SEAR Measles and Rubella Quarterly update December 2020

SEAR Measles and Rubella Quarterly update December 2020 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 weekly measles rubella case-based data reported to SEARO IVD as of 11 January 2021). Vol.4 Issue 4. January 2021 Key highlights - Q1-Q4 2020 (Oct-Dec 2020) • The Region has adopted the goal of “measles and rubella elimination by 2023” (SEA/RC73/R3). • A strategic plan for measles and rubella elimination in WHO South-East Asia Region for the period 2020-2024 has been endorsed by Member States.(link) • Significant impact of COVID-19 on measles and rubella activities in the Region. • Measles-Rubella SIAs planned in 2020 : 2 Country Year Activity Start date Age group Extent Target Areas/comments Bangladesh 2020 Follow-up 12 Dec 2020 9M-9 Y National 34 million Ongoing Maldives 2020 Selective 01/03/2020 9M-40 Y National 395,000 Halted mid-way Nepal 2020 Follow-up 15/02/2020 9-59 M National 2,982,204 Completed in 2 phases Recent cases of measles and rubella in countries already verified for measles elimination, South-East Asia Region Country Year in which verified Confirmed cases Qtr 1+2+3, 2020 Source of infection of measles cases % measles cases with known source Measles Rubella Measles Rubella Imported Import- related Unknown/ not reported Endemic Bhutan 2017 - 0 0 0 0 0 0 NA DPR Korea 2018 - 0 0 0 0 0 0 NA Maldives 2017 2020 15 1 1 14 0 0 100% Sri Lanka 2019 2020 2 0 0 2 0 0 100% Timor-Leste 2018 - 0 6 0 0 0 0 NA 3*Data Source: SEAR MR Surveillance database as of 13 January 2021 Measles and rubella incidence, 2017-2020* *Data Source: Measles and rubella cases reported through JRF submitted by Member States and population data from AERF 2017-2019, Data for 2020 from SEAR MR surveillance database as of 13 January 2021 **Incidence for 2020 is annualized using data for Q4 Measles Incidence per million population Country 2017 2018 2019 2020** Bangladesh 24.5 64.3 34.7 12.3 Bhutan 83.5 24.5 2.7 0.0 DPR Korea 0.0 0.0 0.0 0.0 India 10.0 14.3 7.8 3.9 Indonesia 34.5 20.0 7.3 0.7 Maldives 3.0 3.0 0.0 26.9 Myanmar 24.8 26.5 98.6 8.2 Nepal 3.5 9.0 14.6 13.0 Sri Lanka 0.0 0.0 2.2 0.1 Thailand 29.6 90.9 75.3 12.2 Timor-Leste 0.0 0.0 16.6 0.0 SEAR 15.2 21.7 14.7 4.6 Rubella Incidence per million population Country 2017 2018 2019 2020** Bangladesh 1.8 1.9 1.0 0.5 Bhutan 11.4 15.0 9.4 0.0 DPR Korea 0.0 0.0 0.0 0.0 India 2.1 1.7 2.5 0.8 Indonesia 4.8 6.0 2.7 0.4 Maldives 3.0 0.0 0.0 1.8 Myanmar 0.1 0.2 0.5 0.1 Nepal 0.7 1.2 1.5 1.2 Sri Lanka 0.0 0.0 0.0 0.0 Thailand 0.5 1.0 2.1 0.8 Timor-Leste 2.3 6.2 15.8 4.8 SEAR 2.3 2.2 2.3 0.7 4 Zero-dose and partially vaccinated children – 2019 cohort Country Under 1 year population MCV zero dose children MCV Partially vaccinated RCV zero dose children Bangladesh 3,262,044 97,861 65,241 97,861 Bhutan 11,287 339 564 339 DPR Korea 322,449 6,449 - 322,449 India 26,297,590 1,314,880 2,892,735 1,314,880 Indonesia 4,674,643 560,957 794,689 560,957 Maldives 6,460 65 - 65 Myanmar 968,376 154,940 38,735 154,940 Nepal 621,565 49,725 99,450 49,725 Sri Lanka 318,373 3,184 - 3,184 Thailand 561,446 22,458 50,530 22,458 Timor-Leste 44,981 6,747 2,249 6,747 SEAR 37,089,214 2,225,353 4,079,814 2,596,245 Source: Calculation done based on the population under 1 year from SEAR AERF 2019 submitted by member states and WHO/UNICEF Joint Estimate 2020, July 2020 5 Measles Confirmed measles cases and coverage of MCV1 and MCV2 in SEAR 2000-2020 0 10 20 30 40 50 60 70 80 90 100 0 20,000 40,000 60,000 80,000 100,000 120,000 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 C o ve ra ge ( % ) N u m b e r o f m e as le s ca se s India Indonesia Myanmar Thailand Others MCV1 coverage MCV2 coverage 7Source: WHO/UNICEF coverage estimates, July 2020 and WHO/UNICEF JRF and EPI/MOHFW; Measles cases from JRF 2000-2019 and 2020 from SEAR MR surveillance database as of 13 January 2021 Measles cases by month and country (2017-2020*) 0 500 1000 1500 2000 2500 3000 3500 4000 4500 5000 20 1 7 -0 1 20 1 7 -0 2 20 1 7 -0 3 20 1 7 -0 4 20 1 7 -0 5 20 1 7 -0 6 20 1 7 -0 7 20 1 7 -0 8 20 1 7 -0 9 20 1 7 -1 0 20 1 7 -1 1 20 1 7 -1 2 20 1 8 -0 1 20 1 8 -0 2 20 1 8 -0 3 20 1 8 -0 4 20 1 8 -0 5 20 1 8 -0 6 20 1 8 -0 7 20 1 8 -0 8 20 1 8 -0 9 20 1 8 -1 0 20 1 8 -1 1 20 1 8 -1 2 20 1 9 -0 1 20 1 9 -0 2 20 1 9 -0 3 20 1 9 -0 4 20 1 9 -0 5 20 1 9 -0 6 20 1 9 -0 7 20 1 9 -0 8 20 1 9 -0 9 20 1 9 -1 0 20 1 9 -1 1 20 1 9 -1 2 20 2 0 -0 1 20 2 0 -0 2 20 2 0 -0 3 20 2 0 -0 4 20 2 0 -0 5 20 2 0 -0 6 20 2 0 -0 7 20 2 0 -0 8 20 2 0 -0 9 20 2 0 -1 0 20 2 0 -1 1 20 2 0 -1 2 M ea sl es c as es ( La b +E p i+ C lin ic al ly co m p at ib le ) Month of onset Bangladesh Bhutan DPR Korea India Indonesia Maldives Myanmar Nepal Sri Lanka Thailand Timor Leste 8*Data Source: SEAR MR Surveillance database as of 13 January 2021 Measles cases by country, 2019-2020* 9*Data Source: SEAR MR Surveillance database as of 13 January 2021 Country Suspected cases Confirmed Measles cases (Lab+Epi+Cln) Lab confirmed Epi-Linked Clinically compatible Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Bangladesh 11 633 5 826 4 074 801 951 316 306 339 404 380 257 355 382 831 800 654 802 10-Jan-2021 Bhutan 297 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 11-Jan-2020 DPR Korea 510 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 15-Dec-2020 India 28 725 10 738 4 834 3 426 2 478 1 772 1 670 1 549 1 195 761 429 367 375 453 598 834 735 08-Jan-2021 Indonesia 8 828 1 965 639 22 1 304 328 252 262 197 133 73 124 177 123 118 89 89 30-Dec-2020 Maldives 67 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 12-Jan-2021 Myanmar 6 546 5 244 3 497 1 181 566 931 1 442 988 542 499 373 149 68 71 47 71 63 11-Jan-2021 Nepal 2 101 431 372 55 4 30 40 76 99 58 28 22 23 15 9 14 17 10-Jan-2021 Sri Lanka 389 49 49 0 0 1 0 11 14 19 4 0 0 0 0 0 0 07-Dec-2020 Thailand 9 383 5 373 3 586 705 1 082 766 756 541 456 310 333 378 324 437 414 380 278 11-Jan-2021 Timor Leste 451 33 23 0 10 1 0 0 0 0 1 4 8 11 7 1 0 08-Jan-2021 SEAR 68 930 29 659 17 074 6 190 6 395 4 145 4 466 3 766 2 907 2 160 1 498 1 399 1 357 1 941 1 993 2 043 1 984 Date Received Reported measles cases in 2019 Confirmed measles cases by month in 2019 Country Suspected cases Confirmed Measles cases (Lab+Epi+Cln) Lab confirmed Epi-Linked Clinically compatible Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Bangladesh 5 477 2 097 1 334 338 425 603 707 558 110 3 12 8 8 29 26 25 8 10-Jan-2021 Bhutan 122 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 11-Jan-2020 DPR Korea 458 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 15-Dec-2020 India 17 463 5 399 2 429 574 2 396 961 1 446 1 154 299 202 187 122 140 202 280 209 197 08-Jan-2021 Indonesia 2 906 186 186 0 0 53 69 52 4 2 0 0 1 3 1 1 0 30-Dec-2020 Maldives 254 15 14 0 1 8 7 0 0 0 0 0 0 0 0 0 0 12-Jan-2021 Myanmar 681 443 206 213 24 136 131 62 5 54 36 8 3 4 2 1 1 11-Jan-2021 Nepal 1 381 386 220 162 4 37 57 168 52 21 4 4 9 13 13 4 4 10-Jan-2021 Sri Lanka 88 2 2 0 0 0 2 0 0 0 0 0 0 0 0 0 0 07-Dec-2020 Thailand 1 933 789 343 196 250 202 278 131 39 27 19 16 28 17 16 9 7 11-Jan-2021 Timor Leste 104 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 08-Jan-2021 SEAR 30 867 9 317 4 734 1 483 3 100 2 000 2 697 2 125 509 309 258 158 189 268 338 249 217 Reported measles cases in 2020 Confirmed measles cases by month in 2020 Date Received Rubella Confirmed rubella cases and RCV coverage in SEAR 2005-2020 0 10 20 30 40 50 60 70 80 90 100 0 2,000 4,000 6,000 8,000 10,000 12,000 14,000 16,000 18,000 20,000 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 C o ve ra ge ( % ) N u m b e r o f ru b el la c as es Bangladesh India Indonesia Nepal Thailand Others SEAR RCV1 coverage Source: WHO/UNICEF coverage estimates, July 2020 and WHO/UNICEF JRF and EPI/MOHFW; Rubella cases from JRF 2000-2019 and 2020 from SEAR MR surveillance database as of 13 January 2021 11 Rubella cases by month and country (2017-2020*) 0 200 400 600 800 1000 1200 1400 2 0 17 -0 1 2 0 17 -0 2 2 0 17 -0 3 2 0 17 -0 4 2 0 17 -0 5 2 0 17 -0 6 2 0 17 -0 7 2 0 17 -0 8 2 0 17 -0 9 2 0 17 -1 0 2 0 17 -1 1 2 0 17 -1 2 2 0 18 -0 1 2 0 18 -0 2 2 0 18 -0 3 2 0 18 -0 4 2 0 18 -0 5 2 0 18 -0 6 2 0 18 -0 7 2 0 18 -0 8 2 0 18 -0 9 2 0 18 -1 0 2 0 18 -1 1 2 0 18 -1 2 2 0 19 -0 1 2 0 19 -0 2 2 0 19 -0 3 2 0 19 -0 4 2 0 19 -0 5 2 0 19 -0 6 2 0 19 -0 7 2 0 19 -0 8 2 0 19 -0 9 2 0 19 -1 0 2 0 19 -1 1 2 0 19 -1 2 2 0 20 -0 1 2 0 20 -0 2 2 0 20 -0 3 2 0 20 -0 4 2 0 20 -0 5 2 0 20 -0 6 2 0 20 -0 7 2 0 20 -0 8 2 0 20 -0 9 2 0 20 -1 0 2 0 20 -1 1 2 0 20 -1 2 R u b el la c as es ( La b +E p i) Month of onset Bangladesh Bhutan DPR Korea India Indonesia Maldives Myanmar Nepal Sri Lanka Thailand Timor Leste 12*Data Source: SEAR MR Surveillance database as of 13 January 2021 Rubella cases by country, 2019-2020* 13*Data Source: SEAR MR Surveillance database as of 13 January 2021 Country Rubella cases Lab confirmed Epi-Linked Clinically compatible Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Bangladesh 176 176 0 0 9 12 19 16 11 8 11 10 20 22 25 13 10-Jan-2021 Bhutan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 11-Jan-2020 DPR Korea 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 15-Dec-2020 India 3 466 2 091 1 375 0 160 540 1 081 552 211 102 74 105 126 170 189 156 08-Jan-2021 Indonesia 713 710 3 0 96 90 106 82 66 29 31 69 66 38 26 14 30-Dec-2020 Maldives 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 12-Jan-2021 Myanmar 28 28 0 0 4 2 3 2 3 6 2 1 0 3 2 0 11-Jan-2021 Nepal 44 44 0 0 1 2 6 4 2 10 2 2 2 1 4 8 10-Jan-2021 Sri Lanka 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 07-Dec-2020 Thailand 130 130 0 0 8 11 25 12 19 14 4 7 14 9 4 3 11-Jan-2021 Timor Leste 19 19 0 0 0 0 0 1 0 0 2 0 7 5 3 1 08-Jan-2021 SEAR 4 576 3 198 1 378 0 278 657 1 240 669 312 169 126 194 235 248 253 195 Date Received Reported rubella cases in 2019 Confirmed rubella cases by month in 2019 Country Rubella cases Lab confirmed Epi-Linked Clinically compatible Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Bangladesh 79 79 0 0 12 26 2 0 0 2 2 4 6 10 11 4 10-Jan-2021 Bhutan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 11-Jan-2020 DPR Korea 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 15-Dec-2020 India 1 163 1 094 69 0 168 262 203 69 31 48 43 33 56 99 95 56 08-Jan-2021 Indonesia 101 101 0 0 22 35 24 9 2 1 2 3 1 0 2 0 30-Dec-2020 Maldives 1 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 12-Jan-2021 Myanmar 3 3 0 0 0 0 0 0 1 1 0 0 1 0 0 0 11-Jan-2021 Nepal 37 37 0 0 2 8 4 0 2 2 3 2 6 2 3 3 10-Jan-2021 Sri Lanka 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 07-Dec-2020 Thailand 52 52 0 0 8 25 2 2 3 0 5 0 2 3 2 0 11-Jan-2021 Timor Leste 6 6 0 0 0 0 0 0 0 0 1 1 2 1 1 0 08-Jan-2021 SEAR 1 442 1 373 69 0 212 357 235 80 39 54 56 43 74 115 114 63 Date Received Reported rubella cases in 2020 Confirmed rubella cases by month in 2020 Surveillance for measles and rubella 14 15 Definition of suspected measles and rubella cases Countries Fever and rash Bhutan, DPR Korea, India (three states), Maldives, Myanmar, Nepal, Sri Lanka, Thailand, Timor-Leste Fever, rash and 3 C’s –Cough, Coryza or conjunctivitis Bangladesh, India (except three states), Indonesia Surveillance and laboratory performance indicators (2019 vs 2020) 16*Data Source: SEAR MR Surveillance database as of 13 January 2021 2019 2020 2019 2020 2019 2020 2019 2020 2019 2020 2019 2020 2019 2020 Bangladesh 11 633 5 477 96 97 85 82 9 848 4 470 100 99 100 100 77 63 Bhutan 297 122 98 95 99 95 280 109 65 69 98 99 77 74 DPR Korea 510 458 100 100 100 100 510 458 100 100 83 100 83 100 India 28 725 17 463 53 77 67 79 18 592 11 888 100 98 95 96 57 48 Indonesia 8 828 2 906 65 56 85 99 6 606 2 876 96 99 87 83 16 59 Maldives 67 254 12 78 85 96 56 244 88 98 100 100 55 92 Myanmar 6 546 681 96 96 73 65 4 807 442 96 95 100 100 70 96 Nepal 2 101 1 381 99 98 96 89 2 026 1 227 94 100 100 100 35 61 Sri Lanka 389 88 94 99 99 95 360 73 82 79 98 97 51 66 Thailand 9 383 1 933 38 34 89 82 7 866 1 532 57 65 98 98 47 23 Timor-Leste 451 104 100 100 98 97 444 100 100 97 98 93 65 71 SEAR 68 930 30 867 66 78 78 82 51 395 23 419 92 96 96 96 55 54 Number of serum specimens received in laboratory % serum specimens received at laboratory w/in 5 days of collection % specimens tested for serology of specimens received in the laboratory % serology results reported w/in 4 days of specimen received at laboratory Number of suspected measles cases % suspected cases with adequate investigation initiated w/in 48 hours of notification % suspected cases with serum specimens collectedCountries Case classification (Q4 2019 vs Q4 2020) La bo ra to ry - co nf irm ed Ep id em io lo gi ca lly - co nf irm ed Cl in ic al ly - co m pa tib le La bo ra to ry - co nf irm ed Ep id em io lo gi ca lly - co nf irm ed Cl in ic al ly - co m pa tib le La bo ra to ry - co nf irm ed Ep id em io lo gi ca lly - co nf irm ed La bo ra to ry - co nf irm ed Ep id em io lo gi ca lly - co nf irm ed Q4 2019 Q4 2020 Q4 2019 Q4 2020 Bangladesh 1 190 292 774 58 0 1 60 0 25 0 1 169 1 007 0 0 Bhutan 0 0 0 0 0 0 0 0 0 0 33 16 0 0 DPR Korea 0 0 0 0 0 0 0 0 0 0 139 71 0 0 India 1 325 74 768 171 41 474 510 5 242 8 4 908 2 298 0 370 Indonesia 82 214 2 0 0 77 1 2 0 1 069 73 849 32 Maldives 0 0 0 0 0 0 0 0 0 0 6 8 0 1 Myanmar 155 0 26 4 0 0 5 0 0 0 107 15 0 1 Nepal 40 0 0 19 0 2 13 0 8 0 270 223 0 8 Sri Lanka 0 0 0 0 0 0 0 0 0 0 37 4 0 1 Thailand 771 89 212 9 0 23 16 0 5 0 1 036 140 0 0 Timor-Leste 7* 0 1 0 0 0 9 0 2 0 206 29 0 0 SEAR 3 570 455 1 995 263 41 500 690 6 284 8 8 980 3 884 849 413 Measles Rubella D isc ar de d n on - m ea sle s n on -r ub el la ca se s Pe nd in g cl as sif ic at io n Countries Q4 2019 Q4 2020 Q4 2019 Q4 2020 17Data Source: SEAR MR Surveillance database as of 13 January 2021 * Import/import related case Surveillance performance indicators 18 2019 2020 2019 2020 Bangladesh 3.35 1.91 91 50 Bhutan 39.72 15.98 85 50 DPR Korea 2.10 1.82 ND ND India 1.05 0.74 16 11 Indonesia 1.92 0.77 21 6 Maldives 18.40 41.36 ND ND Myanmar 2.43 0.42 37 6 Nepal 5.53 3.13 92 81 Sri Lanka 1.55 0.33 27 0 Thailand 5.99 1.61 ND ND Timor-Leste 31.63 6.77 38 46 SEAR 1.68 0.92 Countries Reporting rate of discarded non-measles non- rubella cases per 100,000 population % districts reporting at least 2 discarded non-measles non-rubella cases per 100,000 population Data Source: SEAR MR Surveillance database as of 13 January 2021 Non-measles non-rubella discarded case rate per 100,000 population by 1st sub-national level ,2019 and 2020, SEAR 2019 19 2020* * Number of discarded measles cases per 100,000 population . (annualized by week 53, 2020) *Data Source: SEAR MR Surveillance database as of 13 January 2021 Vaccination status of measles cases, SEAR 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% <1 yr 1-4 yrs 5-9 yrs 10-14 yrs 15-24 yrs 25-39 yrs 40+ yrs Unknown N u m b er o f m ea sl es c as e s Vaccination status of confirmed measles cases by age group In SEAR 2019 (n=29,659) 0 dose 1 dose >=2 doses Unknown 0 500 1000 1500 2000 2500 3000 <1 yr 1-4 yrs 5-9 yrs 10-14 yrs 15-24 yrs 25-39 yrs 40+ yrs Unknown N u m b er o f m ea sl es c as e s Vaccination status of confirmed measles cases by age group In SEAR 2020 (n=9,,317) 0 dose 1 dose >=2 doses Unknown 20*Data Source: SEAR MR Surveillance database as of 13 January 2021 Vaccination status of rubella cases, SEAR 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% <1 yr 1-4 yrs 5-9 yrs 10-14 yrs 15-24 yrs 25-39 yrs 40+yrs Unknown N u m b er o f R u b el la c as e s Vaccination status of confirmed rubella cases by age group In SEAR 2020 (n=1,442) 0 dose 1+ dose Unknown 21 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% <1 yr 1-4 yrs 5-9 yrs 10-14 yrs 15-24 yrs 25-39 yrs 40+yrs Unknown N u m b er o f R u b el la c as e s Vaccination status of confirmed rubella cases by age group In SEAR 2019 (n=4,576) 0 dose 1+ dose Unknown *Data Source: SEAR MR Surveillance database as of 13 January 2021 Vaccination status of non-measles non-rubella discarded cases 0% 20% 40% 60% 80% 100% <1 yr 1-4 yrs 5-9 yrs 10-14 yrs 15-24 yrs 25-39 yrs 40+ yrs Unknown N u m b er o f d is ca rd ed c as e s Measles vaccination status of discarded non measles non-rubella cases by age group in SEAR 2019 (n=33,644) 0 dose 1 dose >1 dose Unknown 0% 20% 40% 60% 80% 100% <1 yr 1-4 yrs 5-9 yrs 10-14 yrs 15-24 yrs 25-39 yrs 40+yrs Unknown N u m b e r o f d is ca rd ed c as e s Measles vaccination status of discarded non measles non-rubella cases by age group in SEAR, 2020 (n=19,194) 0 dose 1 dose >1 dose Unknown 0% 20% 40% 60% 80% 100% <1 yr 1-4 yrs 5-9 yrs 10-14 yrs 15-24 yrs 25-39 yrs 40+ yrs Unknown N u m b er o f d is ca rd ed c as e s Rubella vaccination status of discarded non measles non-rubella cases by age group in SEAR 2019 (n=33,644) 0 dose 1+ dose Unknown 0% 20% 40% 60% 80% 100% <1 yr 1-4 yrs 5-9 yrs 10-14 yrs 15-24 yrs 25-39 yrs 40+ yrs Unknown N u m b er o f d is ca rd ed c as e s Rubella vaccination status of discarded non measles non-rubella cases by age group in SEAR (n=19,194) 0 dose 1+ dose Unknown 22*Data Source: SEAR MR Surveillance database as of 13 January 2021 Outbreaks of measles and rubella 23 Major measles outbreaks reported in Q4, 2020 24 *Data Source: SEAR MR Surveillance database as of 13 January 2021 Country Province District Total cases Date of onset of the first case Date of onset of the last case Genotype Jharkhand Garhwa 41 20-Nov-20 11-Dec-20 Unknown Jharkhand Pakur 13 01-Oct-20 14-Dec-20 Unknown Jharkhand Ranchi 7 04-Oct-20 12-Oct-20 Unknown Maharashtra Malegaon Corporation 6 05-Oct-20 21-Nov-20 Unknown Bihar Arwal 5 25-Nov-20 16-Dec-20 Unknown Jharkhand Pakur 5 11-Dec-20 16-Dec-20 Unknown Delhi South-East 4 14-Nov-20 21-Nov-20 Unknown West Bengal Murshidabad 2 19-Nov-20 07-Dec-20 Unknown India Country Province District Total cases Date of onset of the first case Date of onset of the last case Genotype India Jharkhand East Singhbhum 10 23-Oct-20 11-Nov-20 Unknown Major rubella outbreaks reported in Q4, 2020 Laboratory Network 25 Measles and rubella laboratory network in SEAR Country National laboratory Sub-national laboratory National reference laboratory Regional reference laboratory Total Bangladesh 1 1 Bhutan 1 1 DPR Korea 1 1 India 11 5 2 18 Indonesia 4 3 7 Maldives 1 1 Myanmar 1 1 2 Nepal 1 1 2 Sri Lanka 1 1 Thailand 13 1 14 Timor Leste 1 1 Total 23 23 2 1 49 26 Country Serology only (IgM/IgG) Serology + Molecular (RT-PCR) Serology + Molecular (RT- PCR) + Sequencing Bangladesh 1 Bhutan 1 DPR Korea 1 India 5 12 1 Indonesia 3 2 2 Maldives 1 Myanmar 1 1 Nepal 1 1 Sri Lanka 1 Thailand 9 4 1 Timor- Leste 1 Total 19 26 4 India Nepal D8, B3 Bhutan Bangladesh Sri Lanka Myanmar Thailand Indonesia Timor Leste Maldives DPRK D4, B3, D8 D8, B3 D9, D4, D8 D9, B3, D8, H1 D8,D9,B3, H1B3, D8 D8 Source: MeaNS database , National Institute of Health, Thailand, MeaNS, NIVMU Country 2016 2017 2018 2019 2020 Bangladesh D8 B3, D8 B3, D8 B3, D8 B3 Bhutan D8 D8 D8 DPRK India B3,D4,D8 D4,D8 D8 B3, D4, D8 B3, D4, D8 Indonesia D8,D9 D8 D8 Maldives D8 D8 Myanmar H1, D8 H1 D8, H1 B3, D8,H1 Nepal D8, D9 D8 D4, D8 Sri Lanka B3 B3, D8, H1 Thailand H1,B3,D8 H1,B3, D8 B3, D8,H1 B3, D8,H1 D8 Timor-Leste Measles genotypes circulating in SEAR between 2013 and 2020* *Data as of 12 January 2021 27 India Nepal Bhutan Bangladesh Sri Lanka Myanmar Thailand Indonesia Timor Leste Maldives DPRK 1E, 2B 2B 1E, 2B, 1a 1J, 2B 1E,2B Rubella genotype distribution in SEAR between 2013- 2020* Country 2016 2017 2018 2019 2020 Bangladesh Bhutan DPRK India 1J, 2B 2B 2B 2B Indonesia Maldives 1a Myanmar Nepal Sri Lanka Thailand 2B 1E 1a, 1E 1E Timor-Leste Ref: RubeNS database 28 1a *Data as of 12 January 2021 The BIG SIX countries in SEAR Measles Measles cases: Bangladesh 0 200 400 600 800 1000 1200 1400 1600 2 0 1 8 -0 1 2 0 1 8 -0 3 2 0 1 8 -0 5 2 0 1 8 -0 7 2 0 1 8 -0 9 2 0 1 8 -1 1 2 0 1 9 -0 1 2 0 1 9 -0 3 2 0 1 9 -0 5 2 0 1 9 -0 7 2 0 1 9 -0 9 2 0 1 9 -1 1 2 0 2 0 -0 1 2 0 2 0 -0 3 2 0 2 0 -0 5 2 0 2 0 -0 7 2 0 2 0 -0 9 2 0 2 0 -1 1 N u m b er o f ca se s Month of onset Measles cases distribution by month (2018-2020) Lab confirmed Epi-linked Clinically compatible Discarded 0 100 200 300 400 500 600 700 <1 yr 1-4 yrs 5-9 yrs 10-14 yrs 15-24 yrs 25-39 yrs 40+ yrs Unknown N u m b er o f ca se s Age at onset Age distribution by vaccination status (2020-01 to 2020-12) 0 dose 1 dose 2+doses Unknown *Dots are randomly placed within districts 01 Jan 2020 to 31 Dec 2020 01 Jan 2019 to 31 Dec 2019 30 Spot map of Measles cases *Data Source: SEAR MR Surveillance database as of 13 January 2021 Measles cases: India 0 1000 2000 3000 4000 5000 2 0 1 8 -0 1 2 0 1 8 -0 3 2 0 1 8 -0 5 2 0 1 8 -0 7 2 0 1 8 -0 9 2 0 1 8 -1 1 2 0 1 9 -0 1 2 0 1 9 -0 3 2 0 1 9 -0 5 2 0 1 9 -0 7 2 0 1 9 -0 9 2 0 1 9 -1 1 2 0 2 0 -0 1 2 0 2 0 -0 3 2 0 2 0 -0 5 2 0 2 0 -0 7 2 0 2 0 -0 9 2 0 2 0 -1 1 N u m b er o f ca se s Month of onset Measles cases distribution by month (2018-2020) Lab confirmed Epi-linked Clinically compatible Discarded Spot map of Measles cases 31 0 500 1000 1500 2000 <1 yr 1-4 yrs 5-9 yrs 10-14 yrs 15-24 yrs 25-39 yrs 40+ yrs Unknown N u m b er o f ca se s Age at onset Age distribution by vaccination status (2020-01 to 2020-12) 0 dose 1 dose 2+doses Unknown *Dots are randomly placed within states *Data Source: SEAR MR Surveillance database as of 13 January 2021 01 Jan 2020 to 31 Dec 2020 01 Jan 2019 to 31 Dec 2019 Measles cases: Indonesia Spot map of Measles cases 32 0 10 20 30 40 50 60 70 <1 yr 1-4 yrs 5-9 yrs 10-14 yrs 15-24 yrs 25-39 yrs 40+ yrs Unknown N u m b er o f ca se s Age at onset Age distribution by vaccination status (2020-01 to 2020-12) 0 dose 1 dose 2+doses Unknown 0 200 400 600 800 1000 2 0 1 8 -0 1 2 0 1 8 -0 3 2 0 1 8 -0 5 2 0 1 8 -0 7 2 0 1 8 -0 9 2 0 1 8 -1 1 2 0 1 9 -0 1 2 0 1 9 -0 3 2 0 1 9 -0 5 2 0 1 9 -0 7 2 0 1 9 -0 9 2 0 1 9 -1 1 2 0 2 0 -0 1 2 0 2 0 -0 3 2 0 2 0 -0 5 2 0 2 0 -0 7 2 0 2 0 -0 9 2 0 2 0 -1 1 N u m b er o f ca se s Month of onset Measles cases distribution by month (2018-2020) Lab confirmed Epi-linked Clinically compatible Discarded *Dots are randomly placed within provinces *Data Source: SEAR MR Surveillance database as of 13 January 2021 01 Jan 2020 to 31 Dec 2020 01 Jan 2019 to 31 Dec 2019 Measles cases: Myanmar 0 500 1000 1500 2000 2 0 1 8 -0 1 2 0 1 8 -0 2 2 0 1 8 -0 3 2 0 1 8 -0 4 2 0 1 8 -0 5 2 0 1 8 -0 6 2 0 1 8 -0 7 2 0 1 8 -0 8 2 0 1 8 -0 9 2 0 1 8 -1 0 2 0 1 8 -1 1 2 0 1 8 -1 2 2 0 1 9 -0 1 2 0 1 9 -0 2 2 0 1 9 -0 3 2 0 1 9 -0 4 2 0 1 9 -0 5 2 0 1 9 -0 6 2 0 1 9 -0 7 2 0 1 9 -0 8 2 0 1 9 -0 9 2 0 1 9 -1 0 2 0 1 9 -1 1 2 0 1 9 -1 2 2 0 2 0 -0 1 2 0 2 0 -0 2 2 0 2 0 -0 3 2 0 2 0 -0 4 2 0 2 0 -0 5 2 0 2 0 -0 6 2 0 2 0 -0 7 2 0 2 0 -0 8 2 0 2 0 -0 9 2 0 2 0 -1 0 2 0 2 0 -1 1 2 0 2 0 -1 2 N u m b er o f ca se s Month of onset Measles cases distribution by month (2018-2020) Lab confirmed Epi-linked Clinically compatible Discarded Spot map of Measles cases 33 0 50 100 150 200 <1 yr 1-4 yrs 5-9 yrs 10-14 yrs 15-24 yrs 25-39 yrs 40+ yrs Unknown N u m b er o f ca se s Age at onset Age distribution by vaccination status (2020-01 to 2020-12) 0 dose 1 dose 2+doses Unknown *Dots are randomly placed within provinces *Data Source: SEAR MR Surveillance database as of 13 January 2021 01 Jan 2020 to 31 Dec 2020 01 Jan 2019 to 31 Dec 2019 Measles cases: Nepal 0 50 100 150 200 250 300 350 2 0 1 8 -0 1 2 0 1 8 -0 2 2 0 1 8 -0 3 2 0 1 8 -0 4 2 0 1 8 -0 5 2 0 1 8 -0 6 2 0 1 8 -0 7 2 0 1 8 -0 8 2 0 1 8 -0 9 2 0 1 8 -1 0 2 0 1 8 -1 1 2 0 1 8 -1 2 2 0 1 9 -0 1 2 0 1 9 -0 2 2 0 1 9 -0 3 2 0 1 9 -0 4 2 0 1 9 -0 5 2 0 1 9 -0 6 2 0 1 9 -0 7 2 0 1 9 -0 8 2 0 1 9 -0 9 2 0 1 9 -1 0 2 0 1 9 -1 1 2 0 1 9 -1 2 2 0 2 0 -0 1 2 0 2 0 -0 2 2 0 2 0 -0 3 2 0 2 0 -0 4 2 0 2 0 -0 5 2 0 2 0 -0 6 2 0 2 0 -0 7 2 0 2 0 -0 8 2 0 2 0 -0 9 2 0 2 0 -1 0 2 0 2 0 -1 1 2 0 2 0 -1 2 N u m b er o f ca se s Month of onset Measles cases distribution by month (2018-2020) Lab confirmed Epi-linked Clinically compatible Discarded Spot map of Measles cases 34 0 20 40 60 80 100 120 <1 yr 1-4 yrs 5-9 yrs 10-14 yrs 15-24 yrs 25-39 yrs 40+ yrs Unknown N u m b er o f ca se s Age at onset Age distribution by vaccination status (2020-01 to 2020-12) 0 dose 1 dose 2+doses Unknown *Dots are randomly placed within districts *Data Source: SEAR MR Surveillance database as of 13 January 2021 01 Jan 2020 to 31 Dec 2020 01 Jan 2019 to 31 Dec 2019 Measles cases: Thailand 0 500 1000 1500 2000 2 0 1 8 -0 1 2 0 1 8 -0 3 2 0 1 8 -0 5 2 0 1 8 -0 7 2 0 1 8 -0 9 2 0 1 8 -1 1 2 0 1 9 -0 1 2 0 1 9 -0 3 2 0 1 9 -0 5 2 0 1 9 -0 7 2 0 1 9 -0 9 2 0 1 9 -1 1 2 0 2 0 -0 1 2 0 2 0 -0 3 2 0 2 0 -0 5 2 0 2 0 -0 7 2 0 2 0 -0 9 2 0 2 0 -1 1 N u m b er o f ca se s Month of onset Measles cases distribution by month (2018-2020) Lab confirmed Epi-linked Clinically compatible Discarded Spot map of Measles cases 35 0 50 100 150 200 250 300 <1 yr 1-4 yrs 5-9 yrs 10-14 yrs 15-24 yrs 25-39 yrs 40+ yrs Unknown N u m b er o f ca se s Age at onset Age distribution by vaccination status (2020-01 to 2020-12) 0 dose 1 dose 2+doses Unknown *Dots are randomly placed within provinces *Data Source: SEAR MR Surveillance database as of 13 January 2021 01 Jan 2020 to 31 Dec 2020 01 Jan 2019 to 31 Dec 2019 The BIG SIX countries in SEAR Rubella Rubella cases: Bangladesh 0 10 20 30 40 50 60 70 2 0 1 8 -0 1 2 0 1 8 -0 3 2 0 1 8 -0 5 2 0 1 8 -0 7 2 0 1 8 -0 9 2 0 1 8 -1 1 2 0 1 9 -0 1 2 0 1 9 -0 3 2 0 1 9 -0 5 2 0 1 9 -0 7 2 0 1 9 -0 9 2 0 1 9 -1 1 2 0 2 0 -0 1 2 0 2 0 -0 3 2 0 2 0 -0 5 2 0 2 0 -0 7 2 0 2 0 -0 9 2 0 2 0 -1 1 N u m b er o f ca se s Month of onset Rubella cases distribution by month (2018-2020) Lab confirmed Epi-linked 37 0 5 10 15 20 25 30 <1 yr 1-4 yrs 5-9 yrs 10-14 yrs 15-24 yrs 25-39 yrs 40+yrs Unknown N u m b er o f ca se s Age at onset Age distribution by vaccination status (2020-01 to 2020-12) 0 dose 1+dose Unknown Spot map of Rubella cases *Dots are randomly placed within districts *Data Source: SEAR MR Surveillance database as of 13 January 2021 01 Jan 2020 to 31 Dec 2020 01 Jan 2019 to 31 Dec 2019 Rubella cases: India 38 0 200 400 600 800 1000 1200 2 0 1 8 -0 1 2 0 1 8 -0 3 2 0 1 8 -0 5 2 0 1 8 -0 7 2 0 1 8 -0 9 2 0 1 8 -1 1 2 0 1 9 -0 1 2 0 1 9 -0 3 2 0 1 9 -0 5 2 0 1 9 -0 7 2 0 1 9 -0 9 2 0 1 9 -1 1 2 0 2 0 -0 1 2 0 2 0 -0 3 2 0 2 0 -0 5 2 0 2 0 -0 7 2 0 2 0 -0 9 2 0 2 0 -1 1 N u m b er o f ca se s Month of onset Rubella cases distribution by month (2018-2020) Lab confirmed Epi-linked Spot map of Rubella cases 0 100 200 300 400 500 <1 yr 1-4 yrs 5-9 yrs 10-14 yrs 15-24 yrs 25-39 yrs 40+yrs Unknown N u m b er o f ca se s Age at onset Age distribution by vaccination status (2020-01 to 2020-12) 0 dose 1+dose Unknown *Dots are randomly placed within states *Data Source: SEAR MR Surveillance database as of 13 January 2021 01 Jan 2020 to 31 Dec 2020 01 Jan 2019 to 31 Dec 2019 Rubella cases: Indonesia 39 0 50 100 150 200 250 300 2 0 1 8 -0 1 2 0 1 8 -0 3 2 0 1 8 -0 5 2 0 1 8 -0 7 2 0 1 8 -0 9 2 0 1 8 -1 1 2 0 1 9 -0 1 2 0 1 9 -0 3 2 0 1 9 -0 5 2 0 1 9 -0 7 2 0 1 9 -0 9 2 0 1 9 -1 1 2 0 2 0 -0 1 2 0 2 0 -0 3 2 0 2 0 -0 5 2 0 2 0 -0 7 2 0 2 0 -0 9 2 0 2 0 -1 1 N u m b er o f ca se s Month of onset Rubella cases distribution by month (2018-2020) Lab confirmed Epi-linked Spot map of Rubella cases 0 5 10 15 20 25 30 <1 yr 1-4 yrs 5-9 yrs 10-14 yrs 15-24 yrs 25-39 yrs 40+yrs Unknown N u m b er o f ca se s Age at onset Age distribution by vaccination status (2020-01 to 2020-12) 0 dose 1+dose Unknown *Dots are randomly placed within provinces *Data Source: SEAR MR Surveillance database as of 13 January 2021 01 Jan 2020 to 31 Dec 2020 01 Jan 2019 to 31 Dec 2019 Rubella cases: Myanmar 40 0 1 2 3 4 5 6 7 2 0 1 8 -0 1 2 0 1 8 -0 3 2 0 1 8 -0 5 2 0 1 8 -0 7 2 0 1 8 -0 9 2 0 1 8 -1 1 2 0 1 9 -0 1 2 0 1 9 -0 3 2 0 1 9 -0 5 2 0 1 9 -0 7 2 0 1 9 -0 9 2 0 1 9 -1 1 2 0 2 0 -0 1 2 0 2 0 -0 3 2 0 2 0 -0 5 2 0 2 0 -0 7 2 0 2 0 -0 9 2 0 2 0 -1 1 N u m b er o f ca se s Month of onset Rubella cases distribution by month (2018-2020) Lab confirmed Epi-linked Spot map of Rubella cases *Dots are randomly placed within provinces 0 0.5 1 1.5 2 2.5 <1 yr 1-4 yrs 5-9 yrs 10-14 yrs 15-24 yrs 25-39 yrs 40+yrs Unknown N u m b er o f ca se s Age at onset Age distribution by vaccination status (2020-01 to 2020-12) 0 dose 1+dose Unknown *Data Source: SEAR MR Surveillance database as of 13 January 2021 01 Jan 2020 to 31 Dec 2020 01 Jan 2019 to 31 Dec 2019 Rubella cases: Nepal 41 0 2 4 6 8 10 12 2 0 1 8 -0 1 2 0 1 8 -0 3 2 0 1 8 -0 5 2 0 1 8 -0 7 2 0 1 8 -0 9 2 0 1 8 -1 1 2 0 1 9 -0 1 2 0 1 9 -0 3 2 0 1 9 -0 5 2 0 1 9 -0 7 2 0 1 9 -0 9 2 0 1 9 -1 1 2 0 2 0 -0 1 2 0 2 0 -0 3 2 0 2 0 -0 5 2 0 2 0 -0 7 2 0 2 0 -0 9 2 0 2 0 -1 1 N u m b er o f ca se s Month of onset Rubella cases distribution by month (2018-2020) Lab confirmed Epi-linked Spot map of Rubella cases 0 2 4 6 8 10 12 14 16 <1 yr 1-4 yrs 5-9 yrs 10-14 yrs 15-24 yrs 25-39 yrs 40+yrs Unknown N u m b er o f ca se s Age at onset Age distribution by vaccination status (2020-01 to 2020-12) 0 dose 1+dose Unknown *Dots are randomly placed within districts *Data Source: SEAR MR Surveillance database as of 13 January 2021 01 Jan 2020 to 31 Dec 2020 01 Jan 2019 to 31 Dec 2019 Rubella cases: Thailand 42 0 5 10 15 20 25 30 2 0 1 8 -0 1 2 0 1 8 -0 3 2 0 1 8 -0 5 2 0 1 8 -0 7 2 0 1 8 -0 9 2 0 1 8 -1 1 2 0 1 9 -0 1 2 0 1 9 -0 3 2 0 1 9 -0 5 2 0 1 9 -0 7 2 0 1 9 -0 9 2 0 1 9 -1 1 2 0 2 0 -0 1 2 0 2 0 -0 3 2 0 2 0 -0 5 2 0 2 0 -0 7 2 0 2 0 -0 9 2 0 2 0 -1 1 N u m b er o f ca se s Month of onset Rubella cases distribution by month (2018-2020) Lab confirmed Epi-linked Spot map of Rubella cases 0 5 10 15 20 <1 yr 1-4 yrs 5-9 yrs 10-14 yrs 15-24 yrs 25-39 yrs 40+yrs Unknown N u m b er o f ca se s Age at onset Age distribution by vaccination status (2020-01 to 2020-12) 0 dose 1+dose Unknown *Dots are randomly placed within provinces *Data Source: SEAR MR Surveillance database as of 13 January 2021 01 Jan 2020 to 31 Dec 2020 01 Jan 2019 to 31 Dec 2019 The SEAR Measles and Rubella quarterly bulletin is based on surveillance case-based data/aggregated data reported by Member States to the regional offices weekly and measles lab network data monthly. 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. Types of data provided to Regional office • Epidemiologic Data: Case-based and to SEAR IVD by member states • At SEAR IVD, we collect a limited set of variables, including, age, date of onset, country reporting, 1st 2nd and 3rd administrative unit of residence, vaccination status (by recall), date related to specimen collection/testing, and final classification as per SEAR recommended data dictionary. Often suspected cases with recent date of onset are not classified as pending/blank; however, at SEAR we classify as pending cases. • Limitations • Underreporting/lack of reporting and delay reporting • Genetic sequence data are not update properly in the case-based data and taken from different sources • SEAR laboratory network data • SEAR 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, serum results available within 4 days of specimen receipt in the lab. • 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 result in a laboratory may not reported to the surveillance system • 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 • 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 regional level Data source for data contained within this slide deck 43 Disclaimer for all maps: The boundaries and names shown and the designations used on all the maps do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, of concerning the delimitation of its frontiers or boundaries. For contact or feedback: Immunization and Vaccine Development (IVD), Department of Communicable Disease Surveillance (CDS) World Health Organization, Regional Office for South-East Asia, New Delhi – 110002, India Tel: 91-11-2337-0804 / 91-11-4304-0000 E-mail: SearEpidata@who.int 44