Nepal 2011 Immunization and Vaccine Development South-East Asia Region World Health Organization• SEARO/FHR/IVD • 29 August 2012 N epal is a landlocked country bordering with India in the east, west and south, and with China in the north. Topographically, Nepal is divided into three distinct ecological zones: the mountain (Himal), the hill and the plain (Terai). Nepal is divided into five administrative regions and 75 districts. Districts are further divided into village development committees and municipalities. Nepal is the home of 27 millions people and annual population growth rate is 2.1 (2000-2010). Nineteen percent population lives in urban areas. The average household size has decreased from 5.4 in 2001 to 4.7 in 2011. The expanded programme on immunization (EPI) in Nepal was launched in 1979 with two vaccines (BCG and DTP) in three districts. Immunization was made available to all 75 districts by 1989. Source: Comprehensive multi-year plan 2007-2011; WHO, world health statistics 2012 and Nepal demographic health survey 2011. Table 1: Basic information 1 2011 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 19% Population using improved drinking-water sources 89% Population using improved sanitation 31% Total expenditure on health as % of GDP 5.5 Literacy rate among adults aged >15 years 59% Births attended by skilled health personnel 36% 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 history n Launched in 1979 and made available to all 75 districts by 1989. n HepB started in 2002 (in phase manner) n DTP-HepB started in 2005. n AD syringes introduced in 2005. n JE introduced in 2007. n DTP-Hib-HepB introduced in 2009. n Plan to introduce MR in 2012/2013. 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 26 (35%) priority districts had updated micro-plans that include activity to improve immunization coverage. n A standing technical advisory group on immunization is available. It has formal written terms of reference. n Cold chain equipment inventory was updated in 2010. n Out of 75 districts, 57 (76%) had >80% coverage for DTP-Hib-HepB3, 31 (41%) had >90% coverage for MCV1 and 22 (29%) had >80% coverage for TT2+ in pregnant women in 2011. n One (1%) district reported more than 10% drop-out rate for DTP1 to DTP3. n Nepal demographic health survey was conducted in 2011. No coverage survey is planned for the next 24 months. n Vaccine wastage rates 2011: BCG=79%, DTP-Hib-HepB=9%, OPV=23%, MCV=64% and TT=33%. n A national policy for health care waste management including waste from immunization activities is available. n A national system to monitor adverse events following immunization (AEFI) is available. Six AEFI were reported and four events were categorized as “serious” in 2011. n 20% of all spending on vaccine was government financed. n 22% of all spending on routine immunizations was government financed. n Routine vaccines: BCG, OPV, Measles, TT and JE are procured from government funds, and Pentavalent (DTP-Hib-HepB) is co-financed by the government. n A follow-up on the 2010 VPD surveillance review recommendations was completed in May 2011. n For intensification of routine immunization in 2012, Nepal has a plan to reach high- risk areas, migrant/un-reached population and low performing areas. n There is a draft “Immunization Act – 2012”. Total population 27,976,661 Live births 689,020 Children <1 year 655,777 Children <5 years 3,338,608 Children <15 years 11,125,854 Pregnant women 765,578 Women of child bearing age (15-49 years) 5,541,862 Crude birth rate (per 1000 population) 24.1 Neonates protected at birth against NT 81% Neonatal mortality rate 28 (per 1000 LB) Infant mortality rate 41 (per 1000 LB) Under-five mortality rate 50 (per 1000 LB) Maternal mortality ratio 170 (per 100000 LB) 1 SEAR annual EPI reporting form, 2011 and WHO, world health statistics, 2012 Table 2: Immunization schedule, 2011 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. Source: WHO/UNICEF joint reporting form (JRF) 2011
Transcript
Nepal 2011
Immunization andVaccine Development
South-East Asia Region
World Health Organization• SEARO/FHR/IVD • 29 August 2012
Nepal is a landlocked country bordering with India in the east, west and south, and with China in the north. Topographically, Nepal is divided into three distinct ecological zones: the mountain (Himal), the hill and the plain (Terai). Nepal is
divided into five administrative regions and 75 districts. Districts are further divided into village development committees and municipalities. Nepal is the home of 27 millions people and annual population growth rate is 2.1 (2000-2010). Nineteen percent population lives in urban areas. The average household size has decreased from 5.4 in 2001 to 4.7 in 2011. The expanded programme on immunization (EPI) in Nepal was launched in 1979 with two vaccines (BCG and DTP) in three districts. Immunization was made available to all 75 districts by 1989.
Source: Comprehensive multi-year plan 2007-2011; WHO, world health statistics 2012 and Nepal demographic health survey 2011.
to all 75 districts by 1989.n HepB started in 2002 (in phase manner)n DTP-HepB started in 2005.n AD syringes introduced in 2005.n JE introduced in 2007.n DTP-Hib-HepB introduced in 2009.n Plan to introduce MR in 2012/2013.
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 26 (35%) priority districts had updated micro-plans that include activity to improve immunization coverage.
n A standing technical advisory group on immunization is available. It has formal written terms of reference.
n Cold chain equipment inventory was updated in 2010.
n Out of 75 districts, 57 (76%) had >80% coverage for DTP-Hib-HepB3, 31 (41%) had >90% coverage for MCV1 and 22 (29%) had >80% coverage for TT2+ in pregnant women in 2011.
n One (1%) district reported more than 10% drop-out rate for DTP1 to DTP3.
n Nepal demographic health survey was conducted in 2011. No coverage survey is planned for the next 24 months.
n Vaccine wastage rates 2011: BCG=79%, DTP-Hib-HepB=9%, OPV=23%, MCV=64% and TT=33%.
n A national policy for health care waste management including waste from immunization activities is available.
n A national system to monitor adverse events following immunization (AEFI) is available. Six AEFI were reported and four events were categorized as “serious” in 2011.
n 20% of all spending on vaccine was government financed.
n 22% of all spending on routine immunizations was government financed.
n Routine vaccines: BCG, OPV, Measles, TT and JE are procured from government funds, and Pentavalent (DTP-Hib-HepB) is co-financed by the government.
n A follow-up on the 2010 VPD surveillance review recommendations was completed in May 2011.
n For intensification of routine immunization in 2012, Nepal has a plan to reach high-risk areas, migrant/un-reached population and low performing areas.
n There is a draft “Immunization Act – 2012”.
Total population 27,976,661
Live births 689,020
Children <1 year 655,777
Children <5 years 3,338,608
Children <15 years 11,125,854
Pregnant women 765,578
Women of child bearing age (15-49 years)
5,541,862
Crude birth rate (per 1000 population)
24.1
Neonates protected at birth against NT
81%
Neonatal mortality rate 28 (per 1000 LB)
Infant mortality rate 41 (per 1000 LB)
Under-five mortality rate 50 (per 1000 LB)
Maternal mortality ratio 170 (per 100000 LB)
1 SEAR annual EPI reporting form, 2011 and WHO, world health statistics, 2012
Table 2: Immunization schedule, 2011
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.
Source: WHO/UNICEF joint reporting form (JRF) 2011
E P I F a c t S h E E t
World Health Organization• SEARO/FHR/IVD • 29 August 2012
Source: WHO/UNICEF estimates, 2012
Figure 2: DTP3 coverage1, diphtheria and pertussis cases2, 1980-2011
Figure 3: DTP-Hib-HepB3 coverage by district, 2011
% Timeliness of primary result reported3 98 100 99 100 98 100 100 100 100 1001 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 Neonatal Tetanus (% of all Tetanus)
