Expanded programme on Immunization (EPI) factsheet 2023: Nepal

World Health Organization • SEARO/CDS/IVD • 31 October 2023 VACCINES PROTECT SUSTAIN. ACCELERATE. INNOVATE. EXPANDED PROGRAMME ON IMMUNIZATION (EPI) Table 2: Basic information 2022 Table 3: Immunization schedule, 2022 Table 4: Immunization system highlights 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. Total population1 29,266,472 Live births1 525,062 Children <1 year1 520,049 Children <5 years1 2,621,953 Children <15 years1 7,855,158 Pregnant women1 640,387 Women of child bearing age1 (WCBA) (15-49 years)1 8,354,327 Neonatal mortality rate4 21 (per 1,000 LB) Infant mortality rate4 28 (per 1,000 LB) Under-five mortality rate4 33 (per 1,000 LB) Maternal mortality ratio4 151 (per 100,000 LB) Province 7 District 77 Metropolitan 6 Sub metropolitan 11 Municipality 276 Rural municipality 460 Ward 6,743 Population density1 (per sq. km) 198 Population living in urban areas2 66.08% Population using at least basic drinking- water services2 91% Population using at least basic sanitation services2 80% Total expenditure on health as % of GDP2 1.55% Births attended by skilled health personnel4 80% Neonates protected at birth against NT2 89% Children not covered by immunization programme (zero dose children)3 30,269 1 SEAR annual EPI reporting form, 2022 2 WHO, Global Health Observatory (GHO) data http://apps.who.int/gho/data accessed on 03 August 2023 3 DTP1 coverage from WHO and UNICEF estimates of immunization coverage and UN estimated under one population 4 Nepal Demographic and Health Survey 2022 cMYP for immunization 2017-2021 NIAC fully functional (6 meetings conducted in 2022) Spending on vaccines financed by the government 27% Spending on routine immunization programme financed by the government 27% Updated micro-plans that include activities to improve immunization coverage No data 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, Demographic Health Survey 2022 >80% coverage for DTP-Hib- HepB3 66 districts (86%) >90% coverage for MCV1 43 districts (56%) >90% coverage for MCV2 39 districts (51%) >10% drop-out rate for DTP-Hib- HepB1 to DTP-Hib-HepB3 3 districts (4%) Source: WHO/UNICEF JRF, 2022 Figure 1: National immunization coverage, 2013-2022 Figure 16: Immunity against measles - immunity profile by age in 2022* Figure 20: Vaccination status of confirmed (laboratory, Epi linked and clinically compatible) measles cases, by age in 2021 and 2022 Figure 21: Vaccination status of confirmed (laboratory and Epi linked) rubella cases, by age in 2021 and 2022 Table 10: Summary of measles surveillance indicators, 2020-2022 Figure 22: Network of WHO supported surveillance and immunization medical officers and laboratories Figure 18: Confirmed measles cases* by month 2020-2022 Figure 17: Immunity against rubella through vaccination - immunity profile by age in 2022* Figure 19: Confirmed rubella cases* by month 2020-2022 *Modelled 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 *Modelled using MSP tool ver 2 Source: SEAR measles case-based data Source: SEAR Annual EPI Reporting Form (multiple years) ND=No data Source: SEAR measles case-based data Source: WHO and UNICEF estimates of immunization coverage Indicator Target 2020 2021 2022 Number of suspected measles cases 1,381 1,417 1,105 Confirmed measles cases 0 388 143 130 Lab confirmed 0 230 81 26 Epi-Linked 0 155 60 96 Clinically-compatible 0 2 2 8 Confirmed rubella cases 0 37 44 24 Lab confirmed 0 37 44 24 Epi-Linked 0 0 0 0 Discarded non-measles non-rubella cases 956 1,230 949 Percentage of suspected cases with adequate investigation initiated within 48 hours of notification ≥ 80% 100 99 98 Reporting rate of non-measles non-rubella cases to national level per 100,000 population ≥ 2 3.21 4.07 3.24 Percentage of second-level administrative units reporting at least 2 non-measles non-rubella cases per 100,000 population per 100,00 population ≥ 80% 93 96 94 Percentage of surveillance units reporting measles and rubella data to the national level on time, even in the absence of cases ≥ 80% 90 89 87 Percentage of specimens received at the laboratory within 5 days of collection ≥ 80% 69 78 99 Percentage of IgM results reported to the national public health authorities by the laboratory within 4 days of receipt of specimens ≥ 80% 61 79 76 Genotypes detected Measles D8 Rubella ND Vaccine Age of administration BCG Birth DTP-Hib-HepB 6 weeks, 10 weeks and 14 weeks OPV 6 weeks, 10 weeks and 14 weeks Rotavirus 6 weeks and 10 weeks fIPV 14 weeks and 9 months PCV 6 weeks, 10 weeks and 9 months MR 9 months and 15 months JE_LiveAtd 12 months Typhoid conjugate vaccine 15 months Td First contact in pregnancy and +1 month Vitamin A 6 months to 5 years and +6 months Source: WHO/UNICEF JRF, 2022 For contact or feedback: Child Health and Immunization Services Section Family Welfare Division, Department of Health Services Kathmandu, Nepal. Telephone: +977-1-4262263 Email: fwdnip2035@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 Rota Laboratory • Kanti children Hospital, Kathmandu • BP Koirala instate of Health Science, Dharan, Sunsari • Nepalgunj Medical College, Nepalgunj, Banke 10 Field Offices(15 SMOs) Central Office, WHO-IPD Table 1: EPI History Year Milestone 1979 EPI launched 2002 HepB vaccine introduced 2003 AD syringes introduced 2004 MCV SIA started 2005 DTP-HepB vaccine introduced 2009 JE introduced 2009 DTP-Hib-HepB vaccine introduced 2013 MR vaccine introduced 2014 TT vaccine replaced by Td 2014-16 IPV vaccine introduced in 2014 to 2016 2018 fIPV introduced 2015 MR second dose introduced 2015 PCV vaccine introduced 2016 tOPV to bOPV switched on 17 April HPV demonstration project in 2 districts targeting school going girls of grade 6 and out of school girls of the age 10 years 2020 Rotavirus vaccine introduced along with hygiene promotion integration in RI 2022 TCV vaccine introduced Source: FWD, DoHS/ MoHP FACTSHEET 2023 NEPAL World Health Organization • SEARO/CDS/IVD • 31 October 2023 VACCINES PROTECT SUSTAIN. ACCELERATE. INNOVATE. Figure 2: DTP3 coverage1, diphtheria and pertussis cases2, 1980-2022 Table 5: Reported cases of vaccine preventable diseases, 2016-2022 Table 6: AFP surveillance performance indicators, 2016-2022 Figure 10: HepB3 and HepB birth dose immunization coverage1, 2000-2022 Figure 11: MCV1 & MCV2 coverage1 and measles, rubella cases2, 1980-2022 Table 8: OPV SIAs Table 9: MCV/MR SIAs Figure 3: TT2+ coverage1 and NT cases2, 1980-2022 1 WHO and UNICEF estimates of immunization coverage 2 WHO vaccine-preventable diseases: monitoring system 2022 1 Country official estimates, 1980-2022 2 WHO vaccine-preventable diseases: monitoring system 2022 Figure 4: 2021 DTP-Hib-HepB3 coverage by district Non-polio AFP rate by district Adequate stool specimen collection % by district MR1 coverage by district MR2 coverage by district Figure 5: 2022 Source: WHO/UNICEF JRF (multiple years) ND=No data Source: SEAR annual EPI reporting form, 2021 and 2022 (administrative data) Source: SEAR annual EPI reporting form, 2021 and 2022 (administrative data) * with MR campaign as a part of emergency health response in 14 severely affected districts by earthquake Source: WHO/UNICEF JRF (multiple years) * As a part of emergency health response in 14 severely affected districts by earthquake Source: WHO/UNICEF JRF (multiple years) Year Polio Diphtheria Pertussis NT (% of all tetanus) Measles Rubella Mumps JE CRS 2016 0 140 4,890 7 (0.91%) 1,269 656 30,610 98 33 2017 0 728 9,092 7 (0.79%) 97 22 61,228 82 0 2018 0 232 4,153 2 (0.41%) 260 34 29,614 58 0 2019 0 38 5,402 3 (0.5%) 431 44 31,775 71 0 2020 0 38 4,224 3 (0.9%) 388 37 31,489 29 0 2021 0 29 4,588 2 (0.2%) 143 44 13,075 31 ND 2022 0 95 4,828 3 (0.4%) 130 24 8,898 79 0 Indicator 2016 2017 2018 2019 2020 2021 2022 AFP cases 455 371 335 340 230 260 219 Wild poliovirus confirmed cases 0 0 0 0 0 0 0 Compatible cases 0 0 0 0 0 0 0 Non-polio AFP rate1 5.24 4.28 3.86 3.93 2.66 3.02 2.79 Adequate stool specimen collection percentage2 96% 98% 97% 100% 98% 99% 97% Total stool samples collected 904 740 668 670 460 517 466 % NPEV isolation 20 21 15 18 17 15 17 % Timeliness of primary result reported3 100 99 100 100 99 97 21 • 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. 1 WHO and UNICEF estimates of immunization coverage 1 WHO and UNICEF estimates of immunization coverage 2 WHO vaccine-preventable diseases: monitoring system 2022 Figure 6: 2021 Figure 8: 2021 Figure 9: 2022 Figure 12: 2021 Figure 15: 2022 <1 1 – 1.99 >2 No non-polio AFP case <70% 70% - 79% 80% - 89% >90% <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 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 tOPV SNID* <5 years 2,427,411 91 2015 bOPV 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 bOPV SNID <5 years 1,459,078 112 <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 M 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 MR Nationwide 9 months to 5 years 2,548,336 101 Figure 7: 2022 Table 7: Environmental surveillance sites for polio detection, 2019 - 2022 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 2019 1 5 123 10 23 31 58 2020 1 5 44 1 13 11 19 2021 1 5 125 12 23 15 65 2022 3 7 127 11 19 12 57 Figure 13: 2022 Figure 14: 2021 World Health Organization • SEARO/CDS/IVD • 31 October 2023 VACCINES PROTECT SUSTAIN. ACCELERATE. INNOVATE. Figure 2: DTP3 coverage1, diphtheria and pertussis cases2, 1980-2022 Table 5: Reported cases of vaccine preventable diseases, 2016-2022 Table 6: AFP surveillance performance indicators, 2016-2022 Figure 10: HepB3 and HepB birth dose immunization coverage1, 2000-2022 Figure 11: MCV1 & MCV2 coverage1 and measles, rubella cases2, 1980-2022 Table 8: OPV SIAs Table 9: MCV/MR SIAs Figure 3: TT2+ coverage1 and NT cases2, 1980-2022 1 WHO and UNICEF estimates of immunization coverage 2 WHO vaccine-preventable diseases: monitoring system 2022 1 Country official estimates, 1980-2022 2 WHO vaccine-preventable diseases: monitoring system 2022 Figure 4: 2021 DTP-Hib-HepB3 coverage by district Non-polio AFP rate by district Adequate stool specimen collection % by district MR1 coverage by district MR2 coverage by district Figure 5: 2022 Source: WHO/UNICEF JRF (multiple years) ND=No data Source: SEAR annual EPI reporting form, 2021 and 2022 (administrative data) Source: SEAR annual EPI reporting form, 2021 and 2022 (administrative data) * with MR campaign as a part of emergency health response in 14 severely affected districts by earthquake Source: WHO/UNICEF JRF (multiple years) * As a part of emergency health response in 14 severely affected districts by earthquake Source: WHO/UNICEF JRF (multiple years) Year Polio Diphtheria Pertussis NT (% of all tetanus) Measles Rubella Mumps JE CRS 2016 0 140 4,890 7 (0.91%) 1,269 656 30,610 98 33 2017 0 728 9,092 7 (0.79%) 97 22 61,228 82 0 2018 0 232 4,153 2 (0.41%) 260 34 29,614 58 0 2019 0 38 5,402 3 (0.5%) 431 44 31,775 71 0 2020 0 38 4,224 3 (0.9%) 388 37 31,489 29 0 2021 0 29 4,588 2 (0.2%) 143 44 13,075 31 ND 2022 0 95 4,828 3 (0.4%) 130 24 8,898 79 0 Indicator 2016 2017 2018 2019 2020 2021 2022 AFP cases 455 371 335 340 230 260 219 Wild poliovirus confirmed cases 0 0 0 0 0 0 0 Compatible cases 0 0 0 0 0 0 0 Non-polio AFP rate1 5.24 4.28 3.86 3.93 2.66 3.02 2.79 Adequate stool specimen collection percentage2 96% 98% 97% 100% 98% 99% 97% Total stool samples collected 904 740 668 670 460 517 466 % NPEV isolation 20 21 15 18 17 15 17 % Timeliness of primary result reported3 100 99 100 100 99 97 21 • 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. 1 WHO and UNICEF estimates of immunization coverage 1 WHO and UNICEF estimates of immunization coverage 2 WHO vaccine-preventable diseases: monitoring system 2022 Figure 6: 2021 Figure 8: 2021 Figure 9: 2022 Figure 12: 2021 Figure 15: 2022 <1 1 – 1.99 >2 No non-polio AFP case <70% 70% - 79% 80% - 89% >90% <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 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 tOPV SNID* <5 years 2,427,411 91 2015 bOPV 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 bOPV SNID <5 years 1,459,078 112 <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 M 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 MR Nationwide 9 months to 5 years 2,548,336 101 Figure 7: 2022 Table 7: Environmental surveillance sites for polio detection, 2019 - 2022 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 2019 1 5 123 10 23 31 58 2020 1 5 44 1 13 11 19 2021 1 5 125 12 23 15 65 2022 3 7 127 11 19 12 57 Figure 13: 2022 Figure 14: 2021 World Health Organization • SEARO/CDS/IVD • 31 October 2023 VACCINES PROTECT SUSTAIN. ACCELERATE. INNOVATE. Figure 2: DTP3 coverage1, diphtheria and pertussis cases2, 1980-2022 Table 5: Reported cases of vaccine preventable diseases, 2016-2022 Table 6: AFP surveillance performance indicators, 2016-2022 Figure 10: HepB3 and HepB birth dose immunization coverage1, 2000-2022 Figure 11: MCV1 & MCV2 coverage1 and measles, rubella cases2, 1980-2022 Table 8: OPV SIAs Table 9: MCV/MR SIAs Figure 3: TT2+ coverage1 and NT cases2, 1980-2022 1 WHO and UNICEF estimates of immunization coverage 2 WHO vaccine-preventable diseases: monitoring system 2022 1 Country official estimates, 1980-2022 2 WHO vaccine-preventable diseases: monitoring system 2022 Figure 4: 2021 DTP-Hib-HepB3 coverage by district Non-polio AFP rate by district Adequate stool specimen collection % by district MR1 coverage by district MR2 coverage by district Figure 5: 2022 Source: WHO/UNICEF JRF (multiple years) ND=No data Source: SEAR annual EPI reporting form, 2021 and 2022 (administrative data) Source: SEAR annual EPI reporting form, 2021 and 2022 (administrative data) * with MR campaign as a part of emergency health response in 14 severely affected districts by earthquake Source: WHO/UNICEF JRF (multiple years) * As a part of emergency health response in 14 severely affected districts by earthquake Source: WHO/UNICEF JRF (multiple years) Year Polio Diphtheria Pertussis NT (% of all tetanus) Measles Rubella Mumps JE CRS 2016 0 140 4,890 7 (0.91%) 1,269 656 30,610 98 33 2017 0 728 9,092 7 (0.79%) 97 22 61,228 82 0 2018 0 232 4,153 2 (0.41%) 260 34 29,614 58 0 2019 0 38 5,402 3 (0.5%) 431 44 31,775 71 0 2020 0 38 4,224 3 (0.9%) 388 37 31,489 29 0 2021 0 29 4,588 2 (0.2%) 143 44 13,075 31 ND 2022 0 95 4,828 3 (0.4%) 130 24 8,898 79 0 Indicator 2016 2017 2018 2019 2020 2021 2022 AFP cases 455 371 335 340 230 260 219 Wild poliovirus confirmed cases 0 0 0 0 0 0 0 Compatible cases 0 0 0 0 0 0 0 Non-polio AFP rate1 5.24 4.28 3.86 3.93 2.66 3.02 2.79 Adequate stool specimen collection percentage2 96% 98% 97% 100% 98% 99% 97% Total stool samples collected 904 740 668 670 460 517 466 % NPEV isolation 20 21 15 18 17 15 17 % Timeliness of primary result reported3 100 99 100 100 99 97 21 • 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. 1 WHO and UNICEF estimates of immunization coverage 1 WHO and UNICEF estimates of immunization coverage 2 WHO vaccine-preventable diseases: monitoring system 2022 Figure 6: 2021 Figure 8: 2021 Figure 9: 2022 Figure 12: 2021 Figure 15: 2022 <1 1 – 1.99 >2 No non-polio AFP case <70% 70% - 79% 80% - 89% >90% <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 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 tOPV SNID* <5 years 2,427,411 91 2015 bOPV 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 bOPV SNID <5 years 1,459,078 112 <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 M 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 MR Nationwide 9 months to 5 years 2,548,336 101 Figure 7: 2022 Table 7: Environmental surveillance sites for polio detection, 2019 - 2022 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 2019 1 5 123 10 23 31 58 2020 1 5 44 1 13 11 19 2021 1 5 125 12 23 15 65 2022 3 7 127 11 19 12 57 Figure 13: 2022 Figure 14: 2021 World Health Organization • SEARO/CDS/IVD • 31 October 2023 VACCINES PROTECT SUSTAIN. ACCELERATE. INNOVATE. EXPANDED PROGRAMME ON IMMUNIZATION (EPI) Table 2: Basic information 2022 Table 3: Immunization schedule, 2022 Table 4: Immunization system highlights 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. Total population1 29,266,472 Live births1 525,062 Children <1 year1 520,049 Children <5 years1 2,621,953 Children <15 years1 7,855,158 Pregnant women1 640,387 Women of child bearing age1 (WCBA) (15-49 years)1 8,354,327 Neonatal mortality rate4 21 (per 1,000 LB) Infant mortality rate4 28 (per 1,000 LB) Under-five mortality rate4 33 (per 1,000 LB) Maternal mortality ratio4 151 (per 100,000 LB) Province 7 District 77 Metropolitan 6 Sub metropolitan 11 Municipality 276 Rural municipality 460 Ward 6,743 Population density1 (per sq. km) 198 Population living in urban areas2 66.08% Population using at least basic drinking- water services2 91% Population using at least basic sanitation services2 80% Total expenditure on health as % of GDP2 1.55% Births attended by skilled health personnel4 80% Neonates protected at birth against NT2 89% Children not covered by immunization programme (zero dose children)3 30,269 1 SEAR annual EPI reporting form, 2022 2 WHO, Global Health Observatory (GHO) data http://apps.who.int/gho/data accessed on 03 August 2023 3 DTP1 coverage from WHO and UNICEF estimates of immunization coverage and UN estimated under one population 4 Nepal Demographic and Health Survey 2022 cMYP for immunization 2017-2021 NIAC fully functional (6 meetings conducted in 2022) Spending on vaccines financed by the government 27% Spending on routine immunization programme financed by the government 27% Updated micro-plans that include activities to improve immunization coverage No data 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, Demographic Health Survey 2022 >80% coverage for DTP-Hib- HepB3 66 districts (86%) >90% coverage for MCV1 43 districts (56%) >90% coverage for MCV2 39 districts (51%) >10% drop-out rate for DTP-Hib- HepB1 to DTP-Hib-HepB3 3 districts (4%) Source: WHO/UNICEF JRF, 2022 Figure 1: National immunization coverage, 2013-2022 Figure 16: Immunity against measles - immunity profile by age in 2022* Figure 20: Vaccination status of confirmed (laboratory, Epi linked and clinically compatible) measles cases, by age in 2021 and 2022 Figure 21: Vaccination status of confirmed (laboratory and Epi linked) rubella cases, by age in 2021 and 2022 Table 10: Summary of measles surveillance indicators, 2020-2022 Figure 22: Network of WHO supported surveillance and immunization medical officers and laboratories Figure 18: Confirmed measles cases* by month 2020-2022 Figure 17: Immunity against rubella through vaccination - immunity profile by age in 2022* Figure 19: Confirmed rubella cases* by month 2020-2022 *Modelled 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 *Modelled using MSP tool ver 2 Source: SEAR measles case-based data Source: SEAR Annual EPI Reporting Form (multiple years) ND=No data Source: SEAR measles case-based data Source: WHO and UNICEF estimates of immunization coverage Indicator Target 2020 2021 2022 Number of suspected measles cases 1,381 1,417 1,105 Confirmed measles cases 0 388 143 130 Lab confirmed 0 230 81 26 Epi-Linked 0 155 60 96 Clinically-compatible 0 2 2 8 Confirmed rubella cases 0 37 44 24 Lab confirmed 0 37 44 24 Epi-Linked 0 0 0 0 Discarded non-measles non-rubella cases 956 1,230 949 Percentage of suspected cases with adequate investigation initiated within 48 hours of notification ≥ 80% 100 99 98 Reporting rate of non-measles non-rubella cases to national level per 100,000 population ≥ 2 3.21 4.07 3.24 Percentage of second-level administrative units reporting at least 2 non-measles non-rubella cases per 100,000 population per 100,00 population ≥ 80% 93 96 94 Percentage of surveillance units reporting measles and rubella data to the national level on time, even in the absence of cases ≥ 80% 90 89 87 Percentage of specimens received at the laboratory within 5 days of collection ≥ 80% 69 78 99 Percentage of IgM results reported to the national public health authorities by the laboratory within 4 days of receipt of specimens ≥ 80% 61 79 76 Genotypes detected Measles D8 Rubella ND Vaccine Age of administration BCG Birth DTP-Hib-HepB 6 weeks, 10 weeks and 14 weeks OPV 6 weeks, 10 weeks and 14 weeks Rotavirus 6 weeks and 10 weeks fIPV 14 weeks and 9 months PCV 6 weeks, 10 weeks and 9 months MR 9 months and 15 months JE_LiveAtd 12 months Typhoid conjugate vaccine 15 months Td First contact in pregnancy and +1 month Vitamin A 6 months to 5 years and +6 months Source: WHO/UNICEF JRF, 2022 For contact or feedback: Child Health and Immunization Services Section Family Welfare Division, Department of Health Services Kathmandu, Nepal. Telephone: +977-1-4262263 Email: fwdnip2035@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 Rota Laboratory • Kanti children Hospital, Kathmandu • BP Koirala instate of Health Science, Dharan, Sunsari • Nepalgunj Medical College, Nepalgunj, Banke 10 Field Offices(15 SMOs) Central Office, WHO-IPD Table 1: EPI History Year Milestone 1979 EPI launched 2002 HepB vaccine introduced 2003 AD syringes introduced 2004 MCV SIA started 2005 DTP-HepB vaccine introduced 2009 JE introduced 2009 DTP-Hib-HepB vaccine introduced 2013 MR vaccine introduced 2014 TT vaccine replaced by Td 2014-16 IPV vaccine introduced in 2014 to 2016 2018 fIPV introduced 2015 MR second dose introduced 2015 PCV vaccine introduced 2016 tOPV to bOPV switched on 17 April HPV demonstration project in 2 districts targeting school going girls of grade 6 and out of school girls of the age 10 years 2020 Rotavirus vaccine introduced along with hygiene promotion integration in RI 2022 TCV vaccine introduced Source: FWD, DoHS/ MoHP FACTSHEET 2023 NEPAL World Health Organization • SEARO/CDS/IVD • 31 October 2023 VACCINES PROTECT SUSTAIN. ACCELERATE. INNOVATE. EXPANDED PROGRAMME ON IMMUNIZATION (EPI) Table 2: Basic information 2022 Table 3: Immunization schedule, 2022 Table 4: Immunization system highlights 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. Total population1 29,266,472 Live births1 525,062 Children <1 year1 520,049 Children <5 years1 2,621,953 Children <15 years1 7,855,158 Pregnant women1 640,387 Women of child bearing age1 (WCBA) (15-49 years)1 8,354,327 Neonatal mortality rate4 21 (per 1,000 LB) Infant mortality rate4 28 (per 1,000 LB) Under-five mortality rate4 33 (per 1,000 LB) Maternal mortality ratio4 151 (per 100,000 LB) Province 7 District 77 Metropolitan 6 Sub metropolitan 11 Municipality 276 Rural municipality 460 Ward 6,743 Population density1 (per sq. km) 198 Population living in urban areas2 66.08% Population using at least basic drinking- water services2 91% Population using at least basic sanitation services2 80% Total expenditure on health as % of GDP2 1.55% Births attended by skilled health personnel4 80% Neonates protected at birth against NT2 89% Children not covered by immunization programme (zero dose children)3 30,269 1 SEAR annual EPI reporting form, 2022 2 WHO, Global Health Observatory (GHO) data http://apps.who.int/gho/data accessed on 03 August 2023 3 DTP1 coverage from WHO and UNICEF estimates of immunization coverage and UN estimated under one population 4 Nepal Demographic and Health Survey 2022 cMYP for immunization 2017-2021 NIAC fully functional (6 meetings conducted in 2022) Spending on vaccines financed by the government 27% Spending on routine immunization programme financed by the government 27% Updated micro-plans that include activities to improve immunization coverage No data 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, Demographic Health Survey 2022 >80% coverage for DTP-Hib- HepB3 66 districts (86%) >90% coverage for MCV1 43 districts (56%) >90% coverage for MCV2 39 districts (51%) >10% drop-out rate for DTP-Hib- HepB1 to DTP-Hib-HepB3 3 districts (4%) Source: WHO/UNICEF JRF, 2022 Figure 1: National immunization coverage, 2013-2022 Figure 16: Immunity against measles - immunity profile by age in 2022* Figure 20: Vaccination status of confirmed (laboratory, Epi linked and clinically compatible) measles cases, by age in 2021 and 2022 Figure 21: Vaccination status of confirmed (laboratory and Epi linked) rubella cases, by age in 2021 and 2022 Table 10: Summary of measles surveillance indicators, 2020-2022 Figure 22: Network of WHO supported surveillance and immunization medical officers and laboratories Figure 18: Confirmed measles cases* by month 2020-2022 Figure 17: Immunity against rubella through vaccination - immunity profile by age in 2022* Figure 19: Confirmed rubella cases* by month 2020-2022 *Modelled 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 *Modelled using MSP tool ver 2 Source: SEAR measles case-based data Source: SEAR Annual EPI Reporting Form (multiple years) ND=No data Source: SEAR measles case-based data Source: WHO and UNICEF estimates of immunization coverage Indicator Target 2020 2021 2022 Number of suspected measles cases 1,381 1,417 1,105 Confirmed measles cases 0 388 143 130 Lab confirmed 0 230 81 26 Epi-Linked 0 155 60 96 Clinically-compatible 0 2 2 8 Confirmed rubella cases 0 37 44 24 Lab confirmed 0 37 44 24 Epi-Linked 0 0 0 0 Discarded non-measles non-rubella cases 956 1,230 949 Percentage of suspected cases with adequate investigation initiated within 48 hours of notification ≥ 80% 100 99 98 Reporting rate of non-measles non-rubella cases to national level per 100,000 population ≥ 2 3.21 4.07 3.24 Percentage of second-level administrative units reporting at least 2 non-measles non-rubella cases per 100,000 population per 100,00 population ≥ 80% 93 96 94 Percentage of surveillance units reporting measles and rubella data to the national level on time, even in the absence of cases ≥ 80% 90 89 87 Percentage of specimens received at the laboratory within 5 days of collection ≥ 80% 69 78 99 Percentage of IgM results reported to the national public health authorities by the laboratory within 4 days of receipt of specimens ≥ 80% 61 79 76 Genotypes detected Measles D8 Rubella ND Vaccine Age of administration BCG Birth DTP-Hib-HepB 6 weeks, 10 weeks and 14 weeks OPV 6 weeks, 10 weeks and 14 weeks Rotavirus 6 weeks and 10 weeks fIPV 14 weeks and 9 months PCV 6 weeks, 10 weeks and 9 months MR 9 months and 15 months JE_LiveAtd 12 months Typhoid conjugate vaccine 15 months Td First contact in pregnancy and +1 month Vitamin A 6 months to 5 years and +6 months Source: WHO/UNICEF JRF, 2022 For contact or feedback: Child Health and Immunization Services Section Family Welfare Division, Department of Health Services Kathmandu, Nepal. Telephone: +977-1-4262263 Email: fwdnip2035@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 Rota Laboratory • Kanti children Hospital, Kathmandu • BP Koirala instate of Health Science, Dharan, Sunsari • Nepalgunj Medical College, Nepalgunj, Banke 10 Field Offices(15 SMOs) Central Office, WHO-IPD Table 1: EPI History Year Milestone 1979 EPI launched 2002 HepB vaccine introduced 2003 AD syringes introduced 2004 MCV SIA started 2005 DTP-HepB vaccine introduced 2009 JE introduced 2009 DTP-Hib-HepB vaccine introduced 2013 MR vaccine introduced 2014 TT vaccine replaced by Td 2014-16 IPV vaccine introduced in 2014 to 2016 2018 fIPV introduced 2015 MR second dose introduced 2015 PCV vaccine introduced 2016 tOPV to bOPV switched on 17 April HPV demonstration project in 2 districts targeting school going girls of grade 6 and out of school girls of the age 10 years 2020 Rotavirus vaccine introduced along with hygiene promotion integration in RI 2022 TCV vaccine introduced Source: FWD, DoHS/ MoHP FACTSHEET 2023 NEPAL