Beruflich Dokumente
Kultur Dokumente
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
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
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
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
Vaccine
Rotavitrus
Pneumococcal
(PCV 13)
Schedule
6,10, 14 weeks
6, 10, 14, weeks and
booster at 15 months
3.
MMR
4.
5.
Japanese
encephalitis for all
DPT
16-18 mnth ( Booster)
6.
Hib
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
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
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
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.
DPT
Type of
Vaccine
Number of
Doses
Schedule
Toxoid as DT,TT or TD
Booster
Booster
Contraindicati None.
ons
Adverse
VAPP very rarely (Vaccine associated paralytic Polio).
Reactions
Special
Precaution
Dose
Injection site
Store between 2C - 8C. (Vaccine may be frozen for long term storage).
Measles Vaccine
Type of Vaccine
Number of Doses
One dose. Second opportunity not less than one month after first dose.
Schedule
Booster
Contraindications
Adverse Reactions
Special Precaution
None
Dose
0.5 ml
Injection site
Injection type
Subcutaneous
Storage
Store between 2C - 8C. (Vaccine may be frozen for long term storage but not the
diluent.)
Booster
Special
Precaution
Dose
None
Injection site
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
Booster
None
Three Doses.
At birth, 6, 10 & 14 weeks.
Injection site
O.5ml
Conjugate
Booster
None
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
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
Special
Precaution
Dose
Subcutaneous
Store between 2C - 8C.
Meningococcal Vaccine
Type of
Vaccine
Number of
Doses
Schedule
Booster
One
Not less than three months; older than 3 months recommended
Injection site
Upper arm
Injection type
Subcutaneous
Storage
O.5ml
Live viral
Booster
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
Special
Precaution
Dose
O.5ml
Injection site
Summary of injection
sites
Vaccine
Route of administration
BCG
Intradermal
DPT
Intramuscular
Outer mid-thigh
HepB
Intramuscular
Outer mid-thigh
Measles
Subcutaneous
Yellow fever
Subcutaneous
Tetanus
toxoid
JE
Intramuscular
Subcutaneous
Upper arm
Menningococ
cal
Hib
Subcutaneous
Upper arm
Intramuscular
Upper arm (older children)
Injection site
Live Attenuated
SCHEDULE
Booste
Contraindicatio
ns
Complicaions
Excellent safty. No serious
reactions
Special
precautions
Dose
Injection site
Injection type
Storage
THANK YOU