National Immunization program (Health loksewa)

 

National Immunization Programme (NIP)

Ø The National immunization program (NIP) was previously known as Expanded program on immunization (EPI).

Ø It is one of the most cost effective, successful and most priority 1 (P1) program of government of Nepal.

Ø NIP addresses 12 antigens including Rota virus vaccine.

Ø MDVP - Multi dose vial policy

Ø AEFI - Adverse events following immunization

Ø AES - Acute encephalitis syndrome

Ø GAVI - Global alliance for vaccine and immunization

Ø Time for immunization :- 7 times (At birth, 6, 10, 14 weeks, 9, 12, 15 months).

Ø Nepal is the first country in the south east Asia region to have immunization act.

Ø Baishakh month is celebrated as immunization month.

Ø Red strategy is related to immunization.

Ø Bhageshwor of Achham district is the first VDC declared as fully immunized district.

Ø Palpa is the first district declared as first fully immunized district.

 

Important dates:

1796AD	First vaccine introduced by Edward Jenner for small pox disease.
2034/01/01	Small pox eradication declared from Nepal
1977(2034)	Nepal starts EPI from 3 districts (Dhanusha, Rupandehi & Sindhupalchowk) with only 4 antigens i.e. BCG & DPT
2036/37	Polio and Measles added in routine immunization
1988AD	EPI has been expanded to allover 75 districts of Nepal with 6 antigens
1998AD	Polio Eradication Nepal (PEN) was initiated. AFP surveillance was established.
2003AD/ 2060BS	Monovalent hepatitis-B injection was started with support from GAVI. The MoHP adopted injection safety policy. Auto disposable syringe was introduced. Nepal endorsed Multi-dose vial policy (MDVP) for DPT-Hep B, OPV vaccines.
2003/04AD	EPI program was renamed as NIP
2004AD	AEFI sentinel sites was initiated. Surveillance of AES for JE integrated into AFP surveillance.
2005AD	School immunization was initiated with TT for students (grade 1, 2, 3) in 8 districts. Nepal initiated tetravalent DPT, Hep-B with the support from GAVI.
2006AD	JE campaign was started from 6 high risk districts for all above 1 year
2009AD	JE vaccine, which was introduced into the routine immunization program in 16 districts, which is first vaccine to be routinely administered for all children after the first year of life.
2009(2066)	Hemophilus influenza type-B (Hib)vaccine was first introduced in routine immunization  as pentavalent in Baishakh and in Asar 2066 Pentavalent vaccine implemented throughout the country.
2010Aug.30	Last case of polio was detected in Rautahat district.
2012AD	Full immunization program was initiated
2070/71	MR vaccine has been routinely placed in NIP throughout the country.
2014Mar.27	WHO declared the 11 countries of south east Asia including Nepal as polio free Nation.
2071/06/02	IPV has been added to the routine immunization.
2014AD	TT replaced by TD in routine immunization
2015AD	PCV has been added to routine immunization
2015Dec.	HPV vaccine pilot project has been started in Chitwan and Kaski districts.
2072/10/12	Immunization act was endorsed as Immunization Act 2072
2073/01/05	Switch to bivalent polio vaccine from trivalent OPV
2016 July	JE vaccine introduced across all 75 districts
2075/04/01	FIPV was introduced for polio disease. Rota virus vaccine was included in National immunization schedule.
2018Aug.03	Nepal was certified as having control of Rubella and Congenital rubella syndrome
2077/03/18	Initiation of Rota virus vaccine from 77 districts  and sanitation promotion program

Comprehensive Multi-year plan of Action (cMYPoA)

Vision:-  Nepal- a country free of vaccine preventable diseases.

Goal:- Reduction of morbidity, mortality and disability associated

           with vaccine preventable diseases.

Objectives:-  Total 5 objectives

Target population:

Under 1year children:-  BCG, DPT-HepB-Hib, OPV, FIPV,

                                     PCV, MR first

12 months children:-  JE

15 months children:- MR second

Pregnant women:- TD

 

Access and utilization of Immunization services:

Category 1 (Less problem)	High coverage (80%) Low drop-out (<10%)	25 districts
Category 2 (Problem)	High coverage (80%) High drop-out (10%)	17 districts
Category 3 (Problem)	Low coverage (<80%) Low drop-out (<10%)	34 districts
Category 4 (Problem)	Low coverage (<80%) High drop-out (10%)	1 district Udaypur

 

Comparative data of NDHS 2016 and MICS 2014:

	NDHS 2016	MICS 2014
BCG coverage (%)	98	95.7
Pentavalent 3 coverage	86	88.3
Polio 3 coverage	88	91.8
MR coverage	90	92.6
TD 2 and TD 2+	89	77.3
Full Immunization	78	84.5
Not Immunized	1

 

National vaccination coverage by vaccine, FY 2076/77

S.N.	Antigens	%Achieved
1	BCG	86
2	DPT-Hep B-Hib 1	85
3	DPT-Hep B-Hib 2	82
4	DPT-Hep B-Hib 3	78
5	DPT-Hep B-Hib 3 including delayed dose given after 1year of age	80
6	OPV 1	84
7	OPV 2	81
8	OPV 3	77
9	OPV 3 including delayed dose given after 1 year of age	80
10	FIPV 1	79
11	FIPV 2	69
12	PCV 1	85
13	PCV 2	81
14	PCV 3	78
15	MR 1	80
16	MR 2	71
17	JE	78
18	TD 2 & TD 2+	59

 

Vaccination coverage (%) by province, FY 2076/77:-

	Pentavalent 3	MR first	MR second	TD2 & TD2+
Bagmati	68	70	61	45
Gandaki	69	70	75	47
Karnali	88	90	78	65

 

Dropout rates (%) of vaccination, FY 2074/76 to 2076/77:

	2074/75	2075/76	2076/77
BCG vs MR1	11.7	8	7.5
Pentavalent 1vs 3	7.4	4.3	8.9
Pentavalent1 vs MR1	8.0	7.4	6.9

 

Vaccine wastage rates (%), FY 2074/75 to 2076/77:

Ø Vaccine wastage rate of MDVP vaccines must not increase 15% (10 doses) and 5% (1 dose).

Ø MDVP is not applicable in case of BCG, MR and JE as these vaccines should be used within 6hrs for BCG, MR and 1hr for JE.

 

	2074/75	2075/76	2076/77
BCG	76.9	80.5	78
Pentavalent	21.3	22.5	22.5
OPV	22.1	23.4	23.2
PCV	10.7	13.6	14.5
FIPV		27.4	26.4
MR	48.9	49	46.7
JE	44.2	45.7	46.9

 

Vaccine preventable diseases surveillance according to province, FY 2076/77:

1.  Acute flaccid paralysis (AFP)

2.  Suspected Measles and Rubella

3.  Acute Encephalitis

4.  Neonatal tetanus

 

	Bagmati	Gandaki	Karnali
Non-polio AFP cases	66	36	9
Non-polio AFP rate	3.5	4.96	1.72
NMNR cases	364	137	123
NMNR rate	5.70	5.46	3.09
Confirmed Measles	279(65%)	26(3%)	5(1.2%)
Confirmed Rubella	19(52.8%)	7(19.4%)	3(8.3%)
AES cases	257	111	22
JE cases	13	8	2

 

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