The National Immunization Programme (at the time known as the Expanded Programme on Immunization – EPI) was initiated in 1979 in three districts with only two antigens (BCG and DPT) and was rapidly expanded to include all 75 districts with all six recommended antigens (BCG, DTP, OPV, and measles) by 1988. In 2003, with the support of the GAVI Alliance, monovalent Hepatitis B (HepB) vaccine was introduced, which was later administered as a single tetravalent (DPT-HepB) injection. In 2009, vaccination against Haemophilus influenzae type b was introduced through out the nation in a phase wise manner starting in Far Western (FWDR) and Western (WDR) Development Regions. Also in 2009, Japanese encephalitis (JE) vaccine was introduced into the routine immunization programme in 16 JE endemic districts following JE mass vaccination campaigns.
Routine immunization Schedule for children and pregnant women
All children should receive the suggested number of doses of BCG, DPT-HepB-Hib, OPV, and measles vaccines during their first year of life. Similarly, all women of childbearing age should complete 5 doses of TT vaccine during their reproductive life. JE vaccine is available in the routine immunization programme only in districts with high risk of Japanese encephalitis transmission. All of the vaccines in the routine immunization schedule are provided free of cost in all public health facilities in Nepal.
The goal of NIP is to reduce morbidity and mortality associated with vaccine preventable diseases.
1. Achieve and sustain 90% coverage of DPT3 by 2008 and all antigens in all district by 2010;
2. Maintain polio free status;
3. Sustain MNT elimination status;
4. Initiate measles elimination initiatives from 2010;
5. Expand vaccine preventable diseases (VPD) surveillance;
6. Accelerate control of other VPD through introduction of new vaccines;
7. Improve and sustain immunization quality;
8. Expand immunization service beyond infancy.
Source: cMYP 2007-2011, MoHP
Nepal is geographically divided into five ecological regions which are Far-western, Mid-western, Western, Central and Eastern Regions. These regions are further divided into 75 administrative districts. In each district, there are hospitals (at least one), primary health care centers (PHC), health posts (HP) and sub health posts (SHP) through which health care services are delivered. Immunization services are provided through the fixed (health facilities) as well as out reach sessions. Hospitals, PHCs, HPs and SHPs provide immunization services through established clinics. In addition there are 3 to 5 outreach sessions conducted monthly in each VDC or Village Development Committee. Village health workers are primarily responsible for providing immunization services. Female community health volunteers (FCHVs) are the key link between the community and service providers. Their role has been crucial toward achieving and sustaining high immunization coverage through routine or supplemental services.
Objective 1: Achieve and sustain 90% coverage for all antigens
The coverage status of immunization for all antigens in Nepal remains satisfactory. The reported coverage status of the country is around 80% for all antigens. The drop-out rate for all antigens is decreasing. However, the immunization coverage is not uniform throughout and within the districts. Intensified monitoring of VDC coverage (by categorizing the VDCs as per their performance) has been implemented at district level since 2002 in order to promote universal coverage at all VDCs for all antigens.
Objective 2: Maintain polio free status
In 1996, Nepal initiated polio eradication efforts by holding the first Nepal National Immunization Days (NIDs) in all 75 districts. Since then, the polio eradication efforts have continued and expanded. Nepal has achieved and maintained global certification-standard AFP surveillance since 2001.
Objective 3: Sustain MNT elimination status
In 2000, Nepal began concerted efforts to meet the goal of maternal and neonatal tetanus elimination (MNTE) with the initiation of 3-doses of tetanus toxoid (TT) supplemental immunization activities (SIAs). All 75 districts completed the SIAs to achieve MNTE by the end of 2004.
In 2005, WHO & UNICEF validated that Nepal had eliminated neonatal tetanus (NT), i.e., achieved an NT incidence of less than one case per 1,000 live births in every district of the country. Results from the 2006 Nepal Demographic and Health Survey (NDHS) provided further evidence of NT elimination. School-based immunizations for grade one students in 12 districts and immunization of pregnant women with TT is ongoing. Through VPD surveillance, eighteen neonatal tetanus cases were investigated and confirmed in 2009.
Objective 4: Measles elimination initiatives
Measles was endemic in Nepal and was a major cause of child hood morbidity and mortality. However, the burden of measles disease and its associated mortality has decreased sharply after the introduction of measles vaccine through catch-up and follow-up measles campaigns in 2004/05 and 2008/09.
Source : www.nep.searo.who.int/EN/Section4/Section29/Section89.htm