Maldives 2016

Immunization system highlights

� There is a draft comprehensive multi-year plan (cMYP) for immunization covering 2016-2020.

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

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

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

� 100% of all vaccine costs as well as routine immunization costs financed by the government.

� All 20 Atolls have updated micro-plans that include activities to improve immunization coverage.

� All 20 Atolls have ³80% coverage for DTP-Hib-HepB3 and ³90% coverage for MCV1.

� No atoll reported more than 10% drop-out rate DTP1 to DTP3.

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

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 2015

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

EPI history � EPI launched in 1976. � Hepatitis B vaccine introduced in 1993. � MMR vaccine introduced in 2007. � Hib Pentavalent (DTP-Hib-HepB) vaccine started

at national level in 2013. � TT vaccine replaced by Td vaccine in 2015. � IPV introduced in 2015. � Type 2 component of OPV withdrawn on 18

April 2016 by switching from tOPV to bOPV.

Table 2: Immunization schedule, 2015

Source: cMYP 2009-2013 and EPI/MOH

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

World Health Organization• SEARO/FGL/IVD • 31 August 2012World Health Organization• SEARO/FGL/IVD • 31 August 2012 Immunization andVaccine Development

South-East Asia Region

Immunization andVaccine Development

South-East Asia Region

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

Figure 9: Immunity against measles: Immunity profile by age in 2015*

Figure 10: Immunity against measles: Immunity profile by age in 2016*

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

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

Source: SEAR annual EPI reporting form

* 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

Figure 11: Confirmed (Lab and Epi linked) measles outbreak associated cases, by age, 2010–2015

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

Table 10: Performance of Laboratory Surveillance, 2012–2015

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

Source: SEAR Annual EPI Reporting Form ND=No data

Source: SEAR Annual EPI Reporting Form ND=No data

For contact or feedback:National Program on Immunization and Travel HealthHealth Protection Agency, Ministry of Health, Male, Maldives. Phone: +960-3014495, Fax : +960-3014484Email: nash@health.gov.mv, www.health.gov.mv

Figure 13: Laboratory network

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

Total population 347 552

Live births (LB) 7 233

Children <1 year 7 277

Children <5 years 34 447

Children <15 years 96 797

Pregnant women 7 445

Women of child bearing age (15-49 years) 102 759

Neonatal mortality rate 6.0 (per 1,000 LB)

Infant mortality rate 8.4 (per 1,000 LB)

Under-five mortality rate 9.9 (per 1,000 LB)

Maternal mortality ratio 31 (per 100,000 LB)

Division/Province/State/Region –

Atoll/District 20

City 2

Island (inhabited) 196

Total Islands 1192

Population living in urban areas 42%

Population using improved drinking-water sources

99%

Population using improved sanitation 99%

Total expenditure on health as % of GDP 11.4%

Births attended by skilled health personnel 99%

Neonates protected at birth against NT 95%

Vaccine Age of administration

BCG At birth

HepB At birth

DTP-Hib-HepB 2 months, 4 months, 6 months

OPV2 months, 4 months, 6 months and 15+years pilgrims

IPV 6 months

Measles 9 months

MMR 18 months

TdFemales 15 to 45 years, +1 month, +6 months, +1 year, +1 year

Vitamin A 9 - 59 monthsYear Routine/sporadic cases Outbreak associated cases

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 0 0 0 0 0 0 0 0 0 0 0 0

2011 0 0 0 0 0 0 0 0 0 0 0 0

2012 0 0 0 0 0 0 0 0 0 0 0 0

2013 0 0 0 0 0 0 0 0 0 0 0 0

2014 0 0 0 0 0 0 0 0 0 0 0 0

2015 11 0 0 3 0 0 0 0 0 0 0 0

Year

No. o

f Sus

pect

ed M

easl

es

Case classification (number) Indicators

Measles Rubella

Disc

arde

d n

on-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 0 0 0 0 0 0 0 0 0 0 0 0 0

2013 0 0 0 0 0 0 0 0 0 0 0 0 0

2014 9 0 0 0 0 0 9 0 0 100 2.6 ND 100

2015 10 0 0 0 0 0 10 0 0 100 2.9 ND 100

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 0 0 0 0 0 0 0 0 0 – –

2013 0 0 0 0 0 0 0 0 0 – –

2014 100 9 100 0 0 0 0 100 0 – –

2015 100 10 100 0 0 3 30 100 0 – –

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

1

2

3

4

5

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

n=0 n=0 n=0 n=0 n=0 n=0

No Measles case / outbreak

1

2

3

4

5

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

n=0 n=0 n=0 n=0 n=0 n=0(0%) (0%) (0%) (0%) (0%) (0%)

No Measles case / outbreak

Indira Gandhi Memorial Hospital National measles and rubella laboratory

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

Figure 1: National immunization coverage, 1980–2015* Figure 6: MCV1 & MCV2 coverage1 and measles cases2, 1980–2015

Figure 2: DTP3 coverage1, diphtheria and pertussis cases2, 1980–2015

Figure 7: MCV1 coverage by province, 2015

Figure 4: TT2+ coverage1 and NT cases2, 1980–2015Table 7: Districts with more than 95% MCV1 coverage

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

Source: SEAR annual EPI reporting form, 2015 (administrative data)

Source: WHO/UNICEF JRF

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

Source: SEAR annual EPI reporting form, 2015 (administrative data)

1 Country offi cial estimates, 1980–2015.2 WHO vaccine-preventable diseases: monitoring system 2016

Source: WHO/UNICEF JRF

Figure 3: DTP-Hib-HepB3 coverage, 2015Table 6: MCV supplementary immunization activities

Figure 5:Acute Flaccid Paralysis (AFP) cases 2010-2015

Table 3: OPV supplementary immunization activities (SIA)

Figure 8: Sporadic and outbreak associated measles cases* by month 2010–2015

Source: NCCPE report and WHO/UNICEF JRF

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

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.

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

Table 4: AFP surveillance performance indicators, 2006–2015

Last laboratory-confirmed polio case due to wild polio virus (WPV) was reported in 1994.

Maldives achieved maternal neonatal tetanus (MNT) elimination status before 2000.

Indicator 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

AFP cases 1 0 0 4 4 3 4 1 1 5

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

Compatible cases 0 0 0 0 0 0 0 0 0 0

AFP rate 1.04 0 0 4.40 4.53 3.40 4.55 1.08 1.12 5.60

Non-polio AFP rate1 1.04 0 0 4.40 4.53 3.40 4.55 1.08 1.12 5.60

Adequate stool specimen collection percentage2 100% 0% 0% 50% 50% 33% 75% 100% 100% 60%

Total stool samples collected 2 0 0 6 4 2 6 2 2 6

% NPEV isolation 0 0 0 0 0 0 0 0 0 0

% Timeliness of primary result reported3 0 0 0 100 100 0 100 100 100 0

Source: WHO/UNICEF JRF ND=No data

Year ActivityTarget population

(<5 years)Date of 1st round Date of 2nd round

1st round coverage (%)

2nd round coverage (%)

1997–98 NID 40 000 (<5 yrs) 18-Dec-97 18-Jan-98 43 40

1998–99 NID 39 000 (<5 yrs) 18-Dec-98 18-Jan-99 41 44

1999–00 NID 38 000 (<5 yrs) 18-Dec-99 18-Jan-00 47 50

2000–01 NID 37 500 (<5 yrs) 18-Dec-00 18-Jan-01 53 53

2001–02 SNID 35 000 (<5 yrs) 18-Dec-01 18-Jan-02 29 14

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

Measles Rubella Mumps Japanese Encephalitis

Congenital Rubella Syndrome

2006 0 0 0 0 47 0 5 349 ND ND

2007 0 0 0 0 20 ND 341 ND ND

2008 0 0 0 0 2 ND 114 ND ND

2009 0 0 0 0 6 0 71 0 0

2010 0 0 0 0 0 0 50 0 0

2011 0 0 0 0 0 0 69 0 0

2012 0 0 0 0 0 0 14 0 0

2013 0 0 0 0 0 0 17 0 0

2014 0 0 0 0 0 0 0 0 0

2015 0 0 0 0 0 3 0 0 0

Year Vaccine, geographic coverage, target group Target Coverage Achieved

2005MR, nationwide, 6 to 25 years-males and 6 to

35 years-females144 997 82%

2006MR, nationwide, 6 to 25 years-males and 6 to

35 years-females144 997 85%

2007 MMR, nationwide, 4 to 6 years 29 529 56%

Year Number of districts %

2010 20 100

2011 20 100

2012 20 100

2013 20 100

2014 20 100

2015 20 100

0

20

40

60

80

100

0

1

2

3

4

5

6

7

8

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

0

20

40

60

80

100

0

1

2

3

4

5

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

% C

over

age

No. o

f cas

es

Year NT cases TT2+ Coverage

2010 = 4 cases

2011 = 3 cases

2012 = 4 cases

2013 = 1 case

2014 = 1 case

2015 = 5 cases

0

20

40

60

80

100

0

500

1000

1500

2000

2500

3000

3500

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

% C

over

age

No. o

f cas

es

Year

Measles Cases MCV1 Coverage MCV2 Coverage

0

2

4

6

8

10

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

No Measles case / outbreak

1980 1985 1990 1995 2000 2005 2010 2011 2012 2013 2014 2015BCG 7 45 99 99 99 97 97 98 99 99 99 99DTP3 4 28 94 94 98 98 96 96 99 99 99 99OPV3 4 28 94 97 98 98 97 96 99 99 99 99MCV1 47 96 96 99 97 97 96 98 99 99 99

0

20

40

60

80

100

% C

over

age

<70% 70%–79% 80%–89% > 90%

<70% 70%–79% 80%–89% > 90

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

Figure 1: National immunization coverage, 1980–2015* Figure 6: MCV1 & MCV2 coverage1 and measles cases2, 1980–2015

Figure 2: DTP3 coverage1, diphtheria and pertussis cases2, 1980–2015

Figure 7: MCV1 coverage by province, 2015

Figure 4: TT2+ coverage1 and NT cases2, 1980–2015Table 7: Districts with more than 95% MCV1 coverage

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

Source: SEAR annual EPI reporting form, 2015 (administrative data)

Source: WHO/UNICEF JRF

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

Source: SEAR annual EPI reporting form, 2015 (administrative data)

1 Country offi cial estimates, 1980–2015.2 WHO vaccine-preventable diseases: monitoring system 2016

Source: WHO/UNICEF JRF

Figure 3: DTP-Hib-HepB3 coverage, 2015Table 6: MCV supplementary immunization activities

Figure 5:Acute Flaccid Paralysis (AFP) cases 2010-2015

Table 3: OPV supplementary immunization activities (SIA)

Figure 8: Sporadic and outbreak associated measles cases* by month 2010–2015

Source: NCCPE report and WHO/UNICEF JRF

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

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.

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

Table 4: AFP surveillance performance indicators, 2006–2015

Last laboratory-confirmed polio case due to wild polio virus (WPV) was reported in 1994.

Maldives achieved maternal neonatal tetanus (MNT) elimination status before 2000.

Indicator 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

AFP cases 1 0 0 4 4 3 4 1 1 5

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

Compatible cases 0 0 0 0 0 0 0 0 0 0

AFP rate 1.04 0 0 4.40 4.53 3.40 4.55 1.08 1.12 5.60

Non-polio AFP rate1 1.04 0 0 4.40 4.53 3.40 4.55 1.08 1.12 5.60

Adequate stool specimen collection percentage2 100% 0% 0% 50% 50% 33% 75% 100% 100% 60%

Total stool samples collected 2 0 0 6 4 2 6 2 2 6

% NPEV isolation 0 0 0 0 0 0 0 0 0 0

% Timeliness of primary result reported3 0 0 0 100 100 0 100 100 100 0

Source: WHO/UNICEF JRF ND=No data

Year ActivityTarget population

(<5 years)Date of 1st round Date of 2nd round

1st round coverage (%)

2nd round coverage (%)

1997–98 NID 40 000 (<5 yrs) 18-Dec-97 18-Jan-98 43 40

1998–99 NID 39 000 (<5 yrs) 18-Dec-98 18-Jan-99 41 44

1999–00 NID 38 000 (<5 yrs) 18-Dec-99 18-Jan-00 47 50

2000–01 NID 37 500 (<5 yrs) 18-Dec-00 18-Jan-01 53 53

2001–02 SNID 35 000 (<5 yrs) 18-Dec-01 18-Jan-02 29 14

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

Measles Rubella Mumps Japanese Encephalitis

Congenital Rubella Syndrome

2006 0 0 0 0 47 0 5 349 ND ND

2007 0 0 0 0 20 ND 341 ND ND

2008 0 0 0 0 2 ND 114 ND ND

2009 0 0 0 0 6 0 71 0 0

2010 0 0 0 0 0 0 50 0 0

2011 0 0 0 0 0 0 69 0 0

2012 0 0 0 0 0 0 14 0 0

2013 0 0 0 0 0 0 17 0 0

2014 0 0 0 0 0 0 0 0 0

2015 0 0 0 0 0 3 0 0 0

Year Vaccine, geographic coverage, target group Target Coverage Achieved

2005MR, nationwide, 6 to 25 years-males and 6 to

35 years-females144 997 82%

2006MR, nationwide, 6 to 25 years-males and 6 to

35 years-females144 997 85%

2007 MMR, nationwide, 4 to 6 years 29 529 56%

Year Number of districts %

2010 20 100

2011 20 100

2012 20 100

2013 20 100

2014 20 100

2015 20 100

0

20

40

60

80

100

0

1

2

3

4

5

6

7

8

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

0

20

40

60

80

100

0

1

2

3

4

5

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

% C

over

age

No. o

f cas

es

Year NT cases TT2+ Coverage

2010 = 4 cases

2011 = 3 cases

2012 = 4 cases

2013 = 1 case

2014 = 1 case

2015 = 5 cases

0

20

40

60

80

100

0

500

1000

1500

2000

2500

3000

3500

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

% C

over

age

No. o

f cas

es

Year

Measles Cases MCV1 Coverage MCV2 Coverage

0

2

4

6

8

10

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

No Measles case / outbreak

1980 1985 1990 1995 2000 2005 2010 2011 2012 2013 2014 2015BCG 7 45 99 99 99 97 97 98 99 99 99 99DTP3 4 28 94 94 98 98 96 96 99 99 99 99OPV3 4 28 94 97 98 98 97 96 99 99 99 99MCV1 47 96 96 99 97 97 96 98 99 99 99

0

20

40

60

80

100

% C

over

age

<70% 70%–79% 80%–89% > 90%

<70% 70%–79% 80%–89% > 90

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

Figure 1: National immunization coverage, 1980–2015* Figure 6: MCV1 & MCV2 coverage1 and measles cases2, 1980–2015

Figure 2: DTP3 coverage1, diphtheria and pertussis cases2, 1980–2015

Figure 7: MCV1 coverage by province, 2015

Figure 4: TT2+ coverage1 and NT cases2, 1980–2015Table 7: Districts with more than 95% MCV1 coverage

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

Source: SEAR annual EPI reporting form, 2015 (administrative data)

Source: WHO/UNICEF JRF

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

Source: SEAR annual EPI reporting form, 2015 (administrative data)

1 Country offi cial estimates, 1980–2015.2 WHO vaccine-preventable diseases: monitoring system 2016

Source: WHO/UNICEF JRF

Figure 3: DTP-Hib-HepB3 coverage, 2015Table 6: MCV supplementary immunization activities

Figure 5:Acute Flaccid Paralysis (AFP) cases 2010-2015

Table 3: OPV supplementary immunization activities (SIA)

Figure 8: Sporadic and outbreak associated measles cases* by month 2010–2015

Source: NCCPE report and WHO/UNICEF JRF

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

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.

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

Table 4: AFP surveillance performance indicators, 2006–2015

Last laboratory-confirmed polio case due to wild polio virus (WPV) was reported in 1994.

Maldives achieved maternal neonatal tetanus (MNT) elimination status before 2000.

Indicator 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

AFP cases 1 0 0 4 4 3 4 1 1 5

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

Compatible cases 0 0 0 0 0 0 0 0 0 0

AFP rate 1.04 0 0 4.40 4.53 3.40 4.55 1.08 1.12 5.60

Non-polio AFP rate1 1.04 0 0 4.40 4.53 3.40 4.55 1.08 1.12 5.60

Adequate stool specimen collection percentage2 100% 0% 0% 50% 50% 33% 75% 100% 100% 60%

Total stool samples collected 2 0 0 6 4 2 6 2 2 6

% NPEV isolation 0 0 0 0 0 0 0 0 0 0

% Timeliness of primary result reported3 0 0 0 100 100 0 100 100 100 0

Source: WHO/UNICEF JRF ND=No data

Year ActivityTarget population

(<5 years)Date of 1st round Date of 2nd round

1st round coverage (%)

2nd round coverage (%)

1997–98 NID 40 000 (<5 yrs) 18-Dec-97 18-Jan-98 43 40

1998–99 NID 39 000 (<5 yrs) 18-Dec-98 18-Jan-99 41 44

1999–00 NID 38 000 (<5 yrs) 18-Dec-99 18-Jan-00 47 50

2000–01 NID 37 500 (<5 yrs) 18-Dec-00 18-Jan-01 53 53

2001–02 SNID 35 000 (<5 yrs) 18-Dec-01 18-Jan-02 29 14

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

Measles Rubella Mumps Japanese Encephalitis

Congenital Rubella Syndrome

2006 0 0 0 0 47 0 5 349 ND ND

2007 0 0 0 0 20 ND 341 ND ND

2008 0 0 0 0 2 ND 114 ND ND

2009 0 0 0 0 6 0 71 0 0

2010 0 0 0 0 0 0 50 0 0

2011 0 0 0 0 0 0 69 0 0

2012 0 0 0 0 0 0 14 0 0

2013 0 0 0 0 0 0 17 0 0

2014 0 0 0 0 0 0 0 0 0

2015 0 0 0 0 0 3 0 0 0

Year Vaccine, geographic coverage, target group Target Coverage Achieved

2005MR, nationwide, 6 to 25 years-males and 6 to

35 years-females144 997 82%

2006MR, nationwide, 6 to 25 years-males and 6 to

35 years-females144 997 85%

2007 MMR, nationwide, 4 to 6 years 29 529 56%

Year Number of districts %

2010 20 100

2011 20 100

2012 20 100

2013 20 100

2014 20 100

2015 20 100

0

20

40

60

80

100

0

1

2

3

4

5

6

7

8

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

0

20

40

60

80

100

0

1

2

3

4

5

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

% C

over

age

No. o

f cas

es

Year NT cases TT2+ Coverage

2010 = 4 cases

2011 = 3 cases

2012 = 4 cases

2013 = 1 case

2014 = 1 case

2015 = 5 cases

0

20

40

60

80

100

0

500

1000

1500

2000

2500

3000

3500

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

% C

over

age

No. o

f cas

es

Year

Measles Cases MCV1 Coverage MCV2 Coverage

0

2

4

6

8

10

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

No Measles case / outbreak

1980 1985 1990 1995 2000 2005 2010 2011 2012 2013 2014 2015BCG 7 45 99 99 99 97 97 98 99 99 99 99DTP3 4 28 94 94 98 98 96 96 99 99 99 99OPV3 4 28 94 97 98 98 97 96 99 99 99 99MCV1 47 96 96 99 97 97 96 98 99 99 99

0

20

40

60

80

100

% C

over

age

<70% 70%–79% 80%–89% > 90%

<70% 70%–79% 80%–89% > 90

Maldives 2016

Immunization system highlights

� There is a draft comprehensive multi-year plan (cMYP) for immunization covering 2016-2020.

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

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

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

� 100% of all vaccine costs as well as routine immunization costs financed by the government.

� All 20 Atolls have updated micro-plans that include activities to improve immunization coverage.

� All 20 Atolls have ³80% coverage for DTP-Hib-HepB3 and ³90% coverage for MCV1.

� No atoll reported more than 10% drop-out rate DTP1 to DTP3.

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

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 2015

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

EPI history � EPI launched in 1976. � Hepatitis B vaccine introduced in 1993. � MMR vaccine introduced in 2007. � Hib Pentavalent (DTP-Hib-HepB) vaccine started

at national level in 2013. � TT vaccine replaced by Td vaccine in 2015. � IPV introduced in 2015. � Type 2 component of OPV withdrawn on 18

April 2016 by switching from tOPV to bOPV.

Table 2: Immunization schedule, 2015

Source: cMYP 2009-2013 and EPI/MOH

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

World Health Organization• SEARO/FGL/IVD • 31 August 2012World Health Organization• SEARO/FGL/IVD • 31 August 2012 Immunization andVaccine Development

South-East Asia Region

Immunization andVaccine Development

South-East Asia Region

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

Figure 9: Immunity against measles: Immunity profile by age in 2015*

Figure 10: Immunity against measles: Immunity profile by age in 2016*

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

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

Source: SEAR annual EPI reporting form

* 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

Figure 11: Confirmed (Lab and Epi linked) measles outbreak associated cases, by age, 2010–2015

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

Table 10: Performance of Laboratory Surveillance, 2012–2015

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

Source: SEAR Annual EPI Reporting Form ND=No data

Source: SEAR Annual EPI Reporting Form ND=No data

For contact or feedback:National Program on Immunization and Travel HealthHealth Protection Agency, Ministry of Health, Male, Maldives. Phone: +960-3014495, Fax : +960-3014484Email: nash@health.gov.mv, www.health.gov.mv

Figure 13: Laboratory network

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

Total population 347 552

Live births (LB) 7 233

Children <1 year 7 277

Children <5 years 34 447

Children <15 years 96 797

Pregnant women 7 445

Women of child bearing age (15-49 years) 102 759

Neonatal mortality rate 6.0 (per 1,000 LB)

Infant mortality rate 8.4 (per 1,000 LB)

Under-five mortality rate 9.9 (per 1,000 LB)

Maternal mortality ratio 31 (per 100,000 LB)

Division/Province/State/Region –

Atoll/District 20

City 2

Island (inhabited) 196

Total Islands 1192

Population living in urban areas 42%

Population using improved drinking-water sources

99%

Population using improved sanitation 99%

Total expenditure on health as % of GDP 11.4%

Births attended by skilled health personnel 99%

Neonates protected at birth against NT 95%

Vaccine Age of administration

BCG At birth

HepB At birth

DTP-Hib-HepB 2 months, 4 months, 6 months

OPV2 months, 4 months, 6 months and 15+years pilgrims

IPV 6 months

Measles 9 months

MMR 18 months

TdFemales 15 to 45 years, +1 month, +6 months, +1 year, +1 year

Vitamin A 9 - 59 monthsYear Routine/sporadic cases Outbreak associated cases

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 0 0 0 0 0 0 0 0 0 0 0 0

2011 0 0 0 0 0 0 0 0 0 0 0 0

2012 0 0 0 0 0 0 0 0 0 0 0 0

2013 0 0 0 0 0 0 0 0 0 0 0 0

2014 0 0 0 0 0 0 0 0 0 0 0 0

2015 11 0 0 3 0 0 0 0 0 0 0 0

Year

No. o

f Sus

pect

ed M

easl

es

Case classification (number) Indicators

Measles Rubella

Disc

arde

d n

on-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 0 0 0 0 0 0 0 0 0 0 0 0 0

2013 0 0 0 0 0 0 0 0 0 0 0 0 0

2014 9 0 0 0 0 0 9 0 0 100 2.6 ND 100

2015 10 0 0 0 0 0 10 0 0 100 2.9 ND 100

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 0 0 0 0 0 0 0 0 0 – –

2013 0 0 0 0 0 0 0 0 0 – –

2014 100 9 100 0 0 0 0 100 0 – –

2015 100 10 100 0 0 3 30 100 0 – –

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

1

2

3

4

5

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

n=0 n=0 n=0 n=0 n=0 n=0

No Measles case / outbreak

1

2

3

4

5

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

n=0 n=0 n=0 n=0 n=0 n=0(0%) (0%) (0%) (0%) (0%) (0%)

No Measles case / outbreak

Indira Gandhi Memorial Hospital National measles and rubella laboratory

Maldives 2016

Immunization system highlights

� There is a draft comprehensive multi-year plan (cMYP) for immunization covering 2016-2020.

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

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

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

� 100% of all vaccine costs as well as routine immunization costs financed by the government.

� All 20 Atolls have updated micro-plans that include activities to improve immunization coverage.

� All 20 Atolls have ³80% coverage for DTP-Hib-HepB3 and ³90% coverage for MCV1.

� No atoll reported more than 10% drop-out rate DTP1 to DTP3.

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

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 2015

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

EPI history � EPI launched in 1976. � Hepatitis B vaccine introduced in 1993. � MMR vaccine introduced in 2007. � Hib Pentavalent (DTP-Hib-HepB) vaccine started

at national level in 2013. � TT vaccine replaced by Td vaccine in 2015. � IPV introduced in 2015. � Type 2 component of OPV withdrawn on 18

April 2016 by switching from tOPV to bOPV.

Table 2: Immunization schedule, 2015

Source: cMYP 2009-2013 and EPI/MOH

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

World Health Organization• SEARO/FGL/IVD • 31 August 2012World Health Organization• SEARO/FGL/IVD • 31 August 2012 Immunization andVaccine Development

South-East Asia Region

Immunization andVaccine Development

South-East Asia Region

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

Figure 9: Immunity against measles: Immunity profile by age in 2015*

Figure 10: Immunity against measles: Immunity profile by age in 2016*

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

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

Source: SEAR annual EPI reporting form

* 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

Figure 11: Confirmed (Lab and Epi linked) measles outbreak associated cases, by age, 2010–2015

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

Table 10: Performance of Laboratory Surveillance, 2012–2015

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

Source: SEAR Annual EPI Reporting Form ND=No data

Source: SEAR Annual EPI Reporting Form ND=No data

For contact or feedback:National Program on Immunization and Travel HealthHealth Protection Agency, Ministry of Health, Male, Maldives. Phone: +960-3014495, Fax : +960-3014484Email: nash@health.gov.mv, www.health.gov.mv

Figure 13: Laboratory network

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

Total population 347 552

Live births (LB) 7 233

Children <1 year 7 277

Children <5 years 34 447

Children <15 years 96 797

Pregnant women 7 445

Women of child bearing age (15-49 years) 102 759

Neonatal mortality rate 6.0 (per 1,000 LB)

Infant mortality rate 8.4 (per 1,000 LB)

Under-five mortality rate 9.9 (per 1,000 LB)

Maternal mortality ratio 31 (per 100,000 LB)

Division/Province/State/Region –

Atoll/District 20

City 2

Island (inhabited) 196

Total Islands 1192

Population living in urban areas 42%

Population using improved drinking-water sources

99%

Population using improved sanitation 99%

Total expenditure on health as % of GDP 11.4%

Births attended by skilled health personnel 99%

Neonates protected at birth against NT 95%

Vaccine Age of administration

BCG At birth

HepB At birth

DTP-Hib-HepB 2 months, 4 months, 6 months

OPV2 months, 4 months, 6 months and 15+years pilgrims

IPV 6 months

Measles 9 months

MMR 18 months

TdFemales 15 to 45 years, +1 month, +6 months, +1 year, +1 year

Vitamin A 9 - 59 monthsYear Routine/sporadic cases Outbreak associated cases

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 0 0 0 0 0 0 0 0 0 0 0 0

2011 0 0 0 0 0 0 0 0 0 0 0 0

2012 0 0 0 0 0 0 0 0 0 0 0 0

2013 0 0 0 0 0 0 0 0 0 0 0 0

2014 0 0 0 0 0 0 0 0 0 0 0 0

2015 11 0 0 3 0 0 0 0 0 0 0 0

Year

No. o

f Sus

pect

ed M

easl

es

Case classification (number) Indicators

Measles Rubella

Disc

arde

d n

on-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 0 0 0 0 0 0 0 0 0 0 0 0 0

2013 0 0 0 0 0 0 0 0 0 0 0 0 0

2014 9 0 0 0 0 0 9 0 0 100 2.6 ND 100

2015 10 0 0 0 0 0 10 0 0 100 2.9 ND 100

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 0 0 0 0 0 0 0 0 0 – –

2013 0 0 0 0 0 0 0 0 0 – –

2014 100 9 100 0 0 0 0 100 0 – –

2015 100 10 100 0 0 3 30 100 0 – –

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

1

2

3

4

5

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

n=0 n=0 n=0 n=0 n=0 n=0

No Measles case / outbreak

1

2

3

4

5

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

n=0 n=0 n=0 n=0 n=0 n=0(0%) (0%) (0%) (0%) (0%) (0%)

No Measles case / outbreak

Indira Gandhi Memorial Hospital National measles and rubella laboratory