C:\sujan\gurung\JNMA (143) Fina - Journal of Nepal Medical ...

SHORT COMMUNICATION Journal of Nepal Medical Association, 2002:41:438-440NEPAL PAEDIATRIC SOCIETY GUIDELINESFOR CHILDHOOD IMMUNIZATIONThe existing EPI programme of Nepal delivers thefollowing vaccination free of cost in different healthfacilities (hospitals, health centers, health posts andsub health posts) including the private sector healthdelivery institutions. These vaccines are BCG,DPT, Polio, Measles and Teatnus. These vaccinesare termed as essential vaccines. Nepal PaediatricSociety (NEPAS) recommends that these essentialvaccines be given to all infants before the age ofone year as per National Immunization scheduleshown below in cases where these are notcompleted before the age of one year, they shouldbe completed at the earliest opportunity there after:A. NATIONAL IMMUNIZATIONPROGRAMME (EPI)2. OTHER OPTIONSNepal Paediatric Society recommends the followingschedule for optional vaccinations to be given asessential vaccines based on the evidence of burdenof the disease in the country and proven cost-benefitratios around the world. These vaccinations arenot given freely by the His Majesty’s Governmentexcept in situations of epidemics. Parents have todecide themselves on the cost of each vaccinesand their affordability.Table IINEPAS Recommendation as EssentialVaccines along with EPITable INational Immunization Programme (EPI)Address for correspondence :Prof. Pushpa Raj Sharma, PresidentNepal Paediatric SocietyHariharbhawan, Lalitpur, NepalEmail: paed7@healthnet.org.npJNMA, July - September, 2002, 41

Nepal Paediatric Society Guidelines for ... 4391NEPAS has learned that Hepatitis B vaccine willbe gradually incorporated into the nationalimmunization program. It will be given as DPTin three doses schedule. The first dose isrecommended at 6 weeks, second dose at 10 weeksand third dose at 9 months. The first two dosesto be given with DPT-Polio and third dose alongwith measles.2NEPAS recommends MMR vaccine to be listedas essential vaccines. The first dose should be givenat 18 months and second dose to all adolescentsalong with tetanus booster which is beingconsidered at school age.3NEPAS recommends Japenese B Encephalitis tobe listed as essential vaccines for endemic areas ofTarai region. It is given on 0,7 and 30 days.B. NEPAS RECOMMENDATION FOROPTIONAL VACCINESThe following vaccines are categorized as optionalvaccines by NEPAS. NEPAS recommends that thefollowing vaccines should be available as anOPTIONAL VACCINES to those infants andchildren whose parents wisht to immunize theirchildren.Table III* NEPAS recommends that booster be given at 18 months and Td-Polio at 5 years.1. Hepatitis B vaccine (Hep B): If possibleall infants should receive the first dose ofhepatitis B vaccine soon after birth orbefore hospital discharge; The second doseshould be given at least 4 weeks after thefirst dose. The third dose should be givenat least 16 weeks after the first dose.However, the first dose can be given at 6 weeksalong with DPT, second dose at 10 weeks alongwith second dose of DPT and third dose couldbe given at 9 months along with measlesvaccination.2. Tetanus and diphtheria toxoids (Td): It maybe administered at the age of 5 years.3. Haemophilus influenzae type b (Hib)conjugate vaccine: If not given as mentionedas in the schedule during first year, only twoJNMA, July - September, 2002, 41

440 Nepal Paediatric Society Guidelines for ...Table IVC. NEPAS Summary of Vaccination Schedule for Children (essential and optional)Essential; Vaccines Optional Vaccines b boosterdoses are required at the interval of two monthsif given after one year.5. Typhoid Vaccine (Vi antigen): First dose age2 years and booster doses at every 3 years.4. Measles, mumps, and rubella vaccine(MMR): The second dose of MMR isrecommended routinely at age 4-6 years butmay be administered during any visit,provided at least 4 weeks have elapsed sincethe first dose and that both doses areadministered beginning at or after age 12months. Those who have not previouslyreceived the second dose should complete theschedule by the 11-12 year old visit.6. Japanese Encephalitis Vaccine: This vaccinecan be used for children residing and frequentlyvisiting endemic Tarai region. It is given at oneyear or any time after one year on 0,7 and 30days.7. Meningococcal AC vaccine: The first dose isgiven at 2 years and booster doses are givenevery three years.Prepared by Nepal Paediatric Society based on the NEPAS Update on ChildhoodImmunization held on 15 th June, 2002.?????JNMA, July - September, 2002, 41