Vaccine Preventable Diseases (VPDs)

            We are living in 21^st century, the age of supercomputers. With the story of super computers, we should not forget that millions of people are still living with abject poverty and millions of children having to lose their life before fifth birthday. If we go through pages of human history, we will read of global pandemics that created havocs across Europe to Asia. Millions of people had to lose their invaluable life to cholera, flu pandemics, smallpox, tuberculosis, and thousands of children got handicapped and live crippled life due to paralytic poliomyelitis. So this is a story that we should not forget in the backdrop of increasing population, climate change, poverty and rise in multi drug resistant micro – organisms due to inadvertent use of antibiotics.

As a fruit of science has ripened, so do we have various tools to deal with many infectious diseases of impoverished like cholera. Among those tools available, one is vaccines, which are safe, effective and affordable compared to other measures. Vaccine should be understood as a biological product that when given in the form of injection, droplet, skin patch or aerosol protect against targeted diseases producing protective response. I have a faith in vaccine and its long term health impact thereby its contribution in reducing childhood illness and death. So, I do say again and again that vaccine is boon to human kind. As an example, the greatest achievement in the human history is the eradication of small pox so far. The last case of this disease was detected in Ethiopia in 1980s. Another success story can be the endgame of paralytic poliomyelitis, which will soon be eradicated from this globe.

A decade long experience as a disease detective (surveillance medical officer - SMO) in hard to reach area (HRA) of Nepal searching for vaccine preventable diseases (VPDs) is a testimony to my faith in vaccine. During my tenure as a medical officer, we had to manage infectious diseases like Malaria, Visceral leishmaniasis, Cholera, Enteric fever, Japanese encephalitis, Dengue fever / Dengue Hemorrhagic fever, Worm infestation, Acute gastroenteritis, Protein Energy Malnutrition, Acute / Chronic viral hepatitis, Measles / rubella, Vitamin deficiency, micro- nutrient deficiencies. These diseases are rampant and many people even lose their life bringing socio –economic rift in family as well as community as a consequence. Now, the government of Nepal (GoN) has successfully controlled various infectious diseases through introduction of vaccines against diseases like measles & rubella, poliomyelitis, neonatal tetanus, Japanese encephalitis. Some of these diseases are virtually eliminated and some in the process of elimination. Therefore, the introduction of vaccines along with other public health measures has contributed significantly in reducing under 5 mortality. I also have to say and should not forget that the role of health professionals from centre to periphery is commendable. In this efficient public health delivery mechanism, thousands of female community health volunteers (FCHVs) are the backbone in its delivery to the community. They are like a bridge between health system and community. Though, there was a time, Nepal was going through political instability all over the country, it was FCHVs who made routine immunization (RI) run in its usual course and mass vaccination like polio / measles campaign happen throughout country a successful story. However, there are still some diseases like cholera, enteric fever, viral hepatitis, which need attention from government and international organization.  

In Nepal, a large proportion of people rely on unimproved sources for drinking water.  Around half of the population (49 %) opts for open defecation, more so in the rural areas. Only 17 % of populations have adequate access to proper sewage conditions in urban areas, whereas it is almost non - existent in rural areas. Also, there are major limitations in disease reporting through government health system due to incomplete data, and irregular and inconsistent data reporting, so that the burden of disease is seriously under - reported. In 2009, there was a huge cholera outbreak in hilly districts of mid western region, where thousands of people succumbed to this deadly infectious disease. This disease created havoc in the region that led to panicky situation causing socio – political disruption. Since the hilly regions of Nepal is geographically challenging in terms of access to health care and its delivery, many people have to lose their life and bear unnecessary suffering. Therefore, the Government of Nepal (GoN) needs to strengthen surveillance and consider cholera vaccination as a supplement to other preventive measures (i.e. provision of clean water, sanitation and personal hygiene) and the provision of treatment, particularly in high risk areas.

Anuj Bhattachan

15th Oct, 2013