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

July 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 July 2019"). For official data from , please visit our website.

Data source for data contained within this slide deck
The Global Measles and Rubella Report is based on surveillance data reported by Member States to the regional offices weekly or monthly. The regional compilation is reported to HQ monthly. Data are to be reported from the regions on the 1st Friday of the month, and HQ attempts to release the monthly report by the 3rd Monday of the month. Numbers of cases might differ from the official numbers reported annually as part of the WHO/UNICEF Joint reporting process (JRF). The difference can be due to the time lag as the annual data might not be complete at the time of reporting. In addition the difference can be due to multiple surveillance systems at country level. In these cases, the monthly data are extracted from the case based surveillance system while the annual data can be from the aggregated system. Types of data provided to WHO Epidemiologic Data: Case-based and/or Aggregate Reporting to WHO Epidemiologic data comes from Member States in one of two forms Case-based data, which is our recommendation, is provided by most member states. At WHO HQ, we collect a limited set of variables, including, age, date of onset, country reporting, 1st/2nd administrative unit of residence, vaccination status (by recall), date related to specimen collection/testing, and final classification. Regions might or might not collect more data than this. Often suspected cases with recent date of onset are not classified; however, at HQ we classify pending cases as clinically compatible and update the data if/when new data are provided to HQ. For AFR, we classify all cases that are rubella IgM positive as rubella laboratory-confirmed cases. Aggregated data on number of suspected, lab-confirmed, epi-linked, and clinically compatible cases of measles/rubella, by month/year of onset, and by subnational area (though some member states do not provide this level of disaggregation). Source for zero-reporting from some member-states though this is not a consistent process. A few member states send us both case-based and aggregated data as they have two different surveillance systems in the country. If both aggregate and case-based data are sent to HQ, numbers from aggregate surveillance are considered case counts for the country, while case-based data are used for the national slides to show age distribution, proportion vaccinated, and age-specific incidence. Limitations Reporting delays: It can take 2-3 months from the time a case is reported to public health in a member state to the time the data are provided to WHO HQ. Some of this is due to normal reporting delays that are expected as it takes time to get information from a health center to Geneva based on reporting frequencies set by various levels We are working to decrease the delays in reporting. Underreporting/lack of reporting Case definitions for suspect, epidemiologically linked and clinically compatible cases may vary between countries. Completeness of the data reported to WHO is unknown For this monthly update, pending cases are considered measles clinically compatible. These cases may later be discarded or confirmed based on laboratory testing in which case historical case counts may vary from one report to another. This could lead to differences between the Global monthly report and Regional or National surveillance bulletins published by WHO Offices and National authorities. ELISA Laboratory Data from the Global Measles and Rubella Laboratory Network (GMRLN) The Global Measles Rubella Laboratory Network laboratories report the number of samples received as well as the number of samples tested for IgM serology, as well as the number positive, negative and equivocal. These aggregated data are collected to account for the inadequate linking between laboratory and epidemiological data in some countries. Numbers of cases reported may differ from the number of samples tested positive for various reasons Samples tested positive in a laboratory may not reported to the surveillance system IgG screening results are inappropriately included in the surveillance database Inconsistent reporting from laboratories. This is based on the number of SAMPLES tested, not the number of CASES tested. One case can have multiple samples being tested (e.g. different specimen types, repeat specimen collection based on timing of collection). Data are only from network laboratories Non-network laboratories are not included Some laboratories don’t report IgG results are sometimes inappropriately reported Genotyping Data Genotyping data are obtained from the MeaNS ( and RubeNS ( Inadequate sample collection for genotyping challenges interpretation of the data Underreporting WHO recommends that Member States submit genotyping data to these databases, but it is not currently a requirement so there is underreporting Genotype data can’t be linked to epidemiologic data at the global level

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 41/47 124775 114744 27548 81979 5217 44434 31490 20775 11038 6225 782 AMR 31/35 8732 1849 109 246 268 379 355 492 EMR 19/21 20387 11399 6802 917 3680 3024 3600 2559 1662 513 41 EUR 53/53 86149 80359 49831 5087 25441 19025 17846 16482 15145 11847 14 SEAR 11/11 44939 32146 22502 4085 5559 5792 7344 7017 6280 5009 704 WPR 26/27 92002 29025 22701 1015 5309 4949 9720 8569 4661 1122 4 Total 181/194 376984 269522 129384 93083 47055 77333 70246 55670 39165 25071 2037 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 81808 55394 14242 33601 7551 2943 4307 5065 3887 2947 1774 1714 1296 1881 5135 9981 14464 AMR 32/35 29681 16689 3 16 84 152 291 204 410 139 645 2609 5952 6184 EMR 20/21 81037 57958 29430 16271 12257 3936 4891 8101 8031 9526 5663 4495 2774 3036 2395 2074 EUR 53/53 98301 84411 50974 4290 29147 5965 7150 7427 7737 8730 7131 5597 3705 2789 5477 9941 12762 SEAR 11/11 107088 83647 58143 18297 7207 8991 9151 14299 12215 10941 5038 3488 3846 3267 4432 3707 4272 WPR 26/27 79595 30530 18254 1742 10534 1924 2479 3388 3228 3051 2424 2221 1950 1926 2611 3028 2300 Total 184/194 477510 328629 171043 74201 83385 23762 27994 38364 35250 35486 22234 17925 13710 13544 23300 35004 42056 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 41/47 124775 114744 27548 81979 5217 44434 31490 20775 11038 6225 782 AMR 31/35 8732 1849 109 246 268 379 355 492 EMR 19/21 20387 11399 6802 917 3680 3024 3600 2559 1662 513 41 EUR 53/53 86149 80359 49831 5087 25441 19025 17846 16482 15145 11847 14 SEAR 11/11 44939 32146 22502 4085 5559 5792 7344 7017 6280 5009 704 WPR 26/27 92002 29025 22701 1015 5309 4949 9720 8569 4661 1122 4 Total 181/194 376984 269522 129384 93083 47055 77333 70246 55670 39165 25071 2037 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 26402 15869 10196 2820 2853 2630 3542 4081 2633 2314 669 AMR 30/35 9438 1940 3 14 75 129 151 1568 EMR 20/21 15425 8408 4079 503 3826 2017 1611 2178 1977 599 26 EUR 52/53 37775 33849 18992 1310 13547 5569 6369 6908 7072 7913 18 SEAR 11/11 47539 32248 28517 2013 1718 6294 5733 10226 9433 414 148 WPR 26/27 24360 11414 7116 348 3950 1921 2461 3229 2646 1157 Total 181/194 160939 103728 68900 6994 27834 18434 19730 26697 23890 12548 2429 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 70000 75000 80000 85000 Month of onset Measles cases (Lab+Epi+Clinical) AFR AMR EMR EUR SEAR WPR Notes: Based on data received Data Source: IVB Database - This is surveillance data, hence for the last month(s), the data may be incomplete.

(12M period) Top 10** Country Cases Rate
Madagascar 92181 Ukraine 85833 1931.5 India**** 41264 31.16 Philippines 32821 317.66 Nigeria 25044 134.65 Pakistan 11247 58.21 Yemen 10562 382.9 Brazil 9983 48.08 DR Congo 8971 113.94 Kazakhstan 8476 471.21 Other countries with high incidence rates*** Country Cases Rate Georgia 5024 The Republic of North Macedonia 1369 657.79 Kyrgyzstan 2982 500.69 Israel 4011 489.63 Bosnia and Herzegovina 1150 327 Measles cases from countries with known discrepancies between case-based and aggregate surveillance, as reported by country Country Year Cases in Case-based Cases in Aggregate Data Source for aggregate #s DR Congo 2018 5597 67072 SITUATION EPIDEMIOLOGIQUE DE LA ROUGEOLE EN RDC, Week of 09/07/2019 2019 6138 118,647 Somalia 131 9135 Somali EPI/POL Weekly Update Week 26 28 1967 Notes: Based on data received and covering the period between and Incidence: Number of cases / population* * 100,000 - * World population prospects, 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) ****WHO classifies all suspected measles cases reported from India as measles clinically compatible if a specimen was not collected as per the algorithm for classification of suspected measles in the WHO VPD Surveillance Standards. Thus numbers might be different between what WHO reports and what India reports.

(6M period) Top 10* Country Cases Madagascar 81836 Ukraine 60985
India** 24125 Nigeria 23884 Philippines 23246 Kazakhstan 8357 DR Congo 6246 Venezuela (Bolivarian Republic of) 5668 Myanmar 5075 Yemen 4613 Notes: Based on data received Surveillance data from to * Countries with highest number of cases for the period **WHO classifies all suspected measles cases reported from India as measles clinically compatible if a specimen was not collected as per the algorithm for classification of suspected measles in the WHO VPD Surveillance Standards. Thus numbers might be different between what WHO reports and what India reports.

Disclaimer *UN population data is used as the denominator for calculating incidence.

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 44000 46000 48000 Month of onset Number of measles cases Uganda Others Nigeria Niger Madagascar Liberia Ghana Ethiopia DR Congo Chad Cameroon 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.

Measles cases: Angola Number of cases Month of onset
500 1000 1500 Discarded Clinical Epi Lab Month of onset Number of cases National (6 M-14 Y) Cov: 93% 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 Angola age distribution, vaccination status, and incidence, to 100 200 300 400 Incidence rate per 1,000,000 420.8 458.6 143.1 28.1 14.4 5.1 2.9 Year Confirmed Cases 2006 825 2007 245 2008 120 2009 2441 2010 1390 2011 192 2012 4470 2013 6564 2014 12002 2015 103 2016 51 2017 27 2018 57 2019 2864

Measles cases: Democratic Republic of the Congo
1000 2000 3000 Discarded Clinical Epi Lab Month of onset Number of cases Due to surveillance gaps, case-based data is a poor representation of the current situation in DRC 1000 2000 3000 <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 1,000,000 265.9 258.5 87.7 20.8 9.6 5.5 1.1 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 6138

Measles cases: Ethiopia
100 200 300 400 500 600 Discarded Clinical Epi Lab Month of onset Number of cases Sub-national (6-179 M) Cov: 98% National SIA Sub-national SIA Cases are occurring but data has not been reported to WHO. > 4000 cases since Oct 2018 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 Ethiopia age distribution, vaccination status, and incidence, to 10 20 Incidence rate per 1,000,000 17.5 15.8 7.5 4.3 6.4 5.9 0.9 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
This is under-reporting. As of June 16, there were 147,608 cases and 1022 deaths reported for 2019, though outbreaks are over in some districts 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 5000 10000 15000 20000 25000 30000 35000 40000 45000 50000 <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 Madagascar age distribution, vaccination status, and incidence, to 1000 2000 3000 4000 6000 7000 8000 9000 11000 12000 13000 14000 16000 17000 18000 19000 21000 22000 23000 24000 26000 27000 28000 29000 31000 32000 33000 34000 36000 37000 38000 39000 41000 42000 43000 44000 46000 47000 48000 49000 51000 52000 53000 54000 55000 56000 57000 58000 59000 Incidence rate per 1,000,000 3465.3 2724.4 2379.9 1259 641.4 852.4 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 68664

Measles cases: Nigeria
5000 10000 Discarded Clinical Epi Lab Month of onset Number of cases National (9-59 M) Cov: 107% Cov: 106% National SIA Sub-national SIA 5000 10000 15000 <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 100 200 300 400 500 600 Incidence rate per 1,000,000 472.2 577.2 192.8 70 19.4 7.6 4.8 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 7018 2019 24157

Measles case distribution (AMR), 2015-2019
Aggregation of cases at a specific time point 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: Venezuela (Bolivarian Republic of)
Aggregation of cases at a specific time point is an artifact of reporting 2000 4000 6000 Discarded Clinical Epi Lab Month of onset Number of cases National (6 M-15 Y) Cov: 94% National SIA Sub-national SIA 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 Venezuela (Bolivarian Republic of) age distribution, vaccination status, and incidence, to Incidence rate per 1,000,000 398.9 141 40.4 25.9 13.2 4.6 2.3 Year Confirmed Cases 2008 2009 2010 2011 2012 1 2013 2014 2015 2016 2017 727 2018 5668 2019 332

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 Month of onset Number of measles cases Yemen United Arab Emirates Sudan Saudi Arabia Pakistan Others Lebanon Iraq Iran (Islamic Republic of) 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 <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 100 200 300 400 500 600 Incidence rate per 1,000,000 547.2 294.9 96.7 16.3 2.3 0.6 0.1 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 32921 2019 962

Measles cases: Sudan Number of cases Month of onset
200 400 600 800 1000 Discarded Clinical Epi Lab Month of onset Number of cases 1000 2000 3000 <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 1,000,000 939.9 559.8 203.9 63.8 59.4 51.9 7.8 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 4978 2019 2763

Measles cases: Yemen Yemen has not reported to WHO recently
1000 2000 Discarded Clinical Epi Lab Month of onset Number of cases Yemen has not reported to WHO recently 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 Incidence rate per 1,000,000 2022.2 1672.8 711.8 167 50.1 44.7 8.3 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 13621 2019 3469

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 20000 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: France Number of cases Month of onset
200 400 600 800 Discarded Clinical Epi Lab Month of onset Number of cases 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 France age distribution, vaccination status, and incidence, to Incidence rate per 1,000,000 333.4 138.5 53.9 37.1 45.7 43.1 4.4 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 518 2018 2913 2019 1526

Measles cases: Georgia
200 400 600 800 1000 1200 1400 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 Georgia age distribution, vaccination status, and incidence, to 3000 4000 5000 6000 7000 8000 9000 10000 11000 12000 Incidence rate per 1,000,000 3305.6 1155.3 1470.1 1878.5 1867.7 260.7 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 3737

Measles cases: Kazakhstan
1000 2000 Discarded Clinical Epi Lab Month of onset Number of cases 1000 2000 3000 <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 4000 5000 6000 7000 8000 Incidence rate per 1,000,000 7060.9 1735 306.4 172.6 76.5 281.1 169.7 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 7901

Measles cases: Kyrgyzstan
200 400 600 800 Discarded Clinical Epi Lab Month of onset Number of cases 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 Kyrgyzstan age distribution, vaccination status, and incidence, to 2000 3000 4000 5000 6000 7000 8000 9000 10000 Incidence rate per 1,000,000 8783.3 1691.4 240.9 93.2 190.8 96.5 35.7 Year Confirmed Cases 2006 26 2007 2 2008 16 2009 2010 1 2011 210 2012 2013 2014 318 2015 17779 2016 2017 5 2018 1104 2019 2106

Measles cases: Ukraine
5000 10000 15000 Discarded Clinical Epi Lab Month of onset Number of cases National SIA Sub-national SIA 5000 10000 15000 20000 <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 2000 3000 4000 6000 7000 8000 9000 Incidence rate per 1,000,000 8541.4 5771.9 6636 6489.7 1978.8 1355.4 814.7 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 50803

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
1000 2000 3000 Discarded Clinical Epi Lab Month of onset Number of cases Sub-national (9 M-15 Y) Cov: 101% 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 14.4 8.5 9.1 2.1 1.9 0.3 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 5389 2019 661

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 1717.9 613.9 219.8 108.5 132.8 81.2 6.9 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 3069

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 *WHO classifies all suspected measles cases reported from India as measles clinically compatible if a specimen was not collected as per the algorithm for classification of suspected measles in the WHO VPD Surveillance Standards. Thus numbers might be different between what WHO reports and what India reports

Measles cases: India* Number of cases Month of onset
10000 20000 30000 Discarded Clinical Epi Lab Month of onset Number of cases National SIA Sub-national SIA 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 India age distribution, vaccination status, and incidence, to 20 40 60 80 Incidence rate per 1,000,000 70.3 49.7 31.8 10.3 4.7 1.7 0.2 Year Confirmed Cases 2014 80306 2015 83026 2016 70798 2017 61288 2018 69391 2019 21543 *WHO classifies all suspected measles cases reported from India as measles clinically compatible if a specimen was not collected as per the algorithm for classification of suspected measles in the WHO VPD Surveillance Standards. Thus numbers might be different between what WHO reports and what India reports

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 Republic of Korea Philippines Others New Zealand Mongolia Malaysia Japan China Australia Notes: Based on data received Data Source: IVB Database

Measles cases: Philippines
5000 10000 15000 Discarded Clinical Epi Lab Month of onset Number of cases Sub-national (6-59 M) Cov: 69% Cov: 32% National SIA Sub-national SIA 5000 10000 <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 2000 3000 4000 Incidence rate per 1,000,000 4748.9 1091.7 196 105.7 246.2 149.3 16.8 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 20764 2019 21749

(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 37/47 1508 210 266 520 370 120 22 AMR 26/35 4 2 EMR 18/21 627 7 618 44 94 157 324 8 EUR 29/53 356 242 5 109 75 76 68 62 SEAR 11/11 2160 986 1174 235 526 998 329 60 12 WPR 14/27 22385 2261 1715 18409 1130 1283 4167 7601 8204 Total 135/194 27040 2510 2708 21822 1694 2245 5917 8694 8456 34 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 3387 345 367 571 373 353 261 223 226 177 203 175 113 AMR 27/35 2 1 EMR 20/21 1521 149 313 1059 151 173 242 206 115 83 71 80 46 35 EUR 36/53 854 736 7 111 98 75 97 90 81 61 73 50 45 49 52 SEAR 11/11 4447 1463 2984 333 494 870 965 573 130 191 227 211 153 WPR 15/27 4401 359 114 3928 105 95 276 493 757 341 264 220 287 339 408 816 Total 151/194 14612 1244 1897 11471 1017 1228 2034 2135 1979 1001 791 793 812 878 831 1113 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 37/47 1508 210 266 520 370 120 22 AMR 26/35 4 2 EMR 18/21 627 7 618 44 94 157 324 8 EUR 29/53 356 242 5 109 75 76 68 62 SEAR 11/11 2160 986 1174 235 526 998 329 60 12 WPR 14/27 22385 2261 1715 18409 1130 1283 4167 7601 8204 Total 135/194 27040 2510 2708 21822 1694 2245 5917 8694 8456 34 2018 Region Member States* Rubella cases Clin Epi Lab Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Date Received AFR 40/47 1787 328 291 502 320 283 63 AMR 24/35 2 1 EMR 19/21 315 5 310 65 86 95 6 EUR 28/53 298 253 43 52 53 56 66 71 SEAR 11/11 941 55 886 224 245 264 142 60 WPR 15/27 953 105 9 839 115 282 433 18 Total 137/194 4296 363 3867 784 781 1199 1025 438 69 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 6000 6500 7000 7500 8000 8500 9000 9500 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.

Other countries with high incidence rates***
(12M period) Top 10** Country Cases Rate China 23007 16.390 India 2018 1.520 Japan 1728 13.530 Indonesia 1002 3.840 Nigeria 865 4.650 Pakistan 521 2.700 Uganda 452 10.890 Poland 402 10.520 DR Congo 347 4.410 South Africa 321 5.730 Other countries with high incidence rates*** Country Cases Rate Central African Republic 138 30.040 Congo 106 20.680 Liberia 44 9.540 Yemen 249 9.030 United Arab Emirates 64 6.900 Tunisia 70 6.140 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)

Rubella cases: AFR 600 400 200 400 Number of cases (IgM+ only) 300 200
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 (July 2017-June 2019) Top 10 countries (last 12 M) label RCV in RI Cases % of Total Nigeria No 840 32 Uganda 450 17 DR Congo 331 13 Others - 287 11 South Africa 285 Central African Republic 143 5 Congo 101 4 Guinea 55 2 Mozambique 2018 46 Cote d'Ivoire 45 Angola 42 100 200 300 400 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 (July 2018-June 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 300 200 100 150 (lab + epi-linked + clinical)
100 200 300 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 (July 2017-June 2019) Top 10 countries (last 12 M) label RCV in RI Cases % of Total Pakistan No 483 46 Yemen 2015 201 19 Sudan 124 12 Tunisia 2004 68 6 United Arab Emirates 1985 63 Saudi Arabia 1991 36 3 Afghanistan 2018 28 Others - 18 2 Iran (Islamic Republic of) 15 1 Libya 1995 11 Morocco 2014 8 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) EMR Age distribution of Rubella cases by vaccine introduction status in the National EPI Programme (July 2018-June 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: EUR 100 80 60 40 20 (lab + epi-linked + clinical) 150
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 (July 2017-June 2019) Top 10 countries (last 12 M) label RCV in RI Cases % of Total Poland 1988 352 51 Ukraine 2001 180 26 Germany 1991 50 7 Turkey 2006 24 3 Others - 20 Italy 1972 18 Russian Federation 2000 Spain 1978 12 2 Georgia 2004 5 1 Romania 2002 4 Bosnia and Herzegovina 1976 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) EUR Age distribution of Rubella cases by vaccine introduction status in the National EPI Programme (July 2018-June 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: SEAR (excl. India)
100 200 300 400 500 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 (July 2017-June 2019) Top 10 countries (last 12 M) label RCV in RI Cases % of Total Indonesia No 935 74 Bangladesh 2012 154 12 Thailand 1993 119 9 Nepal 2013 26 2 Myanmar 2015 23 Timor-Leste 2016 3 100 200 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 (July 2018-June 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: Indonesia
100 200 300 400 500 Clinical Epi Lab Number of cases SIA (9 M-15 Y) Cov: 101% Cov: 73% National SIA Sub-national SIA Year Confirmed Cases 2015 1379 2016 1170 2017 4499 2018 1625 2019 285 50 100 150 200 250 <1 year 1-4 years 5-9 years 10-14 years 15-24 years 25-39 years 40+ years Male Female Unknown Age at onset Number of cases Indonesia age distribution, sex, and incidence, to 5 10 15 20 Incidence rate per 1,000,000 17.5 6 9.1 3.2 0.8 0.2

Rubella cases: Thailand
10 20 30 Clinical Epi Lab Number of cases Year Confirmed Cases 2015 36 2016 7 2017 24 2018 52 2019 81 10 20 30 <1 year 1-4 years 5-9 years 10-14 years 15-24 years 25-39 years 40+ years Male Female Unknown Age at onset Number of cases Thailand age distribution, sex, and incidence, to Incidence rate per 1,000,000 28.3 2.9 0.5 1.2 2.7 2 0.7

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 (July 2017-June 2019) Top 10 countries (last 12 M) label RCV in RI Cases % of Total India No 1909 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 (July 2018-June 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 8000 6000 4000 2000 (lab + epi-linked + clinical)
2000 4000 6000 8000 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 (July 2017-June 2019) Top 10 countries (last 12 M) label RCV in RI Cases % of Total China 2008 22692 92 Japan 1989 1727 7 Malaysia 1998 163 1 Philippines 2010 59 Viet Nam 2015 35 Cambodia 2013 15 Singapore 1990 12 Lao People's Democratic Republic 2012 9 Republic of Korea 1982 4 Papua New Guinea 2 Others - 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 (lab + epi-linked + clinical) WPR (Excl. China) Age distribution of Rubella cases by vaccine introduction status in the National EPI Programme (July 2018-June 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 10000 Number of cases 5000 Confirmed Cases Year
5000 10000 Clinical Epi Lab Number of cases Year Confirmed Cases 2014 11887 2015 8247 2016 4477 2017 1601 2018 3947 2019 20590

Rubella cases: Japan There is underreporting of rubella cases to WHO from Japan. As of week 26, there are 1896 cases, with 32 new cases in the past week. The latest data is available here. 100 200 300 400 500 Clinical Epi Lab Number of cases Year Confirmed Cases 2014 2015 2 2016 3 2017 5 2018 68 2019 1664 200 400 600 800 <1 year 1-4 years 5-9 years 10-14 years 15-24 years 25-39 years 40+ years Male Female Unknown Age at onset Number of cases Japan age distribution, sex, and incidence, to 10 20 30 Incidence rate per 1,000,000 3.9 3.3 1.3 2.9 18.4 30.1 10.4

(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 34/47 19268 6514 (34) 546 (3) 12208 (63) 12220 2088 (17) 636 (5) 9496 (78) AMR 27/35 5692 4942 306 (6) 75 (2) 4410 (89) 4516 292 (6) 153 (3) 3924 (87) EMR 19/21 17180 13228 3935 (30) 93 (1) 9200 (70) 12004 832 (7) 134 (1) 11038 (92) EUR 38/53 73048 66976 30230 (45) 567 (1) 34443 (51) 34695 920 (3) 119 (0) 33632 (97) SEAR 11/11 17863 15805 6412 (41) 310 (2) 9172 (58) 9818 1074 (11) 256 (3) 8622 (88) WPR 27/27 39943 21213 7137 (34) 295 (1) 11394 (54) 14962 1172 (8) 200 (1) 8371 (56) Total 156/194 172994 141432 54534 (39) 1886 (1) 80827 (57) 88215 6378 (7) 1498 (2) 75083 (85) 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 41/47 48227 10101 (21) 1255 (3) 36871 (76) 37143 5017 (14) 2064 (6) 30062 (81) AMR 29/35 18420 18202 1459 (8) 194 (1) 16118 (89) 15563 496 (3) 353 (2) 14312 (92) EMR 20/21 60852 36723 13053 (36) 168 (0) 23502 (64) 33488 1726 (5) 361 (1) 31401 (94) EUR 38/53 120470 109966 36776 (33) 644 (1) 71986 (65) 71582 1382 (2) 248 (0) 69904 (98) SEAR 11/11 34075 31209 11945 (38) 790 (3) 18454 (59) 20872 2561 (12) 519 (2) 17792 (85) WPR 27/27 34896 30327 5630 (19) 570 (2) 14368 (47) 24972 646 (3) 456 (2) 12961 (52) Total 166/194 316940 274654 78964 (29) 3621 (1) (66) 203620 11828 (6) 4001 (2) (87) Notes: Based on data received * Member States Reporting / Total Member States in Region

Measles and Rubella IgM Data Summary
Data as of July 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 34/47 19268 6514 (34) 546 (3) 12208 (63) 12220 2088 (17) 636 (5) 9496 (78) AMR 27/35 5692 4942 306 (6) 75 (2) 4410 (89) 4516 292 (6) 153 (3) 3924 (87) EMR 19/21 17180 13228 3935 (30) 93 (1) 9200 (70) 12004 832 (7) 134 (1) 11038 (92) EUR 38/53 73048 66976 30230 (45) 567 (1) 34443 (51) 34695 920 (3) 119 (0) 33632 (97) SEAR 11/11 17863 15805 6412 (41) 310 (2) 9172 (58) 9818 1074 (11) 256 (3) 8622 (88) WPR 27/27 39943 21213 7137 (34) 295 (1) 11394 (54) 14962 1172 (8) 200 (1) 8371 (56) Total 156/194 172994 141432 54534 (39) 1886 (1) 80827 (57) 88215 6378 (7) 1498 (2) 75083 (85) Data as of July 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 36/47 14586 3291 (23) 420 (3) 10875 (75) 9765 1616 (17) 576 (6) 7573 (78) AMR 26/35 8152 8008 582 (7) 67 (1) 7036 (88) 7239 343 (5) 163 (2) 6362 (88) EMR 20/21 14104 11620 4159 (36) 32 (0) 7429 (64) 9412 410 (4) 78 (1) 8924 (95) EUR 37/53 30579 28102 9695 (34) 172 (1) 18018 (64) 14809 273 (2) 28 (0) 14489 (98) SEAR 11/11 13573 9546 3479 (36) 264 (3) 5793 (61) 6621 1078 (16) 193 (3) 5346 (81) WPR 27/27 13376 11534 2076 (18) 227 (2) 5838 (51) 9131 253 (3) 168 (2) 4639 (51) Total 157/194 94370 83396 23282 (28) 1182 (1) 54989 (66) 56977 3973 (7) 1206 (2) 47333 (83) 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 SEAR India CatchUp MR 2019 - 9 M-15 Y Rollover-Nat 180000 AFR Democratic Republic of the Congo (the) FollowUp Measles 6-59 M Sub-national Kenya 9 M-5 Y National Nigeria 9-59 M AMR Guatemala Campaign MMR 1-6 Y WPR Solomon Islands 1-4 Y 68173 Niger (the) Zimbabwe Uganda 9 M->15 Y United Republic of Tanzania Madagascar EMR Djibouti Bangladesh Democratic People's Republic of Korea (the) 9 M-14 Y Myanmar Nepal Cameroon Central African Republic (the) unknown 837841 Guinea South Sudan Egypt NIDs 9 M-<6 Y 1.8e+07 Somalia 6 M-5 Y Burkina Faso

Regional Bulletins and Newsletters

July 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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July 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: "July 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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