Global and Regional Updates on VPD

Surveillance
22 November 2022

Indonesia Country Office

 Immunization Agenda 2030

“IA2030 is intended to inspire and align the

activities of community, national, regional and
global stakeholders – national governments,
regional bodies, global agencies, development
partners, health care professionals, academic
and research institutions, vaccine developers
and manufacturers, the private sector and civil
society”

Indonesia Country Office

Immunization is a success story for global health and development,
saving millions of lives every year

Immunization Agenda 2030 ⚫ Between 2010 and 2018, 23

million deaths were averted with
measles vaccine alone
⚫ More than 20 life threatening
diseases can now be prevented
by immunization
⚫ Since 2010, 116 countries have
introduced vaccines that they did
not use previously including
those against major killers like
pneumococcal pneumonia,
diarrhoea, cervical cancer,
typhoid, cholera and meningitis

Indonesia Country Office

Why do countries conduct vaccine-preventable
disease surveillance?

Pre-vaccine Impact of Long-term

introduction introduction monitoring

• To describe disease burden to • To monitor trends to show • To monitor changes in

make decisions about vaccine impact and cost-effectiveness disease after introduction
introduction (e.g., product of vaccine and vaccination • To document control,
choice, target populations) program (e.g., optimize elimination, and eradication
schedules)
• Identify outbreaks for immediate action for effective reactive vaccination
Across campaigns
all • Components of surveillance can be leveraged to monitor other VPDs and other
diseases without vaccines
phases
• Identify unreached populations not getting vaccinated for targeted delivery
strategies (e.g., triangulation)
Indonesia Country Office
4
 Vision of Comprehensive VPD surveillance
All countries have sustainable, high-quality VPD surveillance systems, supported by strong
laboratories, that detect and confirm cases and outbreaks and generate useful data to guide
outbreak prevention and response, immunisation program management, and vaccine policy
to decrease the burden of VPDs as efficiently and effectively as possible

Typhoid
Meningococcus Influenza
Diphtheria Pneumococcus
Rubella Hib
Measles Rotavirus Cholera
Neonatal tetanus JE Non-neonatal tetanus
Polio (AFP) CRS Yellow Fever
Sentinel case-based Notifiable disease surveillance
National case-based surveillance
surveillance Outbreak/event surveillance

Program Workforce Logistics & Monitoring &

Governance management capacity communication Laboratory Supervision evaluation Coordination

Surveillance support functions 5

Global strategy for comprehensive Vaccine-Preventable Disease (VPD) surveillance (who.int) – published in June 2020. summarizes a strategy for VPD surveillance for 2021-2030 as part of IA2030
Diseases in dark-shaded boxes = surveillance commitment in every country. Diseases in light-shaded boxes = surveillance commitment varies by country.
 RECOMMENDED MINIMUM SURVEILLANCE
REQUIREMENT FOR VPDS IN SEA REGION
Sentinel, case-based
Nationwide, lab
Nationwide, with laboratory
supported case-
aggregate confirmation of every
based
case

Diphtheria,
Poliomyelitis Congenital rubella
In all countries Pertussis , Neonatal
Measles and Rubella syndrome,
Tetanus

Non-Neonatal
In selected Japanese Invasive bacterial diseases
Tetanus
countries encephalitis/ AES Rotavirus
Hepatitis B

Indonesia Country Office

STATUS OF SELECTED PRIORITY VPD
SURVEILLANCE

Indonesia Country Office

Dampak COVID-
19 terhadap
Cakupan
Imunisasi Rutin
18 million of the 25 million children did not
receive a single dose of DTP during the year,
the vast majority of whom live in low- and
middle-income countries, with India, Nigeria,
Indonesia, Ethiopia and the Philippines
recording the highest numbers
POLIOMYELITIS

Indonesia Country Office

 Status Bebas Polio BUKAN
Berarti Polio Risk Free
⚫ Regional Asia Tenggara (termasuk Indonesia
didalamnya) →sertifikasi bebas polio tahun 2014

⚫ Target eradikasi tahun 2026

⚫ Terdapat 3 virus polio (tipe 1, tipe 2 dan tipe 3) → tipe

2 (September 2015) dan tipe 3 (Oktober 2019) telah
berhasil dieradikasi.

⚫ Ancaman saat ini,

– WPV1 (Wild Polio Virus type 1)
– cVDPV 1, 2, 3 (Vaccine Derived Polio Virus → mutasi)

⚫ Indonesia → importasi WPV1 2005-2006, cVPDV1

Papua, VDPV2 Aceh

Indonesia Country Office

 Global Polio Updates

⚫ No “risk free” countries

Indonesia Country Office

 Acute Flaccid Paralysis (AFP) Surveillance
is the Backbone
Three objectives on surveillance activities,

1. Enhance and sustain AFP surveillance

sensitivity and timeliness

2. Optimize the Environmental Surveillance

network to contribute to the timely
detection of poliovirus

3. Establish iVDPV surveillance to sustain

polio eradication

Indonesia Country Office

 Report !!

⚫ Semua anak usia < 15 tahun Memenuhi

Kriteria AFP
⚫ Kelumpuhan yang sifatnya lemas
(flaccid)
Pengambilan
⚫ Terjadi mendadak dalam 1 – 14 hari Spesimen
Tinja (2x, jeda
⚫ Bukan disebabkan rudapaksa / 24 jam
trauma
– Bila ada keraguan laporkan sebagai
kasus AFP Periksa Lab

Indonesia Country Office

1. Sindrom Guillain Barre DIAGNOSIS PENYAKIT
(SGB) DENGAN GEJALA AFP
2. Myelitis transversa (Pokja Ahli Nas)
3. Poliomyelitis
4. Polyneuropathy 13.Periodic Paralysis hipokalemi
5. Myelopathy 14.Spinal Muscular Atrophy
6. Dermatomyositis 15.Efek samping sitostatika (mis:
7. Hipokalemi vincristin)
8. Erb’s paralysis 16.Ensepalitis atau Ensefalopati
9. Food drop paralysis 17.Meningitis
10.Stroke pada anak 18.Miastenia gravis umum
11.Todd’s paralysis 19.Metabolic myopathies
12.Duchene Muscular 20.Herediter Motor and Sensory
Dystrophy Neoropathy (HMSN)
INGAT:
Gejala AFP dapat ditemukan juga pada penyakit selain tersebut di atas.
Bila diagnosis pasti belum dapat ditegakkan dapat dituliskan suspek dan DD-
nya
 Indonesia dan Myanmar Masuk
Kriteria Risiko Tinggi untuk Polio, 2022

Low
Disclaimer for all maps: The boundaries and
names shown and the designations used on all Medium
the maps do not imply the expression of any
opinion whatsoever on the part of the World High
Health Organization concerning the legal status
of any country, territory, city or area or of its
authorities, of concerning the delimitation of its
frontiers or boundaries.

Indonesia Country Office

15
MEASLES AND RUBELLA

Indonesia Country Office

 94% reduction on measles mortality globally 2000-2020
SEAR contributed to 9% of estimated global measles mortality in 2020

Proportion of measles mortality across WHO

Regions, 2020 Proportion of measles mortality in SEAR
South- countries 2020
Thailand
European East Western
1%
0% Asia Pacific Myanmar Bangladesh
9% 2% 8% 8%
Nepal
9%

Eastern Indonesia
Mediterranea 12%
n African
34% 55%

India
62%

Americas
0%

Thirteenth Meeting of the WHO South-East Asia Regional Immunization Technical Advisory Group (SEAR ITAG)
New Delhi, India, 17-19 August 2022
Measles Outbreak Kills 700 children in Zimbabwe

⚫ KLB Campak di Zimbabwe sejak April

2022
⚫ Gejala yang muncul adalah demam,
ruam, batuk, pilek →komplikasi diare,
pneumonia.
⚫ KLB besar di beberapa negara lain
seperti Kongo, Zambia, Tanzania,
Paraguai dll
⚫ New South Wales, melaporkan kasus
campak pertama sejak tahun 2020

Indonesia Country Office

Insidensi Campak-Rubela Tertinggi di Indonesia diantara Negara SEAR

Indonesia Country Office

 Nationwide acute fever and rash surveillance for
measles and rubella.
⚫ Suspected Measles case : Fever
and Maculopapular Rash
⚫ Followed by SERUM sample
collection for serological exam.

⚫ URINE sample in case of “hot case –

fever+rash+3C” and/or outbreak
setting

Indonesia Country Office

DIPHTHERIA

Indonesia Country Office

 Penurunan Cakupan
Imunisasi DTP
⚫ Collectively, India, Nepal, and
Indonesia have reported
96%–99% of the cases in the
South-East Asia region since
2000
⚫ CFR 5-10%, pada setting
dengan sistem Kesehatan
lemah, CFR bisa sampai 50%

Indonesia Country Office

Trend Kasus Difteri dan Cakupan Vaksin DPT di
Indonesia, 2022

Indonesia Country Office

 Summary

⚫ Dampak pandemic COVID-19 menyebabkan penurunan cakupan imunisasi dan

performa surveilans VPD/PD3I
⚫ Indonesia dan Myanmar memiliki Risiko transmisi Polio tinggi, dibandingkan
negara-negara SEAR lainnya.
⚫ Indonesia tertinggi insidensi Campak dan Rubela, yang dapat memicu
meningkatnya insidensi penyakit lainnya seperti Diare, Pneumonia dan Meningitis
⚫ Peningkatan kasus Difteri dan angka kematian Difteri di Indonesia
⚫ Perlunya peningkatan cakupan imunisasi yang tinggi dan merata
⚫ Kerjasama lintas sector dalam menangani situasi ini dan situasi KLB yang terjadi di
beberapa wilayah

Indonesia Country Office