Vaccine Preventable Diseases Surveillance

VPD Surveillance

 

SMO network

Acute flaccid paralysis

Measles

Neonatal tetanus

Japanese encephalitis

Other activities

 

Surveillance for Vaccine Preventable Diseases (VPDs) started in 1996 through the Early Warning Reporting System (EWARS) under the Ministry of Health and Population (MoHP). In 1998 through the collaboration between the MoHP and WHO, Polio Eradication Nepal (PEN) was established to increase the sensitivity of the existing AFP surveillance system. In 2003, measles and neonatal tetanus was integrated into AFP surveillance system. Similarly, surveillance for Japanese encephalitis (JE) was integrated in 2004.

 

In 2005, PEN changed its name to the Programme for Immunization Preventable Diseases (IPD) to reflect its expanded activities. There are currently 11 surveillance field offices through out the country. All of the surveillance activities are conducted in close coordination with MoHP, Department of Health Services, Child Health Division, Regional Health Directorates and the District Public Health Offices.

 

Currently, there are 491 weekly reporting units (health facilities) and 89 active surveillance sites that are visited regularly by Surveillance Medical Officers (SMO).

 

 

Reporting and Active Surveillance Sites, Nepal, update as of 2010

 

VPD Reporting Units

 

 

SMO Network

 

IPD currently has 11 field offices located through out Nepal. All of the IPD field offices operate in close coordination with the Regional Health Directorates (RHDs) and the District (Public) Health Offices (DHOs) to carry out the surveillance and immunization related activities. Each field office has at least one SMO, one Administration and Finance Assistant and one driver. All of the offices are equipped with adequate communication and transportation facilities

 

Location and districts covered by IPD Field Offices

 

SMO Location

 

For contact information on SMO network, please click here

 

SMOs main responsibilities:

v      Carry out active case search, surveillance and epidemiological investigations for acute flaccid paralysis (AFP for polio), measles, neonatal tetanus (NT), acute encephalitis syndrome (AES for Japanese encephalitis) and other vaccine preventable diseases (VPDs) in close coordination with the government counterparts.

v      Provide training, technical and logistic assistance for surveillance and outbreak investigation of VPDs to government counterparts

v      Assist the government counterparts in training, planning and monitoring for routine and supplemental immunization activities.

v      Coordinate with counterparts across international borders to achieve polio eradication.

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AFP Surveillance

 

AFP surveillance is carried out on children less than 15 years of age. However, any case of AFP regardless of age should be reported and investigated if poliomyelitis is suspected. The AFP surveillance system in Nepal has achieved global certification standards since 2001 on the two most important surveillance indicators: 1) a non-polio AFP rate; and 2) adequacy rate of stool collection. IPDs current efforts are focused on reaching certification standard AFP surveillance at district level, preventing importation of wild poliovirus, and detecting in a timely way any wild polio cases or vaccine derived paralytic poliomyelitis (VDPP) in Nepal.

 

Polio eradication strategies

 

v      Achieve and maintain the highest coverage levels possible through the administration of OPV in the routine immunization program.

v      Implement nation-wide mass immunization campaigns.

v      Strengthen surveillance for acute flaccid paralysis.

v      Conduct "mop-up" campaigns whenever polio cases are detected.

 

Acute flaccid paralysis

 

The polio surveillance system is based upon surveillance for AFP. Acute flaccid paralysis means that paralysis is of acute onset (comes about suddenly) and the affected limb or limbs are flaccid, i.e. floppy or limp. Tone is diminished as evidenced by examination by palpation or passive movement of joints, but sensation is not affected.

 

Acute: Rapid evolution from onset of weakness to paralysis.

Flaccid: Floppy, not stiff or spastic.

Paralysis: Inability to move affected part.

 

Surveillance is carried out for all cases of AFP and not only for poliomyelitis. Therefore, all AFP cases should be reported, regardless of the final diagnosis. Because paralytic poliomyelitis is only one cause of AFP, maintaining a high sensitivity of AFP reporting will ensure that all cases of paralytic poliomyelitis are detected, reported, and investigated, resulting in preventive control measures to interrupt transmission of disease.

 

Status of AFP Surveillance:

 

Year

AFP Cases

Confirmed Polio cases

Polio Compatible

Non-Polio AFP rate1

Adequacy Rate of Stool Collection2

1998

69

31

-

0.41

35

1999

234

42

-

2.00

76

2000

211

29

-

1.96

79

2001

186

0

0

1.95

83

2002

197

0

1

2.00

87

2003

192

0

1

1.90

86

2004

214

0

0

2.16

84

2005

230

4

2

2.25

84

2006

364

5

2

3.50

86

2007

343

5

0

3.24

83

2008

426

6

0

3.94

88

2009

451

0

0

4.14

88

2010

598

6

0

5.15

89

*Data as of 07 January 2011

1 Expected rate 1 non-polio AFP case (1998-2005) and 2 non-polio AFP cases (2006 onwards) per 100,000 under 15 years children.

2 Expected rate 80% of two stool specimens collected at 24 hours apart and within 14 days of onset of paralysis.

 

See desk review of AFP surveillance 2010

 

For global polio updates, please click here.

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Measles Surveillance

 

Measles surveillance was integrated with AFP surveillance system in 2003. Detailed clinical information is collected from all reported suspected measles cases presenting to sites that have been trained on measles case based surveillance. In addition, all suspected measles outbreaks are investigated by district rapid response teams (RRT) with collection of 5-10 blood samples and urine samples for laboratory confirmation and virus isolation. Following the completion of the measles catch-up campaign in 2004-2005 which provided measles vaccination to children 9 months to 15 years of age, Nepal started case-based surveillance in 2007. The case-based surveillance has been expanding each year in a phase wise manner. Nepal conducted a follow-up measles campaign in 2008 targeting children 9 months to five years of age. As a result of the measles campaigns, the burden of measles disease has decreased dramatically. Measles surveillance has also helped to unmask the previously unrecognized burden of rubella disease in the country.

 

Measles surveillance is an essential component of measles control. Measles surveillance data are needed to:

v      Estimate measles incidence and case fatality rates

v      Identify geographic areas, populations and age groups that are at increased risk

v      Detect outbreaks

v      Monitor changes in measles epidemiology as control measures are implemented

v      Measure the effectiveness of measles control efforts

 

High quality surveillance for measles cases and outbreaks, and monitoring of vaccination coverage is essential for determining the impact of vaccination strategies as well as the effectiveness of a countrys vaccination programme. Information obtained from surveillance helps in focusing efforts and guide modifications in policies and strategies in response to changing epidemiological patterns.

 

Strategies

v      Strong routine immunization

v      A second opportunity for measles immunization (currently provided through periodic mass measles vaccination campaigns)

v      Effective Surveillance

v      Improved management of measles cases

 

Status of measles surveillance

 

Confirmed measles and Rubella Cases, Nepal, 2003-2009

 

Measles and Rubella

 

Status of measles surveillance indicators, 2008-2009

 

Indicators

Target

2008

2009

2010

Annualized incidence of non-measles suspected measles cases per 100,000 population

>2

4.1

6.6

2.9

Percentage of districts reporting at least one non-measles suspected measles case per 100,000 population

>80%

41%

79%

67%

Percentage of suspected cases adequately investigated

>80%

77%

82%

79%

Percentage of outbreaks fully investigated

>80%

92%

97%

97%

Annualized incidence of confirmed measles cases per 1,000,000 population

<1

9.2

1.1

4.0

Annualized incidence of confirmed rubella cases per 100,000 population

-

2.8

4.7

1.7

 

For additional information on measles, please click here

For additional information on rubella, please click here

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Neonatal Tetanus (NT) Surveillance

 

Surveillance of neonatal tetanus is an essential component of maternal and neonatal tetanus elimination (MNTE) and has been integrated into the existing VPD surveillance system. Neonatal tetanus surveillance data are needed to:

 

v      Calculate the incidence of NT in each district.

v      Assess local risk factors associated with NT.

v      Identify districts, geographic areas and population groups in which newborns are at high risk for NT.

v      Estimate the quality of immunization and clean delivery services.

v      Measure progress towards MNT elimination.

 

 

Confirmed NT cases and TT22 Coverage, Nepal, 2005-2009

 

NT Cases

 

For additional information on maternal neonatal tetanus, please click here

 

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Japanese Encephalitis (JE)

 

The first outbreak of JE in Nepal was reported from Rupendehi district in 1978. In Nepal, a total number of 8874 JE cases (clinically confirmed) and 1264 deaths were reported for the six-year period from 1998 to 2003, with an average case fatality rate of 14.2%. In order to determine the JE burden in the country, surveillance of acute encephalitis syndrome (AES) was integrated with existing VPD surveillance system of WHO-IPD in May 2004. Currently, there are 126 hospitals enrolled for weekly reporting of AES case, of these 85 are active surveillance site.

 

JE Status in Nepal, 2005-2009

 

Indicators

2005

2006

2007

2008

2009

2010

No. of districts with JE cases

40

43

47

48

34

40

No. of JE cases

669

295

442

340

147

179

JE deaths

53

42

61

39

7

1

Case fatality rate

7.9

14.2

13.8

11.5

4.8

0.6

JE cases under 15 years

382

158

313

235

108

116

JE cases above 15 years

287

137

129

105

39

63

 

 

AES and Lab-confirmed JE cases, Nepal, 2004-2009

 

JE Cases

 

For additional information on Japanese encephalitis, please click here

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Other activities

 

Pneumonia (Influenza A - H1N1)

 

WHO-IPD supports Avian Influenza Control Project (AICP) at EDCD, DoHS in data collection of pneumonia case for Influenza A (H1N1) through WHO-IPDs network. SMOs provide technical support to the district Rapid Response Team (RRT) for training, orientation, outbreak investigation and response.

 

For additional information on Influenza A (H1N1), please click here

 

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