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

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1980 1985 1990 1995 2000 2005 2006 2007 2008 2009 2010 2011 2012

% C

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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

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1980 1985 1990 1995 2000 2005 2006 2007 2008 2009 2010 2011 2012

% C

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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

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% C

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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.

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120

140

1980 1985 1990 1995 2000 2005 2006 2007 2008 2009 2010 2011 2012

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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: epi@ntc.net.np, drshyam@hotmail.com, 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: SEAREpidata@who.int, 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%