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Infectious Disease

Nepal faces a complex infectious disease landscape — from persistent challenges with tuberculosis and neglected tropical diseases to emerging threats like dengue and antimicrobial resistance. The COVID-19 pandemic exposed both strengths and vulnerabilities in the health system. Antimicrobial resistance is a growing concern, with widespread antibiotic misuse in both human and veterinary medicine. This collection brings together evidence on effective disease control strategies, surveillance systems, antimicrobial stewardship, and outbreak response approaches relevant to Nepal's epidemiological context.

Key Questions

? What TB control strategies have worked in high-burden South Asian countries?
? How should Nepal prepare for future pandemic threats?
? What vector control approaches are most cost-effective for dengue prevention?
? How can antimicrobial stewardship be implemented in resource-limited settings?

3 papers

Efficacy of typhoid conjugate vaccine in Nepal: final results of a phase 3, randomised, controlled trial

Mila Shakya, Merryn Voysey, Katherine Theiss-Nyland, Rachel Colin-Jones, Dikshya Pant, Anup Adhikari, Susan Tonks, Yama F Mujadidi, Peter O'Reilly, Olga Mazur, Sarah Kelly, Xinxue Liu, Archana Maharjan, Ashata Dahal, Naheeda Haque, Anisha Pradhan, Suchita Shrestha, Manij Joshi, Nicola Smith, Jennifer Hill, Jenny Clarke, Lisa Stockdale, Elizabeth Jones, Timothy Lubinda, Binod Bajracharya, Sabina Dongol, Abhilasha Karkey, Stephen Baker, Gordan Dougan, Virginia E Pitzer, Kathleen M Neuzil, Shrijana Shrestha, Buddha Basnyat, Andrew J Pollard, TyVAC Nepal Team · 2021

The role of active case finding in reducing patient incurred catastrophic costs for tuberculosis in Nepal

Suman Chandra Gurung, Kritika Dixit, Bhola Rai, Maxine Caws, Puskar Raj Paudel, Raghu Dhital, Shraddha Acharya, Gangaram Budhathoki, Deepak Malla, Jens W. Levy, Job van Rest, Knut Lönnroth, Kerri Viney, Andrew Ramsay, Tom Wingfield, Buddha Basnyat, Anil Thapa, Bertie Squire, Duolao Wang, Gokul Mishra, Kashim Shah, Anil Shrestha, Noemia Teixeira de Siqueira-Filha · 2019

Spatial Patterns of Dengue Incidence in Nepal During Record Outbreaks in 2022 and 2023: Implications for Public Health Interventions

Simrik Bhandari, Jason K. Blackburn, Sadie J. Ryan · 2025

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3 papers

Efficacy of typhoid conjugate vaccine in Nepal: final results of a phase 3, randomised, controlled trial

Mila Shakya, Merryn Voysey, Katherine Theiss-Nyland et al. · 2021 · Lancet Global Health

Infectious DiseaseHigh

Kathmandu Valley is described as the world's 'enteric fever capital', and this trial was conducted in exactly that setting — Lalitpur — where child typhoid incidence has been measured at 428 per 100,000 person-years and fluoroquinolone non-susceptibility runs at roughly 86% nationally, complicating treatment. This trial's landmark efficacy results directly underpinned Nepal's decision to become the fourth country worldwide to introduce typhoid conjugate vaccine (TCV) into its national immunisation programme, culminating in an April 2022 catch-up campaign that reached over 7 million children at above 90% coverage, with TCV now delivered routinely at 15 months through the Expanded Programme on Immunization (EPI) — one of Nepal's strongest health programmes, achieving 89% Penta-3 coverage nationally (NDHS 2022).

The role of active case finding in reducing patient incurred catastrophic costs for tuberculosis in Nepal

Suman Chandra Gurung, Kritika Dixit, Bhola Rai et al. · 2019 · Infectious Diseases of Poverty

Infectious DiseaseHealth FinancingModerate

Nepal's National TB Programme (NTP) provides free DOTS treatment, yet TB incidence remains high (229 per 100,000 in 2023, WHO Global TB Report 2025) and roughly half of estimated cases go unnotified — a gap partly attributed to financial and access barriers patients face before ever reaching a diagnosis. This study, conducted in two BNMT TB REACH districts (Bardiya and Pyuthan), is the first in Nepal to directly compare patient-incurred costs between active case finding (ACF) and passive case finding (PCF), providing evidence for the NTP's National Strategic Plan ambition to scale up ACF toward the End TB Strategy's milestone of zero TB-affected households facing catastrophic costs. With out-of-pocket spending already 54.2% of Nepal's current health expenditure (NHA 2019/20), the finding that even 'free' TB treatment produces catastrophic costs for a majority of affected households (53% overall) underscores why social protection, not clinical care alone, is essential to closing Nepal's TB financial-protection gap.

Spatial Patterns of Dengue Incidence in Nepal During Record Outbreaks in 2022 and 2023: Implications for Public Health Interventions

Simrik Bhandari, Jason K. Blackburn, Sadie J. Ryan · 2025 · American Journal of Tropical Medicine and Hygiene

Infectious DiseaseEnvironmental HealthModerate

Nepal's dengue burden reached record levels in 2022 (54,784 cases, 88 deaths) and remained high in 2023, with EDCD's own surveillance confirming the vector now reaches 2,438m in Jumla — a climate-driven ascent into hill and mountain districts once assumed too cold for Aedes mosquitoes. This study uses that same EDCD case-surveillance system and finds dengue reached all 77 districts in 2022, while the 'cold spot' it identifies in Karnali's remote northwest (Humla, Mugu, Jumla, Kalikot) is a caution flag rather than reassurance: Karnali has 0% of its sanctioned physician and consultant posts filled, so low reported incidence there may reflect weak case detection rather than true absence of transmission.