PILOT INTRODUCTION OF VI POLYSACCHARIDE TYPHOID VACCINE THROUGH SCHOOL-BASED VACCINATION PROGRAM IN KATHMANDU VALLEY, NEPAL, USING CROSS SUBSIDIZATION SCHEME- INTERNATIONAL VACCINE INSTITUTE
MITRA Samaj carried out Pilot Introduction of Vi Polysaccharide Typhoid Vaccine Program through a school-based vaccination program in Kathmandu Valley, Nepal, using cross subsidization scheme. The overall goal of the programme was to accelerate the introduction of Vi Polysaccharide Typhoid Vaccine in high-risk areas in Kathmandu valley, Nepal.
This was achieved through advocacy with government and non-government organizations, followed regarding the vaccination, followed by the formative research to identify key stakeholders and the communication strategy. Information Education and Communication (IEC) materials on typhoid were developed based on formative research. For Behaviour Change Communication purposes, radio jingles, television commercials were developed to sensitize the target group.
This was made possible through a partnership between the International Vaccine Institute (IVI), located in Korea, and MITRA Samaj.
Typhoid fever continues to be a public health problem in many developing countries. Nepal has one of the highest typhoid incidences and has been infamously nicknamed “the Enteric Fever capital of the world.” School children aged 5-15 years are the population at the highest risk: thus, vaccinating these students is critical for controlling disease burden of typhoid fever in affected communities.
Nepal Tourism Board, Hotel Association of Nepal (HAN) and Trekking Agent Association of Nepal (TAAN) were the stakeholders for vaccination in Tourism sector. Typhoid Vaccination Program was first conducted in tourism sector for which social Mobilization was done in phase wise manner where 2,641 establishments were enumerated. Orientation sessions were also conducted along with distribution of those IEC materials to inform the food handlers and tourism workers about typhoid and its prevention. Then the social mobilization was followed by vaccination where 2,527 individuals were vaccinated from March 15, 2011 to August 11, 2011.
Typhoid Vaccination Program in Lalitpur and Bhaktapur Districts were led by District Public Health Office, Lalitpur and Bhaktapur in coordination with District Education Office Lalitpur and Bhaktapur and various related stakeholders. Social mobilizations were done in all the schools of Lalitpur and Bhaktapur Districts to inform the teachers and parents about the typhoid fever and its prevention along with information of the date of the vaccination. Monitoring and evaluation were also done to assess the effectiveness of social mobilization from 54 randomly selected schools. 78,685 students in 498 schools of Lalitpur sub metropolitan city (LSMC) and Village Development Committee (VDC) of Lalitpur were vaccinated achieving the coverage of 63%. The vaccination in LSMC started from August 18, 2011 to September 19 and in VDCs of Lalitpur from December 1, 2011 to December 31, 2011. Similarly, 62,615 students in 349 schools of Bhaktapur district were vaccinated from December 1, 2011 to January 31, 2012 achieving the coverage of 81%. During the campaign, total 118 (0.335%) AEFI cases of LSMC and 37 (0.007%) in the VDCs were reported. Similarly, 68 (0.1%) AEFI cases were reported in Bhaktapur districts.
A majority of these cases were minor reactions such as pain at the injection side, fever, headache, and vomiting. There were no hospitalizations following any vaccinations.
The assessment of the vaccine effectiveness was done through case control study along with analysis of the secular trend of typhoid cases. Study base comprised of Lalitpur municipality area in Kathmandu valley. The targeted population of the study is all children studying in Grade 1 to Grade 10 living and attending a school in Lalitpur Sub-Metropolitan City (LSMC) and some accessible VDCs of Lalitpur. Case identification was done through nine participating hospitals and two polyclinics in the LSMC from November 2011. The impact assessment of Vi polysaccharide typhoid vaccine through case control study evident that typhoid vaccine is highly effective (PE 87%; 95% CI 33% – 97%). Considering the awareness and need for prevention of typhoid fever, a regular program for the Kathmandu valley will have a larger impact on reducing the burden of typhoid fever. Therefore it can be concluded that two third of typhoid fever cases among school aged children can be prevented with typhoid vaccination.