March 2019 Please note that all data contained within is provisional. The number of cases of measles and rubella officially reported by a member state.

March 2019 Please note that all data contained within is provisional. The number of cases of measles and rubella officially reported by a member state is only available by July of each year (through the joint WHO UNICEF annual data collection exercise). If any numbers from this provisional data are quoted, they should be properly sourced with a date (i.e. “provisional data based on monthly data reported to WHO (Geneva) as of March 2019”). For official data from , please visit our website.

Measles

Number of Reported Measles Cases by WHO Regions
2019 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 35/47 51026 49646 2989 45921 736 38522 11124 AMR 23/35 1503 270 80 190 EMR 9/21 923 282 34 2 246 231 51 EUR 51/53 18822 18169 13290 608 4271 18112 57 SEAR 10/11 6688 5301 3349 424 1528 4611 690 WPR 21/27 3575 670 325 5 340 669 1 Total 149/194 82537 74338 19987 46960 7391 62225 12113 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 80902 54740 16345 30871 7524 2953 4257 5057 3824 2845 1707 1632 1220 1781 5062 9942 14460 AMR 32/35 28734 16615 3 16 84 153 291 204 410 138 645 2608 5887 6176 EMR 20/21 79726 57054 29535 15555 11964 4002 4862 8067 7974 9648 5650 4484 2765 3030 3045 2234 1293 EUR 53/53 96452 83103 50946 4174 27983 5668 6609 7421 7735 8719 7131 5410 3705 2730 5433 9924 12618 SEAR 11/11 104040 82384 57299 17936 7149 8983 8975 14268 12199 10891 5025 3461 3841 3305 4089 3513 3834 WPR 26/27 75214 30381 18290 1742 10349 1926 2479 3388 3229 3051 2422 2221 1949 1923 2610 3042 2141 Total 184/194 465068 324277 172415 70278 81584 23535 27198 38285 35114 35445 22139 17618 13618 13414 22847 34542 40522 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

Number of Reported Measles Cases by WHO Regions
2019 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 35/47 51026 49646 2989 45921 736 38522 11124 AMR 23/35 1503 270 80 190 EMR 9/21 923 282 34 2 246 231 51 EUR 51/53 18822 18169 13290 608 4271 18112 57 SEAR 10/11 6688 5301 3349 424 1528 4611 690 WPR 21/27 3575 670 325 5 340 669 1 Total 149/194 82537 74338 19987 46960 7391 62225 12113 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 36/47 4942 3783 3184 186 413 2519 1264 AMR 19/35 854 40 23 17 EMR 5/21 1008 648 1 647 643 5 EUR 44/53 5459 5176 3219 102 1855 5149 27 SEAR 8/11 4007 3420 2953 202 265 3288 132 WPR 10/27 2213 706 319 386 692 14 Total 122/194 18483 13773 9675 492 3606 12314 1459 Notes: Based on data received and This is surveillance data, hence for the last month, the data may be incomplete. * Member States Reporting / Total Member States in Region

Measles case distribution by month and WHO Region (2015-2019)
5000 10000 15000 20000 25000 30000 35000 40000 45000 50000 55000 60000 65000 Month of onset Measles cases (Lab+Epi+Clinical) AMR WPR SEAR EUR EMR 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.

high incidence rates***
(12M period) Top 10** Country Cases Rate Ukraine 63948 India 63364 47.85 Madagascar 59407 Pakistan 30747 159.14 Philippines 19401 187.78 Yemen 11746 425.82 Brazil 10262 49.42 Nigeria 5847 31.44 Venezuela (Bolivarian Republic of) 5668 179.55 Thailand 5579 81.02 high incidence rates*** Country Cases Rate Georgia 3176 809.09 Liberia 3194 692.27 Albania 1476 504.38 Serbia 4176 473.46 Israel 3377 412.24 Montenegro 201 319.75 Kyrgyzstan 1509 253.37 Measles cases from countries with known discrepancies between case-based and aggregate surveillance, as reported by country Country Year Cases Data Source DR Congo 2018 67072 SITUATION EPIDEMIOLOGIQUE DE LA ROUGEOLE EN RDC, Week of 05/03/2019 2019 17646 Somalia 9135 Somali EPI/POL Weekly Update Week 09 720 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)

(6M period) Top 10* Country Cases
Madagascar 59388 Ukraine 40031 India 14304 Brazil 9198 Philippines 8212 Venezuela (Bolivarian Republic of) 5668 Thailand 4871 Pakistan 4775 Yemen 4057 Israel 3146 Notes: Based on data received Surveillance data from to * Countries with highest number of cases for the period

Measles case distribution (AFR), 2015-2019
2000 4000 6000 8000 10000 12000 14000 16000 18000 20000 22000 24000 26000 28000 30000 32000 34000 36000 38000 40000 42000 Month of onset Number of measles cases Uganda Others Nigeria Niger Madagascar Liberia Ghana Ethiopia Equatorial Guinea DR Congo Cameroon 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.

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.

Measles cases: Democratic Republic of the Congo
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 15-24 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 50 100 150 200 250 300 Incidence rate per 1,000,000 266.2 289.9 101.4 18.3 6.6 3.9 0.9 Year Confirmed Cases 2006 1012 2007 539 2008 214 2009 83 2010 208 2011 1651 2012 2332 2013 2527 2014 1649 2015 5029 2016 4860 2017 3597 2018 5597 2019 315

Measles cases: Ethiopia
200 400 600 Discarded Clinical Epi Lab Month of onset Number of cases Sub-national (6-179 M) Cov: 98% National SIA Sub-national SIA 100 200 300 <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 Incidence rate per 1,000,000 22.1 21.2 11.5 7.2 14.2 7.6 1.1 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 1351

Measles cases: Madagascar
As of February 22, 2019, there were 79,274 as per ‘Rapport de situation No 8, du 17 au 22 février 2019 10000 20000 30000 40000 Discarded Clinical Epi Lab Month of onset Number of cases Sub-national (9 M-14 Y) Cov: 94% National SIA Sub-national SIA Year Confirmed Cases 2006 2 2007 2008 12 2009 2010 1 2011 2012 3 2013 7 2014 2015 6 2016 17 2017 84 2018 23558 2019 46197

Measles cases: Nigeria
1000 2000 3000 Discarded Clinical Epi Lab Month of onset Number of cases National (9-59 M) Cov: 107% Cov: 106% National SIA Sub-national SIA 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 Nigeria age distribution, vaccination status, and incidence, to 20 40 60 80 100 120 140 Incidence rate per 1,000,000 95.9 117.2 56.7 20.4 6.1 3.5 1.4 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 6432 2019 842

Measles case distribution (AMR), 2015-2019
The clustering of cases at specific time points is an artifact of reporting 500 1000 1500 2000 2500 3000 3500 4000 4500 5000 5500 6000 6500 Month of onset Number of measles cases Venezuela (Bolivarian Republic of) USA Peru Others Mexico Costa Rica Colombia Chile Canada Brazil Argentina Notes: Based on data received Data Source: IVB Database

Measles cases: Brazil 6000 Number of cases 4000 2000 Month of onset
2000 4000 6000 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 10262 2019 21

Measles cases: Venezuela (Bolivarian Republic of)
The clustering of cases at specific time points is an artifact of reporting 2000 4000 6000 Discarded Clinical Epi Lab Month of onset Number of cases Sub-national (6 M-15 Y) National SIA Sub-national SIA 500 1000 1500 <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 Incidence rate per 1,000,000 1509.3 523.6 142.7 103.8 31.9 12.6 7 Year Confirmed Cases 2008 2009 2010 2011 2012 1 2013 2014 2015 2016 2017 727 2018 5668 2019

Measles case distribution (EMR), 2015-2019
500 1000 1500 2000 2500 3000 3500 4000 4500 5000 5500 6000 6500 7000 7500 8000 8500 9000 9500 10000 10500 Month of onset Number of measles cases Yemen United Arab Emirates Syrian Arab Republic Sudan Saudi Arabia Pakistan Others Libya Iraq Egypt Afghanistan Notes: Based on data received Data Source: IVB Database

Measles cases: Pakistan
2000 4000 6000 8000 Discarded Clinical Epi Lab Month of onset Number of cases National SIA Sub-national SIA 2000 4000 6000 8000 10000 12000 14000 16000 18000 20000 <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 500 1000 1500 Incidence rate per 1,000,000 1478.6 833.2 240 44.7 6.3 2.4 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 33248 2019 89

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 Sub-national (6 M->15 Y) Cov: 98% National SIA Sub-national SIA 500 1000 1500 2000 2500 <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 200 400 600 800 Incidence rate per 1,000,000 769 450.2 132.5 42.1 55.1 47.7 7.5 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 4978

Measles cases: Tunisia
50 100 150 Discarded Clinical Epi Lab Month of onset Number of cases 10 20 30 40 50 60 <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 Tunisia age distribution, vaccination status, and incidence, to 100 150 200 250 Incidence rate per 1,000,000 247.3 23 9.3 3.8 1.4 1 Year Confirmed Cases 2006 2007 5 2008 2009 2 2010 2011 14 2012 48 2013 17 2014 16 2015 19 2016 7 2017 2018 12 2019 128

Measles cases: Yemen 2000 Number of cases 1000 Month of onset 2500
1000 2000 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 Yemen age distribution, vaccination status, and incidence, to 500 1000 1500 2500 Incidence rate per 1,000,000 2263.4 1909.6 749.4 183.9 49.2 55.6 9.5 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 12617

Measles case distribution (EUR), 2015-2019
1000 2000 3000 4000 5000 6000 7000 8000 9000 10000 11000 12000 13000 14000 15000 16000 17000 18000 19000 Month of onset Number of measles cases Ukraine Serbia Russian Federation Romania Others Kyrgyzstan Kazakhstan Italy Germany Georgia France Notes: Based on data received Data Source: IVB Database

Measles cases: Azerbaijan
20 40 60 80 100 120 Discarded Clinical Epi Lab Month of onset Number of cases 20 40 60 80 100 <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 Azerbaijan age distribution, vaccination status, and incidence, to Incidence rate per 1,000,000 5.4 12.9 8.5 53.2 24.7 1.4 Year Confirmed Cases 2006 2007 2008 5 2009 1 2010 2011 2012 2 2013 164 2014 2015 2016 2017 2018 71 2019 98

Measles cases: Georgia
200 400 600 800 1000 1200 1400 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 Georgia age distribution, vaccination status, and incidence, to 2000 3000 4000 5000 6000 Incidence rate per 1,000,000 5382.2 2108.9 905.8 1053.8 1213.9 1179.9 153.5 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 2203 2019 1098

Measles cases: Kazakhstan
500 1000 1500 Discarded Clinical Epi Lab Month of onset Number of cases 200 400 600 800 <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 Kazakhstan age distribution, vaccination status, and incidence, to 500 1000 1500 2000 Incidence rate per 1,000,000 2061.6 465.6 50 22.8 14 56.1 34.6 Year Confirmed Cases 2006 87 2007 6 2008 24 2009 2011 30 2012 109 2013 73 2014 317 2015 2340 2016 110 2017 2 2018 576 2019 1516

Measles cases: Kyrgyzstan
100 200 300 400 500 600 Discarded Clinical Epi Lab Month of onset Number of cases 200 400 600 800 <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 1000 2000 3000 4000 5000 Incidence rate per 1,000,000 4599.8 880.7 127.9 41.4 81.7 34.6 15.7 Year Confirmed Cases 2006 26 2007 2 2008 16 2009 2010 1 2011 210 2012 2013 2014 318 2015 17779 2016 2017 5 2018 1100 2019 442

Measles cases: Ukraine
5000 10000 15000 Discarded Clinical Epi Lab Month of onset Number of cases National (6-9 Y) Cov: 67% National (1-9 Y) Cov: 57% National SIA Sub-national SIA 2000 4000 6000 8000 10000 12000 14000 <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 5000 7000 Incidence rate per 1,000,000 6582 4865.1 5336.1 4920.2 1548.8 1007 489.8 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 53218 2019 13760

Measles case distribution (SEAR (excl. India)), 2015-2019
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

Measles cases: Indonesia
2000 4000 Discarded Clinical Epi Lab Month of onset Number of cases Sub-national (9 M-15 Y) Cov: 101% Rollover-Nat (9 M-15 Y) Cov: 73% National SIA Sub-national SIA 50 100 150 200 250 <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 5 10 15 Incidence rate per 1,000,000 13.6 8.6 9.9 5.2 3.1 0.7 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 5412 2019 66

Measles case distribution (SEAR, India), 2015-2019
5000 10000 15000 Month of onset Number of measles cases India Notes: Based on data received Data Source: IVB Database

Measles cases: India 30000 Number of cases 20000 10000 Month of onset
10000 20000 30000 Discarded Clinical Epi Lab Month of onset Number of cases National SIA Sub-national SIA 2000 4000 6000 8000 <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 Incidence rate per 1,000,000 89.8 72.3 58.3 16.7 4 1.2 0.2 Year Confirmed Cases 2014 80306 2015 83026 2016 70798 2017 61271 2018 68275 2019 2700

Measles cases: Myanmar
200 400 600 800 1000 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 Myanmar age distribution, vaccination status, and incidence, to 50 100 150 Incidence rate per 1,000,000 7.8 173.1 96.2 33.8 39 15.8 0.8 Year Confirmed Cases 2006 760 2007 1087 2008 334 2009 501 2010 432 2011 1810 2012 2164 2013 1000 2014 110 2015 6 2016 274 2017 1285 2018 1353 2019 1047

Measles cases: Thailand
1000 2000 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 Thailand age distribution, vaccination status, and incidence, to Incidence rate per 1,000,000 1310.7 531.1 188.6 103.8 90.2 57.8 3.8 Year Confirmed Cases 2006 3962 2007 3517 2008 6339 2009 5272 2010 2273 2011 2873 2012 4072 2013 2056 2014 834 2015 190 2016 1009 2017 2033 2018 4938 2019 1169

Measles case distribution (WPR), 2015-2019
2000 4000 6000 8000 10000 12000 14000 16000 18000 Month of onset Number of measles cases Viet Nam Singapore Philippines Others New Zealand Mongolia Malaysia Lao People's Democratic Republic Japan China Australia Notes: Based on data received Data Source: IVB Database

Measles cases: Philippines
1000 2000 3000 Discarded Clinical Epi Lab Month of onset Number of cases 2000 4000 6000 8000 <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 1000 3000 Incidence rate per 1,000,000 2608 780.5 132.6 64.6 119.3 66.3 8.3 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 2409 2018 20755

(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

Rubella

Number of Reported Rubella Cases by WHO Regions
2019 Region Member States* Rubella cases Clin Epi Lab Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Date Received AFR 26/47 151 113 38 AMR 16/35 EMR 8/21 19 EUR 22/53 79 63 3 13 78 1 SEAR 9/11 103 97 6 WPR 9/27 1008 96 57 855 1001 7 Total 90/194 1360 159 60 1141 1308 52 2018 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 3431 338 368 574 372 358 266 246 243 187 203 176 100 AMR 27/35 2 1 EMR 20/21 1492 148 314 1030 149 172 232 199 202 115 108 83 71 81 46 34 EUR 37/53 850 741 7 102 82 97 75 90 80 62 74 50 44 49 SEAR 11/11 4111 1305 2806 311 457 798 907 521 192 129 182 195 193 142 84 WPR 14/27 3610 223 65 3322 105 95 277 494 760 341 265 222 290 344 391 26 Total 151/194 13496 1112 1691 10693 985 1190 1956 2070 1931 994 810 804 793 865 294 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

Number of Reported Rubella Cases by WHO Regions
2019 Region Member States* Rubella cases Clin Epi Lab Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Date Received AFR 26/47 151 113 38 AMR 16/35 EMR 8/21 19 EUR 22/53 79 63 3 13 78 1 SEAR 9/11 103 97 6 WPR 9/27 1008 96 57 855 1001 7 Total 90/194 1360 159 60 1141 1308 52 2018 Region Member States* Rubella cases Clin Epi Lab Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Date Received AFR 21/47 181 164 17 AMR 14/35 EMR 5/21 16 14 2 EUR 15/53 59 48 11 SEAR 7/11 91 82 9 WPR 7/27 84 29 7 Total 69/194 431 77 347 403 28 Notes: Based on data received and This is surveillance data, hence for the last month, the data may be incomplete. * Member States Reporting / Total Member States in Region

Rubella Case Distribution by Month and WHO Region (2015-2019)
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.

high incidence rates***
(12M period) Top 10** Country Cases Rate China 3776 2.69 India 2146 1.62 Indonesia 1339 5.13 Ethiopia 622 6.07 Nigeria 584 3.14 Pakistan 526 2.72 Poland 461 12.06 Uganda 421 10.15 South Africa 417 7.44 Japan 381 2.98 high incidence rates*** Country Cases Rate Congo 120 23.41 Liberia 66 14.30 Yemen 363 13.16 Sudan 309 7.81 Mali 109 6.06 Malaysia 166 5.32 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)

(6M period) Top 10* Country Cases
China 1767 Indonesia 574 Japan 372 Uganda 246 Nigeria 202 Poland 182 India 171 South Africa 162 DR Congo 149 Yemen 133 Notes: Based on data received Surveillance data from to * Countries with highest number of cases for the period

Rubella cases: AFR 600 400 200 500 400 Number of cases (IgM+ only) 300
200 400 600 Not introduced in EPI Introduced <5 years ago (after 2013) Introduced >=5 years ago (2013 and before) Month of onset Number of cases (IgM+ only) AFR Rubella Case Distribution (March 2017-February 2019) Top 10 countries (last 12 M) label RCV in RI Cases % of Total Nigeria No 566 20 Ethiopia 547 19 Uganda 405 14 South Africa 381 13 Others - 318 11 DR Congo 224 8 Congo 115 4 Cote d'Ivoire 2018 100 3 Mozambique 96 Mali 84 Chad 40 1 100 200 300 400 500 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 (March 2018-February 2019) Notes: Based on data received Data Source: IVB Database. RCV in RI: Rubella-containing vaccine in Routine Immunization as of 31 Dec 2016.

Rubella cases: EMR 200 100 (lab + epi-linked + clinical) 200
100 200 Not introduced in EPI Introduced <5 years ago (after 2013) Introduced >=5 years ago (2013 and before) Month of onset Number of cases (lab + epi-linked + clinical) EMR Rubella Case Distribution (March 2017-February 2019) Top 10 countries (last 12 M) label RCV in RI Cases % of Total Pakistan No 463 39 Yemen 2015 340 29 Sudan 238 20 Saudi Arabia 1991 40 3 Afghanistan 2018 34 Tunisia 2004 21 2 Libya 1995 14 1 Others - 13 United Arab Emirates 1985 10 Morocco 2014 9 Lebanon 8 100 200 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) EMR Age distribution of Rubella cases by vaccine introduction status in the National EPI Programme (March 2018-February 2019) Notes: Based on data received Data Source: IVB Database. RCV in RI: Rubella-containing vaccine in Routine Immunization as of 31 Dec 2016.

Rubella cases: Yemen 80 60 Number of cases 40 20 Month of onset 150 60
20 40 60 80 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 Yemen age distribution, vaccination status, and incidence, to 20 40 60 Incidence rate per 1,000,000 59.1 48.2 29.3 9.2 3.5 0.9 0.7 Year Confirmed Cases 2015 159 2016 56 2017 41 2018 402

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 2013) Introduced >=5 years ago (2013 and before) Month of onset Number of cases (lab + epi-linked + clinical) EUR Rubella Case Distribution (March 2017-February 2019) Top 10 countries (last 12 M) label RCV in RI Cases % of Total Poland 1988 418 56 Ukraine 2001 186 25 Germany 1991 47 6 Italy 1972 20 3 Others - 19 Spain 1978 Turkey 2006 16 2 Romania 2002 8 1 Russian Federation 2000 Portugal 1984 5 Kyrgyzstan 4 100 200 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 (March 2018-February 2019) 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.

Rubella cases: Poland 60 Number of cases 40 20 Month of onset 150
20 40 60 Clinical Epi Lab Month of onset Number of cases 50 100 150 <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 Poland age distribution, vaccination status, and incidence, to Incidence rate per 1,000,000 142.9 82 75.1 21 2.9 4.3 1.7 Year Confirmed Cases 2015 2029 2016 1105 2017 476 2018 450 2019 47

Rubella cases: Ukraine
20 40 Clinical Epi Lab Month of onset Number of cases SIA (6-9 Y) Cov: 67% SIA (1-9 Y) Cov: 57% National SIA Sub-national SIA 20 40 60 80 100 <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 5 10 15 25 Incidence rate per 1,000,000 18.7 16.2 23.8 7.1 4.5 0.3 4.1 Year Confirmed Cases 2015 2016 2017 2018 235 2019 17

Rubella cases: SEAR (excl. India)
200 400 600 Not introduced in EPI Introduced <5 years ago (after 2013) Introduced >=5 years ago (2013 and before) Month of onset Number of cases (lab + epi-linked + clinical) SEAR (excl. India) Rubella Case Distribution (March 2017-February 2019) Top 10 countries (last 12 M) label RCV in RI Cases % of Total Indonesia No 1194 76 Bangladesh 2012 282 18 Thailand 1993 55 3 Nepal 2013 29 2 Myanmar 2015 14 1 Timor-Leste 2016 5 100 200 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) SEAR (excl. India) Age distribution of Rubella cases by vaccine introduction status in the National EPI Programme (March 2018-February 2019) Notes: Based on data received Data Source: IVB Database. RCV in RI: Rubella-containing vaccine in Routine Immunization as of 31 Dec 2016.

Rubella cases: SEAR, India
200 400 600 800 1000 Not introduced in EPI Introduced <5 years ago (after 2013) Introduced >=5 years ago (2013 and before) Month of onset Number of cases (lab + epi-linked + clinical) SEAR, India Rubella Case Distribution (March 2017-February 2019) Top 10 countries (last 12 M) label RCV in RI Cases % of Total India No 1867 100 100 200 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) SEAR, India Age distribution of Rubella cases by vaccine introduction status in the National EPI Programme (March 2018-February 2019) Notes: Based on data received Data Source: IVB Database. RCV in RI: Rubella-containing vaccine in Routine Immunization as of 31 Dec 2016.

Rubella cases: WPR 200 400 600 800 1000 1200 Not introduced in EPI Introduced <5 years ago (after 2013) Introduced >=5 years ago (2013 and before) Month of onset Number of cases (lab + epi-linked + clinical) WPR Rubella Case Distribution (March 2017-February 2019) Top 10 countries (last 12 M) label RCV in RI Cases % of Total China 2008 3711 84 Japan 1989 388 9 Malaysia 1998 160 4 Philippines 2010 93 2 Viet Nam 2015 32 1 Singapore 1990 15 Lao People's Democratic Republic 2012 13 Cambodia 2013 5 Mongolia 2009 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 (March 2018-February 2019) Notes: Based on data received Data Source: IVB Database. RCV in RI: Rubella-containing vaccine in Routine Immunization as of 31 Dec 2016.

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 3158 2019 683

Rubella cases: Japan 100 200 300 Month of onset Number of cases 50 100
100 200 300 Clinical Epi Lab Month of onset Number of cases 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 Japan age distribution, vaccination status, and incidence, to 2 4 6 8 Incidence rate per 1,000,000 1.9 0.5 0.4 0.7 4.5 6.7 2.2 Year Confirmed Cases 2014 2015 2 2016 3 2017 5 2018 68 2019 320

(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

Laboratory

Measles and Rubella IgM Data Summary
2019 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 21/47 1856 518 (28) 48 (3) 1290 (70) 1085 109 (10) 42 (4) 934 (86) AMR 20/35 1486 1365 65 (5) 29 (2) 1208 (88) 1351 95 (7) 73 (5) 1116 (83) EMR 9/21 918 910 267 (29) 0 (0) 643 (71) 885 20 (2) 1 (0) 864 (98) EUR 32/53 6936 6062 3152 (52) 32 (1) 2828 (47) 3463 42 (1) 6 (0) 3411 (98) SEAR 11/11 3149 2871 1659 (58) 247 (9) 1326 (46) 1546 249 (16) 206 (13) 1396 (90) WPR 27/27 5143 4919 763 (16) 61 (1) 1427 (29) 4342 292 (7) 30 (1) 1161 (27) Total 120/194 19488 17983 6424 (36) 417 (2) 8722 (49) 12672 807 (6) 358 (3) 8882 (70) 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 40/47 40377 8857 (22) 1004 (2) 30516 (76) 30834 4602 (15) 1755 (6) 24477 (79) AMR 29/35 16389 14977 1467 (10) 182 (1) 13025 (87) 12542 421 (3) 389 (3) 11466 (91) EMR 20/21 60258 36590 12964 (35) 167 (0) 23459 (64) 33311 1725 (5) 361 (1) 31225 (94) EUR 38/53 59998 54741 18303 (33) 321 (1) 35837 (65) 35728 691 (2) 124 (0) 34889 (98) SEAR 11/11 34449 31397 11949 (38) 795 (3) 18633 (59) 21233 2762 (13) 547 (3) 17924 (84) WPR 27/27 34193 29602 5110 (17) 558 (2) 13800 (47) 24238 763 (3) 438 (2) 12362 (51) Total 165/194 245664 207684 58650 (28) 3027 (1) (65) 157886 10964 (7) 3614 (2) (84) Notes: Based on data received * Member States Reporting / Total Member States in Region

Measles and Rubella IgM Data Summary
Data as of March 2019 2019 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 21/47 1856 518 (28) 48 (3) 1290 (70) 1085 109 (10) 42 (4) 934 (86) AMR 20/35 1486 1365 65 (5) 29 (2) 1208 (88) 1351 95 (7) 73 (5) 1116 (83) EMR 9/21 918 910 267 (29) 0 (0) 643 (71) 885 20 (2) 1 (0) 864 (98) EUR 32/53 6936 6062 3152 (52) 32 (1) 2828 (47) 3463 42 (1) 6 (0) 3411 (98) SEAR 11/11 3149 2871 1659 (58) 247 (9) 1326 (46) 1546 249 (16) 206 (13) 1396 (90) WPR 27/27 5143 4919 763 (16) 61 (1) 1427 (29) 4342 292 (7) 30 (1) 1161 (27) Total 120/194 19488 17983 6424 (36) 417 (2) 8722 (49) 12672 807 (6) 358 (3) 8882 (70) Data as of March 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 24/47 2011 418 (21) 38 (2) 1555 (77) 1597 267 (17) 93 (6) 1237 (77) AMR 18/35 848 807 13 (2) 11 (1) 690 (86) 777 20 (3) 21 (3) 664 (85) EMR 6/21 1565 1025 649 (63) 0 (0) 376 (37) 748 17 (2) 1 (0) 730 (98) EUR 32/53 3798 4008 1061 (26) 31 (1) 2862 (71) 2424 37 (2) 5 (0) 2373 (98) SEAR 11/11 1735 1544 800 (52) 50 (3) 690 (45) 832 111 (13) 23 (3) 716 (86) WPR 27/27 1724 137 (8) 20 (1) 704 (41) 1574 36 (2) 655 (42) Total 118/194 11681 11119 3078 (28) 150 (1) 6877 (62) 7952 488 (6) 163 (2) 6375 (80) Notes: Based on data received and * Member States Reporting / Total Member States in Region

Performance of Surveillance

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

Supplementary Immunization Activities

Next 6 months MMR, MR and Measles campaigns
Region Name Activity Type Year StartDate EndDate Age Group(s) Extent Target AFR Benin CatchUp MR 2019 9 M-14 Y National Congo (the) FollowUp EMR Syrian Arab Republic (the) Measles - 7 M-11 Y Guinea-Bissau 9-59 M 287545 Mali Sierra Leone AMR Haiti Egypt NIDs 9 M-<6 Y Zimbabwe SEAR India 9 M-15 Y Rollover-Nat 180000 Cameroon Democratic Republic of the Congo (the) Nigeria United Republic of Tanzania WPR Solomon Islands 71707

Regional Bulletins and Newsletters

March 2019 Please note that all data contained within is provisional. The number of cases of measles and rubella officially reported by a member state.

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March 2019 Please note that all data contained within is provisional. The number of cases of measles and rubella officially reported by a member state.

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Presentation on theme: "March 2019 Please note that all data contained within is provisional. The number of cases of measles and rubella officially reported by a member state."— Presentation transcript:

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