The Immunization Programme Makes remarkable Progress in Bangladesh

 History

The immunization program in Bangladesh was inaugurated on April 7, 1979 (World Health Day).  At that time,  the service was limited to selected number of Upazila Health Complex, major hospitals and some NGOs. It was revealed through a  1985 survey that the fully vaccinated children constituted less than 2 percent of the child population.  To achieve the Global Universal Child Immunization Initiative (UCI),  Government of Bangladesh, began a phase-wise process of EPI intensification from 1985-1990. During this period, the  EPI was expanded throughout 460 Upazilas (Sub-districts), 84 Municipalities and 4 City Corporations.

EPI intensification consisted of:

        establishing the cold chain (refrigerators and freezers) from EPI HQ to District and Upazila levels;

        procuring and managing logistics needs for around 120,000 EPI outreach sites;

        providing basic EPI training for thousands of mid-level managers, supervisors and field workers in government and NGOs;

        conducting advocacy & planning meetings nation-wide;

        co-opting the private sector in developing a communication strategy.

 To improve the programme as a whole the following implementation strategies were developed:

1.       Immunize all children under one year of age throughout the country;

2.       Immunize all women of child bearing age including pregnant women throughout the country;

3.       Extend service delivery up to community-level  in urban and rural areas to cover all target population;

4.       Involve community level health and family planning workers as vaccinators;

5.       Initiate mechanisms to mobilize different groups/sectors both public and private and also involve all communication channels including mass media;

 Within a very short time, EPI was able to increase the coverage of children from 2% in 1985 to 76% in 1995. The annual polio incidence rate/100,000 children <5 years of age has decreased from 52 in 1983 to 14 in 1994. The neonatal tetanus mortality rate/1,000 live birth also decreased from 41 in 1986 to 6 in 1994.

Mission

The mission of the EPI program in Bangladesh is to eradicate or reduce morbidity and mortality from vaccine-preventable diseases to levels where they are no longer a public health concern by providing high-quality EPI services to all children in the country.

Coverage Objective

1.       To increase coverage with a full series of routine vaccines gradually to at least 90% in all Districts by 2010;

Disease Reduction Objectives

1.       To achieve interruption of indigenous wild poliovirus transmission by the end of 2000 and certification of polio eradication by December 2010;

2.       To sustain elimination of neonatal tetanus status (<1 neonatal death per 1000 live birth) nationally and in all districts;

3.       To reduce measles morbidity by 90% and mortality by 95% by 2010 compared with pre-vaccine era;

4.       To reduce the prevalence of HepB chronic infection (HbsAg) among 3-5-year old children by 80%, compared to the prevalence in the pre-vaccine era, by 2010;

5.       To eliminate vitamin A deficiency by 90% in children aged <5 years by 2010;

6.       Introduction of new or under-utilized vaccines;

7.       Eliminate the risk of transmission of blood-borne infections associated with injections administered in the EPI program by 90% by 2010;

Achievements

        Survey shows that the coverage of BCG is 98% which reflects the accessibility of the vaccination service. The Fully Immunized Children (FIC) is 87% and the FIC with in one year is 75%;

        EPI program in Bangladesh was started with preventing six conventional diseases; In the year 2003 Hepatitis-B vaccine was introduced in the routine immunization program.;

        AD syringe and safety box were introduced in the national immunization program from 2004 to ensure injection safety and also so decrease the transmission of blood borne pathogens through injection;

        Introduction of VPD surveillance and AEFI surveillance with proper addressing of adverse events aiming to increase the confidence on EPI among the beneficiaries;

        Organization of measles catch up campaign in 2005-2006 targeting around 35 million children aged 9 months to 10 years;

        Measles surveillance has shifted from out break surveillance to case based surveillance;

        Substantially increased the cold chain capacity from national to Upazila level;

        Received first phase support from GAVI for introduction of HepB vaccine, AD syringe and support for strengthening immunization system;

        The country is maintaining polio free status now. There were stray cases of importation of wild polio virus in March 2006. Previously,  Bangladesh was polio free since 22 August 2000. Till now, the Government of Bangladesh has successfully organized sixteen National Immunization Days; the 17^th one is due for December 2008, fully supported by WHO.

        For achieving neonatal tetanus (NT) elimination, SIAs have been organized for hard-to-reach and high risk areas in 1999, 2000, 2001, 2005 and 2006. This is in addition to the routine TT vaccination among women of child bearing age (5-49 years). Neonatal Tetanus (NT) validation study conducted in 2008 proves the elimination of Neonatal-tetanus (<1/100,000 LB).

 Child (0-11 Months)  Vaccination Schedule

*   Three doses of OPV is to give with DPT three doses and the fourth dose of OPV is to give with Measles

** Vitamin-A (blue capsule) is to give with Measles vaccine

 Women (15-49 Years):  Vaccination Schedule