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SPC/PHoH 7 Paper no.12
ORIGINAL: ENGLISH
7th
Pacific Heads of Health (PHoH) Meeting: 3 to 5 April 2019, Nadi Fiji
Agenda Item 10.1 – Immunisation and Vaccine Preventable Diseases (Current issues and future
directions)
The global increase in vaccine hesitancy is threatening the progress made towards
the elimination or control of vaccine preventable diseases (VPDs). The world is witnessing a
resurgence of measles associated with international travel as well as outbreaks of pertussis
and diphtheria in under-vaccinated communities.
Participants from 19 Pacific island countries and areas (PICs) participated in the
Tenth Pacific Immunisation Programme Managers’ Meeting held in Nadi, Fiji, from 30 July
– 3 August 2018. The meeting found that implementation of several regional vaccine
coverage goals are on track, but uneven coverage is seen across and within PICs, with high
national level immunisation coverage data sometimes masking under-immunised districts.
Countries in the Pacific have experienced outbreaks of mumps, hepatitis A, meningococcal
meningitis, pertussis and rotavirus diarrhoea in the last few years.
The 2018 meningococcal meningitis serogroup C outbreak in Fiji and the
circulating vaccine derived poliovirus outbreaks in Papua New Guinea reminds us that all
countries remain vulnerable to emerging infectious diseases and low immunisation coverage
poses worrying risks. The International Coordinating Group (ICG) on Vaccine Provision for
Meningitis is a mechanism to manage and coordinate the provision of emergency vaccine
supplies for meningococcal meningitis. Fiji is the first country in the Pacific to access
vaccines through this mechanism.
Surveillance for adverse events following immunisation (AEFIs) is in place in 10
PICs but there is significant under-reporting of AEFIs. Engaging communities in risk
communication systems is a key to managing vaccine hesitancy and building resilience.
At present, there is no Pacific-wide harmonisation of the vaccine formulations used
although under the UNICEF VII mechanism participating PICs harmonise their product
selections and therefore have harmonised vaccine formulations. Heads of Health are invited
to consider the question – are we ready to harmonise immunisation schedules across the
Pacific?
SPC/PHoH 7/Paper no. 12
page 2
1. BACKGROUND
1.1 Purpose of this paper
The purpose of this paper is to provide the Heads of Health with updates on the global and
regional epidemiology of vaccine preventable diseases and vaccine coverage in the Pacific, the
conclusions and recommendations of the Tenth Pacific Immunisation Programme Managers’ Meeting
held in 20181, and emerging issues in immunisation. The paper also asks the question – are we ready
to harmonise immunisation schedules across the Pacific?
1.2 Progress towards vaccination targets and interruption of VPD transmission
Progress has been made against many of the Global Vaccine Action Plan (GVAP) targets to
achieve the Decade of Vaccines vision by delivering universal access to immunisation notable
challenges remain. For example, although the number of under-vaccinated children decreased by
more than 1.8 million between 2010 and 2017 globally, in 2017 there were still almost 20 million
under-vaccinated children.2
The Regional strategy and plan of action for measles and rubella elimination in the Western
Pacific is the roadmap to achieve and sustain the interruption of the transmission of measles and
rubella viruses (elimination) in all countries and areas of the Western Pacific Region (WPR) by 2020.
The Sixth Meeting of the Combined Subregional Committees for the Certification of
Poliomyelitis Eradication and Verification of Measles Elimination in Pacific Island Countries and
Areas (SRCC/SRVC) was convened in Nadi, Fiji, from 1 – 3 May 2018.3 The SRCC/SRVC serves as
the expert review group to classify all cases of acute flaccid paralysis (AFP) reported in PICs and
produces the annual report on the Pacific’s poliomyelitis-free status to be submitted to the Regional
Certification Commission. The SRVC also develops the annual report on progress towards achieving
measles elimination to be submitted to the Regional Verification Commission.
1 World Health Organization Regional Office for the Western Pacific and the UNICEF Pacific Office.
Meeting Report of the Tenth Pacific Immunisation Programme Managers Meeting, Nadi, Fiji, 30 July to 3
August 2018. http://iris.wpro.who.int/bitstream/handle/10665.1/14336/RS-2018-GE-41-FJI-eng.pdf
(Accessed 23 February 2019). 2 2018 Assessment report of the Global Vaccine Action Plan. Strategic Advisory Group of Experts on
Immunisation. Geneva: World Health Organization; 2018.
https://www.who.int/immunisation/global_vaccine_action_plan/SAGE_GVAP_Assessment_Report_2018_E
N.pdf?ua=1 (Accessed 28 February 2019) 3 World Health Organization Regional Office for the Western Pacific. Sixth Meeting of the Combined
Subregional Committees for the Certification of Poliomyelitis Eradication and Verification of Measles Elimination in Pacific Island Countries and Areas in Nadi, Fiji, 1 - 3 May 2018.
https://apps.who.int/iris/rest/bitstreams/1156340/retrieve (Accessed 7 March 2019).
SPC/PHoH 7/Paper no. 12
page 3
1.3 The re-emergence of vaccine preventable diseases (VPDs) in the Western Pacific
Region
Measles
Between 2016 and 2017, the number of reported measles cases increased by 31% and
endemic measles transmission was re-established in the Bolivarian Republic of Venezuela, Germany
and the Russian Federation.4
Challenging the measles and rubella elimination target of the Regional Strategy, the WPR has
been affected by a region-wide measles resurgence starting in 2013. International spread of the
disease has caused large-scale or multiple smaller outbreaks in several countries where interruption of
measles transmission had been achieved or measles incidence had been low. In Japan, for example,
222 measles cases were reported in epidemiological weeks 1-7 2019 (to 17 February, 2019),
compared to 282 cases reported during the whole of 2018.5 Similarly, in the Republic of Korea during
weeks 1-7 2019, a total of 324 cases have been reported compared to fewer than 30 cases annually
from 2015-18.6 On a positive note, the Sub-regional Committee for Certification of Polio Eradication
(SRCC)1 concluded that measles and rubella elimination can be feasibly achieved in PICs by the
target date of 2022 if the good progress made across the Pacific continues to include the PICs that
have yet to achieve the regional coverage targets for measles.
Circulating vaccine derived poliovirus outbreaks
Chronic under-immunisation of populations with polio vaccine led to two outbreaks of
unrelated circulating vaccine-derived poliovirus type 1 (cVDPV1) in Papua New Guinea7 and
Indonesia.8 Wild poliovirus continues to be endemic in Afghanistan, Nigeria and Pakistan posing a
continuing risk to wild poliovirus elimination.9
With respect to polio vaccination, the SRVC recommended that all countries in the Western
Pacific Region achieve and sustain high (>90%) polio vaccination coverage, maintain AFP
4 Dabbagh A, Laws RL, Steulet C, Dumolard L, Mulders MN, Kretsinger K, Alexander JP, Rota PA, Goodson
JL. Progress toward regional measles elimination—worldwide, 2000–2017. Morbidity and Mortality Weekly
Report. 2018 Nov 30;67(47):1323.
https://apps.who.int/iris/bitstream/handle/10665/276217/WER9348.pdf?ua=1 (Accessed 28 February 2019) 5 https://www.niid.go.jp/niid/images/idsc/disease/measles/2019pdf/meas19-07.pdf (Accessed 28 February
2019) 6 http://www.cdc.go.kr/CDC/eng/info/CdcKeDIDO.jsp?menuIds=HOME002-MNU0576-
MNU0586&fid=9712&q_type=&q_value=&cid=143084&pageNum= (Accessed 28 February 2019) 7 Disease outbreak news. Circulating vaccine-derived poliovirus type 1 – Papua New Guinea. 20 February
2019. https://www.who.int/csr/don/20-February-2019-polio-png/en/ (Accessed 28 February 2019) 8 Disease outbreak news. Circulating vaccine-derived poliovirus type 1 – Indonesia. 27 February 2019.
https://www.who.int/csr/don/27-february-2019-polio-indonesia/en/ (Accessed 28 February 2019) 9 Global Polio Eradiation Initiative. Global Wild Poliovirus 2014-2019. http://polioeradication.org/wp-
content/uploads/2019/02/global-wild-poliovirus-2013-2019-20190219.pdf (Accessed 28 February 2019)
SPC/PHoH 7/Paper no. 12
page 4
surveillance at the WHO standard and update their polio preparedness and response plans to include
an assessment of the risk from polio importation.
VPDs in the Pacific
According to 2017 data on VPDs derived from the UNICEF-WHO Joint Reporting Process10
there were 10,695 cases of measles, over 4,000 cases of rubella and 22 cases of congenital rubella
syndrome, close to 335,000 cases of mumps, 27,624 cases of pertussis and 141 cases of diphtheria in
the WHO Western Pacific Region (WPR).
The last outbreak of measles in the Pacific occurred in 20141 when three countries
experienced outbreaks. Genotypic analysis confirmed that the outbreak genotype B3 in the Federated
States of Micronesia originated in the Philippines. The outbreak in the Solomon Islands was linked to
PNG and the outbreak in Vanuatu was epidemiologically linked to the Solomon Islands.
In 2017, 6 PICs provided surveillance reports11
for congenital rubella syndrome (CRS),
diphtheria and pertussis (all 0 cases); 7 PICs for measles and rubella (10 cases reported by two
countries) with Fiji12
reporting discarded measles/rubella cases, and neonatal tetanus (0 cases); and 6
PICs for mumps (23 cases). The incidence of measles in 2017 was less than 1 case per 1 million total
population.3 The WPR has maintained its wild polio-free status. The Pacific VPD surveillance data
show significant under-reporting by countries and by disease (for example, given the large numbers of
mumps cases that occurred in 2017). CRS surveillance is weak or non-existent in all PICs. The target
year for elimination of rubella in the PICs has not been defined.3
2. PROGRESS AND ACHIEVEMENTS
2.1 Summary of key findings from the 2017 Joint Reporting Process on immunisation
According to 2017 vaccination coverage data derived from the UNICEF-WHO Joint
Reporting Process, implementation of six out of eight regional immunisation goals is on track in the
Pacific although overall progress in meeting the regional vaccination coverage goals has been slow.
Regional targets for district level vaccination coverage were met in only eight PICs (40%).
10
World Health Organization. Immunisation, Vaccine and Biologicals
https://www.who.int/immunisation/monitoring_surveillance/data/gs_wprprofile.pdf?ua=1 (Accessed 23 February 2019).
11 World Health Organization. Reported incidence time series.
http://www.who.int/entity/immunisation/monitoring_surveillance/data/incidence_series.xls?ua=1 (Accessed
07 March 2019). 12 World Health Organization. Measles and Rubella Surveillance Data.
https://www.who.int/immunisation/monitoring_surveillance/burden/vpd/surveillance_type/measlesreportedc
asesbycountry.xls?ua=1. (Accessed 07 March 2019).
SPC/PHoH 7/Paper no. 12
page 5
As of 2017, of the 17 PICs13
that completed the Joint Reporting Form (JRF), 8 had achieved
the WHO diphtheria-tetanus-pertussis (DTP3) vaccine coverage of 95% or above with another two
achieving the GVAP national coverage target of 90%.
With respect to measles vaccination coverage, first dose coverage of over 95% was reported
by 8 PICs in 2017, all but one of which also achieved over 95% second dose coverage. However,
given the very high communicability of measles, over 95% immunisation coverage is required to
prevent transmission. Countries and areas in the Pacific have not experienced measles outbreaks
since 2014 using a combination of routine and supplementary vaccination; maintaining optimal levels
of immunisation coverage is critical to preventing the re-emergence of measles in the Pacific given
these worrying global and regional trends in measles transmission.
In 2017 there was a fall in the percent of acute flaccid paralysis (AFP) cases investigated
within 48 hours (81%) compared to 100% in 2016, and a significant drop in the percent of AFP cases
with the 60-day follow-up (31% vs. 80% in 2017 and 2016 respectively). Improvements were seen in
timeliness and adequacy of stool sample collection for virological testing.
2.2 Access to emergency vaccines
The Pacific has made use of emergency vaccines for outbreak control a number of times,
most notably for the control of measles, typhoid fever and hepatitis A, and in Fiji more recently for
the control of invasive meningococcal serogroup C disease. WHO established the Strategic Advisory
Group of Experts on immunisation (SAGE) in 1999 as the principal advisory group for vaccines and
immunisation. The SAGE has developed position papers on the emergency vaccination for outbreak
control for hepatitis A14
, measles15
and typhoid16
among others.
Under the UNICEF Vaccine Independence Initiative (VII) mechanism, 13 PICs jointly keep a
buffer stock of vaccines in Nadi, Fiji, to ensure supply security in case of stock-outs due to
unexpected events (natural disasters and cold chain failures) or inaccurate forecasting by countries.
The VII buffer stock is a successful best practice - and the only example in the world for vaccines -
based on Pacific regionalism, South-to-South cooperation and emergency resilience principles. Most
importantly the buffer stock is owned and financed by PICs. UNICEF is managing the buffer stock as
13
Cook Islands, French Polynesia, Fiji, Kiribati, Marshall Islands (Republic of), Micronesia (Federated States
of), Nauru, New Caledonia, Niue, Northern Mariana Islands (Commonwealth of), Palau, Samoa, Solomon Islands, Tonga, Tuvalu, Vanuatu and Wallis and Futuna.
14 WHO position paper on hepatitis a vaccines – June 2012. Weekly Epidemiological Record No. 28-29,
2012;87:261–276. https://www.who.int/wer/2012/wer8728_29.pdf?ua=1 15 Measles vaccines: WHO position paper – April 2017. Weekly Epidemiological Record No 17, 2017;
92:205–228. https://apps.who.int/iris/bitstream/handle/10665/255149/WER9217.pdf?sequence=1 16
Typhoid vaccines: WHO position paper – March 2018. Weekly Epidemiological Record No 13, 2018, 93,
153–17. https://apps.who.int/iris/bitstream/handle/10665/272272/WER9313.pdf?ua=1
SPC/PHoH 7/Paper no. 12
page 6
structured by the official VII Agreement between the countries and UNICEF. In 2017, Fiji and Samoa
used the buffer stock to conduct their national measles and rubella vaccination campaigns.
The International Coordinating Group (ICG) on Vaccine Provision for Meningitis was
established in 1997 following major outbreaks of meningitis in Africa. The ICG stockpile is designed
to provide emergency vaccines to contain outbreaks of meningococcal disease, yellow fever and
cholera. WHO Headquarters in Geneva, Switzerland, provides the ICG Secretariat with UNICEF,
Médecins Sans Frontières and the International Federation of the Red Cross being permanent
members. UNICEF Supply in Copenhagen, Denmark, is responsible for price negotiations,
procurement and logistics operations for the vaccine supplies. In 2018, WHO and UNICEF supported
the Fiji Ministry of Health and Medical Services to access affordable conjugate meningococcal C
vaccine through the ICG mechanism because there is a global shortage of this product and the supply
allocation is therefore regulated.
In conjunction with the WHO position papers on immunisation, the WHO Vaccination in
acute humanitarian emergencies: A Framework for Decision Making is a useful risk assessment tool
to guide decisions on when emergency vaccination should be considered for outbreak control by
vaccine.
3. CHALLENGES
3.1 Emerging VPDs
In 2017-18, Fiji experienced its first outbreak of invasive meningococcal disease (IMD)
serogroup C. The outbreak was declared on 20 March 2018 and lasted for several months. 90% of
confirmed and probable cases were between 0-19 years of age. This outbreak resulted in three
institutional clusters as well as community transmission and affected all four Divisions of Fiji. All the
serogroup C isolates were clone ST-4821 which was first discovered as causing outbreaks in 2003 in
China.
To control the IMD outbreak, Fiji accessed 124,800 doses of emergency monovalent
conjugate meningococcal C vaccine through the International Coordinating Group (ICG) on Vaccine
Provision for Meningitis and an additional 200,000 doses were secured through UNICEF Supply
Division procurement services for mass vaccination of the population at highest risk. The campaign
ran from 14 May – 31 October 2018. The assessed vaccine coverage in Jan 2019 was 91% among the
target population of over 309,000 1-19 year olds in the four Divisions. The last confirmed case
occurred in September 2018 and the outbreak was declared over in December 2018.
SPC/PHoH 7/Paper no. 12
page 7
Should the need arise elsewhere in the Pacific, the technical partners will support countries to
develop the detailed epidemiological analysis and microplanning required as the rationale for access
to the stockpile.
The challenges of implementing a mass vaccination campaign of this size included the need
for detailed microplanning for a phased approach, transport logistics, staff training to deliver different
formulations of the vaccine, cold chain requirements exceeding the normal capacity of the Fiji
Pharmaceutical and Biomedical Services Centre (FPBS), risk communications and community
mobilisation, and monitoring and evaluation.
3.2 Challenges to achieving regional immunisation targets in the Pacific
National case studies presented at the Tenth Pacific Immunisation Programme Managers
Meeting1 identified a number of challenges to achieving and maintaining regional immunisation
targets over time including: limited human resources with high staff turnover; the need for active
follow-up of dropouts through outreach services; tracing families with high mobility; access to
uninterrupted financial flows and resources for immunisation; logistical challenges such as transport
to the outer islands and for other operational needs including supervisory visits; inadequate cold chain
systems; and inadequate information management systems.
Despite vaccination coverage indicators currently being on track in the Pacific to meet global
and regional targets, PICs are facing considerable immunisation supply chain and cold chain
management challenges due to geographical/logistical complexities and limited resources. While
vaccine coverage indicators tell us the percentage of children reached, strong cold chain systems are
required to ensure the vaccines given to children are effective. Without a reliable cold chain, vaccines
can lose their potency (effectiveness) so that vaccinated children may not be immunised. To remain
potent, vaccines must be transported and stored under strict temperature control conditions of between
2°C and 8°C.
There have been considerable improvements in strengthening immunisation cold chain
systems in Fiji, Vanuatu, Solomon Islands and Kiribati, increasing the coverage rates of cold chain
access to for more than 85% of all immunisation service points (health facilities) during the last four
years despite these countries having relatively more complex logistics.
SPC/PHoH 7/Paper no. 12
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3.2 Vaccine hesitancy
Vaccine hesitancy is an increasing concern globally. Vaccine hesitancy is defined by the
SAGE Vaccine Hesitancy Working Group17
as “…the delay in acceptance or refusal of vaccination
despite availability of vaccination services”. SAGE noted that vaccine hesitancy is context specific,
varying across time, place and vaccines, and influenced by factors such as confidence in the
immunisation program, complacency and convenience. Vaccine hesitancy tends to increase after
serious adverse events following immunisation (AEFI).
Generating acceptance and demand for immunisation aims to ensure that parents, caregivers,
communities, and other stakeholders have the necessary knowledge, motivation, and opportunities to
seek vaccination, and to complete the schedule on time. Confidence in the safety and quality of
vaccines and immunisation programs, including through the reporting and investigation of AEFIs and
proactive risk communication and community engagement, is key to maintaining acceptance and
demand for immunisation. Partner support for improved reporting, timely and comprehensive
investigation and data analysis should be considered in this regard.
4. FUTURE DIRECTIONS
4.1 Are we ready to harmonise immunisation schedules across the Pacific?
At present, there is no Pacific-wide harmonisation of the vaccine formulations used, the ages
at which vaccines are recommended nor the number of vaccine doses that are recommended for each
vaccine, although under the UNICEF VII mechanism participating PICs harmonise their product
selections and therefore have harmonised vaccine formulations. For measles-containing vaccines
(MCVs) for example, there are 9 different dosing schedules among the 18 of 20 PICs that have
implemented a 2-dose schedule, while two countries have not yet implemented MCV2. In addition,
14 of the 20 PICs use MMR while 6 use MR vaccines (Table).
Globally, reasons behind variability in immunisation schedules include differences in the
epidemiology of vaccine preventable diseases in each country, the history behind each country’s
immunisation schedule, and differences in the way that countries make decisions about which
vaccines to offer. In 2019, the Pacific can be regarded as one epidemiological unit for the VPDs slated
for elimination.
17 MacDonald NE and the SAGE Working Group on Vaccine Hesitancy. Vaccine hesitancy: Definition, scope
and determinants, Vaccine 2015; 33:4161–4164.
SPC/PHoH 7/Paper no. 12
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A more harmonised approach to immunisation will go some way towards addressing some of
the Pacific regional challenges to achieving the GVAP immunisation goals. UNICEF and WHO has
been working with PICs to strengthen national vaccine supply chains which are not keeping pace with
the increased complexity and changing landscape of immunisation programs. Since the 1980s,
immunisation programs have been increasingly challenged with the need to provide protection against
2.5 times as many diseases than initially targeted, administer three times as many doses per person
and serve a global target population size that has doubled. All PICs should give particular focus and
allocate sufficient resources toward strengthening their immunisation supply chains and cold chain
infrastructure in the coming years. Through the Effective Vaccine Management Initiative led by
WHO and UNICEF, structured technical guidance can be offered.
The proposed introduction of new vaccines provides an opportunity to review the whole
immunisation schedule and learn from the experiences of other countries. A common approach to
immunisation of some, if not all vaccines, across the Pacific can result in some benefits, including
increasing opportunities for pooled procurement with associated economies of scale, and simplifying
the management of individual immunisation schedules for highly mobile children.
4.1 Recommendations for governments:
Heads of Health are invited to:
i. Note the global developments pertaining to the re-emergence of some vaccine preventable
diseases and the risks from emerging VPDs, the coverage of selected vaccines in the Pacific
and progress and challenges in delivering immunisation services.
ii. Consider whether there is rationale in harmonising immunisation schedules across the Pacific
where possible, while recognising that this may not be possible for all countries and all
vaccines.
SPC/PHoH 7/Paper no. 12
page 10
Table – Immunisations offered by antigens for 13 Pacific island countries COK, FJI, KIR, MHL, FSM, NRU, NIU, PLW, WSM, SLB, TON, TUV, VUT. Some countries use multiple formulations
Country Antigens Schedules
Cook Islands BCG birth
DTwP 4 years
DTwPHibHepB 6 weeks; 3, 5 months (not entire country)
HepB_Paediatric birth
HPV 9 years
IPV 5 months
MMR 15 months; 4 years
OPV 6 weeks; 3, 5 months
Pneumo_conj Rotavirus Td
From 2020 From 2020 11 years
Fiji BCG birth
DTwPHibHepB 6, 10, 14 weeks
HepB_Paediatric birth
HPV 8-13 years; + 6 months
IPV 14 weeks
MR 12, 18 months
OPV 6, 10, 14 weeks; 18 months
Pneumo_conj 6, 10, 14 weeks
Rotavirus 6, 14 weeks
Td 6, 11 years (school children and pregnant mothers)
Kiribati BCG birth
DTwP 6 years
DTwPHibHepB 6, 10, 14 weeks
HepB_Paediatric birth
IPV 14 weeks
MR 12 months; 6 years
OPV 6, 10, 14 weeks
Pneumo_conj 6, 10, 14 weeks
Rotavirus 6, 10 weeks
Td 13 years
Marshall Islands BCG birth
DTaPHepBIPV 2, 4, 6, 12 months; 4-6 years
DTaPHibIPV 2, 4, 12 months
DTaPIPV 4-5 years
HepB_Paediatric birth; 2, 6, months
Hib 2, 4, 12 months
HPV 11-12 years
Influenza_Paediatric 6 months-4 years
IPV 2, 4, 6 months; 4-6 years
MMR 12, 13 months
Pneumo_conj 2, 4, 6, 12 months
Rotavirus 2, 4, 6, 12 months
Tdap 11-12 years
FSM BCG birth
SPC/PHoH 7/Paper no. 12
page 11
DTaP 12 months; >=4 years
DTaPHepBIPV 2, 4, 6 months
HepB_Paediatric birth
Hib 2, 4, 12 months
HPV 9 years; +6 months
IPV >= 4 years
MMR 12, +1 months
Pneumo_conj 2, 4, 6, 13 months
Rotavirus 2, 4, 12 months
Td >10 years
Tdap >11 years
Nauru BCG birth
DTwP 18 months
DTwPHibHepB 6, 10, 14 weeks
HepB_Paediatric Birth
HPV IPV
From 2020 14 weeks
MR MMR
12, 15 months From 2020
OPV 6, 10, 14 week; 18 months; 4 years
Pneumo_conj Rotavirus Td
From 2020 From 2020 4 years
Niue BCG birth
DTaPHibHepBIPV 6 weeks; 3, 5 months
DTaPIPV 4 years
HepB_Paediatric birth
HIB 15 months
HPV MMR
From 2020 15 months; 4 years
Pneumo_conj 6 weeks; 3, 5, 15 months
Rotavirus 6 weeks; 3 months
Td 11 years
Palau DTaP 4, 15 months; 4-6 years
DTaPHepBIPV 2, 6 months
HepB_Paediatric birth
Hib 2, 4, 6, 12 months
HPV 9-26 years; +6 months
IPV 3 months; 4-6 years
MMR 12, 15 months
Pneumo_conj 3, 5, 7, 15 months
Rotavirus 2, 4, 6 months
Td >=7 years
Samoa BCG birth
DTwP 5 years
DTwPHibHepB 6, 10, 14 weeks
HepB_Paediatric birth
HPV IPV
From 2020 14 weeks
SPC/PHoH 7/Paper no. 12
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WHO vaccine-preventable diseases: monitoring system Last updated 22-Oct-2018 (data as of 18-Sep-2018) http://apps.who.int/immunisation_monitoring/globalsummary/diseases
MMR 12, 15 months
OPV 6, 10, 14 weeks
Pneumo_conj Rotavirus Td
From 2020 From 2020 28 weeks; +2, +3 months; +1, +1 year
Solomon Islands BCG birth
DTwPHibHepB 6, 10, 14 weeks
HepB_Paediatric birth
HPV 9 years; +6 months (to be introduced in June 2019)
IPV 14 weeks
MR 12 months
OPV 6, 10, 14 weeks
Pneumo_conj 6, 10, 14 weeks
Rotavirus Td
From 2020 1st contact pregnancy; +1, +6 months; +1, +6 years
Tonga BCG birth
DTwP 18 months; 5-6 years
DTwPHibHepB 6, 10, 14 weeks
HepB_Paediatric birth
HPV From 2020
IPV 14 weeks
MMR From 2020
MR 12, 18 months
OPV 6, 10, 14 weeks
Pneumo_conj From 2020
Rotavirus From 2020
Td 16 years (school leavers and pregnant mothers)
Tuvalu BCG birth
DTwP 5-6 years
DTwPHibHepB 6, 10, 14 weeks
HepB_Paediatric birth;
HPV IPV
From 2020 6, 10, 14 weeks; 12 months
MR MMR
12, 18 months From 2020
Pneumo_conj Rotavirus Td
From 2020 From 2020 1st contact; +4 weeks; +6 months (pregnant mothers)
Vanuatu BCG birth
DTwPHibHepB 6, 10, 14 weeks
HepB_Paediatric birth
IPV 14 weeks
HPV MR
From 2020 12 months (second dose to be introduced in 2020)
OPV 6, 10, 14 weeks; 6, 12 years
Pneumo_conj Rotavirus Td
From 2020 From 2020 6, 12 years
Td
1st contact; +2, +6 months; +1, +2 years (pregnant mothers)
SPC/PHoH 7/Paper no. 12
page 13
BCG DTwP
Bacille Calmette-Guérin vaccine Diphtheria and tetanus toxoid with whole cell pertussis vaccine
DTaP Diphtheria and tetanus toxoid with acellular pertussis vaccine
DTaPHepBIPV Diphtheria and tetanus and pertussis and hepatitis B and IPV
DTaPHibHepB Diphtheria and tetanus toxoid with acellular pertussis, Hib and hepatitis B vaccine
DTaPHibHepBIPV Hexavalent diphtheria, tetanus toxoid with acellular pertussis, Hib, hepatitis B and IPV vaccine
DTaPHibIPV Diphtheria and tetanus toxoid with acellular pertussis, Hib and IPV
DTaPIPV Diphtheria and tetanus toxoid with acellular pertussis and IPV
HepB_Paediatric Hepatitis B paediatric dose vaccine
Hib Haemophilus influenzae type b vaccine
HPV Human Papillomavirus vaccine
IPV Inactivated polio vaccine
MMR Measles mumps and rubella vaccine
MR Measles and rubella vaccine
OPV Oral polio vaccine
Pneumo_conj Pneumococcal conjugate vaccine
Rotavirus Rotavirus vaccine
Tdap Tetanus and diphtheria toxoids and acellular pertussis vaccine
Td Tetanus diphtheria vaccine
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