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The Expanded Programme on Immunization in Thailand
Pornsak Yoocharoen, MD.
Bureau of General Communicable Disease, DDC, MOPH
The implications for
The border provincesAnd
The Displace Person Tempolary Shelter
Administrative system for EPI in Thailand
Permanent Secretary Office
Provincial Health Office
National Vaccine Com.
Hospital, Health Center
Monitoring, SupervisionTechnical support
Budget Planning and Procurement
Vaccine storage and supply (VMI)
Immunization policy
National Health Security Office :
NHSO
Dept of Disease Control
GPO
Ministry of Public Health
Immunization Services
Administrative monitoring & control
monitoring & control
Technical support
Advisory Com. On Immunization Practice
(ACIP)
• BoE• Bogcd• 12 Reg. Off. DPC
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
Polio Eradication Measles Elimination
Neonatal Tetanus Elimination
Immunization Target and Immunization Target and StrategiesStrategies
• 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 EPICurrent vaccines in EPI
Vaccine
BCG
HB
OPV
DTP-HB
DTP
JE
dT
MMR
20 – 25 M.
US$
Age VaccineAt Birth BCG, HB1HB1
2 Month OPV1, DTP-HB1DTP-HB1
4 Month OPV2, DTP-HB2DTP-HB2
6 Month OPV3, DTP-HB3DTP-HB3
9 Month MeaslesMeasles ---- > MMR1*MMR1*
18 Month OPV4, DTP4, JE1, JE2#
21/2 Year JE3
4 Year OPV5, DTP5
7 Year (School gr.1) MMR2MMR2
12 Year (School gr.6) dT
Pregnant woman dT3 (depend on immunization history)
Current National Immunization Schedule
* Started in 2010* Started in 2010 ;; # = 1 month apart from # = 1 month apart from JE1JE1
Oversea manufacturers
Air port
GPO
Hospital storage
(CUP)
Health care provider (HC)
Vaccine procurement and distribution by VMI system (NHSO)
Local manufacturer (GPO, TRCS) Monthly supply
National Health Security Office
(NHSO)
Vendor Managed Vendor Managed InventoryInventory
(VMI)(VMI)
DPTS
EPI vaccine coverage and disease incidence, 1977-2012
0
20
40
60
80
100
1977 1981 1985 1989 1993 1997 2001 2005 2009
0
20
40
60
80
100
Neonatal Tetanus
Case rate/100,000 (case / 100,000 live births in NNT)
Vaccine coverage
Source: EPI, Bureau of General Communicable Diseases, DDC MOPH
0
1
2
3
4
5
6
1977 1981 1985 1989 1993 1997 2001 2005 2009
0
20
40
60
80
100
EncephalitisStart JE vaccine in
1991 (17 provinces)
Diphtheria
-1
1
3
5
7
9
11
13
15
1977 1981 1985 1989 1993 1997 2001 2005 2009
0
20
40
60
80
100
Pertussis
0
20
40
60
80
100
1977
1979
1981
1983
1985
1987
1989
1991
1993
1995
1997
1999
2001
2003
2005
2007
2009
2011
Cases rate
0
20
40
60
80
100Vaccine Coverage
Measles
Vaccine coverage in < 5 years Thailand1999, 2003, 2008
Vaccine 1999 2003 2008
BCG 98 99 99.9 DTP3 97 98 98.7 OPV3 97 98 98.7 HB3 95 96 98.4 Measles 94 96 98.1 JE2 84 87 94.6 JE3 - 62 89.3 DTP4 90 93 96.5 DTP5 - 54 79.4 T2 (or booster) 90 93 93
National Immunization Program, Thailand
Vaccine Coverage (%)
MMR gr.1 91.7 dT gr.6 941.
Vaccine coverage survey in primary school, gr.1 and gr.6 in 2008
National Immunization Program, Thailand
High Risk Group : People in …High Risk Group : People in …
• Remote area Remote area
•Hard to reach Hard to reach Migratory pop. Migratory pop. Urban slum Urban slum Illegal migrant Illegal migrant
workerworker
• Mobile team Mobile team
• Closed Closed mmonitorinonitoringg CCoverageoverage EE pidemiological pidemiological
surveillance surveillance Keep UpKeep Up Catch Up Catch Up Mop UpMop Up
MOPH WHO
DDC
BOE(AEFIs)
EPI, GCD
Regional DDC(monitoring)
FDA (Regulation,
Licencing)
MDSC(lot release, vaccine
lab testing)
PHO, BMA
Hospital, Health Center, Imm. Clinic
IPD, OPD, Well baby clinic
AEFI Surveillance
system
AEFI Surveillance
system
Data flow
Data feedback
Insurgency &
Insecurity Health ReformDistrust
in
Health Services
Migratory Pop.Severe AEFI
&
Rumors
VPD VPD Outbreak Outbreak
Believe & Concerns
GeographicalBarriers & Difficulties
Low Vaccine Coverage
Risk factors and Warning SignsRisk factors and Warning Signs
Challenges
Poor vaccine coverage or unknown in … unrest areas migrant workers (Thai and non-Thai) DPTS
Undetected and un-controlled displace persons and illegal migrant workers move in and out the temporary shelters
Free movement of workers in SEAR from the declaration of AEC
Challenges
Many outbreak of VPDs were related to foreign migrant workers
Measles (Myanmar worker) Rubella (Cambodian worker) Diphtheria (Lao hill tribe, Mong)
Canceling of immunization coverage report from local and provincial level, keeping data at local area but no data at national level.
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
High turn over rate among immunization health personnel
Reduce of health staff and Increase of treatment care from public sector and health care reformation
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 …)
• 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.
Next steps implication
Thank You
An ounce of prevention is always better than
A pound of cureA pound of cure..