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

October 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 October 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 43/47 205727 186010 26774 148590 10646 48610 56272 46422 18981 8973 2889 2192 1256 415 AMR 32/35 43607 6506 1 6505 110 246 274 387 389 754 2046 1785 515 EMR 20/21 32855 16920 9699 2093 5128 3408 4205 3297 2714 1758 892 529 107 10 EUR 53/53 108229 97527 57592 6699 33236 19289 18230 16954 15870 14096 7559 3636 1869 24 SEAR 11/11 94678 67604 51448 7958 8198 10337 12419 12385 11486 9347 5084 4343 1928 275 WPR 26/27 126424 49396 37449 2037 9910 7134 14731 11758 6391 3574 2654 1913 1178 63 Total 185/194 611520 423963 182963 167377 73623 88888 106103 91090 55829 38137 19832 14659 8123 1302 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 81837 55423 14270 33601 7552 2944 4307 5065 3887 2947 1774 1715 1296 1881 5141 9985 14481 AMR 32/35 30382 16689 3 16 84 152 291 204 410 139 645 2609 5952 6184 EMR 20/21 81042 57960 29432 16271 12257 3936 4891 8101 8032 9526 5663 4495 2774 3036 2395 2075 EUR 53/53 101392 87499 51094 4986 31419 5966 7191 8610 8946 8733 7741 5598 3705 2790 5478 9942 12799 SEAR 11/11 195417 158468 113721 36675 8072 17643 17970 28129 23964 21320 9748 6556 7210 5900 7177 5907 6944 WPR 26/27 81738 32568 20122 1823 10623 1941 2495 3417 3255 3097 2479 2283 2005 2020 2712 3316 3548 Total 184/194 571808 408607 228639 93356 86612 32433 36870 53406 48236 45914 27609 21057 17129 16272 26153 37497 46031 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 43/47 205727 186010 26774 148590 10646 48610 56272 46422 18981 8973 2889 2192 1256 415 AMR 32/35 43607 6506 1 6505 110 246 274 387 389 754 2046 1785 515 EMR 20/21 32855 16920 9699 2093 5128 3408 4205 3297 2714 1758 892 529 107 10 EUR 53/53 108229 97527 57592 6699 33236 19289 18230 16954 15870 14096 7559 3636 1869 24 SEAR 11/11 94678 67604 51448 7958 8198 10337 12419 12385 11486 9347 5084 4343 1928 275 WPR 26/27 126424 49396 37449 2037 9910 7134 14731 11758 6391 3574 2654 1913 1178 63 Total 185/194 611520 423963 182963 167377 73623 88888 106103 91090 55829 38137 19832 14659 8123 1302 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)
10000 20000 30000 40000 50000 60000 70000 80000 90000 100000 Measles cases (Lab+Epi+Clinical) Month of onset 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 151026 Ukraine 80184 India**** 71834 54.25 Philippines 48420 468.64 Nigeria 27396 147.3 Brazil 13605 65.52 Kazakhstan 10417 579.12 Yemen 10231 370.9 DR Congo 9495 120.59 Thailand 7713 112 Other countries with high incidence rates*** Country Cases Rate Georgia 4756 The Republic of North Macedonia 1902 913.89 Kyrgyzstan 2896 486.25 Israel 3782 461.68 Bosnia and Herzegovina 1396 396.95 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 06/08/2019 2019 6543 140,725 Somalia 131 9135 Somali EPI/POL Weekly Update Week 30 28 2397 Notes: Based on data received and covering the period between and Incidence: Number of cases / population* * 1,000,000 - * World population prospects, 2019 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 40784 India** 35904
Ukraine 31111 Philippines 20394 Nigeria 18644 Kazakhstan 6429 DR Congo 5742 Brazil 4379 Angola 2748 Myanmar 2711 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
10000 20000 30000 40000 50000 60000 Month of onset Number of measles cases Uganda South Sudan Others Nigeria Niger Madagascar Liberia Ghana Ethiopia DR Congo 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: Democratic Republic of the Congo
Due to surveillance gaps, case-based data is a poor representation of the current situation in DRC 1000 2000 3000 Discarded Clinical Epi Lab Month of onset Number of cases Sub-national (6-59 M) Cov: 118% National SIA Sub-national SIA 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 100 200 300 Incidence rate per 1,000,000 301.3 281.4 91.8 24.4 11.4 6.7 1.2 Year Confirmed Cases 2006 1012 2007 539 2008 214 2009 83 2010 208 2011 1651 2012 2332 2013 2527 2014 1649 2015 5029 2016 4860 2017 3597 2018 5624 2019 7422

Measles cases: Ethiopia
200 400 600 800 1000 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 Ethiopia age distribution, vaccination status, and incidence, to 20 40 60 80 100 Incidence rate per 1,000,000 74.9 88.8 42.5 21.7 23.5 13.2 1.9 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 2019 2602

Measles cases: Guinea 100 200 300 Discarded Clinical Epi Lab Month of onset Number of cases Data has not been reported to WHO via case-based surveillance, but as of the October 2 AFRO weekly partners update, there are 971 lab confirmed plus 1100 epidemiologically linked 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 Guinea age distribution, vaccination status, and incidence, to 100 300 500 Incidence rate per 1,000,000 478.3 394.2 82 15.5 4.8 1.6 0.4 Year Confirmed Cases 2006 2 2007 6 2008 92 2009 216 2010 58 2011 20 2012 14 2013 59 2014 2015 29 2016 334 2017 596 2018 517 2019 984

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 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 Nigeria age distribution, vaccination status, and incidence, to 200 400 600 Incidence rate per 1,000,000 509.3 643.7 205.2 77.4 20.5 6.8 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 7018 2019 26793

Measles case distribution (AMR), 2015-2019
Clustering at certain time points for Venezuela 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 Number of cases Month of onset 20000 15000 10000
5000 10000 15000 20000 Discarded Clinical Epi Lab Month of onset Number of cases National (1 -<5 Y) Cov: 98% National SIA Sub-national SIA Year Confirmed Cases 2008 2009 2010 68 2012 2 2013 192 2014 708 2015 214 2016 2017 2018 10326 2019 4476

Measles cases: Venezuela (Bolivarian Republic of)
Clustering at specific time points is an artifact of surveillance reporting to WHO 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 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 Venezuela (Bolivarian Republic of) age distribution, vaccination status, and incidence, to Incidence rate per 1,000,000 175.8 68.8 21.2 15.4 4.7 2.2 0.7 Year Confirmed Cases 2008 2009 2010 2011 2012 1 2013 2014 2015 2016 2017 727 2018 5668 2019 449

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 Tunisia Sudan Saudi Arabia Pakistan Others Lebanon 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 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 Pakistan age distribution, vaccination status, and incidence, to 50 100 150 200 250 300 Incidence rate per 1,000,000 256.1 113.3 63.8 10.4 1.5 0.5 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 1978

Measles case distribution (EUR), 2015-2019
2000 4000 6000 8000 10000 12000 14000 16000 18000 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: Kazakhstan
1000 2000 Discarded Clinical Epi Lab Month of onset Number of cases 1000 2000 3000 4000 <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 6000 8000 10000 Incidence rate per 1,000,000 8404.9 2108 410.1 218.1 100.4 355.9 211.5 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 9843

Measles cases: The Republic of North Macedonia
100 200 300 400 500 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 15-19 years 20-29 years 30+ years 0 doses 1 dose 2+ doses Unknown Age at onset Number of cases The Republic of North Macedonia age distribution, vaccination status, and incidence, to 2000 4000 6000 8000 10000 12000 14000 16000 Incidence rate per 1,000,000 3135.7 641.9 256.3 188 584 884.4 Year Confirmed Cases 2006 2007 2008 28 2009 3 2010 209 2011 731 2012 6 2013 4 2014 107 2015 1 2016 2017 20 2018 64 2019 1881

Measles cases: Poland Number of cases Month of onset
100 200 300 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 15-19 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 20 40 60 80 100 120 Incidence rate per 1,000,000 114.3 55.3 24.4 10.8 14.3 22 58 Year Confirmed Cases 2006 90 2007 74 2008 100 2009 162 2010 10 2011 38 2012 73 2013 83 2014 109 2015 48 2016 138 2017 63 2018 391 2019 1303

Measles cases: Ukraine
5000 10000 15000 Discarded Clinical Epi Lab Month of onset Number of cases 10000 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 5000 6000 7000 8000 9000 Incidence rate per 1,000,000 7958.4 5245.8 6143.8 6082.5 1819.5 1258.9 788.3 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 56430

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 6000 Discarded Clinical Epi Lab Month of onset Number of cases Sub-national (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 10 20 Incidence rate per 1,000,000 17.9 10.2 9.7 2.1 1.6 0.3 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 10778 2019 2238

Measles case distribution (SEAR, India), 2015-2019
5000 10000 15000 20000 25000 Month of onset Number of measles cases India Notes: Based on data received Data Source: IVB Database

Measles cases: India Number of cases Month of onset
20000 40000 60000 Discarded Clinical Epi Lab Month of onset Number of cases 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 India age distribution, vaccination status, and incidence, to 20 40 60 80 Incidence rate per 1,000,000 71.2 42.7 25.4 8.6 4.2 1.5 0.1 Year Confirmed Cases 2014 80306 2015 83026 2016 70798 2017 61288 2018 138852 2019 52950

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: Cambodia
100 200 300 Discarded 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 Cambodia age distribution, vaccination status, and incidence, to 100 Incidence rate per 1,000,000 91.3 52.5 31.9 12.1 5 1.9 Year Confirmed Cases 2006 188 2007 394 2008 1765 2009 865 2010 1156 2011 722 2012 2013 2014 2015 2016 56 2017 10 2018 3 2019 254

Measles cases: New Zealand
100 200 300 400 500 Discarded Clinical Epi Lab Month of onset Number of cases Due to reporting delays, recent data is not seen here. For the latest information is available here. 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 New Zealand age distribution, vaccination status, and incidence, to 500 1000 1500 2000 2500 Incidence rate per 1,000,000 2378.4 658.4 119.1 230.1 520.1 232.9 29.2 Year Confirmed Cases 2006 20 2007 37 2008 15 2009 253 2010 48 2011 599 2012 55 2013 17 2014 274 2015 11 2016 104 2017 2018 2019 997

(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 40/47 3004 241 379 662 591 315 292 291 213 20 AMR 27/35 4 2 EMR 19/21 1407 11 7 1389 48 97 200 389 384 191 88 10 EUR 30/53 492 371 6 115 75 77 68 70 71 41 42 SEAR 11/11 2966 1144 1822 528 1134 538 133 82 80 17 WPR 14/27 31500 2916 2358 26226 1158 1303 4195 7672 9143 5629 1825 573 Total 141/194 39373 3298 3515 32560 1763 2384 6259 9262 10128 6286 2334 918 39 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 3388 345 367 571 373 353 261 223 226 177 203 175 114 AMR 27/35 2 1 EMR 20/21 1521 149 313 1059 151 173 242 206 115 113 83 71 80 46 35 EUR 36/53 839 723 7 109 81 97 75 89 60 48 43 47 50 SEAR 11/11 4343 1461 2882 323 486 858 959 553 189 122 181 221 152 93 WPR 15/27 4422 358 132 3932 106 100 281 495 757 341 265 288 342 411 815 Total 151/194 14515 1230 1913 11372 1006 1224 2027 2131 1958 987 783 782 805 874 831 1107 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 40/47 3004 241 379 662 591 315 292 291 213 20 AMR 27/35 4 2 EMR 19/21 1407 11 7 1389 48 97 200 389 384 191 88 10 EUR 30/53 492 371 6 115 75 77 68 70 71 41 42 SEAR 11/11 2966 1144 1822 528 1134 538 133 82 80 17 WPR 14/27 31500 2916 2358 26226 1158 1303 4195 7672 9143 5629 1825 573 Total 141/194 39373 3298 3515 32560 1763 2384 6259 9262 10128 6286 2334 918 39 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 2593 337 362 560 353 344 218 221 161 37 AMR 24/35 2 1 EMR 20/21 876 92 49 735 103 117 160 128 126 90 89 56 7 EUR 36/53 662 585 6 71 82 97 75 93 81 63 74 SEAR 11/11 1490 55 1435 233 254 345 262 36 WPR 15/27 2549 142 47 2360 118 107 291 511 751 338 255 178 Total 147/194 8172 819 157 7196 873 938 1431 1352 1532 820 664 518 44 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 10000 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 30724 21.890 India 2374 1.790 Japan 2274 17.800 Nigeria 1423 7.650 Pakistan 1087 5.630 Indonesia 891 3.410 South Africa 456 8.140 Uganda 415 10.000 DR Congo 366 4.650 Poland 322 8.420 Other countries with high incidence rates*** Country Cases Rate Central African Republic 170 37.000 Congo 70 13.660 United Arab Emirates 95 10.250 Liberia 39 8.450 Notes: Based on data received and covering the period between and Incidence: Number of cases / population* * 1,000,000 - * 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 600 400 200 600 500 Number of cases (IgM+ only) 400
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 (October 2017-September 2019) Top 10 countries (last 12 M) label RCV in RI Cases % of Total Nigeria No 1412 40 South Africa 423 12 Uganda 385 11 Others - 351 10 DR Congo 331 9 Ethiopia 190 5 Central African Republic 170 Guinea 74 2 Congo 58 Cote d'Ivoire 2018 Mozambique 44 1 100 200 300 400 500 600 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 (October 2018-September 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 400 300 200 100 (lab + epi-linked + clinical) 200
100 200 300 400 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 (October 2017-September 2019) Top 10 countries (last 12 M) label RCV in RI Cases % of Total Pakistan No 1075 69 Sudan 116 7 United Arab Emirates 1985 95 6 Tunisia 2004 86 5 Yemen 2015 50 3 Afghanistan 2018 43 Saudi Arabia 1991 37 2 Others - 26 Libya 1995 16 1 Iran (Islamic Republic of) 15 Morocco 2014 9 100 200 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 (October 2018-September 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 20 150 (lab + epi-linked + clinical)
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 (October 2017-September 2019) Top 10 countries (last 12 M) label RCV in RI Cases % of Total Poland 1988 302 48 Ukraine 2001 149 24 Germany 1991 54 9 Turkey 2006 41 6 Russian Federation 2000 25 4 Italy 1972 18 3 Others - 17 Spain 1978 12 2 Georgia 2004 7 1 Bosnia and Herzegovina 1976 Ireland 1971 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 (October 2018-September 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 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 (October 2017-September 2019) Top 10 countries (last 12 M) label RCV in RI Cases % of Total Indonesia No 719 69 Bangladesh 2012 142 14 Thailand 1993 129 12 Nepal 2013 31 3 Myanmar 2015 17 2 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 (October 2018-September 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 Clinical Epi Lab Number of cases SIA (9 M-15 Y) Cov: 73% National SIA Sub-national SIA Year Confirmed Cases 2015 1379 2016 1170 2017 4499 2018 1637 2019 441 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 17.9 6.4 9.5 7.4 3 1 0.2

Rubella cases: Thailand
10 20 30 Clinical Epi Lab Number of cases Year Confirmed Cases 2015 36 2016 7 2017 24 2018 50 2019 102 10 20 30 40 <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 35.4 3.2 0.7 1 3.4 2.3 0.8

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 (October 2017-September 2019) Top 10 countries (last 12 M) label RCV in RI Cases % of Total India No 2374 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 (October 2018-September 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 10000 5000 (lab + epi-linked + clinical) 600
5000 10000 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 (October 2017-September 2019) Top 10 countries (last 12 M) label RCV in RI Cases % of Total China 2008 30479 92 Japan 1989 2263 7 Malaysia 1998 143 Philippines 2010 106 Viet Nam 2015 26 Cambodia 2013 24 Lao People's Democratic Republic 2012 8 Republic of Korea 1982 6 Singapore 1990 Papua New Guinea 5 Others - 2 200 400 600 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 (lab + epi-linked + clinical) WPR (Excl. China) Age distribution of Rubella cases by vaccine introduction status in the National EPI Programme (October 2018-September 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: Japan Latest information can be found here 100 200 300
100 200 300 400 500 Clinical Epi Lab Number of cases Latest information can be found here Year Confirmed Cases 2014 2015 2 2016 3 2017 5 2018 68 2019 2229 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 Male Female Unknown Age at onset Number of cases Japan age distribution, sex, and incidence, to 10 20 30 40 Incidence rate per 1,000,000 4.8 4.7 2 3 24.4 39.7 13.6

Rubella cases: Philippines
10 20 30 40 Clinical Epi Lab Number of cases SIA (6-59 M) Cov: 69% Cov: 32% National SIA Sub-national SIA Year Confirmed Cases 2014 343 2015 154 2016 165 2017 474 2018 151 2019 89 10 20 30 40 <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 Philippines age distribution, sex, and incidence, to 5 Incidence rate per 1,000,000 12.2 2 0.4 0.3 1.6 0.9 0.2

(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 37/47 32277 10920 (34) 927 (3) 20430 (63) 22721 3373 (15) 1019 (4) 18329 (81) AMR 29/35 10462 9312 508 (5) 110 (1) 8438 (91) 8807 453 (5) 209 (2) 7750 (88) EMR 20/21 27781 22351 5781 (26) 93 (0) 16477 (74) 21054 1802 (9) 200 (1) 19052 (90) EUR 40/53 88741 82093 35594 (43) 637 (1) 43828 (53) 45655 1362 (3) 131 (0) 44125 (97) SEAR 11/11 34037 30082 10921 (36) 1012 (3) 18975 (63) 20364 2225 (11) 733 (4) 18141 (89) WPR 27/27 50351 47655 9225 (19) 565 (1) 16905 (35) 35388 572 (2) 249 (1) 12206 (34) Total 164/194 243649 223770 72949 (33) 3344 (1) (56) 153989 9787 (6) 2541 (2) (78) 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 48173 10061 (21) 1246 (3) 36866 (77) 37127 5017 (14) 2064 (6) 30046 (81) AMR 30/35 20785 20106 1826 (9) 215 (1) 17643 (88) 16774 587 (3) 431 (3) 15356 (92) EMR 20/21 60852 36723 13053 (36) 168 (0) 23502 (64) 33488 1726 (5) 361 (1) 31401 (94) EUR 38/53 120487 109983 36782 (33) 644 (1) 71997 (65) 71582 1382 (2) 248 (0) 69904 (98) SEAR 11/11 34199 31313 11963 (38) 791 (3) 18539 (59) 20978 2562 (12) 526 (3) 17890 (85) WPR 27/27 34896 30327 5630 (19) 570 (2) 14368 (47) 24972 646 (3) 456 (2) 12961 (52) Total 167/194 319392 276625 79315 (29) 3634 (1) (66) 204921 11920 (6) 4086 (2) (87) Notes: Based on data received * Member States Reporting / Total Member States in Region

Measles and Rubella IgM Data Summary
Data as of October 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 37/47 32277 10920 (34) 927 (3) 20430 (63) 22721 3373 (15) 1019 (4) 18329 (81) AMR 29/35 10462 9312 508 (5) 110 (1) 8438 (91) 8807 453 (5) 209 (2) 7750 (88) EMR 20/21 27781 22351 5781 (26) 93 (0) 16477 (74) 21054 1802 (9) 200 (1) 19052 (90) EUR 40/53 88741 82093 35594 (43) 637 (1) 43828 (53) 45655 1362 (3) 131 (0) 44125 (97) SEAR 11/11 34037 30082 10921 (36) 1012 (3) 18975 (63) 20364 2225 (11) 733 (4) 18141 (89) WPR 27/27 50351 47655 9225 (19) 565 (1) 16905 (35) 35388 572 (2) 249 (1) 12206 (34) Total 164/194 243649 223770 72949 (33) 3344 (1) (56) 153989 9787 (6) 2541 (2) (78) Data as of October 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 37/47 22876 4839 (21) 569 (2) 17468 (76) 16606 2716 (16) 969 (6) 12921 (78) AMR 27/35 12645 11881 1100 (9) 115 (1) 10253 (86) 10337 348 (3) 236 (2) 9324 (90) EMR 20/21 28772 24784 8612 (35) 142 (1) 16030 (65) 21732 1054 (5) 422 (2) 20256 (93) EUR 37/53 43036 39003 13407 (34) 236 (1) 25098 (64) 23091 553 (2) 52 (0) 22465 (97) SEAR 11/11 19450 14693 5300 (36) 378 (3) 9005 (61) 9987 1521 (15) 292 (3) 8171 (82) WPR 27/27 22608 18218 3182 (17) 404 (2) 9926 (54) 14321 428 (3) 299 (2) 8237 (58) Total 159/194 149387 131455 36440 (28) 1844 (1) 87780 (67) 96074 6620 (7) 2270 (2) 81374 (85) 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 Nigeria FollowUp Measles 2019 9-59 M National Central African Republic (the) 6-59 M unknown 837841 EMR Somalia - 6 M-5 Y Cameroon MR Uganda CatchUp 9 M-14 Y Guinea South Sudan Egypt NIDs 9 M-<6 Y 1.8e+07 Burkina Faso Lesotho 2020 <15 Y 202214 SEAR Bangladesh Democratic Republic of the Congo (the) Sub-national WPR Micronesia (Federated States of) Campaign MMR

Regional Bulletins and Newsletters

October 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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October 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: "October 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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