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Nepal 2012
Immunization andVaccine Development
South-East Asia Region
World Health Organization• SEARO/FHR/IVD • 30 August 2013
Table 1: Basic information1 2012
Division/Province/State/Region 5
District 75
Municipality 58
Village development committee 3,915
Ward 36,041
Population density (per sq. km) 181
Population living in urban areas 17%
Population using improved drinking-water sources
88%
Population using improved sanitation 35%
Total expenditure on health as % of GDP3 5.4
Literacy rate among adults aged >15 years 60%
Births attended by skilled health personnel 36%
Neonates protected at birth against NT 82%
Vaccine Age of administration
BCG At birth
DTP-Hib-HepB 6 weeks, 10 weeks, 14 weeks
OPV 6 weeks, 10 weeks, 14 weeks
Measles 9 months
JE 12-23 months (high-risk districts)
TT During pregnancy
Vitamin A 6-59 months
EPI historyn EPI was launched in 1979 with two vaccines
(BCG and DTP) in three districts and made available to all 75 districts by 1989.
n HepB started in 2002.n AD syringes introduced in 2003.n DTP-HepB started in 2005.n JE introduced in 2007.n DTP-Hib-HepB introduced in 2009.
Source: cMYP 2007-2011 and 2011-2016
Immunization system highlights
n There is a comprehensive multi-year plan (cMYP) for immunization covering 2011-2016.
n Fifty-six (75%) priority districts had updated micro-plans that included activities to improve immunization coverage.
n A National committee for Immunization Practices (NCIP) with formal written terms of reference exists.
n Out of 75 districts, 48 (64%) had >80% coverage for DTP-Hib-HepB3, 30 (40%) had >90% coverage for MCV1 and 20 (27%) had >80% coverage for TT2+ in pregnant women in 2012.
n Three (4%) districts reported more than 10% drop-out rate for DTP-Hib-HepB1 to DTP-Hib-HepB3.
n Vaccine wastage rates 2012: BCG=79%, DTP-Hib-HepB=8%, OPV=22%, MCV=64% and TT=37%.
n A national policy for health care waste management including waste from immunization activities exists.
n A national system to monitor adverse events following immunization (AEFI) exists.
n 45% of vaccine costs financed by the government. In addition, 84% of routine immunization costs financed by the government.
n For intensification of routine immunization in 2012, activities conducted to reach high-risk areas, migrant/hard to reach populations and low performing areas.
n There is a draft “Immunization Act – 2012” and Immunization Fund.
n Measles-rubella (MR) vaccine for children aged 9 months introduced on 15 June 2013.
Total population 28,480,814
Live births (LB) 692,646
Children <1 year 659,016
Children <5 years 3,277,807
Children <15 years 10,452,459
Pregnant women 769,699
Women of child bearing age (15-49 years)
6,903,630
Neonatal mortality rate2 33 (per 1000 LB)
Infant mortality rate2 46 (per 1000 LB)
Under-five mortality rate2 54 (per 1000 LB)
Maternal mortality ratio 170 (per 100000 LB)
1 SEAR annual EPI reporting form, 2012 and WHO, World Health Statistics, 20132 Nepal demographic and health survey 20113 MOHP/NIP, Nepal
Table 2: Immunization schedule, 2012
Source: WHO/UNICEF joint reporting form (JRF) 2012
Disclaimer: The boundaries and names shown and the designations used on all the maps do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries.
E P I F A C T S H E E T
World Health Organization• SEARO/FHR/IVD • 30 August 2013
Source: WHO/UNICEF estimates, 2013
Figure 2: DTP3 coverage1, diphtheria and pertussis cases2, 1980-2012
Figure 3: DTP-Hib-HepB3 coverage by district, 2012
Figure 5: MCV1 coverage by district, 2012
0
20
40
60
80
100
0
500
1000
1500
2000
2500
1980 1985 1990 1995 2000 2005 2006 2007 2008 2009 2010 2011 2012
% C
over
age
Case
s
Year
Diphtheria Cases Pertussis Cases DTP3 Coverage
12166 6021
1 WHO/UNICEF estimates, 20132 WHO vaccine-preventable diseases: monitoring system 2013 global summary
1 WHO/UNICEF estimates, 20132 WHO vaccine-preventable diseases: monitoring system 2013 global summary
Source: SEAR annual EPI reporting form, 2012 (administrative data)
Source: SEAR annual EPI reporting form, 2012 (administrative data)
0
20
40
60
80
100
0
500
1000
1500
2000
2500
3000
3500
1980 1985 1990 1995 2000 2005 2006 2007 2008 2009 2010 2011 2012
% C
over
age
Case
s
YearMeasles Cases MCV1 Coverage
4810 9397 5023
<70% 70% - 79% 80% - 89% > 90%
<70% 70% - 79% 80% - 89% > 90%
Figure 4: MCV1 coverage1 and measles cases2, 1980-2012
Figure 1: National immunization coverage, 1980-2012
1980 1985 1990 1995 2000 2005 2006 2007 2008 2009 2010 2011 2012
BCG 22 67 74 76 84 87 93 89 87 94 94 97 96
DTP3 8 32 43 54 74 75 89 82 82 89 82 92 90
OPV3 20 42 50 74 78 91 82 82 93 83 92 90
MCV1 34 57 56 71 74 85 81 79 90 86 88 86
0
20
40
60
80
100
% C
over
age
Note: DTP-Hib-HepB introduced in 2009 (2005-2008 DTP-HepB)
Immunization andVaccine Development
South-East Asia Region
1 Country official estimates, 1980-20122 WHO vaccine-preventable diseases: monitoring system 2013 global summary
Table 3: OPV supplementary immunization activities (SIA), 2008-2012
Figure 7: Network of surveillance medical officers (SMOs) and laboratories, 2012
Year Activity Target population (<5 years) Date of 1st round Date of 2nd round 1st round coverage (%)
2nd round coverage (%)
2008 SNID 2,386,263 15-Mar-08 26-Apr-08 96 94
2008 Mop-up 199,751 6-Aug-08 - 98 -
2008 Mop-up 540,115 10-Sep-08 22-Oct-08 90 93
2008 Mop-up 340,364 22-Nov-08 - 92 -
2008 SNID*590,143
3,336,70210-Sep-0806-Dec-08
-9090
-
2009 NID 4,466,960 28-Feb-09 4-Apr-09 93 92
2010 NID 4,466,960 10-Apr-10 22-May-10 88 89
2010 Mop-up 2,873,388 19-Jun-10 - 92 -
2010 Mop-up 1,096,948 17-Jul-10 31-Jul-10 98 98
2010 Mop-up 2,015,085 14-Aug-10 - 96 -
2010 Mop-up 1,096,948 18-Sep-10 - 100 -
2010 Mop-up 436,617 2-Oct-10 30-Oct-10 102 104
2010 Mop-up 436,617 20-Nov-10 - 101 -
2011 NID 4,466,960 12-Feb-11 12-Mar-11 91 92
2011 SNID 1,110,222 12-Nov-11 10-Dec-11 98 99
2012 NID 4,226,966 28-Apr-12 - 94 -
2012 SNID*693,843861,553
2,482,891
14-Feb-1217-Sep-1214-Dec-12
-979174
-
Figure 6: TT2+ coverage1 and NT cases2, 1980-2012
Source: WHO/UNICEF JRF
• Nepalachievedthematernalneonataltetanus(MNT)eliminationstatusofin2005.
0
20
40
60
80
100
0
20
40
60
80
100
120
140
1980 1985 1990 1995 2000 2005 2006 2007 2008 2009 2010 2011 2012
% C
over
age
Case
s
Year
NT Cases TT2+ Coverage
511
MCV supplementary immunization activities• Thefirstcatch-upmeaslescampaignwas
conductedinthreephasesin2004-2005targeting9,423,866childrenaged9monthsupto15years.Thecoveragewas104%.
• Ameaslesfollow-upcampaignwasconductedin2008targeting3,903,515childrenaged9monthsupto5years.Thecoveragewas93%.
• Measles-rubella(MR)campaignwasconductedinNepalinthreephasesin2012-2013targeting9,579,306childrenaged9monthsupto15years.Thecoveragewas101%.
• OnedoseofOPVwasprovidedinallMCVsupplementaryimmunizationactivitiestoallchildren<5years.
National Public Health Laboratory - National measles/rubella laboratory - National Japanese encephalitis (JE) laboratory BP Koirala Institute of Health Sciences - JE laboratory
Invasive bacterial disease (IBD) laboratories - Patan Hospital
Rotavirus laboratory - Tribhuvan University Teaching Hospital
11 Field Offices (15 SMOs)
Central Office, WHO-IPD
Damak, JhapaBiratnagar, MorangLahan, SirahaJanakpur, DhanushaHetauda, MakwanpurKathmandu (Valley)Kathmandu (North)Pokhara, Kaski (East)Pokhara, Kaski (West) Butwal, RupandehiNepalgunj, BankeNepalgunj, Banke (West)Birendranagar, SurkhetDhangadi, Kailali (East)Dhangadi, Kailali (West)
SMO Location:
*During MCV campaigns
World Health Organization• SEARO/FHR/IVD • 30 August 2013 Immunization andVaccine Development
South-East Asia Region
E P I F A C T S H E E T
Indicator 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
AFP cases 192 214 230 364 343 425 451 604 568 640
Wild polio 0 0 4 5 5 6 0 6 0 0
Compatibles 1 0 2 1 0 0 0 0 0 0
AFP rate 1.91 2.16 2.31 3.57 3.29 3.99 4.14 5.52 5.11 6.12
Non-polio AFP rate1 1.90 2.16 2.25 3.50 3.24 3.93 4.14 5.47 5.11 6.12
Adequate stool collection rate2 86% 84% 84% 86% 83% 87% 88% 88% 89% 95%
Total stool samples collected 374 414 443 720 658 782 887 1,134 1,102 1,366
% NPEV 20 29 20 23 20 18 18 20 17 20
% Timeliness of primary result reported3 100 99 100 98 100 100 100 100 100 100
1 Number of discarded AFP cases per 100,000 children under 15 years of age.2 Percent with 2 specimens 24 hours apart and within 14 days of paralysis onset.3 2002 to 2007 result reported within 28 days and 2008 onwards result reported within 14 days of sample received at laboratory.
Year Polio Diphtheria Pertussis Total Tetanus (Incl. NT)
Neonatal Tetanus (% of all Tetanus)
Measles Rubella Mumps Japanese Encephalitis
2003 0 173 4,479 114 51(45%) 13,344 ND ND -
2004 0 81 3,708 104 27 (26%) 12,047 ND ND 371
2005 4 46 2,170 112 29 (26%) 5,023 ND ND 669
2006 5 72 1,092 240 42 (18%) 2,838 ND ND 295
2007 5 44 879 155 32 (21%) 1,415 227 ND 442
2008 6 149 2,297 308 53 (17%) 2,089 781 ND 339
2009 0 277 2,357 276 18 (7%) 189 1275 27,880 147
2010 6 146 2,293 547 13 (2%) 190 510 29,022 197
2011 0 94 1,733 193 95 (49%) 2,359 1,175 39,023 129
2012 0 138 1,595 359 32 (9%) 3,362 801 35,874 75
Table 5: Reported cases of vaccine preventable diseases, 2003-2012
Table 4: AFP surveillance performance indicators, 2003-2012
Figure 8: Non-polio AFP rate by district, 2012 Figure 9: Adequate stool collection rate by district, 2012
Data as of 07 Aug 2013
For contact or feedback:
Expanded Program on Immunization
National Immunization Program, Child Health Division,
Department of Health Services, Teku, Kathmandu, Nepal
Tel +977-1-4261660, 4261463, Fax +977-1-4262263
Email: [email protected], [email protected], www.mohp.gov.np
Immunization and Vaccine Development (IVD)WHO-SEARO, IP Estate, MG Marg, New Delhi 110002, India
Tel: +91 11 23370804, Fax: +91 11 23370251
Email: [email protected], www.searo.who.int/topics/immunization
Non-polio AFP rate = 5.11< 1 1 – 1.99 > 2 No non-polio AFP case
--
Adequate stool collection rate = 89%< 60% 60% – 79% > 80% No AFP case– >
Source: WHO/UNICEF JRF ND = No data
• Lastindigenouswildpoliovirus(WPV3)wasreportedfromSirahadistrictinNovember2000.• Lastimportedwildpoliovirus(WPV1)wasreportedfromRautahatdistrictinAugust2010.
Non-polio AFP rate = 6.12 Adequate stool collection rate = 95%