Nepal has been maintaining certificate standard AFP surveillance since 2001. The surveillance system is sensitive enough to detect polio cases and circulating derived poliovirus. Nepal was declared polio -free by the Regional Certification Commission on 27 March 2014. Nepal adopted the strategies developed by the WHO such as active AFP surveillance, Routine Immunization, SIAs and Mop-up to achieve the goal of Polio eradication. The CHD took lead in planning, delivering and managing the National Immunization Program including polio throughout the country. The community based interventions together with the national and international learning have been accounted for this success in the functional partnership and community based approaches.
Key Strategies for polio eradication
- Routine immunization: Routine immunization is the cornerstone of polio eradication. Uniform and 95% OPV3 routine coverage increases the immunity level in community and thus interrupts the circulation of WPV transmission. Hence, the access of routine immunization services should be expanded at grass-root level.
- Supplementary Immunization Activity (SIA) – (National Immunization Days & Sub National Immunization Days) National Immunization Days aiming to improve universal coverage should be conducted on regular basis. It is an additional national or subnational mass vaccination campaign designed to vaccinate all children under five which helps in interruption of transmission of wild poliovirus. It aims to vaccinate everyone under five, regardless of their previous immunization status.
- Surveillance of acute flaccid paralysis (AFP) – All AFP cases (suspected polio) are detected, reported and investigated. This allows for the identification of any remaining reservoirs of wild polio virus and helps in the decision making for the SIAs need.
- Mop-up campaigns – These are intensive, house to house campaigns that are conducted during the final stage of polio eradication. Mop up is conducted when the polio virus is confined in a limited geographical area, where all children are tracked and vaccinated reaching each house hold, even after successful implementation of NIDs and routine immunization.
- Introduction Of The Injectable Inactivated Polio Vaccine (IPV) IPV is being introduced in Nepal in order to quickly maximize childhood immunity to polio and maintain the country’s polio-free status. IPV has been proven an extremely safe and effective vaccine and has been used successfully in many developed countries for several decades. It is important to note that IPV is recommended in addition to the oral vaccine and does not replace the oral vaccine. (UNICEF)
Historical Development in Polio Eradication
Polio Eradication Initiative in Nepal was begun in 1996 through EWARS and it was part of global efforts of the World Health Organization to achieve the world free of polio. With vigorous attempts backed by appropriate and effective policy measures, Nepal has been able to make the country free from this crippling disease as no new polio cases have been reported in the country for more than three years. The national polio immunization campaign has been carried out so effectively that every child up to five years is successfully administered polio drops. As a result, the country is now proudly able to stand as a polio-free country, which is a matter of satisfaction to all of us. The efforts of the government and support of the donors as well organizations like WHO, UNICEF and the Rotary International have yielded positive results.
- In 1980, the government of Nepal included polio vaccination in regular immunization programme
- In 1996, Nepal initiated polio eradication efforts by holding the first National Immunization Days in all 75 districts. The first NID had been started from Kathmandu.
- In July 1998, the government established an expanded nationwide Acute Flaccid Paralysis Surveillance. Since then, 32 polio infection cases have been detected. Among them 30 were from Terai region
- Two cases were reported from hill districts ( Bajura and Dailekh) Nepal borders with the endemic states of India has always been a threat for imported polio virus. Nepal has been continuously observing national immunization days every year in two rounds to stop indigenous or importation of WPV.
- Nepal set the target of becoming polio free by 2000. No polio virus was detected in 2001, 2002, 2003 and 2004.
- The virus resurfaced in 2005, 2006, 2007 and 2008 (average 4- 6 cases). 20 cases were reported due to cross-border transmission.
- No polio case was reported in 2009 but six cases were detected in 2010 (one WPV1 reported from Mahottari district followed by five WPV1 in Rautahat district).The detail investigation revealed that first case of Mahottari was importation from Bihar.
- No new polio case has been reported since then (30 August 2010). The last nation-wide polio drop campaign in December 2013 was able to achieve over 90 per cent coverage. Door-to-door polio drop was administered to ensure that no child under five years of age was left out from the drive against polio.