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September 2018.

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Presentation on theme: "September 2018."— Presentation transcript:

1 September 2018

2 Measles

3 Number of Reported Measles Cases by WHO Regions
2018 Region Member States* Suspected cases Measles cases Clin Epi Lab Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Date Received AFR 42/47 37876 20879 12428 3890 4561 2776 3888 4822 3126 2298 1552 1709 708 AMR 29/35 20015 5323 3 16 84 152 291 204 405 4168 EMR 20/21 23698 12619 3736 3153 5730 2227 1722 2165 2314 2446 1528 217 EUR 53/53 53894 47098 26901 1712 18485 5655 6531 7153 7449 8501 6881 4919 9 SEAR 11/11 71127 50971 45174 3530 2267 6587 6027 10873 10288 9627 4579 2696 294 WPR 26/27 44067 17698 10912 467 6319 1940 2497 3401 3294 2970 2103 1493 Total 181/194 250677 154588 99151 12752 42685 19188 20681 28498 26623 26133 16847 11439 5179 2017 Region Member States* Suspected cases Measles cases Clin Epi Lab Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Date Received AFR 43/47 51557 24830 11004 8840 4986 3214 2896 3646 2370 2026 1859 1475 1412 1519 1695 1315 1403 AMR 31/35 10876 895 1 8 19 13 5 847 EMR 20/21 36139 12777 1918 693 10166 1103 1080 1296 1280 1460 1057 1061 812 706 941 950 1031 EUR 53/53 30668 24128 4415 5993 13720 1422 1873 3003 2884 2920 2572 1380 868 965 1327 2115 2799 SEAR 11/11 99117 76430 55532 15043 5855 8639 9645 13057 10320 7516 4337 3639 4240 3357 2913 4246 4521 WPR 26/27 53131 10297 2693 107 7497 778 894 1501 1222 1120 800 772 700 725 770 617 398 Total 184/194 281488 149357 75562 30676 43119 15157 16396 22522 18089 15047 10625 8327 8033 7273 7646 9243 10999 Notes: Based on data received This is surveillance data, hence for the last month, the data may be incomplete. * Member States Reporting / Total Member States in Region

4 Number of Reported Measles Cases by WHO Regions
2018 Region Member States* Suspected cases Measles cases Clin Epi Lab Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Date Received AFR 42/47 37876 20879 12428 3890 4561 2776 3888 4822 3126 2298 1552 1709 708 AMR 29/35 20015 5323 3 16 84 152 291 204 405 4168 EMR 20/21 23698 12619 3736 3153 5730 2227 1722 2165 2314 2446 1528 217 EUR 53/53 53894 47098 26901 1712 18485 5655 6531 7153 7449 8501 6881 4919 9 SEAR 11/11 71127 50971 45174 3530 2267 6587 6027 10873 10288 9627 4579 2696 294 WPR 26/27 44067 17698 10912 467 6319 1940 2497 3401 3294 2970 2103 1493 Total 181/194 250677 154588 99151 12752 42685 19188 20681 28498 26623 26133 16847 11439 5179 2017 Region Member States* Suspected cases Measles cases Clin Epi Lab Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Date Received AFR 42/47 32030 15466 7722 4377 3367 2954 2644 3207 1915 1723 1494 1036 493 AMR 30/35 6419 165 1 8 19 13 5 119 EMR 20/21 21295 9634 2805 626 6203 1407 1168 1179 2157 2434 1143 127 EUR 50/53 14575 11882 2198 3311 6373 1092 1848 2918 1702 1824 1418 1077 3 SEAR 11/11 62227 49740 37765 7342 4633 7261 8532 11926 9337 6660 3445 2438 141 WPR 25/27 29317 7056 1993 44 5019 632 813 1451 1292 1166 827 875 Total 178/194 165863 93943 52483 15700 25760 13347 15013 20700 16416 13812 8327 5553 775 Notes: Based on data received & This is surveillance data, hence for the last month, the data may be incomplete. * Member States Reporting / Total Member States in Region

5 Measles case distribution by month and WHO Region (2014-2018)
5000 10000 15000 20000 25000 30000 35000 40000 Month of onset Measles cases (Lab+Epi+Clinical) WPR SEAR EUR EMR AMR AFR Notes: Based on data received Data Source: IVB Database - This is surveillance data, hence for the last month(s), the data may be incomplete.

6 high incidence rates***
(12M period) Top 10** Country Cases Rate India 61567 46.49 Ukraine 30343 682.81 Philippines 12654 122.47 Nigeria 8529 45.86 Yemen 6574 238.32 Serbia 5694 645.57 China 4377 3.12 Indonesia 4097 15.69 DR Congo 3346 42.50 Greece 3217 287.65 high incidence rates*** Country Cases Rate Georgia 1220 310.80 Lebanon 764 127.19 Liberia 434 94.07 Malaysia 2580 82.73 Romania 1539 77.81 Measles cases from countries with known discrepancies between case-based and aggregate surveillance, as reported by country Country Year Cases Data Source DR Congo 2017 45,165 SITUATION EPIDEMIOLOGIQUE DE LA ROUGEOLE EN RDC, Week of 11/09/2018 2018 23,979 Somalia 23,353 Somali EPI/POL Weekly Update Week 36, 2018 7295 Notes: Based on data received and covering the period between and Incidence: Number of cases / population* * 100,000 - * World population prospects, 2017 revision - ** Countries with the highest number of cases for the period - *** Countries with the highest incidence rates (excluding those already listed in the table above)

7 (6M period) Top 10* Country Cases
India 40564 Ukraine 23917 Philippines 10316 Nigeria 4863 Yemen 4482 Serbia 4102 China 2835 DR Congo 2482 France 2435 Sudan 2043 Notes: Based on data received Surveillance data from to * Countries with highest number of cases for the period

8 Measles case distribution (AFR), 2014-2018
2000 4000 6000 8000 Month of onset Number of measles cases Uganda Others Nigeria Niger Gabon Ethiopia Equatorial Guinea DR Congo Chad Cameroon Angola Notes: Based on data received Data Source: IVB Database DRC has experienced a nationwide epidemic that has affected all Provinces, however, only a small proportion of the measles cases in the IDSR aggregate reporting system are reflected in the case based data. As of 27 May 2013, South Sudan has reassigned to the Africa region (AFR) from the Eastern Mediterranean region (EMR). For data presentation and statistical purposes, South Sudan data is presented in AFR for all the years.

9 Disclaimer This document contains data provided to WHO by member states. Note that some member states only provide aggregate data to WHO, and for these, we are unable to generate a country profile. Some member states report all cases at one time point for the entire year, and thus epidemiologic curves generated are not accurate and a reporting artifact. For some countries, cases are reported by age category, not by exact age in months and/or years. Thus, age distribution/incidence is approximate. Cases classified as pending by countries are classified at WHO as clinically compatible at this time, and thus numbers might different between data shown here and provided by the member state or WHO country/regional offices. *UN population data is used as the denominator for calculating incidence.

10 Measles cases: Democratic Republic of the Congo
1000 2000 3000 4000 Discarded Clinical Epi Lab Month of onset Number of cases Sub-national (6-59 M) Cov: 99.5% Cov: 103.5% National SIA Sub-national SIA 500 1000 1500 2000 <1 year 1-4 years 5-9 years 10-14 years 15-24 years 25-39 years 40+ years 0 doses 1 dose 2+ doses Unknown Age at onset Number of cases Democratic Republic of the Congo age distribution, vaccination status, and incidence, to 50 100 150 200 Incidence rate per 1,000,000 134.3 175.9 66.5 13.5 5.1 2.5 0.2 Year Confirmed Cases 2006 1012 2007 539 2008 214 2009 83 2010 208 2011 1651 2012 2332 2013 2527 2014 1649 2015 5029 2016 4932 2017 3613 2018 2871

11 Measles cases: Ethiopia
200 400 600 Discarded Clinical Epi Lab Month of onset Number of cases Sub-national (9 M-14 Y) Cov: 96.3% Sub-national (6-179 M) Cov: 98% National SIA Sub-national SIA 100 200 300 400 500 600 <1 year 1-4 years 5-9 years 10-14 years 15-24 years 25-39 years 40+ years 0 doses 1 dose 2+ doses Unknown Age at onset Number of cases Ethiopia age distribution, vaccination status, and incidence, to 10 20 30 Incidence rate per 1,000,000 27.1 26.9 20.8 15.6 25.3 7.5 0.6 Year Confirmed Cases 2006 1278 2007 1472 2008 3161 2009 2642 2010 6205 2011 3552 2012 4616 2013 6137 2014 14282 2015 17778 2016 4568 2017 1912 2018 954

12 Measles cases: Nigeria
1000 2000 3000 Discarded Clinical Epi Lab Month of onset Number of cases Sub-national (6 M-10 Y) NA (9-59 M) National SIA Sub-national SIA 2000 4000 <1 year 1-4 years 5-9 years 10-14 years 15-24 years 25-39 years 40+ years 0 doses 1 dose 2+ doses Unknown Age at onset Number of cases Nigeria age distribution, vaccination status, and incidence, to 50 100 150 200 Incidence rate per 1,000,000 144.5 174.8 74.6 26.8 10.2 7.1 3.2 Year Confirmed Cases 2006 1019 2007 3129 2008 10453 2009 1498 2010 9072 2011 19062 2012 6423 2013 55392 2014 6850 2015 12391 2016 17581 2017 11188 2018 6182

13 Measles cases: Uganda 600 500 Number of cases 400 300 200 100
100 200 300 400 500 600 Discarded Clinical Epi Lab Month of onset Number of cases 200 400 600 800 1000 1200 1400 <1 year 1-4 years 5-9 years 10-14 years 15-24 years 25-39 years 40+ years 0 doses 1 dose 2+ doses Unknown Age at onset Number of cases Uganda age distribution, vaccination status, and incidence, to 50 100 150 Incidence rate per 1,000,000 205.9 207 94.9 43.3 15.9 4.1 1.5 Year Confirmed Cases 2006 1035 2007 291 2008 115 2009 86 2010 41 2011 132 2012 720 2013 460 2014 315 2015 466 2016 252 2017 892 2018 1877

14 Measles case distribution (AMR), 2014-2018
100 200 300 400 500 600 700 800 900 1000 1100 1200 1300 1400 1500 1600 1700 1800 1900 2000 2100 2200 2300 2400 2500 2600 2700 2800 2900 3000 3100 3200 3300 3400 3500 3600 3700 3800 3900 4000 4100 4200 4300 4400 4500 Month of onset Number of measles cases Venezuela (Bolivarian Republic of) USA Peru Others Mexico Colombia Chile Canada Brazil Argentina Antigua and Barbuda Notes: Based on data received Data Source: IVB Database

15 Measles cases: Brazil 4000 Number of cases 2000 Month of onset
2000 4000 Discarded Clinical Epi Lab Month of onset Number of cases Year Confirmed Cases 2008 2009 2010 68 2012 2 2013 192 2014 708 2015 214 2016 2017 2018 1533

16 Measles cases: Venezuela (Bolivarian Republic of)
The clustering of cases at specific time points is an artifact of reporting 1000 2000 3000 4000 Discarded Clinical Epi Lab Month of onset Number of cases 200 400 600 800 1000 1200 <1 year 1-4 years 5-9 years 10-14 years 15-24 years 25-39 years 40+ years 0 doses 1 dose 2+ doses Unknown Age at onset Number of cases Venezuela (Bolivarian Republic of) age distribution, vaccination status, and incidence, to 500 1500 Incidence rate per 1,000,000 1352.1 459.8 135.5 94.4 24.8 10.7 4.8 Year Confirmed Cases 2008 2009 2010 2011 2012 1 2013 2014 2015 2016 6 2017 727 2018 3545

17 Measles case distribution (EMR), 2014-2018
500 1000 1500 2000 2500 3000 Month of onset Number of measles cases Yemen United Arab Emirates Syrian Arab Republic Sudan Somalia Saudi Arabia Pakistan Others Iraq Egypt Afghanistan Notes: Based on data received Data Source: IVB Database

18 Measles cases: Pakistan
Pakistan has not had lab kits to test for months, but has recently received them. Surveillance data reported to HQ is only provided from the laboratory and thus the data is not indicative of the current situation 500 1000 1500 Discarded Clinical Epi Lab Month of onset Number of cases 500 1000 1500 2000 <1 year 1-4 years 5-9 years 10-14 years 15-24 years 25-39 years 40+ years 0 doses 1 dose 2+ doses Unknown Age at onset Number of cases Pakistan age distribution, vaccination status, and incidence, to 20 40 60 80 100 120 140 Incidence rate per 1,000,000 122 91.8 22.9 3.8 0.6 0.4 Year Confirmed Cases 2006 35 2007 33 2008 53 2009 472 2010 1111 2011 2676 2012 8048 2013 8030 2014 1370 2015 1117 2016 2806 2017 6780 2018 948

19 Measles cases: Sudan 1000 800 Number of cases 600 400 200
200 400 600 800 1000 Discarded Clinical Epi Lab Month of onset Number of cases 200 400 600 800 1000 <1 year 1-4 years 5-9 years 10-14 years 15-24 years 25-39 years 40+ years 0 doses 1 dose 2+ doses Unknown Age at onset Number of cases Sudan age distribution, vaccination status, and incidence, to 100 300 Incidence rate per 1,000,000 336.2 202.3 56.6 24.7 26.1 24.4 3.8 Year Confirmed Cases 2006 274 2007 483 2008 97 2009 68 2010 613 2011 5616 2012 8521 2013 2811 2014 676 2015 3585 2016 1767 2017 665 2018 2126

20 Measles cases: Yemen 1400 1200 1000 Number of cases 800 600 400 200
200 400 600 800 1000 1200 1400 Discarded Clinical Epi Lab Month of onset Number of cases 2000 <1 year 1-4 years 5-9 years 10-14 years 15-24 years 25-39 years 40+ years 0 doses 1 dose 2+ doses Unknown Age at onset Number of cases Yemen age distribution, vaccination status, and incidence, to 500 1000 1500 Incidence rate per 1,000,000 1432.7 1022.1 423.4 105.4 23.4 32.4 6.5 Year Confirmed Cases 2006 4989 2007 50 2008 53 2009 127 2010 372 2011 847 2012 2143 2013 571 2014 817 2015 465 2016 143 2017 2101 2018 5276

21 Measles case distribution (EUR), 2014-2018
1000 2000 3000 4000 5000 6000 7000 8000 9000 Month of onset Number of measles cases Ukraine Serbia Russian Federation Romania Others Kyrgyzstan Italy Germany Georgia France Bosnia and Herzegovina Notes: Based on data received Data Source: IVB Database

22 Measles cases: France 800 Number of cases 600 400 200 Month of onset
200 400 600 800 Discarded Clinical Epi Lab Month of onset Number of cases 200 400 600 <1 year 1-4 years 5-9 years 10-14 years 15-24 years 25-39 years 40+ years 0 doses 1 dose 2+ doses Unknown Age at onset Number of cases France age distribution, vaccination status, and incidence, to 100 300 Incidence rate per 1,000,000 312.9 177 79.8 70.9 83 51.5 5 Year Confirmed Cases 2006 16 2007 40 2008 606 2009 1541 2010 5019 2011 15214 2012 859 2013 272 2014 267 2015 373 2016 79 2017 519 2018 2672

23 Measles cases: Georgia
100 200 300 Discarded Clinical Epi Lab Month of onset Number of cases 100 200 300 400 <1 year 1-4 years 5-9 years 10-14 years 15-24 years 25-39 years 40+ years 0 doses 1 dose 2+ doses Unknown Age at onset Number of cases Georgia age distribution, vaccination status, and incidence, to 500 1000 1500 2000 2500 Incidence rate per 1,000,000 2494.2 812.9 477 590.1 380.8 435.7 45.2 Year Confirmed Cases 2006 8 2007 2 2008 55 2009 23 2010 22 2011 64 2012 30 2013 7868 2014 3190 2015 430 2016 14 2017 96 2018 1128

24 Measles cases: Greece 100 200 300 400 500 600 Month of onset
100 200 300 400 500 600 Discarded Clinical Epi Lab Month of onset Number of cases 200 400 600 800 1000 <1 year 1-4 years 5-9 years 10-14 years 15-24 years 25-39 years 40+ years 0 doses 1 dose 2+ doses Unknown Age at onset Number of cases Greece age distribution, vaccination status, and incidence, to 2000 3000 4000 Incidence rate per 1,000,000 3873.3 1865.4 1075.8 604.6 286.8 235 51.4 Year Confirmed Cases 2006 215 2007 1 2008 2009 2 2010 149 2011 40 2012 3 2013 2014 2015 2016 2017 1067 2018 2168

25 Measles cases: Kyrgyzstan
50 100 150 Discarded Clinical Epi Lab Month of onset Number of cases 50 100 150 <1 year 1-4 years 5-9 years 10-14 years 15-24 years 25-39 years 40+ years 0 doses 1 dose 2+ doses Unknown Age at onset Number of cases Kyrgyzstan age distribution, vaccination status, and incidence, to 200 400 600 800 1000 Incidence rate per 1,000,000 991.3 230.5 23.3 14.5 23.9 10.1 7.5 Year Confirmed Cases 2006 26 2007 2 2008 16 2009 2010 1 2011 210 2012 2013 2014 318 2015 17779 2016 2017 5 2018 364

26 Measles cases: Serbia 1500 Number of cases 1000 500 Month of onset
500 1000 1500 Discarded Clinical Epi Lab Month of onset Number of cases 2000 <1 year 1-4 years 5-9 years 10-14 years 15-19 years 20-29 years 30+ years 0 doses 1 dose 2+ doses Unknown Age at onset Number of cases Serbia age distribution, vaccination status, and incidence, to 1000 3000 4000 5000 6000 Incidence rate per 1,000,000 5167.8 2325.2 515.5 319.7 232.6 444.8 650.2 Year Confirmed Cases 2006 2007 147 2008 2 2009 1 2010 8 2011 358 2012 2013 2014 35 2015 368 2016 14 2017 702 2018 5003

27 Measles cases: Ukraine
2000 4000 6000 Discarded Clinical Epi Lab Month of onset Number of cases 2000 4000 6000 <1 year 1-4 years 5-9 years 10-14 years 15-19 years 20-29 years 30+ years 0 doses 1 dose 2+ doses Unknown Age at onset Number of cases Ukraine age distribution, vaccination status, and incidence, to 1000 3000 Incidence rate per 1,000,000 3627.3 2695.1 2466 1899.4 699.8 477 238.1 Year Confirmed Cases 2006 945 2007 232 2008 41 2009 24 2010 42 2011 1313 2012 12744 2013 3308 2014 2326 2015 141 2016 90 2017 4782 2018 26947

28 Measles case distribution (SEAR (excl. India)), 2014-2018
500 1000 1500 2000 2500 3000 3500 Month of onset Number of measles cases Timor-Leste Thailand Sri Lanka Nepal Myanmar Maldives Indonesia DPR Korea Bhutan Bangladesh Notes: Based on data received Data Source: IVB Database

29 Measles cases: Indonesia
2000 4000 6000 Discarded Clinical Epi Lab Month of onset Number of cases Sub-national (9 M-15 Y) Cov: 100.5% National SIA Sub-national SIA 100 200 300 400 500 <1 year 1-4 years 5-9 years 10-14 years 15-24 years 25-39 years 40+ years 0 doses 1 dose 2+ doses Unknown Age at onset Number of cases Indonesia age distribution, vaccination status, and incidence, to 10 20 Incidence rate per 1,000,000 14 20.3 11.9 5 1.1 0.1 Year Confirmed Cases 2006 21911 2007 20837 2008 16417 2009 21008 2010 23471 2011 23510 2012 16786 2013 10093 2014 9498 2015 6209 2016 7204 2017 11389 2018 1494

30 Measles case distribution (SEAR, India), 2014-2018
5000 10000 15000 Month of onset Number of measles cases India Notes: Based on data received Data Source: IVB Database

31 Measles cases: India 25000 20000 Number of cases 15000 10000 5000
5000 10000 15000 20000 25000 Discarded Clinical Epi Lab Month of onset Number of cases Rollover-Nat (9 M-15 Y) National SIA Sub-national SIA 2000 4000 6000 8000 10000 12000 <1 year 1-4 years 5-9 years 10-14 years 15-24 years 25-39 years 40+ years 0 doses 1 dose 2+ doses Unknown Age at onset Number of cases India age distribution, vaccination status, and incidence, to 20 40 60 80 100 120 Incidence rate per 1,000,000 103.5 98.3 83.9 24.1 4.9 1.6 0.3 Year Confirmed Cases 2014 80306 2015 83026 2016 70798 2017 57392 2018 46296

32 Measles case distribution (WPR), 2014-2018
2000 4000 6000 8000 10000 12000 14000 16000 18000 20000 22000 Month of onset Number of measles cases Viet Nam Singapore Republic of Korea Philippines Papua New Guinea Others Mongolia Malaysia Japan China Australia Notes: Based on data received Data Source: IVB Database

33 Measles cases: Philippines
1000 2000 3000 Discarded Clinical Epi Lab Month of onset Number of cases 2000 4000 6000 <1 year 1-4 years 5-9 years 10-14 years 15-24 years 25-39 years 40+ years 0 doses 1 dose 2+ doses Unknown Age at onset Number of cases Philippines age distribution, vaccination status, and incidence, to 500 1000 1500 Incidence rate per 1,000,000 1574.4 553.1 96.1 44.5 74.5 39.6 5.2 Year Confirmed Cases 2006 216 2007 612 2008 838 2009 1351 2010 6363 2011 6519 2012 1441 2013 4855 2014 53906 2015 2021 2016 647 2017 1606 2018 11670

34 (last 12 months) Notes: Data Source: MeaNS database (Genotypes) and IVB Database (Incidence) as of and covering the period to Pie charts proportional to the number of sequenced viruses

35 Rubella

36 Number of Reported Rubella Cases by WHO Regions
2018 Region Member States* Rubella cases Clin Epi Lab Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Date Received AFR 41/47 2395 338 360 554 351 328 213 173 78 AMR 24/35 2 1 EMR 20/21 557 45 44 468 103 114 119 92 66 60 3 EUR 34/53 589 519 67 81 97 75 93 83 63 SEAR 11/11 1106 55 1051 224 249 310 167 49 10 4 WPR 14/27 2330 150 48 2132 105 288 509 747 337 225 Total 144/194 6979 714 6115 865 926 1346 1217 1327 742 474 82 2017 Region Member States* Rubella cases Clin Epi Lab Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Date Received AFR 42/47 4569 278 515 586 328 343 372 212 331 388 647 459 110 AMR 26/35 EMR 20/21 914 43 1 870 76 111 121 106 156 112 49 22 25 50 47 39 EUR 30/53 703 568 17 118 59 60 87 69 85 58 54 38 46 SEAR 11/11 7640 2258 5382 583 1100 1574 1241 798 357 325 510 339 358 249 206 WPR 14/27 2286 258 162 1866 153 201 342 307 295 194 195 128 115 81 165 Total 143/194 16112 869 2438 12805 1149 1987 2710 2051 1677 1093 835 1038 905 1190 911 566 Notes: Based on data received This is surveillance data, hence for the last month, the data may be incomplete. * Member States Reporting / Total Member States in Region

37 Rubella Case Distribution by Month and WHO Region (2015-2018)
500 1000 1500 2000 2500 3000 3500 4000 4500 5000 5500 Month of onset Rubella cases (Lab+Epi+Clinical) WPR SEAR EUR EMR AMR AFR Notes: Based on data received Data Source: IVB Database - This is surveillance data, hence for the last month(s), the data may be incomplete.

38 Rubella cases: AFR 600 400 200 600 Number of cases (IgM+ only) 400 200
200 400 600 Not introduced in EPI Introduced <5 years ago (after 2012) Introduced >=5 years ago (2012 and before) Month of onset Number of cases (IgM+ only) AFR Rubella Case Distribution (September 2016-August 2018) Top 10 countries (last 12 M) label RCV in RI Cases % of Total South Africa No 1277 32 Ethiopia 680 17 DR Congo 495 12 Others - 394 10 Nigeria 392 Uganda 307 8 Cote d'Ivoire 183 5 Mali 95 2 Madagascar 62 Liberia 59 1 South Sudan 55 200 400 600 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 Rubella vaccine not introduced before 1 January 2017 Rubella vaccine introduced before 1 January 2017 Age at onset (in years) Number of cases (IgM+ only) AFR Age distribution of Rubella IgM+ cases by vaccine introduction status in the National EPI Programme (September 2017-August 2018) Notes: Based on data received Data Source: IVB Database. RCV in RI: Rubella-containing vaccine in Routine Immunization as of 31 Dec 2016.

39 Rubella cases: EMR 150 100 50 100 (lab + epi-linked + clinical) 80
50 100 150 Not introduced in EPI Introduced <5 years ago (after 2012) Introduced >=5 years ago (2012 and before) Month of onset Number of cases (lab + epi-linked + clinical) EMR Rubella Case Distribution (September 2016-August 2018) Top 10 countries (last 12 M) label RCV in RI Cases % of Total Sudan No 299 42 Yemen 2015 157 22 Pakistan 75 10 Saudi Arabia 1991 44 6 Afghanistan 40 Iran (Islamic Republic of) 2004 33 5 Others - 27 4 United Arab Emirates 1985 14 2 Egypt 1999 12 Tunisia 9 1 Libya 1995 8 20 40 60 80 100 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 41 42 43 44 45 46 Rubella vaccine not introduced before 1 January 2017 Rubella vaccine introduced before 1 January 2017 Age at onset (in years) Number of cases (lab + epi-linked + clinical) EMR Age distribution of Rubella cases by vaccine introduction status in the National EPI Programme (September 2017-August 2018) Notes: Based on data received Data Source: IVB Database. RCV in RI: Rubella-containing vaccine in Routine Immunization as of 31 Dec 2016.

40 Rubella cases: Yemen 40 30 Number of cases 20 10 Month of onset 80 30
10 20 30 40 Clinical Epi Lab Month of onset Number of cases 20 40 60 80 <1 year 1-4 years 5-9 years 10-14 years 15-24 years 25-39 years 40+ years 0 doses 1 dose 2+ doses Unknown Age at onset Number of cases Yemen age distribution, vaccination status, and incidence, to 10 30 Incidence rate per 1,000,000 29.5 20.6 4.6 1.4 0.5 Year Confirmed Cases 2015 159 2016 56 2017 41 2018 157

41 Rubella cases: EUR 100 80 60 40 20 (lab + epi-linked + clinical) 200
20 40 60 80 100 Not introduced in EPI Introduced <5 years ago (after 2012) Introduced >=5 years ago (2012 and before) Month of onset Number of cases (lab + epi-linked + clinical) EUR Rubella Case Distribution (September 2016-August 2018) Top 10 countries (last 12 M) label RCV in RI Cases % of Total Poland 1988 451 58 Ukraine 2001 158 20 Germany 1991 8 Italy 1972 26 3 Others - 25 Austria 1973 Turkey 2006 10 1 Kyrgyzstan 9 Portugal 1984 6 Romania 2002 5 Russian Federation 2000 100 200 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 Rubella vaccine not introduced before 1 January 2017 Rubella vaccine introduced before 1 January 2017 Age at onset (in years) Number of cases (lab + epi-linked + clinical) EUR Age distribution of Rubella cases by vaccine introduction status in the National EPI Programme (September 2017-August 2018) Notes: Based on data received Data Source: IVB Database. RCV in RI: Rubella-containing vaccine in Routine Immunization as of 31 Dec Spikes in age-distribution curve are an artifact of reporting by age bands ( 0=<1 yrs, 2=1-4 yrs, 7=5-9 yrs, 12=10-14 yrs, 17=15-19 yrs, 25=20-29 yrs, 45=30+yrs) instead of by age from some member states.

42 Rubella cases: SEAR (excl. India)
200 400 600 Not introduced in EPI Introduced <5 years ago (after 2012) Introduced >=5 years ago (2012 and before) Month of onset Number of cases (lab + epi-linked + clinical) SEAR (excl. India) Rubella Case Distribution (September 2016-August 2018) Top 10 countries (last 12 M) label RCV in RI Cases % of Total Indonesia No 1461 80 Bangladesh 2012 293 16 Nepal 2013 31 2 Thailand 1993 19 1 Myanmar 2015 11 Timor-Leste 2016 5 Bhutan 2006 Sri Lanka 1996 50 100 150 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 Rubella vaccine not introduced before 1 January 2017 Rubella vaccine introduced before 1 January 2017 Age at onset (in years) Number of cases (lab + epi-linked + clinical) SEAR (excl. India) Age distribution of Rubella cases by vaccine introduction status in the National EPI Programme (September 2017-August 2018) Notes: Based on data received Data Source: IVB Database. RCV in RI: Rubella-containing vaccine in Routine Immunization as of 31 Dec 2016.

43 Rubella cases: India 1000 800 Number of cases 600 400 200
200 400 600 800 1000 Clinical Epi Lab Month of onset Number of cases SIA (9 M-15 Y) National SIA Sub-national SIA 50 100 150 200 <1 year 1-4 years 5-9 years 10-14 years 15-24 years 25-39 years 40+ years 0 doses 1 dose 2+ doses Unknown Age at onset Number of cases India age distribution, vaccination status, and incidence, to 0.5 1 1.5 Incidence rate per 1,000,000 0.3 0.9 1.4 0.1 Year Confirmed Cases 2015 3265 2016 9084 2017 2946 2018 280

44 Rubella cases: WPR 800 600 400 200 150 (lab + epi-linked + clinical)
200 400 600 800 Not introduced in EPI Introduced <5 years ago (after 2012) Introduced >=5 years ago (2012 and before) Month of onset Number of cases (lab + epi-linked + clinical) WPR Rubella Case Distribution (September 2016-August 2018) Top 10 countries (last 12 M) label RCV in RI Cases % of Total China 2008 2498 89 Philippines 2010 112 4 Malaysia 1998 110 Viet Nam 2015 55 2 Lao People's Democratic Republic 2012 8 Japan 1989 6 Republic of Korea 1982 3 Singapore 1990 Cambodia 2013 Others - Papua New Guinea 50 100 150 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 Rubella vaccine not introduced before 1 January 2017 Rubella vaccine introduced before 1 January 2017 Age at onset (in years) Number of cases (lab + epi-linked + clinical) WPR (Excl. China) Age distribution of Rubella cases by vaccine introduction status in the National EPI Programme (September 2017-August 2018) Notes: Based on data received Data Source: IVB Database. RCV in RI: Rubella-containing vaccine in Routine Immunization as of 31 Dec 2016.

45 Rubella cases: Philippines
20 40 60 80 Clinical Epi Lab Month of onset Number of cases 20 40 60 80 <1 year 1-4 years 5-9 years 10-14 years 15-24 years 25-39 years 40+ years 0 doses 1 dose 2+ doses Unknown Age at onset Number of cases Philippines age distribution, vaccination status, and incidence, to 5 10 Incidence rate per 1,000,000 8.7 3.2 0.7 3.4 0.9 0.1 Year Confirmed Cases 2014 343 2015 154 2016 165 2017 443 2018 82

46 Rubella cases: China 800 Number of cases 600 400 200 Month of onset
200 400 600 800 Clinical Epi Lab Month of onset Number of cases Year Confirmed Cases 2014 11887 2015 8247 2016 4477 2017 1601 2018 2129

47 (last 12 months) Notes: Data Source: RubNS database (Genotypes) and IVB Database (Incidence) as of and covering the period to Pie charts proportional to the number of sequenced viruses

48 Laboratory

49 Measles and Rubella IgM Data Summary
2018 Region Member States* Specimens received Measles tested Measles positive n(%) Measles equivocal n(%) Measles negative n(%) Rubella tested Rubella positive n(%) Rubella equivocal n(%) Rubella negative n(%) AFR 38/47 19470 4001 (21) 459 (2) 15010 (77) 14094 2334 (17) 805 (6) 10955 (78) AMR 27/35 11374 11643 952 (8) 88 (1) 10190 (88) 10293 310 (3) 207 (2) 9279 (90) EMR 20/21 21506 17655 6238 (35) 85 (0) 11332 (64) 14823 709 (5) 230 (2) 13884 (94) EUR 37/53 39413 35688 12563 (35) 218 (1) 22661 (63) 20416 366 (2) 46 (0) 19984 (98) SEAR 11/11 18315 13548 4879 (36) 341 (3) 8318 (61) 8948 1366 (15) 265 (3) 7314 (82) WPR 27/27 16460 13109 2575 (20) 283 (2) 7285 (56) 10941 346 (3) 248 (2) 6700 (61) Total 160/194 126538 111113 31208 (28) 1474 (1) 74796 (67) 79515 5431 (7) 1801 (2) 68116 (86) 2017 Region Member States* Specimens received Measles tested Measles positive n(%) Measles equivocal n(%) Measles negative n(%) Rubella tested Rubella positive n(%) Rubella equivocal n(%) Rubella negative n(%) AFR 40/47 35202 4635 (13) 666 (2) 29901 (85) 29616 4963 (17) 1261 (4) 23392 (79) AMR 27/35 9098 9018 633 (7) 58 (1) 7710 (85) 8209 330 (4) 108 (1) 7176 (87) EMR 20/21 36251 34782 10561 (30) 127 (0) 24094 (69) 32726 1105 (3) 99 (0) 31522 (96) EUR 38/53 42450 37192 13748 (37) 272 (1) 22642 (61) 26322 434 (2) 66 (0) 25736 (98) SEAR 11/11 35379 32335 13177 (41) 781 (2) 20062 (62) 20383 4831 (24) 741 (4) 14804 (73) WPR 27/27 16467 15211 2100 (14) 333 (2) 11952 (79) 12656 606 (5) 418 (3) 10748 (85) Total 163/194 174847 163740 44854 (27) 2237 (1) (71) 129912 12269 (9) 2693 (2) (87) Notes: Based on data received * Member States Reporting / Total Member States in Region

50 Measles and Rubella IgM Data Summary
2018 data as of September 2018 2018 Region Member States* Specimens received Measles tested Measles positive n(%) Measles equivocal n(%) Measles negative n(%) Rubella tested Rubella positive n(%) Rubella equivocal n(%) Rubella negative n(%) AFR 38/47 19470 4001 (21) 459 (2) 15010 (77) 14094 2334 (17) 805 (6) 10955 (78) AMR 27/35 11374 11643 952 (8) 88 (1) 10190 (88) 10293 310 (3) 207 (2) 9279 (90) EMR 20/21 21506 17655 6238 (35) 85 (0) 11332 (64) 14823 709 (5) 230 (2) 13884 (94) EUR 37/53 39413 35688 12563 (35) 218 (1) 22661 (63) 20416 366 (2) 46 (0) 19984 (98) SEAR 11/11 18315 13548 4879 (36) 341 (3) 8318 (61) 8948 1366 (15) 265 (3) 7314 (82) WPR 27/27 16460 13109 2575 (20) 283 (2) 7285 (56) 10941 346 (3) 248 (2) 6700 (61) Total 160/194 126538 111113 31208 (28) 1474 (1) 74796 (67) 79515 5431 (7) 1801 (2) 68116 (86) 2017 data as of September 2017 2017 Region Member States* Specimens received Measles tested Measles positive n(%) Measles equivocal n(%) Measles negative n(%) Rubella tested Rubella positive n(%) Rubella equivocal n(%) Rubella negative n(%) AFR 36/47 21912 2826 (13) 492 (2) 18594 (85) 18456 3056 (17) 774 (4) 14626 (79) AMR 25/35 7154 6840 107 (2) 71 (1) 4230 (62) 6613 202 (3) 79 (1) 4140 (63) EMR 20/21 21889 21816 6665 (31) 111 (1) 15040 (69) 19675 706 (4) 71 (0) 18898 (96) EUR 37/53 25607 22450 9342 (42) 195 (1) 12597 (56) 14440 269 (2) 37 (0) 14083 (98) SEAR 11/11 24238 21738 8888 (41) 467 (2) 11309 (52) 12567 2963 (24) 432 (3) 9171 (73) WPR 27/27 9655 8751 1093 (12) 223 (3) 7408 (85) 7333 406 (6) 233 (3) 6694 (91) Total 156/194 110455 103507 28921 (28) 1559 (2) 69178 (67) 79084 7602 (10) 1626 (2) 67612 (85) Notes: Based on data received and * Member States Reporting / Total Member States in Region

51 Performance of Surveillance

52 Surveillance sensitivity reporting rate of measles and rubella (12 months, discarded cases* per 100,000 population) Notes: Based on data received and covering the period between and Target: >= 2 discarded cases* / 100,000 population** - * Suspected cases investigated and discarded as non-measles non-rubella using laboratory testing and/or epidemiological linkage to another etiology ** World population prospects, 2017 revision

53 Regional Bulletins and Newsletters

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