FactSheet 2020

BANGLADESH
Expanded progrAmme on immunization (EPI)

Table 1: Basic information 2019 Table 2: Immunization schedule

EPI history
Total population1 167,836,821 Vaccine Age of administration
• EPI launched on 07 April 1979
Live births1 3,408,614 BCG Birth
• TT5 dose for WCBA started in 1993
Children <1 year1 3,262,044 DTP-Hib-HepB 6 weeks, 10 weeks and 14 weeks
• HepB vaccine introduced in 2003
Children <5 years1 16,026,457 OPV 6 weeks, 10 weeks and 14 weeks
• AD syringes introduced in 2004 Children <15 years1 48,991,359 PCV 6 weeks, 10 weeks and 14 weeks
• Pentavalent vaccine introduced in 2009 Pregnant women1 3,749,475 IPV 6 weeks and 14 weeks
• MR vaccine and measles vaccine second Women of child bearing age1 (WCBA) 46,987,746 MR 9 months and 15 months
dose introduced in 2012 (15-49 years)
Td Females 15 - 49 years (5 doses with an
Neonatal mortality rate3 30.0 (per 1,000 LB)
• PCV introduced in 2015 interval of + 1 month, + 6 months, + 1
Infant mortality rate 3
38.0 (per 1,000 LB) year and + 1 year with preceding dose)
• tOPV to bOPV switched on 23 April 2016
and IPV to fIPV switched on November Under-five mortality rate3 45.0 (per 1,000 LB) Vitamin A 6 to 59 months
2017 Maternal mortality ratio 3
165 (per 100,000 LB) Source: WHO/UNICEF JRF, 2019
• HPV demonstration projects launched Division/Province/State/Region 8
on 16 April 2016 in 4 upazillas and 1 Table 3: Immunization system highlights
zone under Gazipur district which was District 64
completed in 2017 cMYP for immunization 2018-2022
Upazilla/Sub-district 489
NITAG fully func-
• TT switched to Td on March 2019 City Corporation 12 tional
Source: cMYP 2018-2022 and EPI/MOHFW Union 4,587 Spending on vaccines financed by the 38%
Ward (EPI) 13,761 government
Sub-Block (EPI) 110,088 Spending on routine immunization pro- 39%
gramme financed by the government
Population density (per sq. km)
1
1,137
Updated micro-plans that include activities 64 districts
Population living in urban areas2 38% to improve immunization coverage (100%)
Disclaimer: The boundaries and names Population using at least basic drinking- National policy for health care waste in place
98.1%
water services3 management including waste from immu-
shown and the designations used
Population using at least basic sanitation nization activities
on all the maps do not imply 81.5%
services3 National system to monitor AEFI in place
the expression of any opinion
whatsoever on the part of the Total expenditure on health as % of GDP2 2.3% Most recent EPI CES EPI CES
Births attended by skilled health personnel 2019
World Health Organization 52.7%
concerning the legal status of any (BDHS 2017-2018) >80% coverage for DTP-Hib-HepB3 63 districts
(98%)
country, territory, city or area or Coverage Evaluation Survey 2019
94.6% >90% coverage for MCV1 62 districts
of its authorities, or concerning (Unpublished)
(97%)
the delimitation of its frontiers or 1
SEAR annual EPI reporting form, 2019
2
WHO, Global Health Observatory (GHO) data >90% coverage for MCV2 62 districts
boundaries.
http://apps.who.int/gho/data accessed on 06 June 2020 (97%)
3
Sample Vital Registration System 2019, Bangladesh Bureau of >10% drop-out rate for DTP-Hib-HepB1 to One district
Statistics DTP-Hib-HepB3
Source: WHO/UNICEF JRF, 2019

Figure 1: National immunization coverage, 1980-2019

Note: Penta replaced DPT in 2009, MCV1 replaced MR1 in 2012

Source: WHO and UNICEF estimates of immunization coverage, July 2020 revision

World Health Organization • SEARO/CDS/IVD • 15 July 2020

Figure 2: DTP3 coverage1, diphtheria and pertussis cases2, Figure 3: TT2+ coverage1 and NT cases2, 1980-2019
1980-2019
No. of cases

No. of cases
% Coverage

% Coverage
1
WHO and UNICEF estimates of immunization coverage, July 2020 revision 1
Country official estimates, 1980-2019
2
WHO vaccine-preventable diseases: monitoring system 2020 2
WHO vaccine-preventable diseases: monitoring system 2020

DTP-Hib-HepB3 coverage by district

Figure 4: 2018 Figure 5: 2019

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

Source: SEAR annual EPI reporting form 2018 (administrative data) Source: Coverage evaluation survey 2019

Table 4: Reported cases of vaccine preventable diseases, 2014-2019

Year Polio Diphtheria Pertussis NT (% of all Measles Rubella Mumps JE CRS

tetanus)

2014 0 13 12 105 (19%) 289 381 ND 183 98

2015 0 6 11 117 (21%) 240 189 ND 76 121

2016 0 2 1 110 (25%) 972 165 ND 1,294 146

2017 0 5 0 96 (27%) 4,001 299 ND 19 202

2018 0 36* 3 85 (37%) 2,263 308 ND 96 194

2019 0 14 12 49 (42%) 5,827** 176 ND 86 160

* 8372 probable cases reported among the migrants in Cox’s Bazar out of which 293 are confirmed cases Source: WHO/UNICEF JRF (multiple years) ND=No data
**135 confirmed measles and 2 rubella cases reported among the migrants in Cox’s Bazar
Table 5: AFP surveillance performance indicators, 2014-2019
• Last polio case due to indigenous WPV reported from Dhaka district in August 2000
• Last polio case due to imported WPV reported from Sunamganj district in November 2006
• Environmental surveillance started in 2015 and is currently functioning at 8 sites

Indicator 2014 2015 2016 2017 2018 2019

AFP cases 1,478 1,413 1,437 1,361 1,404 1,429
Wild poliovirus confirmed cases 0 0 0 0 0 0
Vaccine derived poliovirus cases 0 0 0 0 0 0
Compatible cases 0 0 0 0 0 0
Non-polio AFP rate 1
2.74 2.78 2.85 2.73 2.84 2.92
Adequate stool specimen collection percentage2 98% 97% 99% 99% 99% 100%
Total stool samples collected 3,094 3,008 2,865 2,703 2,796 2,854
% NPEV isolation 22.6 20.4 21.3 19 16.3 19.7
% Timeliness of primary result reported3 97 98 98 88 97 97
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
Results reported within 14 days of sample received at laboratory.

Non-polio AFP rate by district Adequate stool specimen collection % by district

Figure 6: 2018 Figure 7: 2019 Figure 8: 2018 Figure 9: 2019

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

Table 6: Environmental surveillance sites for polio Table 7: OPV SIAs

detection in 2018 and 2019
Year Antigen Geographic Target Target population Coverage (%)
Year # Provinces # sites # samples SL1 SL3 SL1+ VDPV NPEV coverage age
tested SL3 Round 1 Round 2 Round 1 Round 2

2018 2 8 124 2 12 2 0 72 2011 tOPV NID <5 years 22,151,269 22,320,803 102 101
2019 2 20 161 11 35 1 0 63 2012 OPV NID <5 years 22,019,556 22,073,699 101 101
Note: SL1: Sabin like type 1; SL3: Sabin like type 3; VDPV: Vaccine Derived Polio Virus; 2013 tOPV NID <5 years 20,530,418 101 -
NPEV: Non Polio Entero Virus
2014 OPV NID* <5 years 20,631,077 99 -
In 2019, one sample from each of the 12 sites were collected following a clinical
trail by icddr,b in collaboration with CDC Atlanta 2016 tOPV Mop-up SNID <5 years 114,979 115,355 101 101
2016 bOPV Mop-up SNID <5 years 118,272 98 -
2017 bOPV Mop-up SNID <5 years 47,165 153
* One dose OPV given during MR campaign Source: WHO/UNICEF JRF (multiple years)
 Vaccines Protect
SUSTAIN. ACCELERATE. INNOVATE.

Figure 10: MCV1 & MCV2 coverage1 and measles, rubella cases2, 1980-2019

14000 100

12000
80

10000
No. of cases

% Coverage
60
8000

6000 40

4000
20
2000

0 0
1980 1985 1990 1995 2000 2005 2010 2015 2016 2017 2018 2019

Note: MCV1 and MCV2 replaced MR1 and MR2 in 2012

1
WHO and UNICEF estimates of immunization coverage, July 2020 revision 2
WHO vaccine-preventable diseases: monitoring system 2020

MR1 coverage by district MR2 coverage by district

Figure 11: 2018 Figure 12: 2019 Figure 13: 2018 Figure 14: 2019

<80% 80% - 89% 90% - 94% > 95%

Source: SEAR Annual EPI reporting form 2018 administrative data for the year 2018 and 2019 data from coverage evaluation survey
2019

Table 8: MCV/MR SIAs

Year Antigen Geographic Coverage Target group Target Coverage %

2005 MCV 2 districts 9 months to 10 years 1,481,321 93

2006 MCV nationwide 9 months to 10 years 34,199,590 100

2010 MCV nationwide 9 months to 5 years 18,136,066 100

2014 MR nationwide 9 months to 15 years 52,745,231 102

2016 MR subnational 9 months to <5 years 99,489 101

2017 MR subnational 9 months to <5 years 1,556,818 100

2017 MR subnational 6 months to <15 years 121,530 112

Source: WHO/UNICEF JRF (multiple years)

World Health Organization • SEARO/CDS/IVD • 15 July 2020

Figure 15: Immunity against measles - iimmunity profile by age in 2019*

*Modeled using MSP tool ver 2

Figure 16: Immunity against rubella through vaccination - immunity profile by age in 2019*

*Modeled using WHO and UNICEF estimates and JRF (multiple years) and does not include immunity due to natural infection

Figure 17: Confirmed measles cases* by month, 2017-2019 Figure 18: Confirmed rubella cases* by month, 2017-2019
900

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Number of cases

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0
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Jan-17
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*Includes laboratory confirmed, epidemiologically linked and clinically compatible cases *Includes laboratory confirmed and epidemiologically linked cases
Source: SEAR measles case-based data Source: SEAR measles case-based data
 Vaccines Protect
SUSTAIN. ACCELERATE. INNOVATE.

Figure 19: Vaccination status of confirmed (laboratory, Epi linked and clinically compatible) measles cases by age in 2018 and 2019

Source: SEAR measles case-based data

Figure 20: Vaccination status of confirmed (laboratory and Epi linked) rubella cases by age in 2018 and 2019

Source: SEAR measles case-based data

Table 9: Summary of measles surveillance indicators, 2017-2019 Figure 21: Network of WHO supported surveillance and
Indicator Target 2017 2018 2019 immunization medical officers and laboratories
Number of suspected measles cases 8,025 6,662 11,632
Confirmed measles cases 0 4,001 2,263 5,827
Lab confirmed 0 2,612 1,688 4,073
Epi-Linked 0 982 448 802
Clinically-compatible 0 407 127 952
Confirmed rubella cases 0 299 308 176
Lab confirmed 0 240 286 176 Institute of Public Health
Epi-Linked 0 59 22 - - National polio laboratory
- National measles/rubella laboratory
Discarded non-measles non-rubella cases 3,725 4,091 5,629
- National japanese encephalitis
Percentage of suspected cases with adequate
≥ 80% 94 92 96 Invasive Bacterial Disease Laboratories
investigation initiated within 48 hours of notification - Dhaka Shishu Hospital
Reporting rate of non-measles non-rubella cases to - Chittagong Maa-O-Shishu Hospital
≥2 2.3 2.5 3.4
national level per 100,000 population - Kumudini Women’s Medical
Percentage of second-level administrative units College
reporting at least 2 non-measles non-rubella cases ≥ 80% 60 72 93 - Shishu Shasthaya Foundation (SSF)
per 100 000 population Surveillance and Immunization
Percentage of surveillance units reporting measles Medical Officer (SIMO) = 61
and rubella data to the national level on time, even ≥ 80% 98 97 99 Divisional Coordinator (DC) = 7
in the absence of cases Emergency Immunization Coordinator
Percentage of specimens received at the laboratory (E-IC) = 1
≥ 80% 99 100 92
within 5 days of collection Emergency Surveillance and
Percentage of IgM results reported to the national Immunization Medical Officer
public health authorities by the laboratory within 4 ≥ 80% 69 93 86 (E-SIMO) = 3
days of receipt of specimens
Genotypes detected
Measles ND B3, D8 B3,D8
Rubella ND - -
Source: SEAR Annual EPI Reporting Form (multiple years) ND=No data

For contact or feedback:

Expanded Programme on Immunization
Ministry of Health and Family Welfare, Dhaka, Bangladesh
Tel: +880-2-9880530, 8821910-03, Fax: +880-2-8821914
Email: pm.epi.esd@ld.dghs.gov.bd, www.dghs.gov.bd
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.who.int/southeastasia/health-topics/immunization