Total population 156,012,726. Live births (LB) 3,525,888. Children <1 year 3,374,274. Children <5 years 16,381,336. Children <15 years 53,980,403

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1 Bangladesh 4 Immunization system highlights There is a comprehensive multi-year plan (cmyp) for immunization covering -6. A national policy for health care waste management including waste from immunization activities exists. 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. An EPI coverage evaluation survey (CES) was conducted in 4. Another CES is planned in the next 4 months. The last AFP/VPD surveillance and EPI review was completed in March. Table : Basic information 4 Total population 56,,76 Live births (LB) 3,55,888 Children < year 3,374,74 Children <5 years 6,38,336 Children <5 years 53,98,3 Pregnant women 3,55,888 Women of child bearing age (5-49 years) Neonatal mortality rate Infant mortality rate Under-five mortality rate Maternal mortality ratio 4,655,398 4 (per, LB) 33 (per, LB) 4 (per, LB) 7 (per, LB) SEAR annual EPI reporting form, 4 and WHO, World Health Statistics 4 Division/Province/State/Region 7 District 64 Upazilla/Sub-district 48 City Corporation Union 4,498 Ward 3,4 Sub-Block 8, Population density (per sq. km),57 Population living in urban areas 9% Population using improved drinking-water sources 85% Population using improved sanitation 57% Total expenditure on health as % of GDP 3.8% Births attended by skilled health personnel 3% Neonates protected at birth against NT % DTP-Hib-HepB post-introduction evaluation was completed in March. Bangladesh achieved the status of maternal neonatal tetanus (MNT) elimination in 8. 56% spending on vaccines financed by the government. 53% 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 >8% coverage for DTP-Hib-HepB3 and 56 (88%) districts had >9% coverage for MCV. No district reported more than % drop-out rate DTP-Hib- HepB to DTP-Hib-HepB3. Table : Immunization schedule, 4 Vaccine BCG DTP-Hib-HepB OPV MCV TT Vitamin A Age of administration At birth 6 weeks, weeks, 4 weeks 6 weeks, weeks, 4 weeks, 38 weeks MR-38 weeks and +5 years female, Measles-5 months Females 5 to 49 years (5 doses with an interval of + month, + 6 months, + year and + year with preceding dose) 6-59 months Source: WHO/UNICEF joint reporting form (JRF) 4 EPI history Launched on 7 April 979. Vitamin A supplementation started in. TT5 dose for WCBA started in 3. Polio SIA started in 5. HepB started in 3. AD syringes introduced in 4. MCV SIA started in 5. Hib Pentavalent (DTP-Hib-HepB) introduced in 9. MR and second dose introduced in. Source: cmyp -6 IPV and PCV introduced in March 5. 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. World Health Organization SEARO/FHR/IVD July 5 Immunization and Vaccine Development South-East Asia Region

2 E P I FAC T S H E E T Figure : DTP3 coverage, diphtheria and pertussis, 98-4 Figure : National immunization coverage, 98-4,436 3,7 8 BCG DTP3 Pol3 MCV Diphtheria Cases Source: WHO/UNICEF coverage estimates. Pertussis Cases DTP3 Coverage WHO/UNICEF coverage estimates 3. WHO vaccine-preventable diseases: monitoring system 4 & JRF 4. Figure 4: TT+ coverage and NT, 98-4 Figure 3: DTP-Hib-HepB3 coverage, NT TT+ Coverage <7% 7% - 79% 8% - % Country official estimates, 98-4 WHO vaccine-preventable diseases: monitoring system 4 & JRF 4. > 9% Source: SEAR annual EPI reporting form, 4 (administrative data) Table 3: OPV supplementary immunization activities (SIA), 7-4 Activity S * * Target population (< 5 years) 3,8,574,865,659 3,98,744 4,43,6,5,57,,847,5,,3,83,9,556,73,9,53,48,63,77 Date of st round Source: WHO/UNICEF JRF World Health Organization SEARO/FHR/IVD July 5 3-Mar-7 -May-7 7-Oct-7 9-Nov-8 -Jan- 4-Feb- 8-Jan- 7-Jan- -Dec-3 5-Jan-4 Date of nd round st round coverage (%) nd round coverage (%) 8-Apr-7 -Jul-7 8-Dec-7 3-Jan-9 -Feb- -Feb- - - * One dose OPV given during campaign 8 4,879 8

3 Table 4: AFP surveillance performance indicators, 5-4 Last polio case due to indigenous wild polio virus (WPV) was reported from Dhaka district in August. Last polio case due to imported wild polio virus (WPV) was reported from Sunamganj district in November 6. Indicator AFP,458,,844,79,5,537,,567,4,478 Wild poliovirus confirmed 8 Compatible AFP rate Non-polio AFP rate Adequate stool specimen collection percentage 9% 93% 9% 9% % % % 96% 96% 98% Total stool samples collected,846 3,85 3,6 4,76 3,3 3,4 3,578 3,4 3,3 3 % NPEV isolation % Timeliness of primary result reported Number of discarded AFP per, children under 5 years of age. Percent with specimens, 4 hours apart and within 4 days of paralysis onset. 3 5 to 7 result reported within 8 days and 8 onwards result reported within 4 days of sample received at laboratory Figure 5: Non-polio AFP rate by district, 4 Figure 6: Adequate stool specimen collection percentage by district, 4 Source: Weekly Acute Flaccid Paralysis (AFP) data Source: Weekly Acute Flaccid Paralysis (AFP) data <. > No non-polio AFP case < % % 79% > 8% No AFP Table 5: Reported of vaccine preventable disease, 5-4 Polio Diphtheria Pertussis Neonatal Tetanus (% of all Tetanus) Measles Rubella Mumps Japanese Encephalitis Congenital Rubella Syndrome (5%) 5,935 9,9 ND ND ND (%) 6,9 3,48 ND ND ND (%), 3,6 ND 4 ND (6%),6 5,56 ND 7 ND (5%) 78 3,76 ND 5 ND (6%) 788,963 ND 5 ND (5%) 5,65 5,63 ND 3 ND (8%),986 3,45 ND (%) 37 3,34 ND ND Source: WHO/UNICEF JRF ND=No data

4 Figure 7: MCV & MCV coverage and, 98-4 Figure 8: MCV coverage by district, Measles Cases MCV Coverage MCV Coverage WHO/UNICEF coverage estimates. WHO vaccine-preventable diseases: monitoring system 4 & JRF 4. Source: SEAR annual EPI reporting form, 4 (administrative data) Table 6: MCV supplementary immunization activities Table 7: Districts with more than % MCV coverage Vaccine, geographic coverage, target group M, two districts, 9 months to years M, nationwide, 9 months to years M, nationwide, 9 months to 5 years MR, nationwide, 9 months to 5 years Target Coverage Achieved,48,3 93% 34,,59 % 8,36,66 % 5,745,3 % Number of districts % Source: WHO/UNICEF JRFs Source: WHO/UNICEF JRF (multiple years) Figure 9: Sporadic and outbreak associated * by month and MR SIA coverage, M SIA (%) MR SIA (%) 5 3 Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan-3 Feb-3 Mar-3 Apr-3 May-3 Jun-3 Jul-3 Aug-3 Sep-3 Oct-3 Nov-3 Dec-3 Jan-4 Feb-4 Mar-4 Apr-4 May-4 Jun-4 Jul-4 Aug-4 Sep-4 Oct-4 Nov-4 Dec-4 Sporadic Outbreak associated *Includes laboratory confirmed and epidemiologically linked Source: SEAR Monthly VPD reports and WHO/UNICEF coverage estimates 3 revision (July 4) Immunization and Vaccine Development South-East Asia Region

5 Figure : Immunity against : Immunity profile by age in 5* % Figure : Immunity against : Immunity profile by age in 6* % Percent of population 8% % % Percent of population 8% % % % % % Age (in years) Protected by maternal antibodies Protected by routine vaccination with st dose Protected by routine vaccination with nd dose Protected by SIAs Immune due to past infection Susceptible % Age (in years) Protected by maternal antibodies Protected by routine vaccination with st dose Protected by routine vaccination with nd dose Protected by SIAs Immune due to past infection Susceptible *Based on coverage and SIA data up to 4 Source: Modeled using MSP tool ver * Assuming 9% coverage of st dose at age 9 months; 7% coverage of nd dose at 5 months and no SIAs in 5. Source: Modeled using MSP tool ver Figure : Confirmed (Lab and Epi linked) outbreak associated, by age, -4 Figure 3: Unimmunized confirmed (Lab and Epi linked) outbreak associated, by age, n= n=8 n=9 n=56 n= < year -4 years 5-9 years -4 years 5+ years n= n= n=459 n=57 n=78 (%) (43%) (4%) (37%) (44%) 3 4 < year -4 years 5-9 years -4 years 5+ years Source: SEAR annual EPI reporting form (multiple years) Source: SEAR annual EPI reporting form (multiple years) Table 8: Suspected sporadic and Outbreak associated and rubella, -4 Routine/sporadic Outbreak associated suspected case death labconfirmed labconfirmed rubella suspected outbreak Outbreak Investigated case death outbreak* confirmed case* confirmed rubella outbreak* confirmed rubella *, ,666 93,467,3, ,863 9,8 4,744, ,756 33,9 66,683 3, , ,787 4, , Source: Monthly VPD Reporting to WHO/SEARO * Laboratory confirmed & epidemiologically- linked

6 EPI FACT SHEET Table 9: Quality of field and laboratory surveillance for and rubella, -4 Case classification (number) Indicators Suspected Measles Lab-confirmed Measles Epi-Linked Clinically-confirmed Rubella Lab-confirmed Epi-Linked Discarded non- non-rubella Annual incidence of confirmed Measles per million total population Annual incidence of confirmed Rubella per million total population Proportion of all suspected and rubella that have had an adequate investigation initiated within 48 hours of notification Discarded non- non-rubella incidence per, total population Proportion of subnational administrative units reporting at least two discarded non- non-rubella per, total population Proportion of sub-national surveillance units reporting to the national level on time Target - - 8% 8% 8% 8, 75, ,59, , ,337, , , Source: SEAR Annual EPI Reporting Form, 4 ND=No data Table : Performance of Laboratory Surveillance, -4 % Serum specimen collected from suspected 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 3, % 48 6% 3 ND ND ND 3 33, % % 8 ND ND ND 4 67,4 43 7% 3 % B3 ND Source: SEAR Annual EPI Reporting Form, 4 ND=No data Figure 4: Network of WHO supported surveillance medical officers and laboratories, 4 Institute of Public Health - National polio laboratory - National /rubella laboratory - National Japanese encephalitis laboratory Invasive Bacterial Disease Laboratories - Dhaka Shishu Hospital - Chittagong Maa-O-Shishu Hospital - Kumudini Women s Medical College Surveillance Medical Officer (SMO) = 3 Divisional Coordinator (DC) = 5 SMO filled up stations SMO Vacant stations DC filled up stations Data WHO-IVD Bangladesh (as of May 5) For contact or feedback: Expanded Program on Immunization Ministry of Health and Family Welfare, Dhaka, Bangladesh Tel: , 8-3, Fax: abdurrahim3@gmail.com Immunization and Vaccine Development (IVD) WHO-SEARO, IP Estate, MG Marg, New Delhi, India Tel: , Fax: SEAREpidata@who.int, World Health Organization SEARO/FHR/IVD July 5 Immunization and Vaccine Development South-East Asia Region