Success Stories of EPI Programme

in Bangladesh

Dr. Md. Tajul Islam A. Bari

Program Manager

EPI & Surveillance, DGHS

EPI Structure of Rural Area

EPI HQ

District District

Upazila

Union

Ward

Stored in

Cold Room

Stored in ILR

Ward Ward

Immunization Site

Each site active

once a month

On day of

vaccination

activities

Stored in ILR

or freezer

64 Districts, 482 Upazila, 140,000 Immunization Sites

Immunisation success factors

• 140,000 EPI outreach sites

• 45,000 regular field workers and 21,000 first line supervisors

• PLUS NGO, community workers and volunteers

Urban Primary Health Care Service Delivery

Project (UPHCSDP)

A PROJECT

OF

MINISTRY OF LOCAL GOVERNMENT, RURAL

DEVELOPMENT & CO-OPERATIVES

Implemented by

11 City Corporations & 4 Municipalities

Vaccines & Target Population

• Children (0-1 Years) – Tuberculosis- BCG

– Poliomyelitis- OPV

– Diphtheria, Whooping Cough and Tetanus - DPT

– Hepatitis B- Hepatitis B Vaccine

– Measles- Measles Vaccine

- Measles &Rubella- MCV2 & MR vaccine

• Women (15-49 Years of age) – For protection of Neonate against Tetanus –

Tetanus Toxoid

Pentavelent Vaccine Containing

Hib, Hepatitis B and DPT

Vaccination schedule for children of

TT schedule for CBAW

Dose Starting dose/ dose interval Duration of

Protection

TT1 +

MR

15 years completed No Protection

TT2 At least 4 weeks after TT1 3 years

TT3 At least 6 months after TT2 5 years

TT4 At least 1 year after TT3 10 years

TT5 At least 1 year after TT4 Up to reproductive period

There is only minimum interval but no maximum interval in TT immunization schedule

TT Five doses contributes for reducing of maternal and neonatal mortality from tetanus

Vaccine Vial Monitor

Infection Control

Hand hygiene recommended

Auto Disable Syringe

Trends of national coverage: by antigen and fully vaccinated children by one year of age

Hep-B

Introduction

Hib Penta

Introduction

Laboratory Confirmed Polio Cases

29 Cases

18 Districts

6 Divisions

1999

2000

Meghalaya

(INDIA)

West Bengal

(INDIA)

Assam

(INDIA)

Tripura (INDIA)

*Data as of 15-01-13

2006

1 Case

1 District

1 Division

18 Cases

12 Districts

6 Divisions

Wild Poliovirus and VDPV India, 2011

*Dots are randomly placed within blocks (Sub-districts) Data as of 23 May 2011

1

0

1

3

4

4

P1 Wild13-Jan-2011; District Howra, West

Bengal

P3 Wild -

P2 VDPV12-Feb-2011; District Udaipur,

Rajasthan

Date and location of

most recent case

Polio Cases, India, 2011

Total P1 Wild cases

Total polio cases

Total districts with cases

Total P3 Wild cases

Total P2 VDPV cases

Total wild polio cases

Districts with cases in 2011

Districts with cases in current week

= Most recent P1 Wild polio case

= Most recent P3 Wild polio case

= Most recent VDPV type 2 case

A New Vaccine: 'bivalent oral polio vaccine'

(bOPV) increases impact & simplifies logistics

71%

49%

86%

53%

0

10

20

30

40

50

60

70

80

90

100

tOPV bOPV tOPV bOPV

Pro

tec

tio

n a

fte

r 2

do

se

s (

%)

Type 1 polio Type 3 polio

VDPVs

Sequence divergence of the VP1 capsid gene from Sabin strain:

≥1% VDPV

Global Certification Status, 2012

• AMRO (35) : Certification- 1994

• WPRO (27) : Certification- 2000

• EURO (52) : Certification- 2002

• SEARO (11) : Not Certified

• AFRO (48) : 127 (02) 2012

• EMRO (22) : 95 (02) 2012

SEAR Country eradication status : KB : 1986 DSRS: 1993 RM : 1994 RDTL : 1995 DPRK: 1996 KT : 1997

RUM : 2007 RN: 2010 RI : 2006

PRB : 2006 RI : 2011 • Data as of 15-01-2013

Validation of NT Elimination

It was documented in 2008 that Bangladesh already successfully ELIMINATE NEONATAL TETANUS from the country

65

69 6971

78

81 8183

85 86

64

616162

59

6767

71

59

5354

65

40

50

60

70

80

90

100

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

Perc

en

tag

e

0

5000

10000

15000

20000

25000

30000

Nu

mb

er

of

ca

se

s

Measles Case from JRF MCV1 Coverage

Implementation of strategies for

achieving objectives

Measles catch-up campaign

immunized: >35 million

Measles follow-up campaign

immunized: >20 million

Introduce MR vaccine at

9m and MCV2 at 15m

Hib Vaccine Impact Assessment on Meningitis us ing S entinel s ite and Defined P opulationP opulation S urveillanc e around S entinel S ite: Inc idenc e (

BDHS-2010 and CES-

2011

MGD 4 :Targets and Trends for Bangladesh

152

53 50

94

43

31

54

86

100

0

20

40

60

80

100

120

140

160

Base Line Status 2011 Target 2015

New vaccine introduction plan

$0

$20

$40

$60

$80

$100

$120

$140

$160

$180

2009 2011 2012 2013 2014 2015

Mill

ion

s

New

Underused

Traditional

Penta

MR

PCV

Rota

HepB