World Health Organization had initiated a program called
Expanded Program on Immunization (EPI) in 1974 and many countries started
implementing EPI. Expanded program on Immunization (EPI) including BCG, and DPT
vaccines in Nepal started in Nepal in 1979 in three districts. However, EPI
including BCG, DPT, oral polio vaccine, and Measles was expanded to all 75
districts by 1989 only. Since then, Government of Nepal is providing free
immunization services to everyone regardless of their gender, socioeconomic strata
without any discrimination. It is one of the accessible services of Nepal and
has reached to 97% of the total population. Nepal is believed to be one of the
countries recognized for the well functioning immunization system. This is also
considered as the most cost effective public health programme.
The Comprehensive Multi Year Plan (cYMP),
which is a 5-year plan of action, governs the National Immunization Programme
(NIP) of Nepal. NIP is also guided by NHSP II, which focuses on increasing
access and utilization of essential health care services to reduce disparities
and considers Immunization as a package of free essential health care services.
CHD leads all immunization related activities and each district is
responsible for the immunization coverage of that particular district.
Goal of CMYP (comprehensive multi year plan 2011-2016)
1. To reduce child, mortality, morbidity and disability
associated with vaccine preventable diseases.
Objectives and Strategies of CMYP
Objective 1: Achieve and maintain at least 90% vaccination
coverage for all antigens at national and district level by 2016
Key strategies:
1. Increase access and utilization to vaccination by
implementing (Reaching every district) RED strategies in every district
2. Enhance human resources capacity for immunization
management
3. Strengthen immunization monitoring system at all levels
4. Strengthen communication, social mobilization, and advocacy
activities
5. Strengthen immunization services in the municipalities
Objective 2: Ensure access to vaccines of assured quality
and with appropriate waste management
Key strategies:
1. Strengthen the vaccine management system at all levels
Objective 3: Achieve and maintain polio free status
Key strategies:
1. Achieve and maintain high immunity levels against Polio by
strengthening routine immunization and conducting high quality national polio
immunization campaigns.
2. Respond adequately and timely to outbreak of poliomyelitis
with appropriate vaccine.
3. Achieve and maintain certification standard AFP
surveillance.
Objective 4: Maintain maternal and neonatal tetanus
elimination status
Key strategies:
1. Achieve and maintain at least >80% TT2+ coverage
for pregnant women in every districts
2. Conduct Td follow up campaigns in high risk districts
3. Expand school based immunization program
4. Continue surveillance of NT
Objective 5: Initiate measles elimination
Key strategies:
1. Achieve and sustain high population immunity to reduce
measles incidence to elimination level.
2. Investigate all suspected measles like outbreaks with
program response
3. Use platform of measles elimination for Rubella / CRS
control
4. Continue case-based measles
surveillance
Objective 6: Accelerate control of vaccine-preventable
diseases through introduction of new and underused vaccines
Key strategies:
1. Introduction of new and under-used vaccines (rubella,
pneumococcal, typhoid, rota) based on disease burden and financial
sustainability
Objective 7: Strengthen and expand VPD surveillance
Key strategies:
1. Expand VPD surveillance to include vaccine preventable
diseases of public health concern.
2. Strengthen and expand laboratory support for surveillance.
Objective 8: Continue to expand immunization beyond infancy
Key strategies:
1. Consider for booster dose of currently used antigen based
on evidence and protection of adult from potential VPDs.
The current National Immunization activities are guided by
those strategies to meet the objectives set in comprehensive multi-year plan of
Nepal.
As an alternative to the intramuscular injection of a full
dose of IPV, countries may consider using fractional doses (1/5 of the full IPV
dose) via the intradermal route.In the context of an IPV shortage, countries
should consider instituting a 2-dose fractional dose schedule, where feasible,
which could ensure that all eligible infants receive IPV, is dose-sparing and
results in better immunogenicity than a single full dose of IPV. However, the
programmatic and logistic implications of this option must be carefully
assessed.
A schedule of fractional intradermal doses administered at
6 and 14 weeks ensures early and appropriately-timed protection. The 2
fractional doses should be separated by a minimum interval of 4 weeks. One
fractional dose of IPV may be suitable for outbreak response if supplies are
limited. Studies have demonstrated that a single fractional dose of
IPV (1/5 of the full dose) gives lower seroconversion rates than a single full
dose but after 2 fractional doses the rates are similar to those after 2 full
doses.
Furthermore, 2 fractional doses of IPV, given
intradermally at 6 and 14 weeks provide higher seroconversion rates than a
single full dose (intramuscular) given at 14 weeks.
The government has been
providing 11 types of vaccines for free under the National Immunization
Programme. Every year, two billion rupees is spent on providing the vaccines
for around 660,000 children across the country. According to a survey carried out in 2016, immunization
programme covered 78 per cent of children across the country. However, another
survey carried out in the same year counters that and claims the programme
covered 87 per cent of children.
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