Translate into your language

Aug 3, 2013

Measles like illness outbreak in Upper Mustang, Nepal

Science and Technology Conference 2009, Huachiew Chalermprakiet University, Thailand; 10/2009

Background: Since 2004, there have been increasing reports of rubella outbreaks in Nepal, through the Vaccine Preventable Diseases (VPDs) surveillance network. This report details an investigation of a suspected “measles-like illness” outbreak in Mustang, a remote and hard to reach Himalayan district in the Western part of Nepal.

Methods: The Mustang District Rapid Response Team (RRT) investigated the outbreak in Chhonup and Lomanthang villages in Mustang, beginning on the 17th of June 2008, following the standard measles outbreak investigation guidelines. Blood samples were collected from seven children within 4 to 28 days of rash onset. All the samples were tested for both measles and rubella IgM antibodies in the National Public Health Laboratory (NPHL) in Kathmandu, Nepal

Results: Forty-eight cases were detected at the time of the investigation. There were two waves in the outbreak. The first occurred at the beginning of April, and the second from mid-May to mid-June. The primary attack rates were 1% and 4% in Lomanthang and Chhonup respectively. The primary attack rates were highest in the 1 – 9 year old population. No deaths in children with measles-like illness were reported from either village during this investigation. All children found with measles-like illness had been immunized against measles. All 7 serum samples were confirmed to be IgM positive for anti-rubella. The remaining 41 cases with measles like illness were considered epidemiologically linked to these laboratory-confirmed cases, and classified as rubella.

Conclusion: Since there is no vaccination against rubella in Nepal, the number of rubella susceptible individuals in the population has increased. Once the virus was introduced into the community, it spread very quickly and affected many susceptible individuals. It is highly recommended that rubella vaccinations be included in the National Immunization Programme (NIP) of Nepal.

Chhonup Village

Dengue Outbreak in Honduras


Death =  83
Illness = > 66000


Death    = 16
Illness   = 12000

Revisiting Cholera Outbreak in Jajarkot, Nepal, 2009

In 2009, it took around two months before the health authorities and public knew the acute watery diarrhea (AWD) outbreak in hilly districts of Mid Western region of Nepal as cholera. That year, > 15,000 people were affected and > 200 people lost their life. There were joint Government of Nepal (GON), UNICEF and other organizations for implementation of medical and behavioral control activities. This incident demands acute need for enhanced surveillance, hygiene and sanitation promotion and selective vaccination in a high risk, remote area of the country.
Risk factors: In general, illiteracy and poverty are risk factors for cholera, as any other infectious diseases outbreaks in remote areas. We can add, this is further compounded by combination of following reasons:

1.     Poor or difficult access to source of drinking water

2.     Water and food contamination during monsoon due to sanitation runoff and flooding disrupting everyday life exposing community to all possible infectious diseases

3.     Poor hygiene practices like hand washing after cleaning of dirt or waste / working in the field or defecation. This may be due to poor knowledge on disease causation or simply no supplies (e.g. soap)

4.     No latrines / open defaecation – this is general picture in hard to reach areas of the country.

5.     Poor access to health care, which is geographically remote from most people. Even if there is health centre in the vicinity, there can be a situation when there is lack of health personnel and medicines.


1.     Geography - remote with little road access and probably limited or no electricity there. These challenges make it an important to be innovative, but it is not impossible carry out preventive measures provided we have combination of dedicated staffs / leadership with adequate resources. 

2.     Carry out effective as well as put sustainable surveillance system in place throughout country with focus to reach hard to reach areas. This demands trained health staffs and budget, which is greater challenge for low income countries.

Jul 28, 2013

A Short Note on Diseases Surveillance in Nepal

In 1996, the Government of Nepal, Ministry of Health (GoN, MoH) first launched Early Warning and Reporting System (in short EWARS) for hospital-based sentinel surveillance of six diseases: three vaccine-preventable diseases or VPDs (polio, measles and neonatal tetanus or NNT) and three vector-borne diseases - malaria, kala-azar (KA), and Japanese Encephalitis (JE). For which the implementing agency is the Epidemiology and Disease Control Division (EDCD) of the MOH. The primary goal as any surveillance system was designed to provide more timely information to the decision makers to facilitate early response. All hospitals that comes under EWARS are expected to report every week on the number of cases and/or deaths (including “zero” reports) of the six priority diseases (1). However, there remain various challenges which hinder the completeness and timeliness of the reports. We can discuss on this further.
The major milestone in the history of public health arena in Nepal would be the introduction of acute flaccid paralysis (AFP) for the eradication of poliomyelitis since 1996. As Nepal was signatory in the Global Polio Eradication Initiative (GPEI), Polio Eradication Nepal (PEN) - surveillance and support team was established in June 1998 by the Ministry of Health and Population in collaboration with technical support from World Health Organization, Nepal. PEN was later re-named Program for Immunization Preventable Diseases (IPD) because activities were expanded to include surveillance for other vaccine preventable diseases such as measles, neonatal tetanus, and Japanese Encephalitis(2). Currently, along with these Vaccine Preventable Diseases (VPDs), are added other infectious diseases of public health importance e.g., rubella.
In addition, there also exists system of data collection known as Health Management Information Reporting System (HMIS). In this reporting system, various illnesses as well as utilization of health services are reported from every village to districts and then to the central level on monthly basis.
Having said that there exist disease surveillance structure in place, there are astronomical challenges to be solved and taken it in right course.
  • Leadership / Ownership: Unstable political situation, frequent changes in the state government leadership and reshuffling of government key position in parallel, and their changing priority affects public health system as a whole.
  • Policy: Though disease surveillance recognized an important component of public health system at policy level, there are weakness in its implementation due to various reasons like
    • Leadership - weakness
    • Advocacy - weakness
    • Too much dependent on external funding, lacking government ownership
    • Lack of trained human resource
    • Poor infrastructure and network to carry out laboratory surveillance
    • Sample transportation problems (esp. a tremendous challenge in Nepal)
  1. Pyle DF, Nath LM, Shrestha BL, Sharma A, Koirala S. Assessment of Early Warning and Reporting Systems (EWARS) in NEPAL. 2004; Available from:
  2. Field Guide for Surveillance of Vaccine Preventable Diseases (VPDs). 2010; Available from:

WHO: Global policy on the prevention and control of viral hepatitis

World Health Organization
Number of pages: 220
Publication date: July 2013
Languages: English
ISBN: 978 92 4 156463 2

The periodic evaluation of implementation of the WHO strategy requires an initial baseline survey of all Member States. In mid-2012, WHO, in collaboration with the World Hepatitis Alliance, conducted such a survey, asking Member States to provide information relating to the four axes of the WHO strategy. In particular, Member States were asked whether key prevention and control activities are being conducted. This report presents the results.

The first chapter provides an introduction to viral hepatitis and to the global response to this group of diseases. The second chapter provides a global overview of the survey findings. Chapters three through eight present findings from the six WHO regions, including summaries of data from all responding countries. Additional survey data, study methodology information and the survey instrument can be found in Annexes A–E.



Anuj in Himalayas

Hi i am connecting disqus with my blog for healthy interaction and open dialogue