

8000

10000

12000

1980 1985 1990 1995 2000 2005 2010 2011 2012 2013 2014 2015

% C

over

age

No. o

f cas

es

YearMeasles Cases MCV1 Coverage MCV2 Coverage

25934

<70% 70%–79% 80%–89% > 90%

0

100

200

300

400

500

600

700

800

900

Jan-

10Ma

r-10

May-1

0Ju

l-10

Sep-

10No

v-10

Jan-

11Ma

r-11

May-1

1Ju

l-11

Sep-

11No

v-11

Jan-

12Ma

r-12

May-1

2Ju

l-12

Sep-

12No

v-12

Jan-

13Ma

r-13

May-1

3Ju

l-13

Sep-

13No

v-13

Jan-

14Ma

r-14

May-1

4Ju

l-14

Sep-

14No

v-14

Jan-

15Ma

r-15

May-1

5Ju

l-15

Sep-

15No

v-15

No. o

f cas

es

Sporadic measles Outbreak associated measles

M SIA (100%) MR SIA (102%)

World Health Organization• SEARO/FGL/IVD • 31 August 2016World Health Organization• SEARO/FGL/IVD • 31 August 2016 Immunization andVaccine Development

South-East Asia Region

Immunization andVaccine Development

South-East Asia Region

Bangladesh 2016

Immunization system highlights

� There is a comprehensive multi-year plan (cMYP) for immunization covering 2014-2018.

� A standing national technical advisory group on immunization (NTAGI) fully functional.

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

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

� An EPI coverage evaluation survey (CES) was conducted in 2015. Another CES is planned in the next 24 months.

� 27% spending on vaccines financed by the government.

� 29% spending on routine immunization programme financed by the government.

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

� All 64 districts had >80% coverage for DTP-Hib-HepB3 and >90% coverage for MCV1.

� HPV demonstration launched on 16 April 2016 in 4 Upzila and 1 Zone under Gazipur district targeting school going girls of grade 5 and out of school girls of the age 10 years.

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.

Table 1: Basic information1 2015Division/Province/State/Region 7

District 64

Upazilla/Sub-district 489

City Corporation 11

Union 4 498

Ward 13 494

Sub-Block 108 000

Population density (per sq. km) 1 074

Population living in urban areas 33%

Population using improved drinking-water sources

85%

Population using improved sanitation 57%

Total expenditure on health as % of GDP 3.5%

Births attended by skilled health personnel 44%

Neonates protected at birth against NT 94%

Total population 158 435 598

Live births (LB) 3 228 362

Children <1 year 3 089 542

Children <5 years 15 686 321

Children <15 years 50 916 899

Pregnant women 3 551 198

Women of child bearing age (15-49 years)

43 380 414

Neonatal mortality rate 24.2 (per 1 000 LB)

Infant mortality rate 33.2 (per 1 000 LB)

Under-five mortality rate 41.1 (per 1 000 LB)

Maternal mortality ratio 170 (per 100 000 LB)

1 SEAR annual EPI reporting form, 2015 and WHO, World Health Statistics 2015

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

PCV 6 weeks, 10 weeks, 18 weeks

IPV 14 weeks

MR 38 weeks, 15 months

Measles 15 months

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

EPI history � EPI Launched on 07 April 1979. � TT5 dose for WCBA started in 1993. � HepB vaccine introduced in 2003. � AD syringes introduced in 2004. � Hib Pentavalent (DTP-Hib-HepB) vaccine

introduced in 2009. � MR vaccine and measles second dose

introduced in 2012. � Pneumococcal conjugate vaccine introduced

in 2015. � IPV introduced in 2015. � Type 2 component of OPV withdrawn on 23

April 2016 by switching from tOPV to bOPV.

Table 2: Immunization schedule, 2015

Source: cMYP 2011-2016 and EPI/MOHFWSource: WHO/UNICEF joint reporting form (JRF) 2015

Source: WHO/UNICEF joint reporting form (JRF) 2015

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

Figure 12: Confirmed (Lab and Epi linked) measles outbreak associated cases, by age, 2010–2015

Figure 10: Immunity against measles: Immunity profile by age in 2015*

Figure 13: Unimmunized confirmed (Lab and Epi linked)measles outbreak associated cases, by age, 2010–2015

Figure 14: Network of WHO supported surveillance medical officers and laboratories

Figure 11: Immunity against measles: Immunity profile by age in 2016*

*Modeled using MSP tool ver 2 based on coverage data up to 2015.

Source: SEAR annual EPI reporting form (multiple years)

*Modeled using MSP tool ver 2 assuming the schedule and measles containing vaccine (MCV) coverage remain unchanged and no SIAs in 2015 & 2016.

Source: SEAR annual EPI reporting form (multiple years)

Routine/sporadic cases Outbreak associated cases

Year No. of suspected

case

No. of death

No. of lab-confirmed

measles cases

No. of lab-confirmed

rubella cases

No. of suspected

outbreak

No. of Outbreak

Investigated

No. of case

No. of death

No. of measles

outbreak*

No. of confirmed

measles case*

No. of confirmed

rubella outbreak*

No. of confirmed

rubella cases*

2010 1 534 5 43 496 217 217 13 666 0 0 0 193 12 467

2011 2 993 1 1 445 267 333 333 11 863 11 91 2 802 89 4 744

2012 1 764 0 560 161 185 185 6 756 1 33 1 092 66 2 683

2013 1 095 0 55 230 146 146 4 230 0 7 156 87 2 787

2014 1 668 0 97 176 71 71 1 368 0 9 178 11 166

2015 2 470 0 129 130 68 68 922 0 4 78 3 48

Source: Monthly VPD Reporting to WHO/SEARO * Laboratory confirmed & epidemiologically- linked

Table 8: Suspected sporadic and Outbreak associated measles and rubella cases, 2010–2015

Table 9: Quality of field and laboratory surveillance for measles and rubella, 2012–2015

Year

No. o

f Sus

pect

ed M

easl

es

Case classification (number) Indicators

Measles Rubella

Disc

arde

d no

n-m

easl

es n

on-

rube

lla c

ases

Annu

al in

cide

nce

of

confi

rmed

Mea

sles

cas

es p

er

mill

ion

tota

l pop

ulat

ion

Annu

al in

cide

nce

of

confi

rmed

Rub

ella

cas

es p

er

mill

ion

tota

l pop

ulat

ion

Prop

ortio

n of

all

susp

ecte

d m

easl

es a

nd ru

bella

cas

es

that

hav

e ha

d an

ade

quat

e in

vest

igat

ion

initi

ated

with

in

48 h

ours

of n

otifi

catio

n

Disc

arde

d no

n-m

easl

es

non-

rube

lla in

cide

nce

per

100,

000

tota

l pop

ulat

ion

Prop

ortio

n of

sub

natio

nal

adm

inis

trativ

e un

its re

porti

ng

at le

ast t

wo

disc

arde

d no

n-m

easl

es n

on-r

ubel

la c

ases

pe

r 100

,000

tota

l pop

ulat

ion

Prop

ortio

n of

sub

-nat

iona

l su

rvei

llanc

e un

its re

porti

ng

to th

e na

tiona

l lev

el o

n tim

e

Lab-

confi

rmed

Epi-L

inke

d

Clin

ical

ly-c

onfir

med

Lab-

confi

rmed

Epi-L

inke

d

Target – – 80% 2 80% 80%

2012 8 289 715 1 077 599 481 2 592 2 825 11.8 20.2 87 1.9 30 85

2013 5 229 77 123 325 633 2 337 1 728 1.3 19.3 88 1.1 19 85

2014 3 039 143 143 175 223 158 2 138 1.8 2.4 90 1.4 17 89

2015 3 415 158 80 64 152 37 2 880 1.5 1.2 92 1.8 37 92

Source: SEAR Annual EPI Reporting Form, 2015 ND=No data

Table 10: Performance of Laboratory Surveillance, 2012–2015

Year

% Serum specimen collected from

suspected measles cases

Total Serum Specimen

received in Laboratory

% serum specimens

tested

Specimen Positive for Measles IgM

Specimen Positive for Rubella IgM

% Results within 4 of

receipt

% Outbreak tested for

viral detection

Genotypes detected

No. % No. % Measles Rubella

2012 31 2 590 99 714 28% 481 26% 32 ND ND ND

2013 33 1 748 99 77 4% 634 38% 82 ND ND ND

2014 67 2 042 99 143 7% 223 12% 99 0 B3 ND

2015 83 2 839 100 158 6% 152 6% 87 ND ND ND

Source: SEAR Annual EPI Reporting Form, 2015 ND=No data

For contact or feedback: Expanded Program on ImmunizationMinistry of Health and Family Welfare, Dhaka, BangladeshTel: +880-2-9880530, 8821910-03, Fax: +880-2-8821914Email: tajulepi@yahoo.com, www.dghs.gov.bd

Immunization and Vaccine Development (IVD)WHO-SEARO, IP Estate, MG Marg, New Delhi 110002, IndiaTel: +91 11 23370804, Fax: +91 11 23370251Email: SearEpidata@who.int, www.searo.who.int/entity/immunization

0%10%20%30%40%50%60%70%80%90%

100%

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

Perce

nt of

popu

lation

Age (in years)Susceptible Immune due to past infectionProtected by SIAs Protected by routine vaccination with 2nd doseProtected by routine vaccination with 1st dose Protected by maternal antibodies

0%10%20%30%40%50%60%70%80%90%

100%

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

Perce

nt of

popu

lation

Age (in years)Protected by maternal antibodies Protected by routine vaccination with 1st doseProtected by routine vaccination with 2nd dose Protected by SIAsImmune due to past infection Susceptible

050

100150200250300350400450500

2010 2011 2012 2013 2014 2015<1 year 1-4 years 5-9 years 10-14 years 15+ years

n=0 n=2802 n=1092 n=156 n=178 n=78956 949

050

100150200250300350400450500

2010 2011 2012 2013 2014 2015<1 year 1-4 years 5-9 years 10-14 years 15+ years

n=0 n=1212 n=459 n=57 n=78 n=12(0%) (43%) (42%) (37%) (44%) (15%)

Institute of Public Health - National polio laboratory

- National measles/rubella laboratory

- National Japanese encephalitis laboratory

- Dhaka Shishu Hospital- Chittagong Maa-O-Shishu Hospital- Kumudini Women’s Medical College

Invasive Bacteria

Surveillance Medical Officer (SMO) = 30Divisional Coordinator (DC) = 5

Data WHO-IVD Bangladesh (as of May 2016)

World Health Organization• SEARO/FGL/IVD • 31 August 2016World Health Organization• SEARO/FGL/IVD • 31 August 2016 Immunization andVaccine Development

South-East Asia Region

Immunization andVaccine Development

South-East Asia Region

Bangladesh 2016

Immunization system highlights

� There is a comprehensive multi-year plan (cMYP) for immunization covering 2014-2018.

� A standing national technical advisory group on immunization (NTAGI) fully functional.

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

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

� An EPI coverage evaluation survey (CES) was conducted in 2015. Another CES is planned in the next 24 months.

� 27% spending on vaccines financed by the government.

� 29% spending on routine immunization programme financed by the government.

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

� All 64 districts had >80% coverage for DTP-Hib-HepB3 and >90% coverage for MCV1.

� HPV demonstration launched on 16 April 2016 in 4 Upzila and 1 Zone under Gazipur district targeting school going girls of grade 5 and out of school girls of the age 10 years.

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.

Table 1: Basic information1 2015Division/Province/State/Region 7

District 64

Upazilla/Sub-district 489

City Corporation 11

Union 4 498

Ward 13 494

Sub-Block 108 000

Population density (per sq. km) 1 074

Population living in urban areas 33%

Population using improved drinking-water sources

85%

Population using improved sanitation 57%

Total expenditure on health as % of GDP 3.5%

Births attended by skilled health personnel 44%

Neonates protected at birth against NT 94%

Total population 158 435 598

Live births (LB) 3 228 362

Children <1 year 3 089 542

Children <5 years 15 686 321

Children <15 years 50 916 899

Pregnant women 3 551 198

Women of child bearing age (15-49 years)

43 380 414

Neonatal mortality rate 24.2 (per 1 000 LB)

Infant mortality rate 33.2 (per 1 000 LB)

Under-five mortality rate 41.1 (per 1 000 LB)

Maternal mortality ratio 170 (per 100 000 LB)

1 SEAR annual EPI reporting form, 2015 and WHO, World Health Statistics 2015

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

PCV 6 weeks, 10 weeks, 18 weeks

IPV 14 weeks

MR 38 weeks, 15 months

Measles 15 months

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

EPI history � EPI Launched on 07 April 1979. � TT5 dose for WCBA started in 1993. � HepB vaccine introduced in 2003. � AD syringes introduced in 2004. � Hib Pentavalent (DTP-Hib-HepB) vaccine

introduced in 2009. � MR vaccine and measles second dose

introduced in 2012. � Pneumococcal conjugate vaccine introduced

in 2015. � IPV introduced in 2015. � Type 2 component of OPV withdrawn on 23

April 2016 by switching from tOPV to bOPV.

Table 2: Immunization schedule, 2015

Source: cMYP 2011-2016 and EPI/MOHFWSource: WHO/UNICEF joint reporting form (JRF) 2015

Source: WHO/UNICEF joint reporting form (JRF) 2015

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

Figure 12: Confirmed (Lab and Epi linked) measles outbreak associated cases, by age, 2010–2015

Figure 10: Immunity against measles: Immunity profile by age in 2015*

Figure 13: Unimmunized confirmed (Lab and Epi linked)measles outbreak associated cases, by age, 2010–2015

Figure 14: Network of WHO supported surveillance medical officers and laboratories

Figure 11: Immunity against measles: Immunity profile by age in 2016*

*Modeled using MSP tool ver 2 based on coverage data up to 2015.

Source: SEAR annual EPI reporting form (multiple years)

*Modeled using MSP tool ver 2 assuming the schedule and measles containing vaccine (MCV) coverage remain unchanged and no SIAs in 2015 & 2016.

Source: SEAR annual EPI reporting form (multiple years)

Routine/sporadic cases Outbreak associated cases

Year No. of suspected

case

No. of death

No. of lab-confirmed

measles cases

No. of lab-confirmed

rubella cases

No. of suspected

outbreak

No. of Outbreak

Investigated

No. of case

No. of death

No. of measles

outbreak*

No. of confirmed

measles case*

No. of confirmed

rubella outbreak*

No. of confirmed

rubella cases*

2010 1 534 5 43 496 217 217 13 666 0 0 0 193 12 467

2011 2 993 1 1 445 267 333 333 11 863 11 91 2 802 89 4 744

2012 1 764 0 560 161 185 185 6 756 1 33 1 092 66 2 683

2013 1 095 0 55 230 146 146 4 230 0 7 156 87 2 787

2014 1 668 0 97 176 71 71 1 368 0 9 178 11 166

2015 2 470 0 129 130 68 68 922 0 4 78 3 48

Source: Monthly VPD Reporting to WHO/SEARO * Laboratory confirmed & epidemiologically- linked

Table 8: Suspected sporadic and Outbreak associated measles and rubella cases, 2010–2015

Table 9: Quality of field and laboratory surveillance for measles and rubella, 2012–2015

Year

No. o

f Sus

pect

ed M

easl

es

Case classification (number) Indicators

Measles Rubella

Disc

arde

d no

n-m

easl

es n

on-

rube

lla c

ases

Annu

al in

cide

nce

of

confi

rmed

Mea

sles

cas

es p

er

mill

ion

tota

l pop

ulat

ion

Annu

al in

cide

nce

of

confi

rmed

Rub

ella

cas

es p

er

mill

ion

tota

l pop

ulat

ion

Prop

ortio

n of

all

susp

ecte

d m

easl

es a

nd ru

bella

cas

es

that

hav

e ha

d an

ade

quat

e in

vest

igat

ion

initi

ated

with

in

48 h

ours

of n

otifi

catio

n

Disc

arde

d no

n-m

easl

es

non-

rube

lla in

cide

nce

per

100,

000

tota

l pop

ulat

ion

Prop

ortio

n of

sub

natio

nal

adm

inis

trativ

e un

its re

porti

ng

at le

ast t

wo

disc

arde

d no

n-m

easl

es n

on-r

ubel

la c

ases

pe

r 100

,000

tota

l pop

ulat

ion

Prop

ortio

n of

sub

-nat

iona

l su

rvei

llanc

e un

its re

porti

ng

to th

e na

tiona

l lev

el o

n tim

e

Lab-

confi

rmed

Epi-L

inke

d

Clin

ical

ly-c

onfir

med

Lab-

confi

rmed

Epi-L

inke

dTarget – – 80% 2 80% 80%

2012 8 289 715 1 077 599 481 2 592 2 825 11.8 20.2 87 1.9 30 85

2013 5 229 77 123 325 633 2 337 1 728 1.3 19.3 88 1.1 19 85

2014 3 039 143 143 175 223 158 2 138 1.8 2.4 90 1.4 17 89

2015 3 415 158 80 64 152 37 2 880 1.5 1.2 92 1.8 37 92

Source: SEAR Annual EPI Reporting Form, 2015 ND=No data

Table 10: Performance of Laboratory Surveillance, 2012–2015

Year

% Serum specimen collected from

suspected measles cases

Total Serum Specimen

received in Laboratory

% serum specimens

tested

Specimen Positive for Measles IgM

Specimen Positive for Rubella IgM

% Results within 4 of

receipt

% Outbreak tested for

viral detection

Genotypes detected

No. % No. % Measles Rubella

2012 31 2 590 99 714 28% 481 26% 32 ND ND ND

2013 33 1 748 99 77 4% 634 38% 82 ND ND ND

2014 67 2 042 99 143 7% 223 12% 99 0 B3 ND

2015 83 2 839 100 158 6% 152 6% 87 ND ND ND

Source: SEAR Annual EPI Reporting Form, 2015 ND=No data

For contact or feedback: Expanded Program on ImmunizationMinistry of Health and Family Welfare, Dhaka, BangladeshTel: +880-2-9880530, 8821910-03, Fax: +880-2-8821914Email: tajulepi@yahoo.com, www.dghs.gov.bd

Immunization and Vaccine Development (IVD)WHO-SEARO, IP Estate, MG Marg, New Delhi 110002, IndiaTel: +91 11 23370804, Fax: +91 11 23370251Email: SearEpidata@who.int, www.searo.who.int/entity/immunization

0%10%20%30%40%50%60%70%80%90%

100%

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

Perce

nt of

popu

lation

Age (in years)Susceptible Immune due to past infectionProtected by SIAs Protected by routine vaccination with 2nd doseProtected by routine vaccination with 1st dose Protected by maternal antibodies

0%10%20%30%40%50%60%70%80%90%

100%

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

Perce

nt of

popu

lation

Age (in years)Protected by maternal antibodies Protected by routine vaccination with 1st doseProtected by routine vaccination with 2nd dose Protected by SIAsImmune due to past infection Susceptible

050

100150200250300350400450500

2010 2011 2012 2013 2014 2015<1 year 1-4 years 5-9 years 10-14 years 15+ years

n=0 n=2802 n=1092 n=156 n=178 n=78956 949

050

100150200250300350400450500

2010 2011 2012 2013 2014 2015<1 year 1-4 years 5-9 years 10-14 years 15+ years

n=0 n=1212 n=459 n=57 n=78 n=12(0%) (43%) (42%) (37%) (44%) (15%)

Institute of Public Health - National polio laboratory

- National measles/rubella laboratory

- National Japanese encephalitis laboratory

- Dhaka Shishu Hospital- Chittagong Maa-O-Shishu Hospital- Kumudini Women’s Medical College

Invasive Bacteria

Surveillance Medical Officer (SMO) = 30Divisional Coordinator (DC) = 5

Data WHO-IVD Bangladesh (as of May 2016)