Multiple genotypes circulating in the NIS region WHO Euro Regional Reference Laboratory for Measles/Rubella, G.N.Gabrichevsky Research Institute for Epidemiology and Microbiology, Moscow, Russia

Number of measles cases 2015 Measles incidence, NIS,2015 Country Number of measles cases 2015 Genotyping data avail. Azerbaijan Armenia 33 + Belarus 2 Moldova Kazakhstan 2341 Kyrgyzstan 21343 Russia 843 Tajikistan 3 ? Turkmenistan Ukraine 105 Uzbekistan 22 Measles incidence, cases/1 mln. of pop. 0; < 1; 1…5; 5…15; >100; > 3000

Measles incidence and genotypes, Russia, 2014 4711 cases, 32,4/1000000, D8 – 301 (10 gen. variants) D4 Az - 11 D4 MVs/Manchester.GBR/10.09 – 4 B3 - 12 H1 – 2 G3 – 1 112 imp. cases 29 countries Number of cases Week Number of strains D8 Chui first isolation Week Genotype

Measles incidence and genotypes, Russia, 2015 843 cases, 0,58/1000000, D8 – 205 (7 gen. lineages) D8Chui - 115 H1 – 15 (2 gen. lineages) B3 - 1 Number of cases Week Number of strains D8 RoK last isolation D8 Chui last isolation Week Genotype

Measles genotypes, NIS, 2015 Kyrgyzstan 21343 rep. cases MVs/South Kazakhstan.KAZ/5.15/4 5734 MVi/Villupuram.IND/03.07/ Named strain MVs/South Khazakhstan.KAZ/5.15/3 5733 Kyrgyzstan 21343 rep. cases D8 MVs/Chui.KGZ/53.14/ Named strain Uzbekistan 22 cases D8 (2 seq. var. linked to Kaz. outbreak, + 1 linked to Kyrgyzstan?) Armenia 33 cases D8 MVi/Villupuram.IND/03.07/ Named strain MVs/South Khazakhstan.KAZ/5.15/2 5732 Kazakhstan 2341 cases D8 (5 seq, var. 3 gen. lin.) B3 MVs/South Kazakhstan.KAZ/5.15/ MVs/South Kazakhstan.KAZ/4.15/ 5731 MVs/South Khazakhstan.KAZ/3.15/2 5730 MVs/Shymkent City.KAZ/11.15/ MVs/North Khazakhstan.KAZ/11.15/ 5743 MVs/Akmola.KAZ/9.15/ 5740 MVs/Akmola.KAZ/7.15/ 5738 MVs/Tashkent.UZB/7.15 Imp. Kazakhstan/ MVs/Tashkent.UZB/5.15Imp. Kazakhstan / MVs/Aragats.ARM/35.15/2 5920 MVs/Aragats.ARM/35.15/ 5919 MVs/Chui.KGZ/2.15/ 5582 MVs/Bishkek.KGZ/1.15/2 5557 MVs/Bishkek.KGZ/2.15/ 5572 MVs/Bishkek.KGZ/2.15/2 5579 MVs/Bishkek.KGZ/2.15/3 5580 MVs/Talas.KGZ/4.15/ 5594 MVs/Talas.KGZ/4.15/2 5596_ MVs/Talas.KGZ/6.15/ 5600 MVs/Talas.KGZ/6.15/2 5602 MVs/Tashkent.UZB/30.15/ 5849 MVs/Chui.KGZ/53.14/ Named strain MVs/Akmola.KAZ/8.15/ 5739 MVs/Republic of Komi.RUS/35.13/[D8] 3884 Named strain 99 MVs/North Kazakhstan.KAZ/18.15/ 5745 99 MVs/Frankfurt Main.DEU/17.11/ Named strain MVs/Tashkent.UZB/30.15/2 Imp. Kazakhstan MVs/Tashkent.UZB/30.15/3 Imp. Kazakhstan 99 MVs/Pretoria.ZAF/19.09/ MVs/Petropavlovsk.KAZ/22.15/2 MVs/South Khazakhstan.KAZ/3.15/ 5729 MVs/Sohar.OMN/23.12/ Manchester.UNK/30/94_D8 Edmonstonwt.USA/54_A NewYork.USA/94_B3 Ibandan.Nie/97/1 B3 99 97 MVs/Kansas.USA/1.12/2 Named strain Imp Ethiopia 99 MVs/North Khazakhstan.KAZ/17.15/ 5

Kyrgyzstan and linked сases in Russia MVs/Tyumen.RUS/4.15/ Imp. Kyrgyzstan Russia 2015 Kyrgyzstan – linked cases MVs/Tyumen.RUS/11.15/ Imp. Kyrgyzstan MVs/Stavropol.RUS/19.15/ Imp. Kyrgyzstan MVs/Republic of Dagestan.RUS/20.15/ Imp. Kyrgyzstan MVs/Ufa.RUS/16.15/ Imp. Kyrgyzstan MVs/Novosibirsk.RUS/19.15/ Imp. Kyrgyzstan MVs/Moscow.RUS/17.15/ Imp. Kyrgyzstan MVs/Moscow.RUS/16.15/8/ Imp. Kyrgyzstan MVs/Moscow.RUS/16.15/5 Imp. Kyrgyzstan MVs/Moscow.RUS/16.15/3 Imp. Kyrgyzstan MVs/Moscow.RUS/15.15/4 Imp. Kyrgyzstan MVs/Moscow.RUS/12.15/6 Imp. Kyrgyzstan MVs/Moscow.RUS/10.15/2 Imp. Kyrgyzstan MVs/Krasnoyarsk.RUS/11.15/ Imp. Kyrgyzstan MVs/Irkutsk.RUS/25.15/3 Imp. Kyrgyzstan MVs/Irkutsk.RUS/25.15/2 Imp. Kyrgyzstan MVs/Ulan-Ude.RUS/23.15/ Imp. Kyrgyzstan MVs/Ivanovo.RUS/8.15/ Imp. Kyrgyzstan MVs/Talas.KGZ/6.15/2 5602 Kyrgyzstan 2015 MVs/Talas.KGZ/6.15/ 5600 MVs/Talas.KGZ/4.15/2 5596_ MVs/Talas.KGZ/4.15/ 5594 MVs/Bishkek.KGZ/2.15/3 5580 MVs/Bishkek.KGZ/2.15/2 5579 MVs/Bishkek.KGZ/2.15/ 5572 MVs/Bishkek.KGZ/1.15/2 5557 MVs/Chui.KGZ/2.15/ 5582 MVs/Chui.KGZ/53.14/ Named strain 2014 100 MVs/Chelyabinsk.RUS/53.14/ Imp. Kyrgyzstan MVs/Bishkek.KGZ/53.14/ 5553 MVs/Chui.KGZ/53.14/2 5558 MVi/Villupuram.IND/03.07/ Named strain MVs/Chui.KGZ/23.14/ Imp. Kazakhstan MVs/St.Petersburg.RUS/19.15/ Imp. Kyrgyzstan Manchester.UNK/30/94_D8 Edmonstonwt.USA/54_A 5

Russia, measles 2016 Number of cases Region Jan Feb Mar Apr Total MVs/Republic of Buriatia.RUS/7.16/2/ 6036.4 Region Jan Feb Mar Apr Total Moscow 1 2 R. of Tatarstan Ingush Republic North Osetia R. Of Chechnya 4 5 Rostov on Don Irkutsk Stavropol R. of Buryatia   Russia 9 22 MVs/Liaoning.CHN/13.14/2 MVs/Republic of Buriatia.RUS/7.16/ 6036.2 MVs/Irkutsk.RUS/21.16/ 6130 MVs/Irkutsk.RUS/20.16/2/ 6128 MVs/Irkutsk.RUS/20.16/ Linked to China 91 MVs/Hong Kong.CHN/49.12/ H1 Named strain MVs/Republic of Buriatia.RUS/15.16/ 6082 MVs/Republic of Buriatia.RUS/18.16/2/ 6106 99 MVs/Ulaanbaatar.MNG/44.15/ MVs/Republic of Buriatia.RUS/18.16/ 6104 99 MVs/Shandong.CHN/13.15/18 MVs/Hong Kong.CHN/42.11/ Named strain Hunan.CHN/93/7_H1 Edmonstonwt.USA/54_A 91 MVs/Republic of Tatarstan.RUS/4.16/ Imp. India MVs/Faridabad.IND/22.14/ Manchester.UNK/30/94_D8 99 MVs/Perm.RUS/3.16/ Imp. Kazakhstan MVi/Villupuram.IND/03.07 Named strain / 99 MVs/Ingush Republic.RUS/17.16/ 6119 80 MVs/Frankfurt Main.DEU/17.11/ Named strain MVs/Lipetsk.RUS/22.16/ Linked to R.of Chechnya 99 MVs/Moscow.RUS/17.16/ 6085 MVs/Rostov-on-Don.RUS/17.16/ 6114 MVs/Rostov-on-Don.RUS/17.16/2/ 6116 MVs/Rostov-on-Don.RUS/19.16/ 6117 5

Summary Measles incidence linked to virus importation that results in different scenarios (from sporadic cases to nation-wide outbreaks); Multiple introduction of the virus + “pockets of susceptible” (unvaccinated adults and young infants, Roma pop., religious groups) sustain prolonged transmission; Predominance of different D8 measles lineages with origin outside of the NIS region and simultaneous transmission of many different sequence variants of the virus observed. Исправить слайд для результатов 2012г.

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“Extra slides”

Rubella incidence, NIS,2015 - 2016 Country Number of cases 2015 Genotyping data avail. Azerbaijan Armenia* Belarus 1 ? Moldova Kazakhstan 2 Kyrgyzstan 101 Russia 25 + Tajikistan Turkmenistan Ukraine 248 Uzbekistan Number of cases, Russia 2016 (Jan – Apr) Region Jan Feb Mar Apr Total Archangelsk 2 St. Petersburg 1 Moscow 4 Yaroslavl 7 3 9 23 Orel Kursk Krasnodar Stavropol Russia 8 6 12 35

Rubella genotypes, Russia, 2014 - 2016 RVs/Yaroslavl.RUS/13.16/ 6066 RVs/Yaroslavl.RUS/16.16/ 6099 Outbake 28 cases Oct 2015 - May 2016 Unknown source RVs/Yaroslavl.RUS/12.16/ 6069 RVs/Yaroslavl.RUS/11.16/ 6062 RVs/Yaroslavl.RUS/03.16/ 6009 Strains 2015 RVs/Orel.RUS/53.15/ 6002 RVs/Zongo.COD/13.13/ 100 RVs/Kinshasa.COD/23.12/ Strains 2016 97 RVs/Novgorod.RUS/13.15/ 5375 Outbreak 6 cases African students Feb – Mar 2015 Unknown source 88 RVs/Novgorod.RUS/13.15/2 5377 RVs/Moscow.RUS/22.16/ 6132 95 RVs/Florida.USA/04.16/ Imp.India RVs/Astrakhan.RUS/10.14/ 4z175/1 RVi/Kedah.MYS/05.14/ RVi/Kelantan.MYS/05.14/ 99 RVs/HongKong.CHN/49.08 99 RVs/Astrakhan.RUS/03.14/ 4859 RVs/Astrakhan.RUS/16.14/ 4z995 RVs/Astrakhan.RUS/16.14/2 4z998 RVs/Astrakhan.RUS/01.15/CRS 5027 Rvi/Seattle.WA.USA/16.00[2B] RVi/TelAviv.ISR/68[2B] RVi/BEL/63[1a] RVi/Dezhou.CHN/02[1E] 100 RVi/North Carolina.USA/15.11/[1E] Imp Indonezia 97 99 RVs/Moscow.RUS/17.14/ 4z830 97 RVs/Samara.RUS/27.14/ 4N829 5

Summary Rubella in Russia is not endemic, very limited data for other countries. Исправить слайд для результатов 2012г.