Expanded progrAmme on immunization (EPI): Nepal 2021 Factsheet

World Health Organization • SEARO/CDS/IVD • 31 August 2021 ExpAnDED pROgRAmmE On ImmunIzAtIOn (EpI) Table 1: Basic information 2020 Table 2: Immunization schedule, 2020 Table 3: Immunization system highlights EPI hIsTory • EPI launched in 1979 • HepB vaccine introduced in 2002 • AD syringes introduced in 2003 • MCV SIA started in 2004 • DTP-HepB vaccine introduced in 2005 • JE introduced in 2009 • DTP-Hib-HepB vaccine introduced in 2009 • MR vaccine introduced in 2013 • IPV vaccine introduced in 2014 to 2016 • fIPV introduced in 2018 • MR second dose introduced in 2015 • PCV vaccine introduced in 2015 • tOPV to bOPV switched on 17 April 2016 • HPV demonstration project in 2 districts targeting school going girls of grade 6 and out of school girls of the age 11 years Source: EPI/MOHP 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. FacTshEET 2021 NEPal Total population1 29,803,732 Live births1 639,278 Children <1 year1 620,739 Children <5 years1 3,013,891 Children <15 years1 8,649,461 Pregnant women1 753,866 Women of child bearing age1 (WCBA) (15-49 years)1 8,630,092 Neonatal mortality rate2 19.8 (per 1,000 LB) Infant mortality rate2 25.6 (per 1,000 LB) Under-five mortality rate2 30.8 (per 1,000 LB) Maternal mortality ratio2 186 (per 100,000 LB) Division/Province/State/Region 7 District 77 Municipality 191 Village development committee 3,639 Ward 35,163 Population density1 (per sq. km) 180 Population living in urban areas3 20.60% Population using at least basic drinking- water services2 90% Population using at least basic sanitation services2 77% Total expenditure on health as % of GDP2 5.80% Births attended by skilled health personnel2 77% Neonates protected at birth NT2 89% 1 SEAR annual EPI reporting form, 2020 2 WHO, Global Health Observatory (GHO) data http://apps.who.int/gho/data accessed on 01 August 2021 cMYP for immunization 2017-2021 NIAC fully functional Spending on vaccines financed by the government 37% Spending on routine immunization programme financed by the government 49% Updated micro-plans that include activities to improve immunization coverage 77 districts (100%) National policy for health care waste management including waste from immunization activities in place National system to monitor AEFI in place Most recent EPI CES Nepal, Multiple Indicator Cluster Survey 2019 ≥80% coverage for DTP-Hib- HepB3 40 districts (52%) ≥90% coverage for MCV1 14 districts (18%) ≥90% coverage for MCV2 5 districts (7%) ≥10% drop-out rate for DTP-Hib- HepB1 to DTP-Hib-HepB3 18 districts (23%) Source: WHO/UNICEF JRF, 2020 Figure 1: National immunization coverage, 1980-2020 Source: WHO and UNICEF estimates of immunization coverage Vaccine age of administration BCG Birth DTP-Hib-HepB 6 weeks, 10 weeks and 14 weeks OPV 6 weeks, 10 weeks and 14 weeks fIPV 6 weeks and 14 weeks PCV 6 weeks, 10 weeks and 9 months MR 9 months and 15 months JE_LiveAtd 12 months Td First contact in pregnancy and +1 month Vitamin A 6 months to 5 years and +6 months Rotavirus 6 weeks and 10 weeks Source: WHO/UNICEF JRF, 2020 Figure 2: DTP3 coverage1, diphtheria and pertussis cases2, 1980-2020 Table 4: reported cases of vaccine preventable diseases, 2015-2020 Figure 3: TT2+ coverage1 and NT cases2, 1980-2020 1 WHO and UNICEF estimates of immunization coverage 2 WHO vaccine-preventable diseases: monitoring system 2020 1 Country official estimates, 1980-2020 2 WHO vaccine-preventable diseases: monitoring system 2020 Figure 4: 2019 DTP-hib-hepB3 coverage by district Figure 5: 2020 Source: WHO/UNICEF JRF (multiple years) ND=No data Source: SEAR annual EPI reporting form, 2019 and 2020 (administrative data) year Polio Diphtheria Pertussis NT (% of all tetanus) Measles rubella Mumps JE crs 2015 0 26 4,416 266 (30%) 1,599 626 38,858 937 50 2016 0 140 4,890 7 (0.91%) 1,269 656 30,610 98 33 2017 0 728 9,092 7(0.79%) 99 21 61,228 63 0 2018 0 232 4,153 2 (0.41%) 260 34 29,614 57 0 2019 0 0 0 3 (0.5%) 430 44 0 71 0 2020 0 0 0 3 (0.9%) 388 37 0 29 0 <70% 70% - 79% 80% - 89% >90% Table 5: aFP surveillance performance indicators, 2015-2020 Table 7: oPV sIas Non-polio aFP rate by district adequate stool specimen collection % by district Source: WHO/UNICEF JRF (multiple years) * with MR campaign as a part of emergency health response in 14 severely affected districts by earthquake Indicator 2015 2016 2017 2018 2019 2020 AFP cases 394 455 371 335 340 230 Wild poliovirus confirmed cases 0 0 0 0 0 0 Compatible cases 0 0 0 0 0 0 Non-polio AFP rate1 3.87 5.24 4.28 3.86 3.93 2.66 Adequate stool specimen collection percentage2 94% 96% 98% 97% 100% 98% Total stool samples collected 791 904 740 668 670 460 % NPEV isolation 18 20 21 15 18 17 % Timeliness of primary result reported3 100 100 99 100 100 99 • Last polio case due to indigenous WPV2 reported from Saptrai district in 1999. • Last polio case due to indigenous WPV3 reported from Siraha district in November 2000. • Last polio case due to imported WPV1 was reported from Rautahat district in August 2010. 1 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 Results reported within 14 days of sample received at laboratory. Figure 6: 2019 Figure 8: 2019 Figure 9: 2020 <1 1 – 1.99 >2 No non-polio AFP case <60% 60% - 79% >80% No AFP year antigen Geographic coverage Target age Target population coverage (%) round 1 round 2 round 1 round 2 2010 bOPV NID <5 years 4,466,960 88 89 2011 bOPV NID <5 years 4,466,960 91 92 2011 bOPV SNID <5 years 1,110,222 98 99 2012 bOPV NID <5 years 4,226,966 94 2013 tOPV NID <5 years 4,165,094 91 2014 tOPV NID <5 years 4,226,966 91 2015 bOPV SNID* <5 years 2,427,411 91 2015 tOPV SNID <5 years 559,511 90 2016 tOPV SNID <5 years 2,915,641 97 2017 bOPV SNID <5 years 1,462,863 108 2020 ND SNID <5 years 1,459,078 112 Figure 7: 2020 Table 6: Environmental surveillance sites for polio detection, 2018 - 2020 Note: SL1: Sabin like type 1; SL2: Sabin like type 2; SL3: Sabin like type 3; VDPV: Vaccine Derived Polio Virus; NPEV: Non Polio Entero Virus SL2 was isolated due to contamination of bOPV year # Provinces # sites # samples tested Isolation sl1 sl3 sl1+sl3 sl2 sl1+sl2 sl1+sl2+sl3 sl2+sl3 VDPV NPEV 2018 1 5 123 10 31 32 35 2019 1 5 123 10 23 31 50 2020 1 5 44 1 13 11 15 World Health Organization • SEARO/CDS/IVD • 31 August 2021 VACCInES PROtECt SUSTAIN. ACCELERATE. INNOVATE. Figure 10: hepB3 and hepB birth dose immunization coverage1, 2000-2020 Figure 11: McV1 & McV2 coverage1 and measles, rubella cases2, 1980-2020 Table 8: McV sIas Mr1 coverage by district Mr2 coverage by district Source: SEAR annual EPI reporting form, 2019 and 2020 (administrative data) * As a part of emergency health response in 14 severely affected districts by earthquake Source: WHO/UNICEF JRF (multiple years) 1 WHO and UNICEF estimates of immunization coverage 1 WHO and UNICEF estimates of immunization coverage 2 WHO vaccine-preventable diseases: monitoring system 2020 Figure 12: 2019 Figure 15: 2020 <80% 80% - 89% 90% - 94% > 95% year antigen Geographic coverage Target group Target coverage % 2004 M nationwide 9 months to 15 years 9,423,866 104% 2008 M nationwide 9 months to 5 years 3,903,515 93% 2012 MR nationwide 9 months to 15 years 9,579,306 101% 2015* MR subnational 6 months to 5 years 500,344 91% 2016 MR subnational 6 months to 9 months 2,501,919 101% 2020 Nationwide 9 months to 59 months 2,548,336 101% Figure 13: 2020 Figure 14: 2019 Figure 16: Immunity against measles - immunity profile by age in 2020* Figure 18: confirmed measles cases* by month 2018-2020 Figure 17: Immunity against rubella through vaccination - immunity profile by age in 2020* Figure 19: confirmed rubella cases* by month 2018-2020 *Modeled using WHO and UNICEF estimates and JRF (multiple years) and does not include immunity due to natural infection *Includes laboratory confirmed, epidemiologically linked and clinically compatible cases Source: SEAR measles case-based data *Includes laboratory confirmed and epidemiologically linked cases Source: SEAR measles case-based data *Modeled using MSP tool ver 2 Vaccines Protect SUSTAIN. ACCELERATE. INNOVATE. Figure 20: Vaccination status of confirmed (laboratory, Epi linked and clinically compatible) measles cases, by age in 2019 and 2020 Figure 21: Vaccination status of confirmed (laboratory and Epi linked) rubella cases, by age in 2019 and 2020 Table 9: summary of measles surveillance indicators, 2018-2020 Figure 22: Network of Who supported surveillance and immunization medical officers and laboratories Source: SEAR measles case-based data Source: SEAR Annual EPI Reporting Form (multiple years) ND=No data Source: SEAR measles case-based data Indicator Target 2018 2019 2020 Number of suspected measles cases 1,475 2,101 ND Confirmed measles cases 0 260 430 ND Lab confirmed 0 179 367 ND Epi-Linked 0 54 59 ND Clinically-compatible 0 27 4 ND Confirmed rubella cases 0 34 44 ND Lab confirmed 0 34 44 ND Epi-Linked 0 0 0 ND Discarded non-measles non-rubella cases 1,181 1,627 ND Percentage of suspected cases with adequate investigation initiated within 48 hours of notification ≥ 80% 98.4 0.99 ND Reporting rate of non-measles non-rubella cases to national level per 100,000 population ≥ 2 4.07 5.5 ND Percentage of second-level administrative units reporting at least 2 non-measles non-rubella cases per 100,00 population ≥ 80% 86 100 100 Percentage of surveillance units reporting measles and rubella data to the national level on time, even in the absence of cases ≥ 80% 89 89 ND Percentage of specimens received at the laboratory within 5 days of collection ≥ 80% 16 59 ND Percentage of IgM results reported to the national public health authorities by the laboratory within 4 days of receipt of specimens ≥ 80% 30 64 ND Genotypes detected Measles D8 ND ND Rubella ND ND ND For contact or feedback: child health and Immunization section Family Welfare Division, Department of Health Service Kathmandu, Nepal. Telephone: +977-1-4262263 Email: childhealthimmunization@gmail.com and jgautamdr@gmail.com Immunization and Vaccine Development (IVD) WHO-SEARO, IP Estate, MG Marg, New Delhi 110002, India Tel: +91 11 23370804, Fax: +91 11 23370251 Email: SearEpidata@who.int www.who.int/southeastasia/health-topics/immunization National Public health laboratory, Kathmandu • National measles/rubella laboratory • National Japanese encephalitis (JE) laboratory BP Koirala Institute of health sciences, Dharan • Measles Rubella/JE reference laboratory Invasive bacterial disease (IBD) laboratories, lalitpur • Patan Hospital rotavirus laboratory • Tribhuvan University Teaching Hospital, Kathmandu • BP Koirala Institute of Health Science, Dharan, Sunsari • Nepalguinj Medical College, Nepalgunj, Banke 11 Field offices (15 sMos) central office, Who-IPD