Bangladesh 2007

EPI Fact Sheet

Percent of Total
Table 1: Demography1 2007 Population Density by Districts
Population
Total Population 144,092,465
Population Growth Rate2 2.02%
Live Births 4,135,449 2.9
Birth Rate 28.7 / Per 1000 population
Infant Mortality Rate2 51 / Per 1000 live births
Children < 1 Year 3,613,703 2.5
Children < 5 Years 18,587,927 12.9 Number of persons
per sq. km
Children < 15 Years 3 56,685,978 39.3 9 - 81
82 - 94
Pregnant Women 5,043,233 3.5 95 - 113
114 - 131
Women of Child Bearing Age 132 - 370
35,590,846 24.7
(15-49 Years)
1
Source: SEAR Annual EPI Reporting Form, 2007.
2
Core Indicators, 2005 (Health Situation in WHO SEAR and WPR).
3
57,718,398 are used to calculate Non-Polio AFP rates in 2008.

Table 2: Vaccine Preventable Diseases, 2000-2007 (WHO/UNICEF JRF)

Year Diphtheria Pertussis Measles Total Tetanus Neonatal Tetanus Polio Rubella
(% of all Tetanus)
2000 21 252 5,098 1,155 376 (32.6%) 1 ND1
2001 122 16 4,414 1,221 436 (35.7%) 0 ND
2002 73 587 3,484 1,036 336 (32.4%) 0 ND
2003 78 332 4,067 715 390 (54.5%) 0 ND
2004 117 140 9,743 1,897 748 (39.4%) 0 347
2005 125 125 25,935 1,388 341 (24.6%) 0 9,229
2006 35 46 6,192 1,235 257 (20.8%) 18 3,418
2007 86 87 2,924 1,034 206 (19.9%) 0 13,226
1
No Data
Table 3: Percent Immunization Coverage, 1990 - 2007 (WHO/UNICEF Estimated Coverage)
Year OPV3 BCG DTP3 MCV1 100
1990 69 86 69 65
1991 74 87 74 68
1992 67 89 66 69
80
1993 74 93 74 74
1994 84 95 84 78
1995 69 93 69 79
1996 77 90 77 69 60
% Coverage

1997 78 92 78 72
1998 82 92 82 72
1999 81 94 81 76 40
2000 83 95 83 76 OPV3
BCG
2001 83 94 83 76
MCV1
2002 85 95 85 77
20 DTP3
2003 85 95 85 77
2004 85 95 85 76
2005 88 99 88 81
2006 88 96 88 81 0
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
2007 96 97 90 88

Table 4: Immunization Schedule, 2007 (WHO/UNICEF JRF) Figure 1: HepB3 Immunization Coverage, 2007
Vaccine Age of Administration Country Official Estimated Coverage in:
BCG Birth 2004 = 59.0%
2005 = 84.0%
DTP 6 weeks, 10 weeks, 14 weeks 2006 = 84.0%
OPV 6 weeks, 10 weeks, 14 weeks, 38 weeks 2007 = 95.0%
Measles 38 weeks
TT Women of Child Bearing Age
(WCBA Y 15-49) - 15 Years, + 1 month, + 6
months, + 1 year, + 1 year <70
70 % - 79 %
Td NA 80 % - 89 %
HepB 6 weeks, 10 weeks and 14 weeks >90 %
Hib NA
Yellow Fever NA Source: SEAR Annual EPI Reporting Form, 2007.
Vitamin A 38 weeks

EPI Fact Sheet • World Health Organization • SEARO • IVD• Publish 11-Aug-2008 Page 1 of 4
 Bangladesh 2007
EPI Fact Sheet
`
Figure 2: Surveillance and Lab Network Table 5: OPV SIA History, 1995-2008
Y ear N ID s / N um ber o f D ate o f 1st D ate of 2n d 1st rou nd 2nd rou nd
SN ID s C hild ren R o un d R ou nd C o verage C o verage
U nd er 5 years (% ) (% )
Targ eted
1995 1st N ID s 18,788,765 16-M ar-95 16-A pr-95 90 88
1996 2nd N ID s 19,051,808 16-Apr-96 16-M ay-96 99 Adm inistrative
1996 3rd N ID s 19,051,808 8-D ec-96 - 92 -
1997 3rd N ID s 19,318,533 - 8-Jan-97 - 100
1997 4th N ID s 19,904,890 7-D ec-97 - 99 -
1998 4th N ID s 19,904,890 - 18-Jan-98 - 98
1998 5th N ID s 19,889,095 14-D ec-98 - 100 -
1999 5th N ID s 19,889,095 - 2-F eb-99 - 101
1999 6th N ID s 20,198,505 2-N ov-99 2-D ec-99 101 101
1999 S N ID s 2,165,161 12-S ep-99 - 97 -
2000 7th N ID s 21,374,811 23-Apr-00 29-M ay-00 98 98
6 Divisions 2000 8th N ID s 21,374,811 15-N ov-00 17-D ec-00 96 102
64 Districts (Zila) 2000 S N ID s 1,988,499 6-Aug-00 - 95 -
461 Sub-Districts (Upa-Zila) 2001 9th N ID s 21,718,055 8-Apr-01 13-M ay-01 95 96
2001 S N ID s 2,728,959 26-A ug-01 4-Sep-01 99 -
6 City Corporations 2002 S N ID s 17,194,445 10-A ug-02 14-Sep-02 96 95
Polio & Measles Lab 2002 10th N ID s 21,575,833 27-Jan-02 10-M ar-02 97 95
Divisional Coordinators 2003 11th N ID s 22,247,141 30-M ar-03 4-M ay-03 96 96
2004 12th N ID s 22,081,086 18-Jan-04 29-Feb-04 98 97
2006 13th N ID s 22,804,311 16-Apr-06 13-M ay-06 102 102
2006 13th N ID s 23,083,686 11-Jun-06 6-Aug-06 102 102
=6
= 43 2006 S N ID s 1,528,576 14-O ct-06 - 101 -
2006 14th N ID s 23,499,840 25-N ov-06 23-D ec-06 102 101
2007 15th N ID s 23,860,574 3-M ar-07 8-Apr-07 101 101
2007 S N ID s 1,865,659 20-M ay-07 1-Jul-07 101 101
2007 16th N ID s 23,918,744 27-O ct-07 8-D ec-07 102 101
2008* 17th N ID 23,918,744 O ct-08 N ov-08 - -
Source: EPI, Bangladesh, May-2008. * P lanned N ID s in 2008
Source: NCCPE Report, AERF and coverage submitted by country

Table 6: AFP Surveillance Indicators1,

Figure 3: AFP Indicator Maps, 2007
2001-2007
Non-Polio AFP Rate* % Adequate Stool
Prior to the 2006 outbreak from an imported case from by District Collection Rate* by District
India, the last laboratory confirmed wild polio case (Type
P1) was reported from Dhaka district in August 2000.
Indicator 2001 2002 2003 2004 2005 2006 2007
AFP cases 1,287 1,365 1,128 1,301 1,458 1,619 1,844
Wild Polio 0 0 0 0 0 18 0
Compatibles 36 0 0 2 0 2 0
AFP Rate 2.55 2.70 2.03 2.31 2.66 2.91 3.25
Non-Polio AFP Rate2 2.48 2.70 2.03 2.31 2.66 2.87 3.25
Adequate Stool Collection
80% 89% 89% 90% 92% 93% 92%
Rate3
Total Stool Samples Tested 2,487 2,666 2,200 2,523 2,846 3,185 3,611
% NPEV 29 28 23 20 20 15 15
% Reported Within 28
99 100 99 100 100 98 100
Days
1
For 2008 data, See the IVD VPD Weekly Bulletin.
2
Number of discarded AFP cases per 100,000 children under 15 years of age.
3
Percent with 2 specimens 24 hours apart and within 14 days of paralysis onset.

No Non-polio AFP case No AFP case

<1 < 80%

1 - 1.99
Non-polio AFP 80%-89% Adequate Stool
>2
Rate = 3.25 > 90% Collection Rate = 92%

* Number of discarded AFP cases per 100,000

*Percent with 2 specimens, 24 hours apart and within
children under 15 years of age.
14 days of paralysis onset.
Figure 4: MCV1 Coverage and Measles Figure 5: MCV1 Coverage by District, 2006-2007
Cases, 1990-2007
2006: 36 (56.3%) of 64 2007: 42 (65.6%) of 64
districts had > 90% MCV1 districts had > 90% MCV1
coverage. coverage.
30000 100
MCV1
25000 80
20000
% Coverage

60
Cases

15000
40
10000

5000 20

0 0
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007

Year
Measles Cases MCV1 Coverage <70
70 % - 79 %
80 % - 89 %
>90 %

Source: WHO/UNICEF Estimated Coverage, 1990-2007. Source: SEAR Annual EPI Reporting Form, 2006 & 2007

EPI Fact Sheet • World Health Organization • SEARO • IVD• Publish 11-Aug-2008 Page 2 of 4
 Bangladesh 2007
EPI Fact Sheet
Figure 6: Distribution of Lab Confirmed Rubella Outbreak Figure 7: Immunization Coverage, 2006-
Cases by Age Group, 2006-2007 2007 (WHO/UNICEF JRF)
2006 Rubella Lab Confirmed Outbreaks = 26 2007 Rubella Lab Confirmed Outbreaks = 102 2006
Unknow n
< 1 Year Unknow n 100
>15 Years 0% < 1 Year
7% 0%
11% >15 Years 80

% Coverage
10%
12%
60

1-4 Years
40
25% 10-14
10-14 Years Years
20
1-4 Years
19% 15%
27% 0
BCG DTP3 OPV3 MCV1
2007
100

% Coverage
80
60
5-9 Years
5-9 Years 36% 40
38% Age Group 2006 2007 20
Cases % Cases %
0
< 1 Year 234 6.8 1298 9.8
1-4 Years 863 25.2 3621 27.4 BCG DTP3 OPV3 MCV1
5-9 Years 1322 38.7 4655 35.2 Antigen
10-14 Years 634 18.5 2013 15.2
>15 Years 363 10.6 1638 12.4 Administrative Coverage
Unknown 2 0.1 1 0.0
Total 3418 100 13226 100
Country Official Estimated Coverage
Source: SEAR Annual EPI Reporting Form, 2007.
WHO/UNICEF Estimates
Note: No lab confirmed Measles Outbreaks reported in
Bangladesh, 2007.
Figure 9: DTP3 Coverage and Diphtheria and
Figure 8: DTP3 Coverage by District, 2007
Pertussis Cases, 1990-2007
Out of 64 districts, number of
districts with >80% DTP3
coverage:
2004 = 60 (93.7%); 16000 100
2005 = 54 (84.4%); 14000 DPT3
2006 = 51 (79.6%) 80
2007 = 53 (82.8%) 12000

% Coverage
10000 60
Cases

8000
6000 40
2007 National DTP3 Official
Estimated Coverage = 87% 4000
20
2000
0 0
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
Year 2007

<70 Diphtheria Cases Pertussis Cases DTP3 Coverage

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

Source: SEAR Annual EPI Reporting Form, 2007 Source: WHO/UNICEF Estimated Coverage, 1990-2007.

Figure 10: Routine TT2+ Immunization Coverage by Figure 11: TT2+ Coverage and NT Cases
District, 2007 1990-2007
Out of 64 districts, Number of
districts with >80% TT2+
coverage:
2004 = 10 (15%); 1000
TT2+ 100
2005 = 6 (9.3%); 900 90
2006 = 0 (0%) 800 80
2007 = 0 (0%) 700 70
% Coverage

600 60
Cases

500 50
400 40
2007 National TT2+ Official 300 30
Estimated Coverage = 93% 200 20
100 10
0 0
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007

=0
Year
<30
NT cases TT2+ Coverage
30 % - 49%
50 % - 79 %
>80 %
Source: WHO/UNICEF JRF and Country Official Estimated
Coverage, 1990-2007
Source: SEAR Annual EPI Reporting Form, 2007.

EPI Fact Sheet • World Health Organization • SEARO • IVD• Publish 11-Aug-2008 Page 3 of 4
 Bangladesh 2007
EPI Fact Sheet
Table 7: Immunization System Indicator Highlights (WHO/UNICEF JRF)
Planning and
• There is a costed, multi-year plan (MYP) for immunization covering 2008-2010.
Management
• An annual costed, activity work plan was available for immunization activities in 2007.
• 64 (100%) districts have updated micro-plans that include activities to raise
immunization coverage at the upazila / zone level.
• An inventory of cold chain equipment was completed in 2007.
• The vaccine management assessment was conducted in 2007.

System • 64 (100%) districts had at least one supervisory visit to each health facility in the district.
Performance
• 1 (1%) district reported more than 10% drop-out rate DTP1 to DTP3
• Out of 64 districts, 53 (83%) had > 80% coverage for DTP3, 42 (66%) had > 90%
coverage for MCV1 and 0 (0%) had > 80% coverage for TT2+ in pregnant women.

Coverage • EPI Coverage Evaluation Survey (CES) was conducted in 2007.

Surveys
• Next coverage survey is planned in the next 24 months

Vaccine Wastage • 68% MCV vaccine wastage reported.

Vaccine Supply • There were no stock-outs reported for any of the antigens at national or district level.
and Routine
Service

Safety • Activity work plan is available for immunization injection safety.

• 64 (100%) districts use AD syringes for routine immunization and all vaccine deliveries
to vaccination sites include safety boxes.
• A national system to monitor AEFI is available and 1388 adverse cases were reported
in 2007.
• Incinerator and open burning methods are used for the disposal of immunization waste.

Financing • 70% of all spending on routine immunization was financed using government funds.
• 60% of all spending on vaccine was financed using government funds.
• The national budget includes a line item for purchase of vaccines.
• The national budget includes a line item for purchase of injection supply for routine
immunization.
Table 8: EPI and Surveillance Strengths

• Case-based and aggregated VPD data submitted to SEARO monthly.

• Strong Surveillance Medical Officer network supports AFP and VPD surveillance.
• Excellent Vaccine Preventable Disease data management.
• High rate of timeliness (100%) and completeness (100%) for AFP and VPD data submitted to SEARO.
• VPD Bulletin “EPI Surveillance Bulletin” produced monthly.
• VPD surveillance and routine immunization data available at district level.
• Active site visits, zero reporting and active surveillance are implemented for measles, AFP and NT.

Primary Data Source:
WHO-UNICEF Joint Reporting Form (JRF)
SEAR Annual EPI Reporting Form (AERF)
Country Contact Information:
Expanded Program on Immunization (EPI),
Ministry of Health, Dhaka, Bangladesh
Phone: +880-2-8821911-14; Fax: +880-2-8821814
Email: epi-bangla@bdonline.com
Prepared by: Immunization and Vaccine Development (IVD)
World Health Organization, South East-Asia Regional Office
IP Estate, Mahatma Gandhi Road, New Delhi 110002, India.
Tel: +91 11 23370804, Direct Fax: +91 11 23370251, 23370106
Email: epidata@searo.who.int and/or searpolio@yahoo.co.in
IVD Internet: http://www.searo.who.int/EN/Section1226.asp
IVD VPD surveillance bulletin: http://www.searo.who.int/EN/Section1226/showfiles.asp
Weekly IVD VPD/AFP update: http://www.searo.who.int/EN/Section1226/showafpfiles.asp
Monthly IVD VPD/AFP update: http://www.searo.who.int/EN/Section1226/showafpmonth.asp

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