SPC/PHoH 7 Paper no.12

ORIGINAL: ENGLISH

7th

Pacific Heads of Health (PHoH) Meeting: 3 to 5 April 2019, Nadi Fiji

Agenda Item 10.1 – Immunisation and Vaccine Preventable Diseases (Current issues and future

directions)

The global increase in vaccine hesitancy is threatening the progress made towards

the elimination or control of vaccine preventable diseases (VPDs). The world is witnessing a

resurgence of measles associated with international travel as well as outbreaks of pertussis

and diphtheria in under-vaccinated communities.

Participants from 19 Pacific island countries and areas (PICs) participated in the

Tenth Pacific Immunisation Programme Managers’ Meeting held in Nadi, Fiji, from 30 July

– 3 August 2018. The meeting found that implementation of several regional vaccine

coverage goals are on track, but uneven coverage is seen across and within PICs, with high

national level immunisation coverage data sometimes masking under-immunised districts.

Countries in the Pacific have experienced outbreaks of mumps, hepatitis A, meningococcal

meningitis, pertussis and rotavirus diarrhoea in the last few years.

The 2018 meningococcal meningitis serogroup C outbreak in Fiji and the

circulating vaccine derived poliovirus outbreaks in Papua New Guinea reminds us that all

countries remain vulnerable to emerging infectious diseases and low immunisation coverage

poses worrying risks. The International Coordinating Group (ICG) on Vaccine Provision for

Meningitis is a mechanism to manage and coordinate the provision of emergency vaccine

supplies for meningococcal meningitis. Fiji is the first country in the Pacific to access

vaccines through this mechanism.

Surveillance for adverse events following immunisation (AEFIs) is in place in 10

PICs but there is significant under-reporting of AEFIs. Engaging communities in risk

communication systems is a key to managing vaccine hesitancy and building resilience.

At present, there is no Pacific-wide harmonisation of the vaccine formulations used

although under the UNICEF VII mechanism participating PICs harmonise their product

selections and therefore have harmonised vaccine formulations. Heads of Health are invited

to consider the question – are we ready to harmonise immunisation schedules across the

Pacific?

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1. BACKGROUND

1.1 Purpose of this paper

The purpose of this paper is to provide the Heads of Health with updates on the global and

regional epidemiology of vaccine preventable diseases and vaccine coverage in the Pacific, the

conclusions and recommendations of the Tenth Pacific Immunisation Programme Managers’ Meeting

held in 20181, and emerging issues in immunisation. The paper also asks the question – are we ready

to harmonise immunisation schedules across the Pacific?

1.2 Progress towards vaccination targets and interruption of VPD transmission

Progress has been made against many of the Global Vaccine Action Plan (GVAP) targets to

achieve the Decade of Vaccines vision by delivering universal access to immunisation notable

challenges remain. For example, although the number of under-vaccinated children decreased by

more than 1.8 million between 2010 and 2017 globally, in 2017 there were still almost 20 million

under-vaccinated children.2

The Regional strategy and plan of action for measles and rubella elimination in the Western

Pacific is the roadmap to achieve and sustain the interruption of the transmission of measles and

rubella viruses (elimination) in all countries and areas of the Western Pacific Region (WPR) by 2020.

The Sixth Meeting of the Combined Subregional Committees for the Certification of

Poliomyelitis Eradication and Verification of Measles Elimination in Pacific Island Countries and

Areas (SRCC/SRVC) was convened in Nadi, Fiji, from 1 – 3 May 2018.3 The SRCC/SRVC serves as

the expert review group to classify all cases of acute flaccid paralysis (AFP) reported in PICs and

produces the annual report on the Pacific’s poliomyelitis-free status to be submitted to the Regional

Certification Commission. The SRVC also develops the annual report on progress towards achieving

measles elimination to be submitted to the Regional Verification Commission.

1 World Health Organization Regional Office for the Western Pacific and the UNICEF Pacific Office.

Meeting Report of the Tenth Pacific Immunisation Programme Managers Meeting, Nadi, Fiji, 30 July to 3

August 2018. http://iris.wpro.who.int/bitstream/handle/10665.1/14336/RS-2018-GE-41-FJI-eng.pdf

(Accessed 23 February 2019). 2 2018 Assessment report of the Global Vaccine Action Plan. Strategic Advisory Group of Experts on

Immunisation. Geneva: World Health Organization; 2018.

https://www.who.int/immunisation/global_vaccine_action_plan/SAGE_GVAP_Assessment_Report_2018_E

N.pdf?ua=1 (Accessed 28 February 2019) 3 World Health Organization Regional Office for the Western Pacific. Sixth Meeting of the Combined

Subregional Committees for the Certification of Poliomyelitis Eradication and Verification of Measles Elimination in Pacific Island Countries and Areas in Nadi, Fiji, 1 - 3 May 2018.

https://apps.who.int/iris/rest/bitstreams/1156340/retrieve (Accessed 7 March 2019).

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1.3 The re-emergence of vaccine preventable diseases (VPDs) in the Western Pacific

Region

Measles

Between 2016 and 2017, the number of reported measles cases increased by 31% and

endemic measles transmission was re-established in the Bolivarian Republic of Venezuela, Germany

and the Russian Federation.4

Challenging the measles and rubella elimination target of the Regional Strategy, the WPR has

been affected by a region-wide measles resurgence starting in 2013. International spread of the

disease has caused large-scale or multiple smaller outbreaks in several countries where interruption of

measles transmission had been achieved or measles incidence had been low. In Japan, for example,

222 measles cases were reported in epidemiological weeks 1-7 2019 (to 17 February, 2019),

compared to 282 cases reported during the whole of 2018.5 Similarly, in the Republic of Korea during

weeks 1-7 2019, a total of 324 cases have been reported compared to fewer than 30 cases annually

from 2015-18.6 On a positive note, the Sub-regional Committee for Certification of Polio Eradication

(SRCC)1 concluded that measles and rubella elimination can be feasibly achieved in PICs by the

target date of 2022 if the good progress made across the Pacific continues to include the PICs that

have yet to achieve the regional coverage targets for measles.

Circulating vaccine derived poliovirus outbreaks

Chronic under-immunisation of populations with polio vaccine led to two outbreaks of

unrelated circulating vaccine-derived poliovirus type 1 (cVDPV1) in Papua New Guinea7 and

Indonesia.8 Wild poliovirus continues to be endemic in Afghanistan, Nigeria and Pakistan posing a

continuing risk to wild poliovirus elimination.9

With respect to polio vaccination, the SRVC recommended that all countries in the Western

Pacific Region achieve and sustain high (>90%) polio vaccination coverage, maintain AFP

4 Dabbagh A, Laws RL, Steulet C, Dumolard L, Mulders MN, Kretsinger K, Alexander JP, Rota PA, Goodson

JL. Progress toward regional measles elimination—worldwide, 2000–2017. Morbidity and Mortality Weekly

Report. 2018 Nov 30;67(47):1323.

https://apps.who.int/iris/bitstream/handle/10665/276217/WER9348.pdf?ua=1 (Accessed 28 February 2019) 5 https://www.niid.go.jp/niid/images/idsc/disease/measles/2019pdf/meas19-07.pdf (Accessed 28 February

2019) 6 http://www.cdc.go.kr/CDC/eng/info/CdcKeDIDO.jsp?menuIds=HOME002-MNU0576-

MNU0586&fid=9712&q_type=&q_value=&cid=143084&pageNum= (Accessed 28 February 2019) 7 Disease outbreak news. Circulating vaccine-derived poliovirus type 1 – Papua New Guinea. 20 February

2019. https://www.who.int/csr/don/20-February-2019-polio-png/en/ (Accessed 28 February 2019) 8 Disease outbreak news. Circulating vaccine-derived poliovirus type 1 – Indonesia. 27 February 2019.

https://www.who.int/csr/don/27-february-2019-polio-indonesia/en/ (Accessed 28 February 2019) 9 Global Polio Eradiation Initiative. Global Wild Poliovirus 2014-2019. http://polioeradication.org/wp-

content/uploads/2019/02/global-wild-poliovirus-2013-2019-20190219.pdf (Accessed 28 February 2019)

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surveillance at the WHO standard and update their polio preparedness and response plans to include

an assessment of the risk from polio importation.

VPDs in the Pacific

According to 2017 data on VPDs derived from the UNICEF-WHO Joint Reporting Process10

there were 10,695 cases of measles, over 4,000 cases of rubella and 22 cases of congenital rubella

syndrome, close to 335,000 cases of mumps, 27,624 cases of pertussis and 141 cases of diphtheria in

the WHO Western Pacific Region (WPR).

The last outbreak of measles in the Pacific occurred in 20141 when three countries

experienced outbreaks. Genotypic analysis confirmed that the outbreak genotype B3 in the Federated

States of Micronesia originated in the Philippines. The outbreak in the Solomon Islands was linked to

PNG and the outbreak in Vanuatu was epidemiologically linked to the Solomon Islands.

In 2017, 6 PICs provided surveillance reports11

for congenital rubella syndrome (CRS),

diphtheria and pertussis (all 0 cases); 7 PICs for measles and rubella (10 cases reported by two

countries) with Fiji12

reporting discarded measles/rubella cases, and neonatal tetanus (0 cases); and 6

PICs for mumps (23 cases). The incidence of measles in 2017 was less than 1 case per 1 million total

population.3 The WPR has maintained its wild polio-free status. The Pacific VPD surveillance data

show significant under-reporting by countries and by disease (for example, given the large numbers of

mumps cases that occurred in 2017). CRS surveillance is weak or non-existent in all PICs. The target

year for elimination of rubella in the PICs has not been defined.3

2. PROGRESS AND ACHIEVEMENTS

2.1 Summary of key findings from the 2017 Joint Reporting Process on immunisation

According to 2017 vaccination coverage data derived from the UNICEF-WHO Joint

Reporting Process, implementation of six out of eight regional immunisation goals is on track in the

Pacific although overall progress in meeting the regional vaccination coverage goals has been slow.

Regional targets for district level vaccination coverage were met in only eight PICs (40%).

10

World Health Organization. Immunisation, Vaccine and Biologicals

https://www.who.int/immunisation/monitoring_surveillance/data/gs_wprprofile.pdf?ua=1 (Accessed 23 February 2019).

11 World Health Organization. Reported incidence time series.

http://www.who.int/entity/immunisation/monitoring_surveillance/data/incidence_series.xls?ua=1 (Accessed

07 March 2019). 12 World Health Organization. Measles and Rubella Surveillance Data.

https://www.who.int/immunisation/monitoring_surveillance/burden/vpd/surveillance_type/measlesreportedc

asesbycountry.xls?ua=1. (Accessed 07 March 2019).

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As of 2017, of the 17 PICs13

that completed the Joint Reporting Form (JRF), 8 had achieved

the WHO diphtheria-tetanus-pertussis (DTP3) vaccine coverage of 95% or above with another two

achieving the GVAP national coverage target of 90%.

With respect to measles vaccination coverage, first dose coverage of over 95% was reported

by 8 PICs in 2017, all but one of which also achieved over 95% second dose coverage. However,

given the very high communicability of measles, over 95% immunisation coverage is required to

prevent transmission. Countries and areas in the Pacific have not experienced measles outbreaks

since 2014 using a combination of routine and supplementary vaccination; maintaining optimal levels

of immunisation coverage is critical to preventing the re-emergence of measles in the Pacific given

these worrying global and regional trends in measles transmission.

In 2017 there was a fall in the percent of acute flaccid paralysis (AFP) cases investigated

within 48 hours (81%) compared to 100% in 2016, and a significant drop in the percent of AFP cases

with the 60-day follow-up (31% vs. 80% in 2017 and 2016 respectively). Improvements were seen in

timeliness and adequacy of stool sample collection for virological testing.

2.2 Access to emergency vaccines

The Pacific has made use of emergency vaccines for outbreak control a number of times,

most notably for the control of measles, typhoid fever and hepatitis A, and in Fiji more recently for

the control of invasive meningococcal serogroup C disease. WHO established the Strategic Advisory

Group of Experts on immunisation (SAGE) in 1999 as the principal advisory group for vaccines and

immunisation. The SAGE has developed position papers on the emergency vaccination for outbreak

control for hepatitis A14

, measles15

and typhoid16

among others.

Under the UNICEF Vaccine Independence Initiative (VII) mechanism, 13 PICs jointly keep a

buffer stock of vaccines in Nadi, Fiji, to ensure supply security in case of stock-outs due to

unexpected events (natural disasters and cold chain failures) or inaccurate forecasting by countries.

The VII buffer stock is a successful best practice - and the only example in the world for vaccines -

based on Pacific regionalism, South-to-South cooperation and emergency resilience principles. Most

importantly the buffer stock is owned and financed by PICs. UNICEF is managing the buffer stock as

13

Cook Islands, French Polynesia, Fiji, Kiribati, Marshall Islands (Republic of), Micronesia (Federated States

of), Nauru, New Caledonia, Niue, Northern Mariana Islands (Commonwealth of), Palau, Samoa, Solomon Islands, Tonga, Tuvalu, Vanuatu and Wallis and Futuna.

14 WHO position paper on hepatitis a vaccines – June 2012. Weekly Epidemiological Record No. 28-29,

2012;87:261–276. https://www.who.int/wer/2012/wer8728_29.pdf?ua=1 15 Measles vaccines: WHO position paper – April 2017. Weekly Epidemiological Record No 17, 2017;

92:205–228. https://apps.who.int/iris/bitstream/handle/10665/255149/WER9217.pdf?sequence=1 16

Typhoid vaccines: WHO position paper – March 2018. Weekly Epidemiological Record No 13, 2018, 93,

153–17. https://apps.who.int/iris/bitstream/handle/10665/272272/WER9313.pdf?ua=1

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structured by the official VII Agreement between the countries and UNICEF. In 2017, Fiji and Samoa

used the buffer stock to conduct their national measles and rubella vaccination campaigns.

The International Coordinating Group (ICG) on Vaccine Provision for Meningitis was

established in 1997 following major outbreaks of meningitis in Africa. The ICG stockpile is designed

to provide emergency vaccines to contain outbreaks of meningococcal disease, yellow fever and

cholera. WHO Headquarters in Geneva, Switzerland, provides the ICG Secretariat with UNICEF,

Médecins Sans Frontières and the International Federation of the Red Cross being permanent

members. UNICEF Supply in Copenhagen, Denmark, is responsible for price negotiations,

procurement and logistics operations for the vaccine supplies. In 2018, WHO and UNICEF supported

the Fiji Ministry of Health and Medical Services to access affordable conjugate meningococcal C

vaccine through the ICG mechanism because there is a global shortage of this product and the supply

allocation is therefore regulated.

In conjunction with the WHO position papers on immunisation, the WHO Vaccination in

acute humanitarian emergencies: A Framework for Decision Making is a useful risk assessment tool

to guide decisions on when emergency vaccination should be considered for outbreak control by

vaccine.

3. CHALLENGES

3.1 Emerging VPDs

In 2017-18, Fiji experienced its first outbreak of invasive meningococcal disease (IMD)

serogroup C. The outbreak was declared on 20 March 2018 and lasted for several months. 90% of

confirmed and probable cases were between 0-19 years of age. This outbreak resulted in three

institutional clusters as well as community transmission and affected all four Divisions of Fiji. All the

serogroup C isolates were clone ST-4821 which was first discovered as causing outbreaks in 2003 in

China.

To control the IMD outbreak, Fiji accessed 124,800 doses of emergency monovalent

conjugate meningococcal C vaccine through the International Coordinating Group (ICG) on Vaccine

Provision for Meningitis and an additional 200,000 doses were secured through UNICEF Supply

Division procurement services for mass vaccination of the population at highest risk. The campaign

ran from 14 May – 31 October 2018. The assessed vaccine coverage in Jan 2019 was 91% among the

target population of over 309,000 1-19 year olds in the four Divisions. The last confirmed case

occurred in September 2018 and the outbreak was declared over in December 2018.

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Should the need arise elsewhere in the Pacific, the technical partners will support countries to

develop the detailed epidemiological analysis and microplanning required as the rationale for access

to the stockpile.

The challenges of implementing a mass vaccination campaign of this size included the need

for detailed microplanning for a phased approach, transport logistics, staff training to deliver different

formulations of the vaccine, cold chain requirements exceeding the normal capacity of the Fiji

Pharmaceutical and Biomedical Services Centre (FPBS), risk communications and community

mobilisation, and monitoring and evaluation.

3.2 Challenges to achieving regional immunisation targets in the Pacific

National case studies presented at the Tenth Pacific Immunisation Programme Managers

Meeting1 identified a number of challenges to achieving and maintaining regional immunisation

targets over time including: limited human resources with high staff turnover; the need for active

follow-up of dropouts through outreach services; tracing families with high mobility; access to

uninterrupted financial flows and resources for immunisation; logistical challenges such as transport

to the outer islands and for other operational needs including supervisory visits; inadequate cold chain

systems; and inadequate information management systems.

Despite vaccination coverage indicators currently being on track in the Pacific to meet global

and regional targets, PICs are facing considerable immunisation supply chain and cold chain

management challenges due to geographical/logistical complexities and limited resources. While

vaccine coverage indicators tell us the percentage of children reached, strong cold chain systems are

required to ensure the vaccines given to children are effective. Without a reliable cold chain, vaccines

can lose their potency (effectiveness) so that vaccinated children may not be immunised. To remain

potent, vaccines must be transported and stored under strict temperature control conditions of between

2°C and 8°C.

There have been considerable improvements in strengthening immunisation cold chain

systems in Fiji, Vanuatu, Solomon Islands and Kiribati, increasing the coverage rates of cold chain

access to for more than 85% of all immunisation service points (health facilities) during the last four

years despite these countries having relatively more complex logistics.

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3.2 Vaccine hesitancy

Vaccine hesitancy is an increasing concern globally. Vaccine hesitancy is defined by the

SAGE Vaccine Hesitancy Working Group17

as “…the delay in acceptance or refusal of vaccination

despite availability of vaccination services”. SAGE noted that vaccine hesitancy is context specific,

varying across time, place and vaccines, and influenced by factors such as confidence in the

immunisation program, complacency and convenience. Vaccine hesitancy tends to increase after

serious adverse events following immunisation (AEFI).

Generating acceptance and demand for immunisation aims to ensure that parents, caregivers,

communities, and other stakeholders have the necessary knowledge, motivation, and opportunities to

seek vaccination, and to complete the schedule on time. Confidence in the safety and quality of

vaccines and immunisation programs, including through the reporting and investigation of AEFIs and

proactive risk communication and community engagement, is key to maintaining acceptance and

demand for immunisation. Partner support for improved reporting, timely and comprehensive

investigation and data analysis should be considered in this regard.

4. FUTURE DIRECTIONS

4.1 Are we ready to harmonise immunisation schedules across the Pacific?

At present, there is no Pacific-wide harmonisation of the vaccine formulations used, the ages

at which vaccines are recommended nor the number of vaccine doses that are recommended for each

vaccine, although under the UNICEF VII mechanism participating PICs harmonise their product

selections and therefore have harmonised vaccine formulations. For measles-containing vaccines

(MCVs) for example, there are 9 different dosing schedules among the 18 of 20 PICs that have

implemented a 2-dose schedule, while two countries have not yet implemented MCV2. In addition,

14 of the 20 PICs use MMR while 6 use MR vaccines (Table).

Globally, reasons behind variability in immunisation schedules include differences in the

epidemiology of vaccine preventable diseases in each country, the history behind each country’s

immunisation schedule, and differences in the way that countries make decisions about which

vaccines to offer. In 2019, the Pacific can be regarded as one epidemiological unit for the VPDs slated

for elimination.

17 MacDonald NE and the SAGE Working Group on Vaccine Hesitancy. Vaccine hesitancy: Definition, scope

and determinants, Vaccine 2015; 33:4161–4164.

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A more harmonised approach to immunisation will go some way towards addressing some of

the Pacific regional challenges to achieving the GVAP immunisation goals. UNICEF and WHO has

been working with PICs to strengthen national vaccine supply chains which are not keeping pace with

the increased complexity and changing landscape of immunisation programs. Since the 1980s,

immunisation programs have been increasingly challenged with the need to provide protection against

2.5 times as many diseases than initially targeted, administer three times as many doses per person

and serve a global target population size that has doubled. All PICs should give particular focus and

allocate sufficient resources toward strengthening their immunisation supply chains and cold chain

infrastructure in the coming years. Through the Effective Vaccine Management Initiative led by

WHO and UNICEF, structured technical guidance can be offered.

The proposed introduction of new vaccines provides an opportunity to review the whole

immunisation schedule and learn from the experiences of other countries. A common approach to

immunisation of some, if not all vaccines, across the Pacific can result in some benefits, including

increasing opportunities for pooled procurement with associated economies of scale, and simplifying

the management of individual immunisation schedules for highly mobile children.

4.1 Recommendations for governments:

Heads of Health are invited to:

i. Note the global developments pertaining to the re-emergence of some vaccine preventable

diseases and the risks from emerging VPDs, the coverage of selected vaccines in the Pacific

and progress and challenges in delivering immunisation services.

ii. Consider whether there is rationale in harmonising immunisation schedules across the Pacific

where possible, while recognising that this may not be possible for all countries and all

vaccines.

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Table – Immunisations offered by antigens for 13 Pacific island countries COK, FJI, KIR, MHL, FSM, NRU, NIU, PLW, WSM, SLB, TON, TUV, VUT. Some countries use multiple formulations

Country Antigens Schedules

Cook Islands BCG birth

DTwP 4 years

DTwPHibHepB 6 weeks; 3, 5 months (not entire country)

HepB_Paediatric birth

HPV 9 years

IPV 5 months

MMR 15 months; 4 years

OPV 6 weeks; 3, 5 months

Pneumo_conj Rotavirus Td

From 2020 From 2020 11 years

Fiji BCG birth

DTwPHibHepB 6, 10, 14 weeks

HepB_Paediatric birth

HPV 8-13 years; + 6 months

IPV 14 weeks

MR 12, 18 months

OPV 6, 10, 14 weeks; 18 months

Pneumo_conj 6, 10, 14 weeks

Rotavirus 6, 14 weeks

Td 6, 11 years (school children and pregnant mothers)

Kiribati BCG birth

DTwP 6 years

DTwPHibHepB 6, 10, 14 weeks

HepB_Paediatric birth

IPV 14 weeks

MR 12 months; 6 years

OPV 6, 10, 14 weeks

Pneumo_conj 6, 10, 14 weeks

Rotavirus 6, 10 weeks

Td 13 years

Marshall Islands BCG birth

DTaPHepBIPV 2, 4, 6, 12 months; 4-6 years

DTaPHibIPV 2, 4, 12 months

DTaPIPV 4-5 years

HepB_Paediatric birth; 2, 6, months

Hib 2, 4, 12 months

HPV 11-12 years

Influenza_Paediatric 6 months-4 years

IPV 2, 4, 6 months; 4-6 years

MMR 12, 13 months

Pneumo_conj 2, 4, 6, 12 months

Rotavirus 2, 4, 6, 12 months

Tdap 11-12 years

FSM BCG birth

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DTaP 12 months; >=4 years

DTaPHepBIPV 2, 4, 6 months

HepB_Paediatric birth

Hib 2, 4, 12 months

HPV 9 years; +6 months

IPV >= 4 years

MMR 12, +1 months

Pneumo_conj 2, 4, 6, 13 months

Rotavirus 2, 4, 12 months

Td >10 years

Tdap >11 years

Nauru BCG birth

DTwP 18 months

DTwPHibHepB 6, 10, 14 weeks

HepB_Paediatric Birth

HPV IPV

From 2020 14 weeks

MR MMR

12, 15 months From 2020

OPV 6, 10, 14 week; 18 months; 4 years

Pneumo_conj Rotavirus Td

From 2020 From 2020 4 years

Niue BCG birth

DTaPHibHepBIPV 6 weeks; 3, 5 months

DTaPIPV 4 years

HepB_Paediatric birth

HIB 15 months

HPV MMR

From 2020 15 months; 4 years

Pneumo_conj 6 weeks; 3, 5, 15 months

Rotavirus 6 weeks; 3 months

Td 11 years

Palau DTaP 4, 15 months; 4-6 years

DTaPHepBIPV 2, 6 months

HepB_Paediatric birth

Hib 2, 4, 6, 12 months

HPV 9-26 years; +6 months

IPV 3 months; 4-6 years

MMR 12, 15 months

Pneumo_conj 3, 5, 7, 15 months

Rotavirus 2, 4, 6 months

Td >=7 years

Samoa BCG birth

DTwP 5 years

DTwPHibHepB 6, 10, 14 weeks

HepB_Paediatric birth

HPV IPV

From 2020 14 weeks

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WHO vaccine-preventable diseases: monitoring system Last updated 22-Oct-2018 (data as of 18-Sep-2018) http://apps.who.int/immunisation_monitoring/globalsummary/diseases

MMR 12, 15 months

OPV 6, 10, 14 weeks

Pneumo_conj Rotavirus Td

From 2020 From 2020 28 weeks; +2, +3 months; +1, +1 year

Solomon Islands BCG birth

DTwPHibHepB 6, 10, 14 weeks

HepB_Paediatric birth

HPV 9 years; +6 months (to be introduced in June 2019)

IPV 14 weeks

MR 12 months

OPV 6, 10, 14 weeks

Pneumo_conj 6, 10, 14 weeks

Rotavirus Td

From 2020 1st contact pregnancy; +1, +6 months; +1, +6 years

Tonga BCG birth

DTwP 18 months; 5-6 years

DTwPHibHepB 6, 10, 14 weeks

HepB_Paediatric birth

HPV From 2020

IPV 14 weeks

MMR From 2020

MR 12, 18 months

OPV 6, 10, 14 weeks

Pneumo_conj From 2020

Rotavirus From 2020

Td 16 years (school leavers and pregnant mothers)

Tuvalu BCG birth

DTwP 5-6 years

DTwPHibHepB 6, 10, 14 weeks

HepB_Paediatric birth;

HPV IPV

From 2020 6, 10, 14 weeks; 12 months

MR MMR

12, 18 months From 2020

Pneumo_conj Rotavirus Td

From 2020 From 2020 1st contact; +4 weeks; +6 months (pregnant mothers)

Vanuatu BCG birth

DTwPHibHepB 6, 10, 14 weeks

HepB_Paediatric birth

IPV 14 weeks

HPV MR

From 2020 12 months (second dose to be introduced in 2020)

OPV 6, 10, 14 weeks; 6, 12 years

Pneumo_conj Rotavirus Td

From 2020 From 2020 6, 12 years

Td

1st contact; +2, +6 months; +1, +2 years (pregnant mothers)

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BCG DTwP

Bacille Calmette-Guérin vaccine Diphtheria and tetanus toxoid with whole cell pertussis vaccine

DTaP Diphtheria and tetanus toxoid with acellular pertussis vaccine

DTaPHepBIPV Diphtheria and tetanus and pertussis and hepatitis B and IPV

DTaPHibHepB Diphtheria and tetanus toxoid with acellular pertussis, Hib and hepatitis B vaccine

DTaPHibHepBIPV Hexavalent diphtheria, tetanus toxoid with acellular pertussis, Hib, hepatitis B and IPV vaccine

DTaPHibIPV Diphtheria and tetanus toxoid with acellular pertussis, Hib and IPV

DTaPIPV Diphtheria and tetanus toxoid with acellular pertussis and IPV

HepB_Paediatric Hepatitis B paediatric dose vaccine

Hib Haemophilus influenzae type b vaccine

HPV Human Papillomavirus vaccine

IPV Inactivated polio vaccine

MMR Measles mumps and rubella vaccine

MR Measles and rubella vaccine

OPV Oral polio vaccine

Pneumo_conj Pneumococcal conjugate vaccine

Rotavirus Rotavirus vaccine

Tdap Tetanus and diphtheria toxoids and acellular pertussis vaccine

Td Tetanus diphtheria vaccine

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