nepal 2011 - south-east asia regional office expanded programme on immunization (epi) in nepal was...
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.
Table 1: Basic information1 2011Division/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 historyn 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
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
Figure 5: MCV1 coverage by district, 2011
602112166
0
500
1000
1500
2000
2500
1980 1985 1990 1995 2000 2005 2006 2007 2008 2009 2010 2011
Year
Cas
es
0
20
40
60
80
100
% C
over
age
Diphtheria cases Pertussis cases DTP3 coverage
1 WHO/UNICEF estimates, 20122 WHO vaccine-preventable diseases: monitoring system 2012 global summary
1 WHO/UNICEF estimates, 20122 WHO vaccine-preventable diseases: monitoring system 2012 global summary
Source: SEAR annual EPI reporting form, 2011 (administrative data)
Source: SEAR annual EPI reporting form, 2011 (administrative data)
0
500
1000
1500
2000
2500
3000
1980 1985 1990 1995 2000 2005 2006 2007 2008 2009 2010 2011
Year
Cas
es
0
20
40
60
80
100
% C
over
age
Measles cases MCV1 coverage
93974810 5023
<70% 70% - 79% 80% - 89% > 90%
<70% 70% - 79% 80% - 89% > 90%
Figure 4: MCV1 coverage1 and measles cases2, 1980-2011
Figure 1: National immunization coverage, 1980-2011
0
20
40
60
80
100
% C
over
age
BCG 22 67 74 76 84 87 93 89 87 94 94 97
DTP3 8 32 43 54 74 75 89 82 82 89 82 92
OPV3 20 42 50 74 78 91 82 82 93 83 92
MCV1 34 57 56 71 74 85 81 79 90 86 88
1980 1985 1990 1995 2000 2005 2006 2007 2008 2009 2010 2011
Note: DTP-Hib-HepB introduced in 2009 (2005-2008 DTP-HepB)
Immunization andVaccine Development
South-East Asia Region
1 Country official estimates, 1980-20112 WHO vaccine-preventable diseases: monitoring system 2012 global summary
Table 3: OPV supplementary immunization activities, 2008-2011
Figure 7: Network of surveillance medical officers (SMOs) and laboratories, 2011
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 -
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
Figure 6: TT2+ coverage1 and NT cases2, 1980-2011
Source: WHO/UNICEF JRF
• Nepalachievedthematernalneonataltetanus(MNT)eliminationstatusofin2005.
0
20
40
60
80
100
120
140
1980 1985 1990 1995 2000 2005 2006 2007 2008 2009 2010 2011
Year
Cas
es
0
20
40
60
80
100
% C
over
age
NT cases TT2+ coverage
511
Source: WHO/IPD Nepal, August 2012
MCV supplementary immunization activities• Thefirstcatch-upmeaslescampaignwas
conductedinthreephasesin2004-2005targeting9,423,866childrenaged9monthsto<15years.Theachievementwas104%.
• Ameaslesfollow-upcampaignwasconductedin2008targeting3,903,515childrenaged9monthsto5years.Theachievementwas93%.
• Ontheplannedmeasles-rubella(MR)campaignfor2012,Nepal(atthetimeofprintingthisfactsheet)hasconductedthefirstphaseinFebruary2012targeting1,786,088children9monthsto<15years.Theachievementwas103%.
• ThesecondphaseMRcampaignwillbeconductedinSeptember2012andthethirdphaseisplannedfor2012-2013.
• OnedoseOPVisgiventoallchildren<5yearsduringMRcampaign.
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 - Kanti Children 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:
World Health Organization• SEARO/FHR/IVD • 29 August 2012 Immunization andVaccine Development
South-East Asia Region
E P I F a c t S h E E t
Indicator 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
AFP cases 197 192 214 230 364 343 425 451 604 568
Wild polio 0 0 0 4 5 5 6 0 6 0
Compatibles 1 1 0 2 1 0 0 0 0 0
AFP rate 2.01 1.91 2.16 2.31 3.57 3.29 3.99 4.14 5.52 5.11
Non-polio AFP rate1 2.00 1.90 2.16 2.25 3.50 3.24 3.93 4.14 5.47 5.11
Adequate stool collection rate2 87% 86% 84% 84% 86% 83% 87% 88% 88% 89%
Total stool samples collected 387 374 414 443 720 658 782 887 1,134 1,102
% NPEV 33 20 29 20 23 20 18 18 20 17
% 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)
Measles Rubella Mumps Japanese Encephalitis
2002 0 108 4,683 241 92 (38%) 6,749 ND ND -
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
Table 5: Reported cases of vaccine preventable diseases, 2002-2011
Table 4: AFP surveillance performance indicators, 2002-2011
Figure 8: Non-polio AFP rate by district, 2011 Figure 9: Adequate stool collection rate by district, 2011
Data as of 30 July 2012
For contact or feedback:
Expanded Program on Immunization
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/vaccine
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.