National Health

Programs in Nepal
Prof. Dr. I .Dudani

I. Disease Control
Programs:-

1.
Tuberculosis control
2.
Malaria control
3.
Leprosy control
4.
HIV/AIDS/STI control
5.
Dengue control
6.
Control of Lymphatic Filariasis
7.
Kala-Azar elimination
8.
Neonatal & Maternal Tetanus
elimination
9.
Poliomyelitis eradication
10.
Japanese B encephalitis control

II. Nutritional
Programmes:Growth
Monitoring Programme

1.
2. Breast Feeding
3. Supplementary Feeding
4. Vit. A supplementation
5. Iron supplementation
6. Universal salt iodization
7. Food fortification
8. Zn treatment
9. Micronutrient powder supplementation
10. Management of acute malnutrition
11. Deworming of 2-5 years children

III. Reproductive Health Programs:

(Family Health Programs)
1. Family Planning
2. Safe motherhood Program
3. FCHV Program
4. Primary Health Care Outreach
5. Demographic & Reproductive
Health Research
6. CB-IMCI (IMMNI, IMNCI)

Safe Motherhood Programme

includes:
1. Family planning
2. Antenatal care
3. Clean and safe delivery
4. Postnatal care
5. Referral for complicated and high
risk cases
6. Access to essential obstetric care
7. Care of the new born
(Resuscitation and thermal control of
newborn)

Child Health Programme

1. NIP
2. CB-IMCI
a) Management of <2 months cases
eradication
b) Diarrheal diseases control
Tetanus Neonatorum
c) Acute Respiratory Illnesses (ARI)
Elimination
d) FCHV program
School TT program
e) CB-- Newborn care package (CB-NCP)
campaign
3. Nutrition:
a)
Control of PEM
treatment
b)

Iodine disorders
Deworming of

f) Polio
g)

h)
i) JE

h)
i)

Zn

IV. Supporting Programs:

1. National Health Training
2. I.E.C
3. Community Drug Program
4. National Health Laboratory
Services
5. Administrative Management
6. Financial Management

Child Health Programs

1
2
3
4
5
6
7
8

NIP
CB-IMCI
FCHV
Nutrition Care Programs
Newborn Care Programs
ARI
DDC
Measles, Poliomylitis, JE, School TT

Definitions
CONTROL: Means reducing the transmission of
disease resulting in reduction of
incidence and duration of disease
ELIMINATION: Means interruption of
transmission by extermination of
disease agent
ERADICATION: Means termination of
transmission by extermination of
disease agent

National Non-Government
Organisations
1. Family Planning Association of Nepal
(FPAN)
2. AAMAA Milan Kendra (Mothers Club)
3. Nepal CRS (Contraceptive Retail Sale)
Company
4. Nepal Red Cross Society
5. National Vit A prpogramme
6. Pashupati Homeopathic Hospital

WHO
Nepal

National Immunization
Program
(Expanded Program on
1974 Immunization)

1979 in 3 districts
1988 in all districts
1996 joined global polio eradication
Objectives:
1. To reduce child morbidity & mortality of IPD
2. To sustain 90% coverage
3. To eliminate MNT
4. To reduce measles morbidity and mortality
5. To eradicate poliomyelitis
6. To increase public awareness
7. To introduce new vaccines and
to improve immunization quality

Target Groups:
1.

Infants

2. Pregnant women (2 doses

of TT)
3. 1, 2, 3 Grade school
children for
TT

National Immunization
Schedule

BCG
One dose
OPV
3 doses
14 weeks
DPT
HEPB ( Combo vaccine)
Hib
3 doses
14 weeks
Measles
1 dose
months
TT
2 doses
Pregnant women

At birth
6,10 &

6,10 &
9

National Immunization
Schedule
S.N Vaccine

Schedule

1.

BCG

2.

DPT-Hep B- Hib
-OPV
Measles

Birth or first
contact
6,10, 14 weeks

3.
4.

Japanese
encephalitis in
endemic zones

9 months
> 1 year of age

Additional NEPAS Recommendation

S.N
1.
2.

Vaccine
Rotavitrus
Pneumococcal
(PCV 13)

Schedule
6,10, 14 weeks
6, 10, 14, weeks and
booster at 15 months

3.

MMR

4.

15 mnths and booster

at 5 yrs
> 1 year old

5.

Japanese
encephalitis for all
DPT
16-18 mnth ( Booster)

6.

Hib

16- 18 mnth (Booster)

Optional NEPAS
Recommendation

S.N Vaccine
1.
2.

3.
4.
5.

Typhoid ( Typhim
Vi)
Hepatitis A

Varicella
Meningococcal A
and C
HPV for girls

Schedule

2 year and booster at

5 year
>12 mnths and
booster at 16-18
mnths
>12 mnths and 5
years

10 year age

Strategies for
achievement of NIP

1. Routine immunization
2. Outreach services in the form
of 3-5
immunization sessions at
several locations
in each VDC
3. Mobile teams
4. NGOs
5. Strengthen School,
Municipality and

Vaccine Preventable Diseases

I. BACTERIAL: Cholera, Diphtheria,

Pertussis, Plague, Tetanus, Tuberculosis,
Typhoid etc
II. VIRAL:
Hepatitis A, Hepatitis B,
Influenza Measles, Meningitis, Mumps,
Polio, Rabies, Rubella, Yellow fever,
Japanese B, Varicella, Dengue,
Cytomegalovirus, Adenovirus, Rotavirus,
Para influenza, Herpes simplex, HIV etc

III. RICKETTSIAL:

Epidemic typhus

Adult vaccination
Tetanus,Diptheria (Td)
MMR
Varicella
Influenza
dose
Pneumococcal
(polysaccharide)
yearly
Hepatitis A
Hepatitis B
Meningococcal
Human papilloma virus
(HPV)

19-49yrs
50-64yrs
1 dose
every 10 yr
1 or 2 doses
1 dose
2 doses
1
1-2 doses

2 doses
3 doses
1 dose
3 doses

1 dose

VACCINES
Vaccine is an immuno-biological substance designed
to produce specific protection against a given
disease.
Vaccine is prepared from:
1. Modified organism
2. Inactivated or killed organism
3. Extracted cellular fractions
4. Toxoids
5. Subunit vaccines
6. Recombinant vaccines
7. Synthetic peptides
8. Anti-iodotype vaccines
9. Naked DNA vaccines

HAZARDS OF IMMUNIZATION
1. Due to inoculation:
Local: Pain, swelling, redness, abscess,
tenderness, nodule formation
General : Fever, malaise, headache etc
2. Due to faulty technique
3. Due to hypersensitivityimmediate or
delayed
4. Neurological complications: Encephalitis,
neuroparalysis, subacute sclerosing
panencephalitis (SSPE)
5. Provocative reactions: Eg Polio after DPT
6. Damage to fetus

Immunisation For Elderly

Influenza: For 65 years and above Trivalent
inactivated vaccine 0.5 ml IM Nasal vaccine
under trial
Pneumococcal Pneumonia: For 65 years +
Purified capsular polysaccharide 0.5 ml IM/SC
once in a life time
Tetanus and Diphtheria: Full course with
booster dose every ten years
Varicella: For elderly who have not suffered
from varicella during younger age
Selective Immunization: Individuals
undertaking journey to countries where
diseases like Hepatitis A, Hepatitis B,
Meningococcal meningitis, Japanese B
encephalitis, Typhoid and yellow fever are

Type of
Vaccine
Doses
Schedule
Booster
Contraindic
ations
Adverse
Reactions
Special
Precaution
Dose

BCG
Vaccine
Live Bacterial, lyophilized (freeze-dried)
One. 0.1 or 0.05 ml ID
At or as soon as possible after birth.
A papule develops after 2to 3 wks increases to 4-8mm by 5-6 wks
scar by 6-12 wks
None.
Symptomatic HIV infection, immunodeficiency, local skin lesions
Local abscess; regional lymphadenitis; Rarely, distant spread to
osteomyelitis; disseminated TB. Keloid formation,Abscess
Correct intra-dermal inj. with special syringe and needle.
0.05ml for newborn, 0.1 ml for older child.

Injection site Outer upper left arm of Shoulder.

Storage

Store between 2C - 8C. (Vaccine may be frozen for long term

storage but not the diluent).

DPT

Tetanus Toxoid Vaccine

Type of
Vaccine
Number of
Doses
Schedule

Toxoid as DT,TT or TD

At least 2 primary doses.

Dose at first contact. 4 weeks after TT -1. 6 months after
TT- 2. 1 year after TT- 3.
1 year after TT - 4. (For women of child bearing age.)

Booster

TT/ TD every 10 years or during pregnancy. DT 18 months to 6 years of

age.
Contraindicati Anaphylactic reaction to previous dose.
ons
Adverse
Mild local or systemic reactions are common.
Reactions
Special
Reduced diphtheria (TD instead of DT) for 7 years of age or above.
Precaution
Dose
0.5 ml.
Injection site

Outer upper Arm.

Injection type Intramuscular.

Storage

Store between 2C - 8C. Never freeze.

Oral Polio Vaccine

Type of
Vaccine
Number of
Doses
Schedule

Live Oral Polio Vaccine (OPV)

Booster

Supplementary doses given during polio eradicating activities.

Four in endemic countries (including birth dose.)

At birth, 6, 10 & 14 weeks.

Contraindicati None.
ons
Adverse
VAPP very rarely (Vaccine associated paralytic Polio).
Reactions
Special
Precaution
Dose

Children with congenital immune deficiency syndrome should receive IPV

other than OPV.
2 drops.

Injection site

Injection type Storage

Store between 2C - 8C. (Vaccine may be frozen for long term storage).

Measles Vaccine
Type of Vaccine

Live attenuated viral

Number of Doses

One dose. Second opportunity not less than one month after first dose.

Schedule

9-11 months of age.

Booster

A second opportunity for measles immunization is recommended. (Routine or

campaign)
Severe reaction to previous dose; pregnancy; congenital or acquired immune
disorders. (not HIV)
Measles, Fever, Rash 5-12 days later; Idiopathic Thrombocytopenic Purpura;
rarely, Encephalitis; Anaphylaxis.

Contraindications
Adverse Reactions

Special Precaution

None

Dose

0.5 ml

Injection site

Outer mid-thigh /upper arm depending on the age..

Injection type

Subcutaneous

Storage

Store between 2C - 8C. (Vaccine may be frozen for long term storage but not the
diluent.)

MR & MMR Vaccine

Type of
Vaccine
Number of
Doses
Schedule

Live attenuated viral

One dose.
Generally 12 - 15 months.

Booster

A second opportunity for immunization is recommended. (Routine or

campaign)
Contraindicati Severe reaction to previous dose; pregnancy; congenital or acquired
ons
immune disorders. (not HIV). Although it is not recommended to administer
the vaccine during pregnancy, there has never been the evidence of damage
to the fetus from vaccinating the mother during pregnancy.
Adverse
Reactions

Same as Measles vaccine, plus cases of arthritis in adolescent females for

rubella containing vaccine and parotitis; rarely aseptic meningitis with
mumps containing vaccine.

Special
Precaution
Dose

None

Injection site

Outer mid-thigh /upper arm depending on the age.

Injection type

Subcutaneous

Storage

Store between 2C - 8C. (Vaccine may be frozen for long term storage but
not the diluent.)

0.5 ml

Hep B Vaccine

Type of
Vaccine
Number of
Doses
Schedule

Recombinant DNA or Plasma derived.

Booster

None

Three Doses.
At birth, 6, 10 & 14 weeks.

Contraindicati Anaphylactic reaction to previous dose

ons
Adverse
Local soreness and redness rarely anaphylactic shock
Reactions
Special
Precaution
Dose

Birth dose must be given if there is risk of perinatal reaction

Injection site

Outer mid-thigh (infants)/outer upper arm (children and adults)

O.5ml

Injection type Intramuscular

Storage

Store between 2C - 8C. Never freeze.

Haemophilus influenzae (Hib) vaccine

(Prevents meningitis, pneumonia, epiglottitis etc
caused by H.influenzae type b bacteria )
Type of
Vaccine
Number of
Doses
Schedule

Conjugate

Booster

None

Two or three doses (depending on manufacturer)

6,10,14 weeks of age

Contraindica Hypersensitivity to previous dose

tions
Adverse
Mild local reaction
Reactions
Special
Precaution

None

Dose

O.5ml

Injection site Outer mid-thigh (infants)/outer upper arm (children and adults)
Injection
type
Storage

Intramuscular
Store between 2C - 8C.

Japanese encephalitis
(JE) vaccine

Type of
Vaccine
Number of
Doses
Schedule
Booster

Inactivated mouse brain-derived

Standard 3 dose schedule

The interval between 1 and 2 dose should be 7 days the 3rd dose should be
given at day 30
Most countries give a booster after one year, then 3 yearly

Contraindic Hypersensitivity to previous dose

ations
Adverse
Reactions

Occasional mild local or systemic reactions, serious allergic reaction

including generalized urticaria, hypotension, collapse occur 1/1000

Special
Precaution

JE vaccine not usually given under 12 months of age

Dose

O.5ml to child 1 to 3 years of age; 1.0 ml to child older than 3 years

Injection site Upper arm

Injection
type
Storage

Subcutaneous
Store between 2C - 8C.

Meningococcal Vaccine
Type of
Vaccine
Number of
Doses
Schedule

Purified bacterial capsular polysaccharide

Booster

Every three to five years

One
Not less than three months; older than 3 months recommended

Contraindicati Severe adverse reaction to previous dose

ons
Adverse
Occasional mild local reaction; mild fever
Reactions
Special
Precaution
Dose

Children under 2 years of age are not protected by the vaccine

Injection site

Upper arm

Injection type

Subcutaneous

Storage

Store between 2C - 8C. .

O.5ml

Yellow fever vaccine

Type of
Vaccine
Number of
Doses
Schedule

Live viral

Booster

International health regulations require a booster every 10 years

One
9 months of age with measles vaccine

Contraindicat Egg allergy; immune deficiency from medication or disease; symptomatic HIV
ions
infection; hypersensitivity to previous dose; pregnancy
Adverse
Reactions

Hypersensitivity to egg; rarely, encephalitis in the very young; hepatic failure

Special
Precaution

Do not give before six months of age ; avoid during pregrancy

Dose

O.5ml

Injection site

Upper right arm

Injection type Subcutaneous

Storage

Store between 2C - 8C.

Summary of injection
sites

Vaccine

Route of administration

BCG

Intradermal

Upper left arm

DPT

Intramuscular

Outer mid-thigh

HepB

Intramuscular

Outer mid-thigh

Measles

Subcutaneous

Upper left arm

Yellow fever

Subcutaneous

Upper right arm

Tetanus
toxoid
JE

Intramuscular

Outer upper arm

Subcutaneous

Upper arm

Menningococ
cal
Hib

Subcutaneous

Upper arm

Intramuscular
Upper arm (older children)

Injection site

Outer mid-thigh (infants)

OKAVAX: Biken Varicella

Vaccine
TYPE OF
VACCINE
NUMBER OF
DOSES

Live Attenuated

Single dose 0.5 ml

subcutaneous
Diluent: Sterile water

SCHEDULE
Booste
Contraindicatio
ns
Complicaions
Excellent safty. No serious
reactions
Special
precautions
Dose
Injection site
Injection type
Storage

O.5 ml to be delayed for 3

months

THANK YOU