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Global Measles and Rubella Update April 2019

Global Measles and Rubella Update April 2019.

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Global Measles and Rubella Update April 2019

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  1. Global Measles and Rubella Update April 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 April 2019”). For official data from 1980-2017, please visit our website.

  2. 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). • Limitations • 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 (www.who-measles.org) and RubeNS (www.who-rubella.org). • Limitations • 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

  3. Measles

  4. Number of Reported Measles Cases by WHO Regions • Notes: Based on data received 2019-04 - This is surveillance data, hence for the last month, the data may be incomplete. * Member States Reporting / Total Member States in Region

  5. Number of Reported Measles Cases by WHO Regions • Notes: Based on data received 2019-04 and 2018-04 - This is surveillance data, hence for the last month, the data may be incomplete. * Member States Reporting / Total Member States in Region

  6. Measles case distribution by month and WHO Region (2015-2019) 75000 70000 65000 60000 55000 50000 45000 40000 Measles cases (Lab+Epi+Clinical) 35000 30000 25000 20000 15000 10000 5000 0 2015-03 2016-03 2017-03 2018-03 2019-03 2015-01 2015-02 2015-04 2015-05 2015-06 2015-07 2015-08 2015-09 2015-10 2015-11 2015-12 2016-01 2016-02 2016-04 2016-05 2016-06 2016-07 2016-08 2016-09 2016-10 2016-11 2016-12 2017-01 2017-02 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-04 Month of onset SEAR EUR AFR AMR EMR WPR Notes: Based on data received 2019-04 - Data Source: IVB Database - This is surveillance data, hence for the last month(s), the data may be incomplete.

  7. Measles Incidence Rate per Million (12M period) • Notes: Based on data received 2019-04 and covering the period between 2018-03 and 2019-02 –DRC and Somalia incidence on the map is a reflection of the numbers in this monthly case-based data not the number reported in aggregate surveillance as shown in the table. 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)

  8. Number of Reported Measles Cases (6M period) • Notes: Based on data received 2019-04 - Surveillance data from 2018-09 to 2019-02 - * Countries with highest number of cases for the period

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

  10. Measles case distribution (AFR), 2015-2019 44000 Uganda Ethiopia Equatorial Guinea 42000 Others DR Congo Nigeria 40000 Niger Chad 38000 Madagascar Cameroon 36000 Liberia 34000 32000 30000 28000 26000 24000 Number of measles cases 22000 20000 18000 16000 14000 12000 10000 8000 6000 4000 2000 0 2015-01 2015-02 2015-03 2015-04 2015-05 2015-06 2015-07 2015-08 2015-09 2015-10 2015-11 2015-12 2016-01 2016-02 2016-03 2016-04 2016-05 2016-06 2016-07 2016-08 2016-09 2016-10 2016-11 2016-12 2017-01 2017-02 2017-03 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 Month of onset Notes: Based on data received 2019-04 - 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.

  11. Measles cases: Central African Republic 200 Number of cases 100 0 Discarded 2017-03 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 Clinical Epi Lab Month of onset Central African Republic age distribution, vaccination status, and incidence, 2018-03 to 2019-02 60 153.7 150 50 40 96.7 100 Incidence rate per 1,000,000 Number of cases 30 20 50 12.9 10 6.8 6 4.8 0 0 0 <1 year 1-4 years 5-9 years 10-14 years 15-24 years 25-39 years 40+ years Age at onset 0 doses 1 dose 2+ doses Unknown

  12. Measles cases: Cameroon 800 600 Number of cases 400 200 0 Discarded 2017-03 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 Clinical Epi Lab Month of onset Cameroon age distribution, vaccination status, and incidence, 2018-03 to 2019-02 1000 304.8 300 275.3 800 200 600 Incidence rate per 1,000,000 Number of cases 400 85.6 100 200 30.4 10.1 7.4 2 0 0 <1 year 1-4 years 5-9 years 10-14 years 15-24 years 25-39 years 40+ years Age at onset 0 doses 1 dose 2+ doses Unknown

  13. Measles cases: Chad 1500 1000 Number of cases 500 0 Discarded 2017-03 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 Clinical Epi Lab Month of onset Chad age distribution, vaccination status, and incidence, 2018-03 to 2019-02 2000 780.7 800 696.7 1500 600 Incidence rate per 1,000,000 Number of cases 1000 400 312.7 176.8 500 200 119 88.5 15.9 0 0 <1 year 1-4 years 5-9 years 10-14 years 15-24 years 25-39 years 40+ years Age at onset 0 doses 1 dose 2+ doses Unknown

  14. Measles cases: Democratic Republic of the Congo Due to surveillance gaps, case-based data is a poor representation of the current situation in DRC 1500 1000 Number of cases 500 0 Discarded 2017-03 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 Clinical Epi Lab Month of onset Democratic Republic of the Congo age distribution, vaccination status, and incidence, 2018-03 to 2019-02 4000 301.1 281.9 300 3000 200 Incidence rate per 1,000,000 Number of cases 2000 111.2 100 1000 21.6 9.8 4.7 0.9 0 0 <1 year 1-4 years 5-9 years 10-14 years 15-24 years 25-39 years 40+ years Age at onset 0 doses 1 dose 2+ doses Unknown

  15. Measles cases: Ethiopia Sub-national (6-179 M) Cov: 98% Cases are occurring but data has not been reported to WHO. Approximately 4000 cases since Oct 2018 600 500 400 Number of cases 300 200 100 0 Discarded 2017-03 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 Clinical Epi National SIA Sub-national SIA Lab Month of onset Ethiopia age distribution, vaccination status, and incidence, 2018-03 to 2019-02 250 21.4 19.3 20 200 150 Incidence rate per 1,000,000 Number of cases 10.2 10 10 100 7.2 5.9 50 1.1 0 0 <1 year 1-4 years 5-9 years 10-14 years 25-39 years 40+ years 15-24 years Age at onset 0 doses 1 dose 2+ doses Unknown

  16. Measles cases: Madagascar Sub-national (9 M-14 Y) Cov: 94% 40000 30000 Number of cases 20000 10000 0 Discarded 2017-03 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 Clinical Epi National SIA Sub-national SIA Lab Month of onset Madagascar age distribution, vaccination status, and incidence, 2018-03 to 2019-02 51000 50000 40000 49000 48000 47000 43146.6 46000 45000 44000 35000 43000 42000 41000 40000 39000 38000 37000 30000 36000 35000 34000 33000 32000 31000 25000 30000 29000 28000 27000 Incidence rate per 1,000,000 26000 Number of cases 25000 24000 20000 23000 22000 21000 20000 19000 18000 15000 17000 16000 15000 14000 13000 12000 11000 10000 10000 9000 8000 7000 6000 5000 1634 1452.8 5000 1305.5 4000 795.7 702 412.7 3000 2000 1000 0 0 <1 year 1-4 years 5-9 years 10-14 years 15-24 years 25-39 years 40+ years Age at onset 0 doses 1 dose 2+ doses Unknown

  17. Measles cases: Nigeria National (9-59 M) National (9-59 M) Cov: 107% Cov: 106% 3000 2000 Number of cases 1000 0 Discarded 2017-03 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 Clinical Epi National SIA Sub-national SIA Lab Month of onset Nigeria age distribution, vaccination status, and incidence, 2018-03 to 2019-02 165.3 4000 157.1 150 3000 Incidence rate per 1,000,000 100 Number of cases 2000 66.3 50 1000 21.5 5.1 2.5 1 0 0 <1 year 1-4 years 5-9 years 10-14 years 15-24 years 25-39 years 40+ years Age at onset 0 doses 1 dose 2+ doses Unknown

  18. Measles cases: South Sudan National (6-59 M) Cov: 84% 400 300 Number of cases 200 100 0 Discarded 2017-03 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 Clinical Epi National SIA Sub-national SIA Lab Month of onset South Sudan age distribution, vaccination status, and incidence, 2018-03 to 2019-02 250 241.9 250 200 200 147.2 150 150 Incidence rate per 1,000,000 Number of cases 100 100 52.4 37.5 50 50 6.4 5.5 0 0 0 <1 year 1-4 years 5-9 years 10-14 years 25-39 years 40+ years 15-24 years Age at onset 0 doses 1 dose 2+ doses Unknown

  19. Measles case distribution (AMR), 2015-2019 The clustering of cases at specific time points is an artifact of reporting Venezuela (Bolivarian Republic of) Colombia 6500 USA Chile Canada Peru 6000 Others Brazil Argentina Mexico 5500 Costa Rica 5000 4500 4000 3500 Number of measles cases 3000 2500 2000 1500 1000 500 0 2015-01 2015-02 2015-03 2015-04 2015-05 2015-06 2015-07 2015-08 2015-09 2015-10 2015-11 2015-12 2016-01 2016-02 2016-03 2016-04 2016-05 2016-06 2016-07 2016-08 2016-09 2016-10 2016-11 2016-12 2017-01 2017-02 2017-03 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 Month of onset Notes: Based on data received 2019-04 - Data Source: IVB Database

  20. Measles cases: Brazil 6000 4000 Number of cases 2000 0 Discarded 2017-03 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 Clinical Epi Lab Month of onset

  21. Measles cases: Venezuela (Bolivarian Republic of) The clustering of cases at specific time points is an artifact of reporting Sub-national (6 M-15 Y) 6000 4000 Number of cases 2000 0 Discarded 2017-03 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 Clinical Epi National SIA Sub-national SIA Lab Month of onset Venezuela (Bolivarian Republic of) age distribution, vaccination status, and incidence, 2018-03 to 2019-02 1500 1200 1377.4 1000 1000 800 Incidence rate per 1,000,000 Number of cases 600 465.7 500 400 127.3 200 95.1 30.1 11.7 6.6 0 0 <1 year 1-4 years 5-9 years 10-14 years 15-24 years 25-39 years 40+ years Age at onset 0 doses 1 dose 2+ doses Unknown

  22. Measles case distribution (EMR), 2015-2019 10500 Libya Yemen 10000 United Arab Emirates Lebanon 9500 Iraq Sudan Egypt Saudi Arabia 9000 Afghanistan Pakistan 8500 Others 8000 7500 7000 6500 6000 5500 Number of measles cases 5000 4500 4000 3500 3000 2500 2000 1500 1000 500 0 2015-01 2015-02 2015-03 2015-04 2015-05 2015-06 2015-07 2015-08 2015-09 2015-10 2015-11 2015-12 2016-01 2016-02 2016-03 2016-04 2016-05 2016-06 2016-07 2016-08 2016-09 2016-10 2016-11 2016-12 2017-01 2017-02 2017-03 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 Month of onset Notes: Based on data received 2019-04 - Data Source: IVB Database

  23. Measles cases: Pakistan 8000 6000 Number of cases 4000 2000 0 Discarded 2017-03 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 Clinical Epi National SIA Sub-national SIA Lab Month of onset Pakistan age distribution, vaccination status, and incidence, 2018-03 to 2019-02 1500 1371.1 15000 1000 10000 756.6 Incidence rate per 1,000,000 Number of cases 500 5000 221 42.3 6.1 0.4 2.2 0 0 <1 year 1-4 years 5-9 years 10-14 years 25-39 years 40+ years 15-24 years Age at onset 0 doses 1 dose 2+ doses Unknown

  24. Measles cases: Sudan 1000 800 600 Number of cases 400 200 0 Discarded 2017-03 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 Clinical Epi Lab Month of onset Sudan age distribution, vaccination status, and incidence, 2018-03 to 2019-02 2500 828.1 800 2000 600 481.9 1500 Incidence rate per 1,000,000 Number of cases 400 1000 148.8 200 500 57.9 51 49.9 7.6 0 0 <1 year 1-4 years 5-9 years 10-14 years 25-39 years 40+ years 15-24 years Age at onset 0 doses 1 dose 2+ doses Unknown

  25. Measles cases: Tunisia 600 500 400 Number of cases 300 200 100 0 Discarded 2017-03 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 Clinical Epi Lab Month of onset Tunisia age distribution, vaccination status, and incidence, 2018-03 to 2019-02 200 1000 903.6 800 150 600 Incidence rate per 1,000,000 Number of cases 100 400 50 200 116.1 29.2 19.1 10.1 8.5 6.9 0 0 <1 year 1-4 years 5-9 years 10-14 years 15-24 years 25-39 years 40+ years Age at onset 0 doses 1 dose 2+ doses Unknown

  26. Measles case distribution (EUR), 2015-2019 20000 Ukraine Kazakhstan Italy Serbia 19000 Germany Russian Federation 18000 Georgia Romania 17000 Others France Kyrgyzstan 16000 15000 14000 13000 12000 11000 Number of measles cases 10000 9000 8000 7000 6000 5000 4000 3000 2000 1000 0 2015-01 2015-02 2015-03 2015-04 2015-05 2015-06 2015-07 2015-08 2015-09 2015-10 2015-11 2015-12 2016-01 2016-02 2016-03 2016-04 2016-05 2016-06 2016-07 2016-08 2016-09 2016-10 2016-11 2016-12 2017-01 2017-02 2017-03 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 Month of onset Notes: Based on data received 2019-04 - Data Source: IVB Database

  27. Measles cases: Azerbaijan 150 100 Number of cases 50 0 Discarded 2017-03 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 Clinical Epi Lab Month of onset Azerbaijan age distribution, vaccination status, and incidence, 2018-03 to 2019-02 140 80 73.1 120 100 60 44.1 80 Incidence rate per 1,000,000 Number of cases 40 60 29.1 26.9 20.1 40 20 10.2 5.1 20 0 0 <1 year 1-4 years 5-9 years 10-14 years 15-24 years 25-39 years 40+ years Age at onset 0 doses 1 dose 2+ doses Unknown

  28. Measles cases: Georgia 1400 1200 1000 800 Number of cases 600 400 200 0 Discarded 2017-03 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 Clinical Epi Lab Month of onset Georgia age distribution, vaccination status, and incidence, 2018-03 to 2019-02 1200 4969.6 5000 1000 4000 800 Incidence rate per 1,000,000 3000 Number of cases 600 1941.8 2000 400 1169.9 1129 1006.4 840.2 1000 200 150.3 0 0 <1 year 1-4 years 5-9 years 10-14 years 25-39 years 40+ years 15-24 years Age at onset 0 doses 1 dose 2+ doses Unknown

  29. Measles cases: Israel 1000 800 600 Number of cases 400 200 0 Discarded 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 Clinical Epi Lab Month of onset Israel age distribution, vaccination status, and incidence, 2018-03 to 2019-02 1200 3919.9 1000 4000 800 3000 Incidence rate per 1,000,000 Number of cases 600 2000 1445.5 400 821 1000 435.9 200 316.3 195.8 108.7 0 0 <1 year 1-4 years 5-9 years 10-14 years 15-24 years 25-39 years 40+ years Age at onset 0 doses 1 dose 2+ doses Unknown

  30. Measles cases: Kazakhstan 2000 Number of cases 1000 0 Discarded 2017-03 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 Clinical Epi Lab Month of onset Kazakhstan age distribution, vaccination status, and incidence, 2018-03 to 2019-02 1500 4000 3682.3 3000 1000 Incidence rate per 1,000,000 Number of cases 2000 500 848.1 1000 121.8 114.9 71.2 59.6 31.1 0 0 <1 year 1-4 years 5-9 years 10-14 years 15-24 years 20-29 years 30+ years Age at onset 0 doses 1 dose 2+ doses Unknown

  31. Measles cases: Kyrgyzstan 600 400 Number of cases 200 0 Discarded 2017-03 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 Clinical Epi Lab Month of onset Kyrgyzstan age distribution, vaccination status, and incidence, 2018-03 to 2019-02 7000 6159.5 1000 6000 800 5000 4000 600 Incidence rate per 1,000,000 Number of cases 3000 400 2000 1168.4 200 1000 164.5 126.6 53.8 51.8 25.7 0 0 <1 year 1-4 years 5-9 years 10-14 years 15-24 years 25-39 years 40+ years Age at onset 0 doses 1 dose 2+ doses Unknown

  32. Measles cases: Ukraine 15000 10000 Number of cases 5000 0 Discarded 2017-03 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 Clinical Epi National SIA Sub-national SIA Lab Month of onset Ukraine age distribution, vaccination status, and incidence, 2018-03 to 2019-02 8000 7277.5 15000 7000 5898.9 5539.7 6000 5267 5000 10000 Incidence rate per 1,000,000 Number of cases 4000 3000 5000 1728.8 2000 1148.8 598.5 1000 0 0 <1 year 1-4 years 5-9 years 10-14 years 15-24 years 20-29 years 30+ years Age at onset 0 doses 1 dose 2+ doses Unknown

  33. Measles case distribution (SEAR (excl. India)), 2015-2019 3500 Timor-Leste Maldives Thailand Indonesia Sri Lanka DPR Korea Nepal Bhutan 3000 Myanmar Bangladesh 2500 2000 Number of measles cases 1500 1000 500 0 2015-01 2015-02 2015-03 2015-04 2015-05 2015-06 2015-07 2015-08 2015-09 2015-10 2015-11 2015-12 2016-01 2016-02 2016-03 2016-04 2016-05 2016-06 2016-07 2016-08 2016-09 2016-10 2016-11 2016-12 2017-01 2017-02 2017-03 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 Month of onset Notes: Based on data received 2019-04 - Data Source: IVB Database

  34. Measles cases: Indonesia Sub-national (9 M-15 Y) Rollover-Nat (9 M-15 Y) Cov: 101% Cov: 73% 4000 3000 Number of cases 2000 1000 0 Discarded 2017-03 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 Clinical Epi National SIA Sub-national SIA Lab Month of onset Indonesia age distribution, vaccination status, and incidence, 2018-03 to 2019-02 250 14.8 15 200 9.2 150 10 8.4 Incidence rate per 1,000,000 Number of cases 100 4.5 5 2.6 50 0.6 0 0 0 <1 year 1-4 years 5-9 years 10-14 years 15-24 years 25-39 years 40+ years Age at onset 0 doses 1 dose 2+ doses Unknown

  35. Measles case distribution (SEAR, India), 2015-2019 India 15000 10000 Number of measles cases 5000 0 2015-01 2015-02 2015-03 2015-04 2015-05 2015-06 2015-07 2015-08 2015-09 2015-10 2015-11 2015-12 2016-01 2016-02 2016-03 2016-04 2016-05 2016-06 2016-07 2016-08 2016-09 2016-10 2016-11 2016-12 2017-01 2017-02 2017-03 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 Month of onset Notes: Based on data received 2019-04 - Data Source: IVB Database

  36. Measles cases: India 30000 20000 Number of cases 10000 0 Discarded 2017-03 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 Clinical Epi National SIA Sub-national SIA Lab Month of onset India age distribution, vaccination status, and incidence, 2018-03 to 2019-02 10000 100 88.2 82.1 80 60 49.7 Incidence rate per 1,000,000 Number of cases 5000 40 20 12.6 4.1 1.2 0.2 0 0 <1 year 1-4 years 5-9 years 10-14 years 15-24 years 25-39 years 40+ years Age at onset 0 doses 1 dose 2+ doses Unknown

  37. Measles cases: Myanmar 1400 1200 1000 800 Number of cases 600 400 200 0 Discarded 2017-03 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 Clinical Epi Lab Month of onset Myanmar age distribution, vaccination status, and incidence, 2018-03 to 2019-02 1200 300 264.8 1000 244 250 800 200 149.3 Incidence rate per 1,000,000 Number of cases 600 150 400 100 60.4 50.2 50 25.6 200 1.1 0 0 <1 year 1-4 years 5-9 years 10-14 years 15-24 years 25-39 years 40+ years Age at onset 0 doses 1 dose 2+ doses Unknown

  38. Measles cases: Thailand 2000 Number of cases 1000 0 Discarded 2017-03 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 Clinical Epi Lab Month of onset Thailand age distribution, vaccination status, and incidence, 2018-03 to 2019-02 2000 1528.4 1500 1500 1000 Incidence rate per 1,000,000 Number of cases 1000 561.2 500 500 202.2 109 102.3 68.1 4.3 0 0 <1 year 1-4 years 5-9 years 10-14 years 15-24 years 25-39 years 40+ years Age at onset 0 doses 1 dose 2+ doses Unknown

  39. Measles case distribution (WPR), 2015-2019 18000 Malaysia Viet Nam Singapore Japan Philippines China 16000 Others Cambodia New Zealand Australia Mongolia 14000 12000 10000 Number of measles cases 8000 6000 4000 2000 0 2015-01 2015-02 2015-03 2015-04 2015-05 2015-06 2015-07 2015-08 2015-09 2015-10 2015-11 2015-12 2016-01 2016-02 2016-03 2016-04 2016-05 2016-06 2016-07 2016-08 2016-09 2016-10 2016-11 2016-12 2017-01 2017-02 2017-03 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 Month of onset Notes: Based on data received 2019-04 - Data Source: IVB Database

  40. Measles cases: Philippines 3000 2000 Number of cases 1000 0 Discarded 2017-03 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 Clinical Epi Lab Month of onset Philippines age distribution, vaccination status, and incidence, 2018-03 to 2019-02 8000 3000 2632.4 6000 2000 Incidence rate per 1,000,000 Number of cases 4000 1000 773.1 2000 129.9 119.5 66.8 62.9 8.4 0 0 <1 year 1-4 years 5-9 years 10-14 years 15-24 years 25-39 years 40+ years Age at onset 0 doses 1 dose 2+ doses Unknown

  41. Distribution of measles genotypes (last 12 months) • Notes: Data Source: MeaNS database (Genotypes) and IVB Database (Incidence) as of 2019-04-09 and covering the period 2018-03-01 to 2019-02-28 - Pie charts proportional to the number of sequenced viruses

  42. Rubella

  43. Number of Reported Rubella Cases by WHO Regions • Notes: Based on data received 2019-04 - This is surveillance data, hence for the last month, the data may be incomplete. * Member States Reporting / Total Member States in Region

  44. Number of Reported Rubella Cases by WHO Regions • Notes: Based on data received 2019-04 and 2018-04- This is surveillance data, hence for the last month, the data may be incomplete. * Member States Reporting / Total Member States in Region

  45. Rubella Case Distribution by Month and WHO Region (2015-2019) WPR 5000 SEAR EUR 4500 EMR 4000 AMR AFR 3500 3000 Rubella cases (Lab+Epi+Clinical) 2500 2000 1500 1000 500 0 2015-01 2015-02 2015-03 2015-04 2015-05 2015-06 2015-07 2015-08 2015-09 2015-10 2015-11 2015-12 2016-01 2016-02 2016-03 2016-04 2016-05 2016-06 2016-07 2016-08 2016-09 2016-10 2016-11 2016-12 2017-01 2017-02 2017-03 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 Month of onset Notes: Based on data received 2019-04 - Data Source: IVB Database - This is surveillance data, hence for the last months, the data may be incomplete. AFR had rubella cases prior to January 2018, but reporting only commenced in January 2018.

  46. Rubella Reported Cases per Million (12M period) • Notes: Based on data received 2019-04 and covering the period between 2018-03 and 2019-02 - 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)

  47. Rubella cases: AFR AFR Rubella Case Distribution (April 2017-March 2019) 600 500 400 (IgM+ only) Number of cases 300 200 100 0 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 Month of onset Introduced <5 years ago Introduced >=5 years ago Not introduced in EPI (after 2013) (2013 and before) AFR Age distribution of Rubella IgM+ cases by vaccine introduction status in the National EPI Programme (April 2018-March 2019) 500 400 300 (IgM+ only) Number of cases 200 100 0 3 0 6 8 9 1 2 4 5 7 13 23 30 31 32 33 34 35 36 37 38 39 43 10 15 16 18 19 20 25 26 28 29 40 46 45 11 12 14 17 21 22 24 27 41 42 44 Age at onset (in years) Rubella vaccine not introduced before 1 January 2017 Rubella vaccine introduced before 1 January 2017 Notes: Based on data received 2019-04 Data Source: IVB Database. RCV in RI: Rubella-containing vaccine in Routine Immunization as of 31 Dec 2016.

  48. Rubella cases: AMR AMR Rubella Case Distribution (April 2017-March 2019) 2 (lab + epi-linked + clinical) Number of cases 1 0 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 Month of onset Introduced <5 years ago Introduced >=5 years ago Not introduced in EPI (after 2013) (2013 and before) AMR Age distribution of Rubella cases by vaccine introduction status in the National EPI Programme (April 2018-March 2019) 2 (lab + epi-linked + clinical) Number of cases 1 0 3 0 6 8 9 1 2 4 5 7 13 23 30 31 32 33 34 35 36 37 38 39 43 10 15 16 18 19 20 25 26 28 29 40 46 45 11 12 14 17 21 22 24 27 41 42 44 Age at onset (in years) Rubella vaccine not introduced before 1 January 2017 Rubella vaccine introduced before 1 January 2017 Notes: Based on data received 2019-04 Data Source: IVB Database. RCV in RI: Rubella-containing vaccine in Routine Immunization as of 31 Dec 2016.

  49. Rubella cases: EMR EMR Rubella Case Distribution (April 2017-March 2019) 200 (lab + epi-linked + clinical) Number of cases 100 0 2017-03 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 Month of onset Introduced <5 years ago Introduced >=5 years ago Not introduced in EPI (after 2013) (2013 and before) EMR Age distribution of Rubella cases by vaccine introduction status in the National EPI Programme (April 2018-March 2019) 200 (lab + epi-linked + clinical) Number of cases 100 0 3 0 6 8 9 1 2 4 5 7 13 23 30 31 32 33 34 35 36 37 38 39 43 10 15 16 18 19 20 25 26 28 29 40 46 45 11 12 14 17 21 22 24 27 41 42 44 Age at onset (in years) Rubella vaccine not introduced before 1 January 2017 Rubella vaccine introduced before 1 January 2017 Notes: Based on data received 2019-04 Data Source: IVB Database. RCV in RI: Rubella-containing vaccine in Routine Immunization as of 31 Dec 2016.

  50. Rubella cases: EUR EUR Rubella Case Distribution (April 2017-March 2019) 100 80 60 (lab + epi-linked + clinical) Number of cases 40 20 0 2017-03 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 Month of onset Introduced <5 years ago Introduced >=5 years ago Not introduced in EPI (after 2013) (2013 and before) EUR Age distribution of Rubella cases by vaccine introduction status in the National EPI Programme (April 2018-March 2019) 200 (lab + epi-linked + clinical) Number of cases 100 0 3 0 6 8 9 1 2 4 5 7 13 23 30 31 32 33 34 35 36 37 38 39 43 10 15 16 18 19 20 25 26 28 29 40 46 45 11 12 14 17 21 22 24 27 41 42 44 Age at onset (in years) Rubella vaccine not introduced before 1 January 2017 Rubella vaccine introduced before 1 January 2017 Notes: Based on data received 2019-04 Data Source: IVB Database. RCV in RI: Rubella-containing vaccine in Routine Immunization as of 31 Dec 2016. 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.

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