Nepas Journal 28-1


-1-

Immunization prevents millions of deaths every year
and reduces the costs of treatment and disability caused by
infectious diseases. Immunization also has the potential to
significantly boost economic growth.1 By improving the health
of a population, immunization also improves their education
and work prospects. Despite political disturbances and
insurgency in the last twelve years, it is heartening to note a
very good childhood immunization coverage all over the
country in Nepal. Nepal Demographic and Health Survey 2006,
reports excellent coverage by age 12 months2. Eighty percent
of children had all basic vaccines. Eighty percent of children
had received measles vaccine; and that only 3.2% of children
had not been immunized. It is also a noteworthy fact that
because of additional measles immunization provided to
children less than 14 years of age; the incidence of measles
has come down markedly. In addition, achievements in the
field of polio eradication are also praiseworthy. If it was not
for the two bordering states of India(Bihar and UP), Nepal
may have been certified a polio free country.

The field of immunization is now extremely exciting.
This is especially true in the countries where basic
immunization delivery systems are well in place. Yet in many
countries, efforts to increase immunization coverage are
hampered by high cost of some of the vaccines. As a result
more than 28 million children missed out on immunization
during their first year of life- leaving them vulnerable to
infectious diseases both during childhood and during the
productive adult years; and more than 1.5 million children die
every year in the world’s poorest regions from rotavirus and
pneumococcal diseases for which newly licensed vaccines are
available3.

For poor countries like Nepal, Global Alliance for
Vaccine and Immunization (GAVI) a public private global
health partnership, launched in 2000 has already moved into
its second phase (2006-15). Nepal is already a beneficiary;
Hepatitis B vaccine is now provided through routine
immunizations all over the country. World Health
Organization’s (WHO) position paper on Haemophilus
influenza type b conjugate vaccines has affirmed safety and
efficacy of conjugate Hib vaccines. It has recommended that
this vaccine should be included in all routine infant
immunization programmes. It is further recommended that lack
of local surveillance data should not delay the introduction of
this vaccine4. It is once again heartening to note that Hib
vaccine will be introduced in immunization programme of
Nepal by 2009.

Editorial

Childhood Immunizations in Nepal: Present Situation and Future
Directions.
Adhikari N. 1
1. Dr. Neelam Adhikari. Chief of Pediatric Services, Patan Hospital. Professor of Pediatrics, National Academy of Medical Sciences
(NAMS).

Address for correspondence: neelamadhikari@gmail.com

A number of other new vaccines are or will soon be
available which could prevent many more childhood deaths.
We will be soon talking about new Pneumococcal, Rotavirus,
and Human Papilloma vaccines for Nepal.  Once introduced
in industrialized countries, it takes an average of 15-20 years
for a new vaccine to become widely available in the developing
world. Advance Market Commitments (AMC) will help to
minimize these gaps5. AMC for vaccines is a financial
commitment to subscribe the future purchase (for a certain
pre determined price) for a vaccine not yet available if an
appropriate vaccine is developed and if it demanded by
developing countries. An AMC is not a purchase guarantee,
as industry will receive the subsidy if the product meets the
targeted standards and there is demand for these products. An
AMC has been designed for pneumococcal vaccines.

With such exciting developments, we from NEPAS
need to update our policies, guidelines and recommendations
for childhood immunizations. Some suggestions for this
purpose are as below.

Universal immunizations for children must include the
boosters of diphtheria and tetanus. MMR vaccines should be
incorporated in national immunization schedule. First dose of
measles vaccination at 9 months and a dose of MMR vaccine
at 15 months of age will obviate need for National Measles
Immunization campaigns. However, while considering strategy
of rubella immunization of children, simultaneous
immunization of child bearing age women should be adopted
to decrease incidence of congenital rubella syndrome.

References:

1. David Bloom, David Canning and Mark Weston: The
value of immunization, World Economics Vol 6, no 3,
July-Sept 2005

2. Ministry of Health, New Era, Macro International: Nepal
Demographic and Health Survey 2006

3. WHO data 2005

4. WHO Position Paper on Hemophilus Influenzae
vaccines: Weekly Epidemiological Record, 24
November 2006, 81st year.

5. Advance Market Commitments as posted on website:
www.gavialliance.org January 2007