Lost Khop Card or Missed a Dose? Catch-Up Vaccination in Nepal

Catch-up immunization simply means giving a child the doses they missed so that their protection is completed, even if the timing is late. In Nepal's National Immunization Program (NIP), run by the Department of Health Services (DoHS) under the Ministry of Health and Population (MoHP), the schedule lists the ideal age for each dose. Real life, however, often gets in the way: a child falls sick on vaccination day, the family travels or migrates for work, a health post runs out of a vaccine, or the khop card is lost. None of these situations means the child has to begin the whole schedule again.

The single most important thing anxious parents should know is that an interrupted vaccination schedule is resumed, not restarted. This is the standard position of the World Health Organization (WHO) and is followed by Nepal's NIP. For almost every vaccine, the doses a child already received still "count"; the immune system does not forget them. A long gap between doses does not reduce the final protection for most multi-dose vaccines, so health workers give only the doses that are still owed rather than repeating earlier ones.

This matters because fear of "having to start over" or embarrassment about being late is itself a reason many children never come back. Being a few weeks, months, or even a couple of years behind is a very common and completely fixable situation. The correct response is to visit a health facility as soon as possible and let a health worker read the child's history and continue from the right point.

Under the Immunization Act, 2072 (2016 AD) — informally the Khop Ain — every child in the target group has a legal right to receive the vaccines in the national program free of cost. The Act, which President Bidya Devi Bhandari signed into law in January 2016, places the duty to immunize on both health workers and caregivers and made Nepal one of the first low-income countries to enshrine financial commitment to immunization in law. Free routine childhood vaccines are provided at government health posts, primary health care centres, and public hospitals across all seven provinces.

In practice this means routine childhood vaccination is available free of charge to children up to age 15 at government facilities, and no citizenship certificate, birth certificate, or payment is required to receive a dose that is due. A child who is behind schedule can walk in and be caught up without a fee. The program currently delivers around 11 antigens (vaccine types) nationally, including BCG, pentavalent (DPT-HepB-Hib), oral polio (OPV), injectable polio (fIPV), pneumococcal (PCV), rotavirus, measles-rubella (MR), Japanese encephalitis (JE), and typhoid conjugate vaccine (TCV), plus HPV for eligible girls.

Private hospitals and clinics also offer these and additional optional vaccines, but they charge a fee. If cost is a concern, the government health post is the right place to go — the same nationally supplied vaccines are given there at no charge. Female Community Health Volunteers (FCHVs) in each ward can also tell families when and where the nearest immunization session is held.

Typhoid is a heavy burden in Nepal, with an estimated tens of thousands of cases and hundreds of deaths each year, most of them in children under 15. To tackle this, Nepal ran a nationwide typhoid conjugate vaccine (TCV) campaign launched in April 2022 with support from Gavi, the Vaccine Alliance, WHO, and UNICEF. This was a one-time "catch-up" cohort: rather than only starting with 15-month-olds, the campaign offered a single TCV dose to a wide age band — children roughly 15 months up to 15 years — so that a whole generation of older children who had never been eligible could be protected at once.

The campaign reached more than seven million children and, importantly, was also used to find "zero-dose" children — those who had missed all or most of their routine vaccines — and bring them back into the system. After the campaign, TCV was folded into the routine schedule as a single dose given at 15 months of age. That means children born since are covered routinely, while the campaign closed the gap for older children in a single sweep.

For parents today, the practical takeaway is this: if your child was in the eligible age band during the 2022 campaign and did not receive TCV then, ask at your health post whether a catch-up dose can still be given. TCV in the routine schedule is a single dose at 15 months, so a child who missed it as an infant can usually still receive that one dose later.

In February 2025 (Magh 2081 BS), Nepal ran its first nationwide human papillomavirus (HPV) vaccination campaign to protect girls against cervical cancer, which is one of the most common and deadly cancers among Nepali women. Like the TCV campaign, this used a multi-age-cohort (catch-up) approach: instead of vaccinating only one grade, it targeted a wide band of adolescent girls — those in roughly grades 6 to 10 and out-of-school girls aged 10 to 14 years — so that several years' worth of girls could be caught up simultaneously.

The campaign, launched around World Cancer Day (4 February 2025), reached well over 1.4 million girls within about two weeks and achieved high coverage using a single-dose HPV schedule. After this catch-up drive, HPV was added to the routine National Immunization Program, so going forward the vaccine is offered each year to the ongoing routine cohort — grade 6 girls, or out-of-school girls around age 10.

If a girl in the eligible age range missed the 2025 campaign, parents should not assume the chance is gone. Ask at the school health program or the nearest health post whether a catch-up HPV dose is available; because Nepal uses a single-dose schedule, catching up is straightforward. Girls who are now entering the routine grade-6 cohort will be offered the vaccine through the school-based program.

The khop card (immunization card) is the family's copy of the child's vaccination record, but it is not the only record. Health workers also enter every dose into the facility's EPI (Expanded Programme on Immunization) register and, increasingly, into electronic records. So a lost card does not mean the history is gone — it usually means you need to have the record re-copied from the facility that gave the doses.

To get a duplicate, go back to the health facility where the child was vaccinated (the same health post, PHC centre, or hospital) and ask staff to check the EPI register and issue a fresh card with the doses already given. If you have moved to a new area, take whatever you can — an old photo of the card, the child's name and date of birth, the mother's name, and the previous ward or facility name — to your new health post; they can start a new card and, where possible, request the earlier record. During the COVID-19 vaccine drive, Nepalis were similarly told to return to the vaccinating centre or the municipality's health section for a replacement, and the same principle applies to childhood immunization.

If the original facility cannot locate the entry, the ward or municipality health section and the District (or local) Health Office keep the register books and can help trace the record. Where no written record can be found at all, a health worker will assess the child's age and history and give the doses that are appropriate — again, resuming rather than needlessly restarting. Once you have a new card, photograph it and keep a copy on your phone so a future loss is only a minor inconvenience.

It is worth stating plainly because it removes the biggest source of parental worry: for the childhood vaccines in Nepal's routine schedule — pentavalent (DPT-HepB-Hib), OPV/IPV, PCV, MR, JE and others — a delay does not force a restart. If a child received one or two of the three pentavalent doses and then stopped, the health worker gives only the remaining dose(s) at appropriate intervals; the earlier doses are not repeated. The same logic applies across the multi-dose series in the program.

There are a small number of technical exceptions worldwide (for example, certain oral typhoid or specific cholera products can require repeating if a defined window is exceeded), but these are not part of the standard childhood injectable schedule that most Nepali parents are dealing with. For the routine baby and child vaccines, the guiding rule remains "resume, do not restart." The health worker will decide the correct minimum spacing between the catch-up doses.

The one situation that does require care is age limits: some vaccines are only recommended up to a certain age (for instance, rotavirus has an upper age limit, and BCG and some early-infancy vaccines are prioritized for the youngest children). A health worker will tell you which missed vaccines can still be given for your child's current age and which are no longer indicated. This is exactly why an in-person visit is better than guessing — bring the child in, and staff will tailor a safe catch-up plan.

The path back on track is short and free. The most important action is simply to show up at a government health facility; everything else follows from there. Do not wait for the "next campaign" or worry about being scolded for being late — health workers routinely handle catch-up cases and would far rather see a late child than an unvaccinated one.

If you are unsure where the nearest immunization session is, ask your ward's Female Community Health Volunteer (FCHV) or call the local health post. Sessions are often held on fixed days each month, and outreach clinics reach many villages. Keeping the new card safe and photographing it prevents the same problem next time.