Typhoid Vaccine Used in Vietnam and its Impact

Ad-Hoc Consultation on Typhoid Vaccine Introduction and Typhoid Surveillance,

18-20 April 2011, Bangkok, ThailandNguyen Van Cuong, Deputy NEPI Manager

Vietnam

# population: 86 m.

# < 1 year old: 1.6 m.

# regions: 4

# provinces: 63

# districts: 695

# communes: 11,138

EPI vaccines in VietnamVaccine Schedule Year start % Coverage

area 2010BCG Birth 1981 100

DPT-HepB-Hib M2, M3, M4 2010 100

DPT M18 2011 100

OPV M2, M3, M4 1981 100

Measles M9, M18 1981 100

HepB Birth 1997 100

JE M12, +W2; Y2 1997 80

Typhoid Y3-Y5 1997 5

Cholera Y2-Y5 1997 2

TT PW; +M1; +M6; +Y1; +Y1 1981 100

Typhoid vaccine in EPI 1997 - 2010

Company Year # doses (x1000) Type vaccine

Aventis Pasteur

1997 - 2003: 3 - 5 Y 4,300 TYPHIM Vi

IVAC/DAVAC (Vietnam)

2004 - 2010: 5 - 10Y

2011: 3-5Y2,080 Typhoid Vi

polysaccharide

Total 6,380

Estimated Average Annual Incidence of Typhoid, 1999-2003 (DOMI program)

Average annual number of cases nation-wide, all ages (1999-2003): 11,696

Average annual incidence rate: 14.7 per 100,000

Out of 61 provinces: 2 have high over incidence

(>100/100,000) in all age groups combined.

18 have medium incidence (10 – 100/ 100,000)

Age Groups

Age group (years)

Avg. Annual incidence/ 100,000

(1999-2003)

Percent

< 2* -- --2-4 26.5 21%5-9 39.4 31%10-14 31.8 25%15-19 11.3 9%20-29 11.1 9%30-39 3.8 3%40 and over 2.4 4%All ages 14.7 100%

Estimated annual age-specific incidence nation-wide, based on meta-analysis (using age-specific rates from Dong Thap province)

* No cases in children < 2 years were found in Dong Thap, so incidence in this age group could not be estimated

56% 77%

Children < 15 years old are most at risk.Overall incidence of 5-14 year olds per year: 35.6 per 100,000

# provinces introduce Typhoid vaccine, 1997-2010Year Province

1997 8

1998-1999 17

2000 20

2001 27

2002 24

2003 29

2004 32

2005 35

2006 30

2007 24

2008 0

2009 3

2010 2

1997: (8)

2002:(24)

2005: (35)2007: (24)

2010: (2)

Number of doses Typhoid vaccine use in EPI, 1997 - 2011 (x 1000)

Target population and coverage rate, 1997 - 2010

0,07 0,09 0,12 0,260,49

0,700,47 0,40 0,51

3,83

0,00

0,50

1,00

1,50

2,00

2,50

3,00

3,50

4,00

4,50

US

$Vaccine Price per Series to Vietnam

EPI Program, 2010

Vaccines given and cases in Dien Bien province, 1998 - 2008

0

200

400

600

800

1000

1200

1400

1600

0

5000

10000

15000

20000

25000

30000

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Num

ber o

f cas

es

Vacc

ine

dose

s gi

ven

Vaccines given

Cases identified

Vaccine coverage and Typhoid incidence (DOMI) -1

Vaccine coverage and Typhoid incidence (DOMI) - 2

Vaccine coverage and Typhoid incidence (DOMI) - 3

Vaccine coverage and Typhoid incidence (DOMI) - 4

Vaccine coverage and Typhoid incidence (DOMI) - 5

Vaccine coverage and Typhoid incidence (DOMI) - 6

Conclusions• Nationwide decrease in typhoid fever incidence in

parallel with nationwide increase in vaccine coverage

• Control of typhoid fever through immunization in high risk regions of the Northwest and Mekong River Delta prior of the other

• Reduction in typhoid fever disease burden could also be attributed to other common preventive measures than just immunization

• Long term and detail plan include surveillance need to be prepared

• Support from international organization (technical and finance)

Thank you