Indonesia 2014
Immunization andVaccine Development
South-East Asia Region
World Health Organization• SEARO/FHR/IVD • 22 July 2015
Table 1: Basic information1 2014
Division/Province/State/Region 34
District 413
City 98
Village 79,411
Population density (per sq. km) 132
Population living in urban areas 51%
Population using improved drinking-water sources
85%
Population using improved sanitation 59%
Total expenditure on health as % of GDP 2.9%
Births attended by skilled health personnel 83%
Neonates protected at birth against NT 85%
Vaccine Age of administration
HepB 0 to 7 days of birth
BCG 1 month
OPV 1 month, 2 months, 3 months, 4 months
DTP-HepB 2 months, 3 months, 4 months
DTP-Hib-HepB2 months, 3 months, 4 months, 18 months (selected provinces)
Measles 9 months, 24 months, 6-7 years
DT 6 -7 years
Td 7-8 years, 8-9 years
TT Females 15 to 39 years
Vitamin A 6 – 59 months
EPI history�� EPI launched in 1977.
�� HepB introduced in 1997.
�� AD syringe introduced in 2002.
�� MCV2 introduced in 2004.
�� DTP-HepB introduced in 2004 (in
phases).
�� Hib Pentavalent (DTP-Hib-HepB)
introduced in four provinces in
August 2013.
Source: cMYP 2015-2019
Immunization system highlights
� There is a comprehensive multi-year plan (cMYP) for immunization covering 2015-2019.
� 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.
� A national policy for health care waste management including waste from immunization activities exists.
� 29 provinces have achieved MNT elimination status by May 2013.
� VPD surveillance and EPI review was conducted in June 2013.
� Basic Health Research survey was conducted in 2013.
� Drop-out study on vaccine hesitancy was carried out in Java provinces in 2011.
� 78% spending on routine vaccine financed by the government.
� 64% spending on routine immunization programme financed by the central government.
� 179 (35%) districts have updated micro-plans that include activities to raise immunization coverage.
� Out of 511 districts, 354(69%) districts had > 80% coverage for DTP-HepB3, 258 (50%) districts had > 90% coverage for MCV1 and no data on districts that had > 80% coverage for TT2+ in pregnant women in 2014.
� 74 (14%) districts reported more than 10% drop-out rate DTP1 to DTP3.
� Stock-out was reported for BCG, DTP-HepB, Polio, Measles & TT vaccines in 2014.
� Plan to introduce IPV nationwide in 2015-2016.
Total population 252,124,458
Live births (LB) 4,809,304
Children <1 year 4,665,025
Children <5 years 24,085,400
Children <15 years NA
Pregnant women 5,290,235
Women of child bearing age (15-49 years)
53,017,364
Neonatal mortality rate 15 (per 1,000 LB)
Infant mortality rate 26 (per 1,000 LB)
Under-five mortality rate 31 (per 1,000 LB)
Maternal mortality ratio 190 (per 100,000 LB)
1 SEAR annual EPI reporting form, 2014 and WHO, World Health Statistics 2014
Table 2: Immunization schedule, 2014
Source: WHO/UNICEF joint reporting form (JRF) 2014
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.
E P I F A C T S H E E T
World Health Organization• SEARO/FHR/IVD • 22 July 2015
Source: WHO/UNICEF coverage estimates.
Figure 3: DTP-Hib-HepB3 coverage, 2014
Figure 2: DTP3 coverage1, diphtheria and pertussis cases2, 1980-2014
1980 1985 1990 1995 2000 2005 2010 2011 2012 2013 2014
No.
of c
ases
Year
Diphtheria Cases Pertussis Cases DTP3 Coverage
0
2000
4000
6000
8000
10000
12000
1 WHO/UNICEF coverage estimates.2 WHO vaccine-preventable diseases: monitoring system 2014 & JRF 2014.
1 Country official estimates, 1980-2013, 2014 data not available2 WHO vaccine-preventable diseases: monitoring system 2014 & JRF 2014.
Source: SEAR annual EPI reporting form, 2014 (administrative data)
0
20
40
60
80
100
0200400600800
1000120014001600
1980 1985 1990 1995 2000 2005 2010 2011 2012 2013 2014
NT cases TT2+
% C
over
age
No. o
f cas
es
Figure 4: TT2+ coverage1 and NT cases2, 1980-2014
Table 3: OPV supplementary immunization activities (SIA), 2007-2014
Year Activity Target population (age)
Date of 1st round Date of 2nd round 1st round coverage (%)
2nd round coverage (%)
2002 NID 20,031,168 Sep-2002 Oct-2002 107 109
2005 SNID 6,287,418 May-2005 Jun-2005 104 93
2005 NID 23,426,156 Aug-2005 Sep-2005 95 98
2005 NID 23,620,427 Nov-2005 - 98 -
2006 SNID 3,050,873 Jan-2006 - 98 -
2006 NID 23,620,427 Feb-2006 Apr-2006 99 100
2006 SNID 4,523,187 Jun-2006 Aug-2006 96 98
2006 SNID 6,045,438 Sep-2006 - 92 -
2007 SNID 12,517,699 Feb-2007 Aug-2007 90 92
2009 SNID* 2,052,067 Oct-2009 - 97 -
2010 SNID* 4,322,178 Oct-2010 - 92 -
2011 SNID* 13,958,095 Oct-2011 - 98
Figure 1: National immunization coverage, 1980-2014
* During measles campaign Source: WHO/UNICEF JRF
1980 1985 1990 1995 2000 2005 2010 2011 2012 2013 2014BCG 61 65 74 77 81 86 88 98 99 98 93DTP3 27 60 69 75 72 81 81 83 85 78OPV3 13 60 71 72 79 82 81 84 86 79MCV1 26 58 63 76 77 78 80 85 84 77
0
20
40
60
80
100
% C
over
age
<70% 70% - 79% 80% - 89% > 90%
Source: WHO/UNICEF coverage estimates.
Figure 2: DTP3 coverage1, diphtheria and pertussis cases2, 1980-2014
0
20
40
60
80
100
1980 1985 1990 1995 2000 2005 2010 2011 2012 2013 2014
% C
over
age
No.
of c
ases
Year
Diphtheria Cases Pertussis Cases DTP3 Coverage
0
2000
4000
6000
8000
10000
12000
1 WHO/UNICEF coverage estimates.2 WHO vaccine-preventable diseases: monitoring system 2014 & JRF 2014.
Figure 1: National immunization coverage, 1980-2014
1980 1985 1990 1995 2000 2005 2010 2011 2012 2013 2014BCG 61 65 74 77 81 86 88 98 99 98 93DTP3 27 60 69 75 72 81 81 83 85 78OPV3 13 60 71 72 79 82 81 84 86 79MCV1 26 58 63 76 77 78 80 85 84 77
0
20
40
60
80
100
% C
over
age
0
20
40
60
80
100
% C
over
age
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 2005 to 2007 result reported within 28 days and 2008 onwards result reported within 14 days of sample received at laboratory.
Table 4: AFP surveillance performance indicators, 2005-2014
Figure 5: Non-polio AFP rate by province, 2014 Figure 6: Adequate stool specimen collection percentage by province, 2014
The last polio case due to wild polio virus (WPV) was reported from Tenggara district, Aceh on 20 February 2006.
<1 1 – 1.99 >2 No non-polio AFP case 80%> No AFP< 60% 60% – 79%–
Indicator 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
AFP cases 1,939 1,526 1,557 1,684 1,724 1,641 1,720 1,951 1,963 1,765
Wild poliovirus confirmed cases 303 2 0 0 0 0 0 0 0 0
Compatible cases 75 15 4 1 0 0 0 0 0 0
AFP rate 3.12 2.48 2.52 2.75 2.83 2.62 2.75 2.76 2.74 2.43
Non-polio AFP rate1 2.44 2.45 2.52 2.75 2.83 2.62 2.75 2.76 2.74 2.43
Adequate stool specimen collection percentage2 80% 83% 85% 84% 86% 85% 91% 92% 88% 89%
Total stool samples collected 3,760 2,978 3,020 3,328 3,343 3,184 3,386 3,828 3,826 3,424
% NPEV isolation 10 12 12 9 8 9 9 9 9 7
% Timeliness of primary result reported3 99 100 100 99 99 100 99 99 99 98
Year Polio Diphtheria Pertussis Neonatal Tetanus(% of all Tetanus)
Measles Rubella Mumps Japanese Encephalitis
Congenital Rubella Syndrome
2005 303a 1,385 8,897 132 (7%) 15,853 ND ND ND ND
2006 2 162 3,356 118 (37%) 20,422 105 ND ND ND
2007 0 183 ND 141 (100%) 19,456 168 ND ND ND
2008 0 219 ND 183 (100%) 15,369 340 ND ND ND
2009 0 189 973 158 (68%) 20,818 2,090 ND ND ND
2010 0 432 ND 147 (100%) 18,869 1,323 ND ND ND
2011 0 806 1,941 114 (54%) 21,893 1,959 ND ND ND
2012 0 1,192 ND 106 15,489 1,020 ND ND ND
2013 0 775 2,976 78 (35%) 8,419 2,355 ND ND ND
2014 0 430 2,082 84 (8%) 12,943 3,843 ND 72 ND
Table 5: Reported cases of vaccine preventable disease, 2005-2014
a Excludes forty-six type 1 VDPVs. Source: WHO/UNICEF JRF ND=No data
Source: Weekly Acute Flaccid Paralysis (AFP) data Source: Weekly Acute Flaccid Paralysis (AFP) data
Immunization andVaccine Development
South-East Asia Region
<70% 70% - 79% 80% - 89% > 90%
1 WHO/UNICEF coverage estimates, for 2014 Country official estimate used, 2014-MCV2 coverage not available.2 WHO vaccine-preventable diseases: monitoring system 2014 & JRF 2014.
Figure 7: MCV1 & MCV2 coverage1 and measles cases2, 1980-2014
0
20
40
60
80
100
05000
100001500020000250003000035000400004500050000
1980 1985 1990 1995 2000 2005 2010 2011 2012 2013 2014
% C
over
age
No. o
f cas
es
Year
Measles Cases MCV1 Coverage MCV2 coverage
Figure 8: MCV1 coverage by province, 2014
Source: SEAR annual EPI reporting form, 2014 (administrative data)
Table 6: MCV supplementary immunization activities
Year Activity Age Target Coverage (%)
2000 Sub-national 6-12 Y 6,665,950 95
2003 Sub-national 6-12 Y 1,030,445 95
2004 Sub-national 6-12 Y 2,180,918 94
2005 Sub-national 6 M-15 Y 5,515,324 94
2006 Sub-national 6 M-5 Y 3,978,096 93
2006 Sub-national 6-12 Y 3,161,323 96
2007 Sub-national 6 M-12 Y 2,692,912 106
2007 Sub-national 6 Y-12 Y 2,569,350 102
2007 Sub-national 6-59 M 14,916,592 93
2008 Sub-national 1-3 Y 11,203 78
2009 Sub-national 9-59 M 1,763,122 97
2010 Sub-national 9-59 M 3,619,024 92
2011 Sub-national 9-59 M 11,843,093 98
Year Number of districts %
2010 197 40
2011 198 40
2012 269 54
2013 226 45
2014 199 38
Table 7: Districts with more than 95% MCV1 coverage
Source: WHO/UNICEF JRFs
Source: WHO/UNICEF JRF (multiple years)
Jan-
10Fe
b-10
Mar
-10
Apr-
10M
ay-1
0Ju
n-10
Jul-1
0Au
g-10
Sep-
10Oc
t-10
Nov-
10De
c-10
Jan-
11Fe
b-11
Mar
-11
Apr-
11M
ay-1
1Ju
n-11
Jul-1
1Au
g-11
Sep-
11Oc
t-11
Nov-
11De
c-11
Jan-
12Fe
b-12
Mar
-12
Apr-
12M
ay-1
2Ju
n-12
Jul-1
2Au
g-12
Sep-
12Oc
t-12
Nov-
12De
c-12
Jan-
13Fe
b-13
Mar
-13
Apr-
13M
ay-1
3Ju
n-13
Jul-1
3Au
g-13
Sep-
13Oc
t-13
Nov-
13De
c-13
Jan-
14Fe
b-14
Mar
-14
Apr-
14M
ay-1
4Ju
n-14
Jul-1
4Au
g-14
Sep-
14Oc
t-14
Nov-
14De
c-14
Sporadic measles Outbreak associated measles
0
100
200
300
400
500
600
700
No. o
f cas
es
M, SIA (92%) M, SIA (98%)
Figure 9: Sporadic and outbreak associated measles cases* by month and MR SIA coverage, 2010-2014
*Includes laboratory confirmed and epidemiologically linked casesSource: SEAR Monthly VPD reports
Figure 10: Immunity against measles: Immunity profile by age in 2015*
Figure 11: Immunity against measles: Immunity profile by age in 2016*
* Based on coverage and SIA data for up to 2014.Source: Modeled using MSP tool ver 2
* Assuming the schedule of 2nd dose of Measles containing vaccine is changed to 15 months and a measles SIA targeting age group 9 months to 9 years is done in 2016 with coverage more than 95%.Source: Modeled using MSP tool ver 2
Figure 12: Confirmed (Lab and Epi linked) measles outbreak associated cases, by age, 2010-2014
Figure 13: Unimmunized confirmed (Lab and Epi linked)measles outbreak associated cases, by age, 2010-2014
Source: SEAR annual EPI reporting form (multiple years) Source: SEAR annual EPI reporting form (multiple years)
Table 8: Suspected sporadic and Outbreak associated measles and rubella cases, 2010-2014
Year Routine/sporadic cases Outbreak associated cases
No. of suspected
case
No. of death
No. of lab-confirmed measles cases
No. of lab-confirmed
rubella cases
No. of suspected outbreak
No. of Outbreak
Investigated
No. of case
No. of death
No. of measles
outbreak*
No. of confirmed measles
case*
No. of confirmed
rubella outbreak*
No. of confirmed
rubella cases*
2010 19,111 6 659 750 188 132 3,044 7 90 2,066 40 504
2011 23,282 0 1,175 1,808 356 286 4,993 14 251 3,747 60 586
2012 18,798 4 429 1,565 163 144 2,328 4 65 1,117 76 939
2013 11,521 1 689 707 128 96 1,677 1 71 803 24 310
2014 12,943 7 1,471 713 173 119 2,104 21 114 1,285 7 69
Source: Monthly VPD Reporting to WHO/SEARO * Laboratory confirmed & epidemiologically- linked
0%
20%
10%
40%
60%
70%80%
90%
30%
50%
100%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Perc
ent o
f pop
ulat
ion
Age (in years)Protected by maternal antibodies Protected by routine vaccination with 1st doseProtected by routine vaccination with 2nd dose Protected by SIAsImmune due to past infection Susceptible
0
50
100
150
200
250
300
350
400
450
500
2010 2011 2012 2013 2014<1 year 1-4 years 5-9 years 10-14 years 15+ years
n=1627 n=2617 n=1119 n=365 n=1285
0%
20%
40%
60%
80%
100%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Perc
ent o
f pop
ulat
ion
Age (in years)Protected by maternal antibodies Protected by routine vaccination with 1st doseProtected by routine vaccination with 2nd dose Protected by SIAsImmune due to past infection Susceptible
n=1107 n=1468 n=775 n=280 ND
0
50
100
150
200
250
300
350
400
450
500
2010 2011 2012 2013 2014
<1 year 1-4 years 5-9 years 10-14 years 15+ years
(68%) (56%) (69%) (77%)
E P I F A C T S H E E T
World Health Organization• SEARO/FHR/IVD • 22 July 2015 Immunization andVaccine Development
South-East Asia Region
For contact or feedback:
Expanded Program on ImmunizationMinistry of Health, Jakarta, Indonesia
Tel : +62 21 4249024, Fax: +62 21 4249024
Email: [email protected] or [email protected]
www.depkes.go.id
Immunization and Vaccine Development (IVD)WHO-SEARO, IP Estate, MG Marg, New Delhi 110002, India
Tel: +91 11 23370804, Fax: +91 11 23370251
Email: [email protected],
www.searo.who.int/entity/immunization
Table 9: Quality of field and laboratory surveillance for measles and rubella, 2012-2014
Year
No. o
f Sus
pect
ed M
easl
es
Case classification (number) Indicators
Measles Rubella
Disc
arde
d no
n-m
easl
es n
on-r
ubel
la
case
s
Annu
al in
cide
nce
of c
onfir
med
Mea
sles
ca
ses
per m
illio
n to
tal p
opul
atio
n
Annu
al in
cide
nce
of c
onfir
med
Rub
ella
ca
ses
per m
illio
n to
tal p
opul
atio
n
Prop
ortio
n of
all
susp
ecte
d m
easl
es a
nd
rube
lla c
ases
that
hav
e ha
d an
ade
quat
e in
vest
igat
ion
initi
ated
with
in 4
8 ho
urs
of
notifi
catio
n
Disc
arde
d no
n-m
easl
es n
on-r
ubel
la
inci
denc
e pe
r 100
,000
tota
l pop
ulat
ion
Prop
ortio
n of
sub
natio
nal a
dmin
istra
tive
units
repo
rting
at l
east
two
disc
arde
d no
n-m
easl
es n
on-r
ubel
la c
ases
per
10
0,00
0 to
tal p
opul
atio
n
Prop
ortio
n of
sub
-nat
iona
l sur
veill
ance
un
its re
porti
ng to
the
natio
nal l
evel
on
time
Lab-
confi
rmed
Epi-L
inke
d
Clin
ical
ly-c
onfir
med
Lab-
confi
rmed
Epi-L
inke
d
Target � - - 80% 2 80% 80%
2012 18,798 429 ND ND 1,565 ND 1,561 1.75 6.18 ND 0.61 ND 64.23
2013 11,521 747 ND ND 742 ND 1,376 3.01 2.93 ND 0.54 ND 60.22
2014 12,943 1,870 ND ND 779 ND 2,173 7.39 3.08 ND 0.86 ND 22.06
Source: SEAR Annual EPI Reporting Form, 2014 ND=No data
Table 10: Performance of Laboratory Surveillance, 2012-2014
Year
% Serum specimen collected
from suspected measles cases
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
2012 25 4,657 89 403 10% 921 25% 68 ND ND ND
2013 45 5,169 100 996 20% 1,042 25% 97 ND ND ND
2014 70 8,448 100 5,194 62% 1,140 36% 60 ND ND ND
Source: SEAR Annual EPI Reporting Form, 2014 ND=No data
Figure 14: Network of WHO supported surveillance medical officers and laboratories, 2014
Polio, measles & rubella laboratories- National Institute of Health Research and
Development (NIHRD), Jakarta - Biofarma, Bandung - Public Health Laboratory, Surabaya
Measles & rubella laboratory - Public Health Laboratory, Yogyakarta
Japanese encephalitis laboratory - NIHRD, Jakarta
Source: EPI Indonesia