Transcript EPI Program in Thailand 2012
The Expanded Programme on Immunization in Thailand The implications
for
The border provinces
And
The Displace Person Tempolary Shelter
Pornsak Yoocharoen, MD.
Bureau of General Communicable Disease, DDC, MOPH
Administrative system for EPI in Thailand Ministry of Public Health National Vaccine Com.
Immunization policy Advisory Com. On Immunization Practice (ACIP) Technical support Dept of Disease Control
• BoE • Bogcd • 12 Reg.
Off. DPC Monitoring, Supervision Technical support National Health Security Office : NHSO Budget Planning and Procurement GPO Vaccine storage and supply (VMI) Permanent Secretary Office Administrative monitoring & control Provincial Health Office monitoring & control Hospital, Health Center Immunization Services
Immunization Policy
• Immunization is the basic health need • All people have the right to be
prevented from VPDs
• The service must be provided with
equality and free of charge
• The service must be safe and in good
quality
Immunization Target and Strategies
Polio Eradication Measles Elimination Neonatal Tetanus Elimination
• Maintain high vaccine coverage (> 90%) • Keep good quality in vaccine administration
& cold chain management
• Assessment Immunization Standard
and Accreditation
• AEFI surveillance & management
Current vaccines in EPI
Vaccine
BCG
HB
OPV
DTP-HB
DTP
JE
dT
MMR 20 – 25 M.
US$
Current National Immunization Schedule At Birth 2 Month 4 Month 6 Month 9 Month 18 Month Age 2 1 / 2 Year 4 Year 7 Year (School gr.1) 12 Year (School gr.6) Pregnant woman Vaccine BCG , HB1 OPV1, DTP-HB1 OPV2, DTP-HB2 OPV3, DTP-HB3 Measles --- > MMR1* OPV4, DTP4, JE1, JE2 # JE3 OPV5, DTP5 MMR2 dT dT3 (depend on immunization history) * Started in 2010 ; # = 1 month apart from JE1
Vaccine procurement and distribution by VMI system (NHSO) Oversea manufacturers Air port National Health Security Office (NHSO) Local manufacturer (GPO, TRCS) Vendor Managed Inventory (VMI) GPO Monthly supply Hospital storage (CUP) DPTS Health care provider (HC)
EPI vaccine coverage and disease incidence, 1977-2012 Cases rate 100 Vaccine Coverage 100
100 100
80
80 80
80 60 40 Measles 60 40
60 40 60
Neonatal Tetanus
40 20
20 20
20
0
8 7 6 5 4 3 2 1 0
1977
6 5 4 3 2 1 0
1977 1981 1985 1989 1993 Diphtheria 1997 2001 2005 Encephalitis Start JE vaccine in 1991 (17 provinces) 1981 1985 1989 1993 1997 2001 2005 2009 2009 0
100 80 60 40 20 0 100 80 60 40 20 0 0
1977 1981 1985 1989 1993 1997 2001 2005 2009
15 13 11 9 7 5 3 1 -1
1977 1981 1985 1989 1993 Pertussis 1997 2001 2005 2009 Source: EPI, Bureau of General Communicable Diseases, DDC MOPH
0 100 80 60 40 20 0
Case rate/100,000 (case / 100,000 live births in NNT) Vaccine coverage
Vaccine coverage in < 5 years Thailand 1999, 2003, 2008 Vaccine 1999 2003 2008 BCG DTP3 OPV3 HB3 Measles JE2 JE3 DTP4 DTP5 T2 (or booster) 98 97 97 95 94 84 90 90 99 98 98 96 96 87 62 93 54 93 99.9
98.7
98.7
98.4
98.1
94.6
89.3
96.5
79.4
93
National Immunization Program, Thailand
Vaccine coverage survey in primary school, gr.1 and gr.6 in 2008 Vaccine MMR gr.1
dT gr.6
Coverage (%) 91.7
94.1
National Immunization Program, Thailand
High Risk Group : People in …
• •
Remote area Hard to reach
Migratory pop.
Urban slum Illegal migrant worker
• •
Mobile team Closed monitoring
Coverage Epidemiological surveillance
Keep Up Catch Up Mop Up
AEFI Surveillance system MOPH WHO DDC FDA (Regulation, Licencing) EPI, GCD MDSC (lot release, vaccine lab testing) BOE (AEFIs) Regional DDC (monitoring) PHO, BMA Data flow Data feedback Hospital, Health Center, Imm. Clinic IPD, OPD, Well baby clinic
Risk factors and Warning Signs
Distrust in Health Services Insurgency & Insecurity Health Reform Geographical Barriers & Difficulties Severe AEFI & Rumors Low Vaccine Coverage Believe & Concerns Migratory Pop.
VPD Outbreak
Challenges
Poor vaccine coverage or unknown in …
unrest areas
migrant workers (Thai and non-Thai)
DPTS
Free movement of workers in SEAR from the declaration of AEC
Undetected and un-controlled displace persons and illegal migrant workers move in and out the temporary shelters
Challenges
Canceling of immunization coverage report from local and provincial level, keeping data at local area but no data at national level.
Many outbreak of VPDs were related to foreign migrant workers
Measles (Myanmar worker) Rubella (Cambodian worker) Diphtheria (Lao hill tribe, Mong)
Challenges
Changing of budget allocation from MOPH to NHSO, limitation of budget but increase flexibility of budget management.
By law, the NHSO will support vaccine only Thai but not include non-Thai population
Dilemma of command line between MOPH and NHSO (direct command and financial support)
Challenges
To harmonize the separated function of immunization services by EPI program and vaccine procurement and delivery system by NHSO
Reduce of health staff and Increase of treatment care from public sector and health care reformation
High turn over rate among immunization health personnel
Opportunities
• Fully support at national level, NHSO have
potentially supported with high level of finance.
• Outsource of the delivery system to public-
private sector using Vender Manage Inventory system (VMI).
• Potentially support equipment for cold
chain system. (Refrigerator, vaccine carrier, thermometer …)
Next steps implication
• To convince the NHSO should have fully
support the routine immunization vaccines to DPTS and also others foreign children who live in Thailand.
• To co-operate with neighboring countries
around Thailand should intensify routine immunization activities to increase and maintain high vaccine coverage, more than 90%, in every country.
Thank You
An ounce of prevention
is always better than