Indonesia 2014

Immunization andVaccine Development

South-East Asia Region

World Health Organization• SEARO/FHR/IVD • 22 July 2015

Table 1: Basic information1 2014

Division/Province/State/Region 34

District 413

City 98

Village 79,411

Population density (per sq. km) 132

Population living in urban areas 51%

Population using improved drinking-water sources

85%

Population using improved sanitation 59%

Total expenditure on health as % of GDP 2.9%

Births attended by skilled health personnel 83%

Neonates protected at birth against NT 85%

Vaccine Age of administration

HepB 0 to 7 days of birth

BCG 1 month

OPV 1 month, 2 months, 3 months, 4 months

DTP-HepB 2 months, 3 months, 4 months

DTP-Hib-HepB2 months, 3 months, 4 months, 18 months (selected provinces)

Measles 9 months, 24 months, 6-7 years

DT 6 -7 years

Td 7-8 years, 8-9 years

TT Females 15 to 39 years

Vitamin A 6 – 59 months

EPI history�� EPI launched in 1977.

�� HepB introduced in 1997.

�� AD syringe introduced in 2002.

�� MCV2 introduced in 2004.

�� DTP-HepB introduced in 2004 (in

phases).

�� Hib Pentavalent (DTP-Hib-HepB)

introduced in four provinces in

August 2013.

Source: cMYP 2015-2019

Immunization system highlights

� There is a comprehensive multi-year plan (cMYP) for immunization covering 2015-2019.

� A standing national technical advisory group on immunization (NTAGI) with formal written terms of reference exists.

� 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.

� 29 provinces have achieved MNT elimination status by May 2013.

� VPD surveillance and EPI review was conducted in June 2013.

� Basic Health Research survey was conducted in 2013.

� Drop-out study on vaccine hesitancy was carried out in Java provinces in 2011.

� 78% spending on routine vaccine financed by the government.

� 64% spending on routine immunization programme financed by the central government.

� 179 (35%) districts have updated micro-plans that include activities to raise immunization coverage.

� Out of 511 districts, 354(69%) districts had > 80% coverage for DTP-HepB3, 258 (50%) districts had > 90% coverage for MCV1 and no data on districts that had > 80% coverage for TT2+ in pregnant women in 2014.

� 74 (14%) districts reported more than 10% drop-out rate DTP1 to DTP3.

� Stock-out was reported for BCG, DTP-HepB, Polio, Measles & TT vaccines in 2014.

� Plan to introduce IPV nationwide in 2015-2016.

Total population 252,124,458

Live births (LB) 4,809,304

Children <1 year 4,665,025

Children <5 years 24,085,400

Children <15 years NA

Pregnant women 5,290,235

Women of child bearing age (15-49 years)

53,017,364

Neonatal mortality rate 15 (per 1,000 LB)

Infant mortality rate 26 (per 1,000 LB)

Under-five mortality rate 31 (per 1,000 LB)

Maternal mortality ratio 190 (per 100,000 LB)

1 SEAR annual EPI reporting form, 2014 and WHO, World Health Statistics 2014

Table 2: Immunization schedule, 2014

Source: WHO/UNICEF joint reporting form (JRF) 2014

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.

E P I F A C T S H E E T

World Health Organization• SEARO/FHR/IVD • 22 July 2015

Source: WHO/UNICEF coverage estimates.

Figure 3: DTP-Hib-HepB3 coverage, 2014

Figure 2: DTP3 coverage1, diphtheria and pertussis cases2, 1980-2014

1980 1985 1990 1995 2000 2005 2010 2011 2012 2013 2014

No.

of c

ases

Year

Diphtheria Cases Pertussis Cases DTP3 Coverage

0

2000

4000

6000

8000

10000

12000

1 WHO/UNICEF coverage estimates.2 WHO vaccine-preventable diseases: monitoring system 2014 & JRF 2014.

1 Country official estimates, 1980-2013, 2014 data not available2 WHO vaccine-preventable diseases: monitoring system 2014 & JRF 2014.

Source: SEAR annual EPI reporting form, 2014 (administrative data)

0

20

40

60

80

100

0200400600800

1000120014001600

1980 1985 1990 1995 2000 2005 2010 2011 2012 2013 2014

NT cases TT2+

% C

over

age

No. o

f cas

es

Figure 4: TT2+ coverage1 and NT cases2, 1980-2014

Table 3: OPV supplementary immunization activities (SIA), 2007-2014

Year Activity Target population (age)

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

2nd round coverage (%)

2002 NID 20,031,168 Sep-2002 Oct-2002 107 109

2005 SNID 6,287,418 May-2005 Jun-2005 104 93

2005 NID 23,426,156 Aug-2005 Sep-2005 95 98

2005 NID 23,620,427 Nov-2005 - 98 -

2006 SNID 3,050,873 Jan-2006 - 98 -

2006 NID 23,620,427 Feb-2006 Apr-2006 99 100

2006 SNID 4,523,187 Jun-2006 Aug-2006 96 98

2006 SNID 6,045,438 Sep-2006 - 92 -

2007 SNID 12,517,699 Feb-2007 Aug-2007 90 92

2009 SNID* 2,052,067 Oct-2009 - 97 -

2010 SNID* 4,322,178 Oct-2010 - 92 -

2011 SNID* 13,958,095 Oct-2011 - 98

Figure 1: National immunization coverage, 1980-2014

* During measles campaign Source: WHO/UNICEF JRF

1980 1985 1990 1995 2000 2005 2010 2011 2012 2013 2014BCG 61 65 74 77 81 86 88 98 99 98 93DTP3 27 60 69 75 72 81 81 83 85 78OPV3 13 60 71 72 79 82 81 84 86 79MCV1 26 58 63 76 77 78 80 85 84 77

0

20

40

60

80

100

% C

over

age

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

Source: WHO/UNICEF coverage estimates.

Figure 2: DTP3 coverage1, diphtheria and pertussis cases2, 1980-2014

0

20

40

60

80

100

1980 1985 1990 1995 2000 2005 2010 2011 2012 2013 2014

% C

over

age

No.

of c

ases

Year

Diphtheria Cases Pertussis Cases DTP3 Coverage

0

2000

4000

6000

8000

10000

12000

1 WHO/UNICEF coverage estimates.2 WHO vaccine-preventable diseases: monitoring system 2014 & JRF 2014.

Figure 1: National immunization coverage, 1980-2014

1980 1985 1990 1995 2000 2005 2010 2011 2012 2013 2014BCG 61 65 74 77 81 86 88 98 99 98 93DTP3 27 60 69 75 72 81 81 83 85 78OPV3 13 60 71 72 79 82 81 84 86 79MCV1 26 58 63 76 77 78 80 85 84 77

0

20

40

60

80

100

% C

over

age

0

20

40

60

80

100

% C

over

age

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 4: AFP surveillance performance indicators, 2005-2014

Figure 5: Non-polio AFP rate by province, 2014 Figure 6: Adequate stool specimen collection percentage by province, 2014

The last polio case due to wild polio virus (WPV) was reported from Tenggara district, Aceh on 20 February 2006.

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

Indicator 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

AFP cases 1,939 1,526 1,557 1,684 1,724 1,641 1,720 1,951 1,963 1,765

Wild poliovirus confirmed cases 303 2 0 0 0 0 0 0 0 0

Compatible cases 75 15 4 1 0 0 0 0 0 0

AFP rate 3.12 2.48 2.52 2.75 2.83 2.62 2.75 2.76 2.74 2.43

Non-polio AFP rate1 2.44 2.45 2.52 2.75 2.83 2.62 2.75 2.76 2.74 2.43

Adequate stool specimen collection percentage2 80% 83% 85% 84% 86% 85% 91% 92% 88% 89%

Total stool samples collected 3,760 2,978 3,020 3,328 3,343 3,184 3,386 3,828 3,826 3,424

% NPEV isolation 10 12 12 9 8 9 9 9 9 7

% Timeliness of primary result reported3 99 100 100 99 99 100 99 99 99 98

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

Measles Rubella Mumps Japanese Encephalitis

Congenital Rubella Syndrome

2005 303a 1,385 8,897 132 (7%) 15,853 ND ND ND ND

2006 2 162 3,356 118 (37%) 20,422 105 ND ND ND

2007 0 183 ND 141 (100%) 19,456 168 ND ND ND

2008 0 219 ND 183 (100%) 15,369 340 ND ND ND

2009 0 189 973 158 (68%) 20,818 2,090 ND ND ND

2010 0 432 ND 147 (100%) 18,869 1,323 ND ND ND

2011 0 806 1,941 114 (54%) 21,893 1,959 ND ND ND

2012 0 1,192 ND 106 15,489 1,020 ND ND ND

2013 0 775 2,976 78 (35%) 8,419 2,355 ND ND ND

2014 0 430 2,082 84 (8%) 12,943 3,843 ND 72 ND

Table 5: Reported cases of vaccine preventable disease, 2005-2014

a Excludes forty-six type 1 VDPVs. Source: WHO/UNICEF JRF ND=No data

Source: Weekly Acute Flaccid Paralysis (AFP) data Source: Weekly Acute Flaccid Paralysis (AFP) data

Immunization andVaccine Development

South-East Asia Region

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

1 WHO/UNICEF coverage estimates, for 2014 Country official estimate used, 2014-MCV2 coverage not available.2 WHO vaccine-preventable diseases: monitoring system 2014 & JRF 2014.

Figure 7: MCV1 & MCV2 coverage1 and measles cases2, 1980-2014

0

20

40

60

80

100

05000

100001500020000250003000035000400004500050000

1980 1985 1990 1995 2000 2005 2010 2011 2012 2013 2014

% C

over

age

No. o

f cas

es

Year

Measles Cases MCV1 Coverage MCV2 coverage

Figure 8: MCV1 coverage by province, 2014

Source: SEAR annual EPI reporting form, 2014 (administrative data)

Table 6: MCV supplementary immunization activities

Year Activity Age Target Coverage (%)

2000 Sub-national 6-12 Y 6,665,950 95

2003 Sub-national 6-12 Y 1,030,445 95

2004 Sub-national 6-12 Y 2,180,918 94

2005 Sub-national 6 M-15 Y 5,515,324 94

2006 Sub-national 6 M-5 Y 3,978,096 93

2006 Sub-national 6-12 Y 3,161,323 96

2007 Sub-national 6 M-12 Y 2,692,912 106

2007 Sub-national 6 Y-12 Y 2,569,350 102

2007 Sub-national 6-59 M 14,916,592 93

2008 Sub-national 1-3 Y 11,203 78

2009 Sub-national 9-59 M 1,763,122 97

2010 Sub-national 9-59 M 3,619,024 92

2011 Sub-national 9-59 M 11,843,093 98

Year Number of districts %

2010 197 40

2011 198 40

2012 269 54

2013 226 45

2014 199 38

Table 7: Districts with more than 95% MCV1 coverage

Source: WHO/UNICEF JRFs

Source: WHO/UNICEF JRF (multiple years)

Jan-

10Fe

b-10

Mar

-10

Apr-

10M

ay-1

0Ju

n-10

Jul-1

0Au

g-10

Sep-

10Oc

t-10

Nov-

10De

c-10

Jan-

11Fe

b-11

Mar

-11

Apr-

11M

ay-1

1Ju

n-11

Jul-1

1Au

g-11

Sep-

11Oc

t-11

Nov-

11De

c-11

Jan-

12Fe

b-12

Mar

-12

Apr-

12M

ay-1

2Ju

n-12

Jul-1

2Au

g-12

Sep-

12Oc

t-12

Nov-

12De

c-12

Jan-

13Fe

b-13

Mar

-13

Apr-

13M

ay-1

3Ju

n-13

Jul-1

3Au

g-13

Sep-

13Oc

t-13

Nov-

13De

c-13

Jan-

14Fe

b-14

Mar

-14

Apr-

14M

ay-1

4Ju

n-14

Jul-1

4Au

g-14

Sep-

14Oc

t-14

Nov-

14De

c-14

Sporadic measles Outbreak associated measles

0

100

200

300

400

500

600

700

No. o

f cas

es

M, SIA (92%) M, SIA (98%)

Figure 9: Sporadic and outbreak associated measles cases* by month and MR SIA coverage, 2010-2014

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

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

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

* Based on coverage and SIA data for up to 2014.Source: Modeled using MSP tool ver 2

* Assuming the schedule of 2nd dose of Measles containing vaccine is changed to 15 months and a measles SIA targeting age group 9 months to 9 years is done in 2016 with coverage more than 95%.Source: Modeled using MSP tool ver 2

Figure 12: Confirmed (Lab and Epi linked) measles outbreak associated cases, by age, 2010-2014

Figure 13: Unimmunized confirmed (Lab and Epi linked)measles outbreak associated cases, by age, 2010-2014

Source: SEAR annual EPI reporting form (multiple years) Source: SEAR annual EPI reporting form (multiple years)

Table 8: Suspected sporadic and Outbreak associated measles and rubella cases, 2010-2014

Year 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 19,111 6 659 750 188 132 3,044 7 90 2,066 40 504

2011 23,282 0 1,175 1,808 356 286 4,993 14 251 3,747 60 586

2012 18,798 4 429 1,565 163 144 2,328 4 65 1,117 76 939

2013 11,521 1 689 707 128 96 1,677 1 71 803 24 310

2014 12,943 7 1,471 713 173 119 2,104 21 114 1,285 7 69

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

0%

20%

10%

40%

60%

70%80%

90%

30%

50%

100%

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

Perc

ent o

f pop

ulat

ion

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

0

50

100

150

200

250

300

350

400

450

500

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

n=1627 n=2617 n=1119 n=365 n=1285

0%

20%

40%

60%

80%

100%

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

Perc

ent o

f pop

ulat

ion

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

n=1107 n=1468 n=775 n=280 ND

0

50

100

150

200

250

300

350

400

450

500

2010 2011 2012 2013 2014

<1 year 1-4 years 5-9 years 10-14 years 15+ years

(68%) (56%) (69%) (77%)

E P I F A C T S H E E T

World Health Organization• SEARO/FHR/IVD • 22 July 2015 Immunization andVaccine Development

South-East Asia Region

For contact or feedback:

Expanded Program on ImmunizationMinistry of Health, Jakarta, Indonesia

Tel : +62 21 4249024, Fax: +62 21 4249024

Email: primayosephine@yahoo.com or ratnayasfiyaw@gmail.com

www.depkes.go.id

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

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

Email: SEAREpidata@who.int,

www.searo.who.int/entity/immunization

Table 9: Quality of field and laboratory surveillance for measles and rubella, 2012-2014

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-r

ubel

la

case

s

Annu

al in

cide

nce

of c

onfir

med

Mea

sles

ca

ses

per m

illio

n to

tal p

opul

atio

n

Annu

al in

cide

nce

of c

onfir

med

Rub

ella

ca

ses

per m

illio

n to

tal p

opul

atio

n

Prop

ortio

n of

all

susp

ecte

d m

easl

es a

nd

rube

lla c

ases

that

hav

e ha

d an

ade

quat

e in

vest

igat

ion

initi

ated

with

in 4

8 ho

urs

of

notifi

catio

n

Disc

arde

d no

n-m

easl

es n

on-r

ubel

la

inci

denc

e pe

r 100

,000

tota

l pop

ulat

ion

Prop

ortio

n of

sub

natio

nal a

dmin

istra

tive

units

repo

rting

at l

east

two

disc

arde

d no

n-m

easl

es n

on-r

ubel

la c

ases

per

10

0,00

0 to

tal p

opul

atio

n

Prop

ortio

n of

sub

-nat

iona

l sur

veill

ance

un

its re

porti

ng to

the

natio

nal l

evel

on

time

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 18,798 429 ND ND 1,565 ND 1,561 1.75 6.18 ND 0.61 ND 64.23

2013 11,521 747 ND ND 742 ND 1,376 3.01 2.93 ND 0.54 ND 60.22

2014 12,943 1,870 ND ND 779 ND 2,173 7.39 3.08 ND 0.86 ND 22.06

Source: SEAR Annual EPI Reporting Form, 2014 ND=No data

Table 10: Performance of Laboratory Surveillance, 2012-2014

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 25 4,657 89 403 10% 921 25% 68 ND ND ND

2013 45 5,169 100 996 20% 1,042 25% 97 ND ND ND

2014 70 8,448 100 5,194 62% 1,140 36% 60 ND ND ND

Source: SEAR Annual EPI Reporting Form, 2014 ND=No data

Figure 14: Network of WHO supported surveillance medical officers and laboratories, 2014

Polio, measles & rubella laboratories- National Institute of Health Research and

Development (NIHRD), Jakarta - Biofarma, Bandung - Public Health Laboratory, Surabaya

Measles & rubella laboratory - Public Health Laboratory, Yogyakarta

Japanese encephalitis laboratory - NIHRD, Jakarta

Source: EPI Indonesia