SEA Region Measles and Rubella Quarterly update July -September 2022

SEA Region Measles and Rubella Quarterly update July -September 2022 The boundaries and names shown and the designations used on this map 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, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. © WHO. All rights reserved Key highlights – Q3 2022 (July-Sept 2022) • The Region has adopted the goal of “measles and rubella elimination by 2023” (SEA/RC73/R3). The 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) • Thirteenth Meeting of the WHO South-East Asia Regional Immunization Technical Advisory Group was conducted between 17 – 19 August 2022,New Delhi, India has provided further guidance to accelerate progress towards measles and rubella elimination. • Fifth biennial bi-regional cross-border meeting on polio, measles-rubella, and other priority Vaccine Preventable Diseases, between WHO South-East Asia and Western Pacific Region, conducted in Kathmandu, Nepal, 28-30 September 2022 to strengthen cross- border collaboration and strengthen point of entry for VPD surveillance and immunization. 2 Recent cases of measles and rubella in countries already verified for measles elimination, South-East Asia Region Country Year in which verified Confirmed cases 2021 Confirmed cases 2022 Source of infection of measles cases % measles cases with known source Measles Rubella Measles Rubella Measles Rubella Imported Import- related Unknown/ not reported Endemic Bhutan 2017 - 0 0 4 2 0 0 0 0 NA DPR Korea 2018 - 0 0 0 0 0 0 0 0 NA Maldives 2017 2020 0 0 0 0 0 0 0 0 NA Sri Lanka 2019 2020 0 0 0 0 0 0 0 0 NA Timor-Leste 2018 - 1 2 7 2 0 1 0 0 NA Data as of 17 October 2022 Measles and rubella incidence, 2018-2022 Data Source: Measles and rubella cases reported through JRF submitted by Member States and population data from AERF 2018-2019, Data for 2020-2022 from SEAR MR surveillance database Measles Incidence per million population Country 2018 2019 2020 2021 2022 Bangladesh 64.3 34.7 14.2 1.20 1.45 Bhutan 24.5 2.7 0 0 6.65 DPR Korea 0 0 0 0 NR India 14.3 7.8 4.0 4.10 9.29 Indonesia 20.0 7.3 1.1 1.41 7.59 Maldives 3.0 0.0 26.9 0 0 Myanmar 26.5 98.6 8.1 0.15 0.23 Nepal 9.0 14.6 13.0 4.73 0.55 Sri Lanka 0 2.2 0.1 0 0 Thailand 90.9 75.3 12.2 1.06 1.94 Timor-Leste 0 16.6 0 0.76 4.75 SEAR 21.7 14.7 4.9 3.25 7.58 Rubella Incidence per million population Country 2018 2019 2020 2021 2022 Bangladesh 1.9 1.0 0.4 0.76 0.85 Bhutan 15.0 9.4 0 0 3.32 DPR Korea 0 0 0 0 NR India 1.7 2.5 1.0 1.18 1.37 Indonesia 6.0 2.7 0.6 0.91 2.20 Maldives 0.0 0.0 1.8 0 0 Myanmar 0.2 0.5 0.1 0.05 0 Nepal 1.2 1.5 1.2 1.46 0.76 Sri Lanka 0 0 0 0 0 Thailand 1.0 2.1 0.8 0.11 0.06 Timor-Leste 6.2 15.8 4.8 1.52 3.80 SEAR 2.2 2.3 0.8 1.03 1.32 Data as of 17 October 2022 Zero-dose and partially vaccinated children – 2021 cohort 5Source: Calculation done based on the population under 1 year from United Nations Population Divisions and Coverage from WHO/UNICEF Joint Estimate 2021, July 2022 Number % Number % Bangladesh 2 957 723 88 732 3% 118 309 4% Bhutan 9 507 285 3% 570 6% DPR Korea 340 046 197 227 58% 3 400 1% India 22 591 299 2 485 043 11% 1 581 391 7% Indonesia 4 422 245 1 238 229 28% 972 894 22% Maldives 7 305 73 1% 219 3% Myanmar 893 712 500 479 56% 17 874 2% Nepal 597 369 59 737 10% 17 921 3% Sri Lanka 304 378 9 131 3% 0 0% Thailand 640 380 25 615 4% 57 634 9% Timor-Leste 32 027 6 726 21% 320 1% SEAR 32 795 991 4 611 276 14% 2 770 534 8% Country Under 1 year population MCV zero dose children MCV Partially vaccinated Measles Confirmed measles cases and coverage of MCV1 and MCV2 in SEAR 2000-2022 Source: WHO/UNICEF coverage estimates, July 2020 and WHO/UNICEF JRF and EPI/MOHFW; Measles cases from JRF 2000-2021 and 2022 from SEAR MR surveillance database Data as of 17 October 2022 Measles cases by month and country (2019-2022*) Data as of 17 October 2022 Measles cases by country, 2021-2022* 9 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 4936 201 153 0 48 20 8 28 32 9 26 23 32 23 0 Bhutan 92 4 4 0 0 0 1 0 0 0 1 2 0 0 0 DPR Korea 0 0 0 0 0 0 0 0 0 0 0 0 India 53706 10412 3710 2 874 3 828 575 728 1 257 1 356 1 203 1 301 1 544 1 304 1 081 63 Indonesia 8701 1645 1645 0 0 107 145 191 234 275 528 88 77 0 0 Maldives 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Myanmar 49 10 7 0 3 2 0 2 1 2 1 1 1 0 0 Nepal 776 13 11 0 2 2 1 1 3 3 0 2 1 0 0 Sri Lanka 41 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Thailand 184 20 7 0 94 2 3 1 1 6 7 7 22 35 17 Timor Leste 199 5 5 0 0 0 0 0 0 0 4 0 0 1 0 SEAR 68 687 12 310 5 542 2 874 3 975 708 886 1 480 1 627 1 498 1 868 1 667 1 437 1 140 80 0 0 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 4083 203 122 26 55 7 7 54 27 5 4 3 11 14 28 18 25 Bhutan 147 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 DPR Korea 491 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 India 33379 5833 1870 417 3 546 269 350 510 307 166 315 611 666 741 598 610 690 Indonesia 2860 385 123 0 262 26 24 20 35 31 23 17 22 34 57 49 47 Maldives 24 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Myanmar 30 8 5 0 3 1 2 0 1 0 3 0 0 1 0 0 0 Nepal 1417 143 81 60 2 19 9 12 4 4 2 5 45 29 11 2 1 Sri Lanka 85 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Thailand 243 70 8 0 62 12 6 19 7 4 7 0 2 3 2 3 5 Timor Leste 42 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 SEAR 42 801 6 643 2 210 503 3 930 334 398 615 381 210 354 636 746 822 696 682 769 Reported measles cases in 2022 Confirmed measles cases by month in 2022 Reported measles cases in 2021 Confirmed measles cases by month in 2021 Data as of 17 October 2022 Rubella Confirmed rubella cases and RCV coverage in SEAR 2005-2022 Source: WHO/UNICEF coverage estimates, July 2020 and WHO/UNICEF JRF and EPI/MOHFW; Measles cases from JRF 2000-2021 and 2022 from SEAR MR surveillance database Data as of 17 October 2022 Rubella cases by month and country (2019-2022*) 12Data as of 17 October 2022 Rubella cases by country, 2021-2022* Country Rubella cases Lab confirmed Epi-Linked Clinically compatible Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Bangladesh 118 116 2 0 12 9 9 14 16 19 10 19 9 1 Bhutan 2 2 0 0 1 0 0 0 0 0 0 0 0 0 DPR Korea 0 0 0 0 0 0 0 0 0 0 0 0 0 India 1 535 1 480 55 0 144 128 204 197 183 147 198 199 125 10 Indonesia 477 477 0 0 116 103 120 75 16 31 11 5 0 0 Maldives 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Myanmar 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Nepal 18 18 0 0 2 2 4 2 1 1 2 3 1 0 Sri Lanka 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Thailand 3 3 0 0 0 0 0 0 0 0 0 1 2 0 Timor Leste 4 4 0 0 0 0 0 0 1 1 0 0 2 0 SEAR 2 157 2 100 57 0 275 242 337 288 217 199 221 227 139 11 0 0 Country Rubella cases Lab confirmed Epi-Linked Clinically compatible Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Bangladesh 129 127 2 0 8 7 7 5 6 7 2 14 26 19 12 16 Bhutan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 DPR Korea 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 India 1 679 1 639 40 0 99 101 110 41 32 73 137 225 235 207 232 187 Indonesia 247 247 0 0 5 2 7 8 10 8 6 11 20 45 65 60 Maldives 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Myanmar 3 3 0 0 1 0 0 0 0 1 0 0 0 0 1 0 Nepal 44 44 0 0 5 4 4 4 2 3 7 3 3 4 3 2 Sri Lanka 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Thailand 7 7 0 0 0 0 2 1 1 2 0 0 0 1 0 0 Timor Leste 2 2 0 0 0 2 0 0 0 0 0 0 0 0 0 0 SEAR 2 111 2 069 42 0 118 116 130 59 51 94 152 253 284 276 313 265 Reported rubella cases in 2022 Reported rubella cases in 2021 Confirmed rubella cases by month in 2022 Confirmed rubella cases by month in 2021 Data as of 17 October 2022 Surveillance for measles and rubella 14 15 Definition of suspected measles and rubella cases Countries Fever and rash Bangladesh, Bhutan, DPR Korea, India, Indonesia; Maldives, Myanmar, Nepal, Sri Lanka, Thailand, Timor-Leste Fever, rash and 3 C’s –Cough, Coryza or conjunctivitis Suspected Measles cases by month of onset, last 14 months (data from weekly case- based reports) Data as of 17 October 2022 Bangladesh 4 083 4 936 706 546 372 495 328 320 693 493 607 760 685 673 370 7 16-Oct-22 Bhutan 147 92 20 7 10 1 4 2 2 4 7 30 22 13 7 1 14-Oct-22 DPR Korea 491 0 35 41 47 33 0 0 0 0 0 0 0 0 0 0 22-Feb-22 India 33 379 53 706 4 633 4 807 4 530 4 532 3 094 3 837 6 750 6 804 7 509 6 973 7 128 5 966 5 306 339 14-Oct-22 Indonesia 2 860 8 701 156 451 603 621 762 558 790 972 994 1 863 1 626 1 083 53 0 17-Oct-22 Maldives 24 3 5 1 5 1 2 1 0 0 0 0 0 0 0 0 28-Sep-22 Myanmar 30 49 1 0 2 1 5 0 6 2 10 10 8 4 2 2 17-Oct-22 Nepal 1 417 776 162 121 106 123 71 49 101 92 79 115 107 89 72 1 10-Oct-22 Sri Lanka 85 43 6 28 16 6 2 5 13 2 6 7 5 1 0 0 26-Sep-22 Thailand 243 184 10 7 9 11 14 9 6 3 30 34 11 23 37 17 17-Oct-22 Timor-Leste 42 199 4 3 3 1 3 4 20 17 8 18 31 66 32 0 11-Oct-22 TOTAL 42 801 68 689 5 738 6 012 5 703 5 825 4 285 4 785 8 381 8 389 9 250 9 810 9 623 7 918 5 879 367 Se p- 22 O ct -2 2 Date of last reportM ar -2 2 A pr -2 2 M ay -2 2 Ju n- 22 Ju l-2 2 A ug -2 2 Suspected Measles cases by month of onset, last 14 months (data from weekly case-based reports) Country 2021 total Suspected Measles cases 2022 suspected Measles cases to date Se p- 21 O ct -2 1 N ov -2 1 D ec -2 1 Ja n- 22 Fe b- 22 Surveillance and laboratory performance indicators (Q1-Q3 2021 vs Q1-Q3 2022) Data as of 17 October 2022 2021 2022 2021 2022 2021 2022 2021 2022 2021 2022 2021 2022 2021 2022 Bangladesh 2 670 4 779 97 96 86 93 2 305 4 444 100 100 100 100 100 98 Bhutan 129 88 99 85 95 91 123 80 100 100 100 100 73 49 DPR Korea 370 0 100 NR 100 NR 370 NR 100 NR 100 NR 100 NR India 19 510 52 162 83 77 83 81 16 098 42 043 100 100 100 100 70 77 Indonesia 1 185 8 701 65 68 85 100 1 007 8 686 98 100 100 100 83 82 Maldives 17 3 53 100 88 100 15 3 100 100 100 100 86 33 Myanmar 27 46 56 83 100 96 27 44 100 100 100 100 100 94 Nepal 1 067 775 100 99 99 100 1 054 774 100 100 100 100 69 81 Sri Lanka 35 41 100 85 97 100 34 41 97 100 100 100 78 78 Thailand 216 164 42 40 95 92 205 151 71 88 100 100 97 97 Timor-Leste 35 190 100 99 94 89 33 169 100 99 100 100 89 82 SEAR 25 261 66 949 85 78 84 84 21 271 56 435 100 100 100 100 76 80 Countries % 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 collected Number of serum specimens received in laboratory % serum specimens received at laboratory w/in 5 days of collection Case classification (Q1-Q3 2021 vs Q1-Q3 2022) La b o ra to ry - co n fi rm ed Ep id em io lo gi ca lly -c o n fi rm ed C lin ic al ly - co m p at ib le La b o ra to ry - co n fi rm ed Ep id em io lo gi ca lly -c o n fi rm ed C lin ic al ly - co m p at ib le La b o ra to ry - co n fi rm ed Ep id em io lo gi ca lly -c o n fi rm ed La b o ra to ry - co n fi rm ed Ep id em io lo gi ca lly -c o n fi rm ed 2021 2022 2021 2022 Bangladesh 59 47 26 147 47 0 80 2 112 2 2 456 4 471 0 0 Bhutan 0 0 0 4 0 0 0 0 2 0 129 82 0 0 DPR Korea 0 0 0 0 0 0 0 0 0 0 370 0 0 0 India 1 145 2 503 287 3 518 3 776 2 771 1 016 35 1 448 55 14 482 38 629 42 1 965 Indonesia 55 177 0 1 645 0 0 77 0 477 0 875 3 175 1 3 404 Maldives 0 0 0 0 0 0 0 0 0 0 17 3 0 0 Myanmar 5 3 0 7 3 0 2 0 0 0 17 36 0 0 Nepal 69 1 59 11 2 0 35 0 18 0 903 695 0 49 Sri Lanka 0 0 0 0 0 0 0 0 0 0 35 41 0 0 Thailand 6 54 0 7 74 0 6 0 3 0 150 80 0 0 Timor-Leste 0 0 0 7 0 0 2 0 2 0 33 178 0 3 SEAR 1 339 2 785 372 5 346 3 902 2 771 1 218 37 2 062 57 19 467 47 390 43 5 421 2021 2022 2021 2022 Countries Measles Rubella D is ca rd ed n o n - m ea sl es n o n - ru b el la c as es P en d in g cl as si fi ca ti o n Data as of 17 October 2022 Case classification (Q1-Q3 2021 vs Q1-Q3 2022) 19Data as of 17 October 2022 Measles Rubella Surveillance performance indicators 2019 2020 2021 2022 2019 2020 2021 2022 Bangladesh 3.35 1.93 2.22 3.31 91 52 70 98 Bhutan 39.72 15.98 19.44 13.97 85 50 75 40 DPR Korea 2.10 2.09 1.99 0.00 ND ND ND ND India 1.05 0.77 1.80 3.53 16 11 45 68 Indonesia 1.92 0.99 0.82 1.50 21 10 13 21 Maldives 18.40 41.54 4.39 0.67 ND ND 48 14 Myanmar 2.43 0.43 0.03 0.09 37 4 0 1 Nepal 5.53 3.15 4.07 3.03 92 81 84 69 Sri Lanka 1.55 0.39 0.39 0.24 27 0 0 0 Thailand 5.99 1.61 0.25 0.16 ND ND ND ND Timor-Leste 31.63 7.08 2.96 17.82 38 46 15 77 SEAR 1.68 0.98 1.66 2.97 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 Countries Data as of 17 October 2022 Non-measles non-rubella discarded case rate per 100,000 population by 1st sub- national level, 2021-2022* * Number of discarded measles cases per 100,000 population . (annualized by week 30, 2022) 2021 2022 Data as of 17 October 2022 Vaccination status of measles cases - 2019-2022 Data as of 17 October 2022 Vaccination status of rubella cases - 2019-2022 Data as of 17 October 2022 Vaccination status by age and by sex of measles cases 24 2019 2020 2021 2022 Data as of 17 October 2022 Vaccination status by age and by sex of rubella cases 25 2019 2020 2021 2022 Data as of 17 October 2022 Outbreaks of measles and rubella 26 Major cases reported in 2021-22 27 2021 Rubella 2022 Measles Country Province Total cases CHITTAGONG 97 KHULNA 32 RAJSHAHI 25 UTTAR PRADESH 1304 WEST BENGAL 679 MAHARASHTRA 667 JHARKHAND 447 BIHAR 359 GUJARAT 333 SULAWESI_SELATAN 74 MALUKU_UTARA 59 JAKARTA 48 SUMATERA_SELATAN 46 KARNALI 61 LUMBINI 30 Narathiwat 12 Yala 12 Bangladesh India Indonesia Thailand Nepal Country Province Total cases CHITTAGONG 35 KHULNA 21 DHAKA 21 UTTAR PRADESH 414 MADHYA PRADESH 193 MAHARASHTRA 188 WEST BENGAL 139 ODISHA 121 JAKARTA 46 JAWA_TIMUR 45 Bangladesh India Indonesia Country Province Total cases DHAKA 40 CHITTAGONG 37 RAJSHAHI 35 JHARKHAND 1982 UTTAR PRADESH 1629 WEST BENGAL 1356 MAHARASHTRA 902 BIHAR 845 HARYANA 742 ACEH 631 SUMATERA_BARAT 510 RIAU 181 JAWA_TIMUR 64 Rayong 12 Chiang Mai 9 Indonesia Thailand Bangladesh India Country Province Total cases RAJSHAHI 26 CHITTAGONG 23 DHAKA 20 UTTAR PRADESH 331 MAHARASHTRA 133 WEST BENGAL 132 KARNATAKA 126 BIHAR 125 JAWA_TENGAH 99 JAKARTA 86 JAWA_TIMUR 80 Indonesia Bangladesh India Laboratory Network 28 Measles and rubella laboratory network in SEA Region 29 Country National laboratory Sub national laboratory Regional reference laboratory Total Bangladesh 1 1 Bhutan 1 1 DPR Korea 1 1 India 7 18 2 27 Indonesia 3 4 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 18 37 3 58 Source: MeaNS database , National Institute of Health, Thailand, MeaNS, NIVMU Measles genotypes circulating between 2016 and 2021* 30 B3, D8 D8 B3,D4,D8, D9, H1 D8,D9D8 B3,D8, H1 D8,D9 B3,D8, H1 B3,D8, H1 Country 2016 2017 2018 2019 2020 2021 Bangladesh B3, D8 B3, D8 B3, D8 B3 B3 D8 Bhutan D8 D8 D8 DPR Korea India B3,D4,D8 B3,D4,D8 D4,D8, H1 B3,D4,D8, D9 B3,D4,D8 D8 Indonesia D8,D9 D8 D8 Maldives D8 Myanmar D8, H1 H1 B3,D8, H1 D8, H1 Nepal D8, D9 Sri Lanka D8 H1 B3, D8 Thailand B3,D8, H1 B3,D8, H1 B3,D8, H1 B3,D8, H1 D8 Timor-Leste Rubella genotype distribution between 2016- 2021* Ref: RubeNS database 31 Country 2016 2017 2018 2019 2020 2021 Bangladesh Bhutan DPR Korea India 1J, 2B 2B 2B 2B Indonesia Maldives Myanmar Nepal Sri Lanka Thailand 2B 1E 1E Timor-Leste 1J, 2B 1E, 2B The BIG SIX countries Immunization coverage and immunity gaps MCV2 coverage following the COVID-19 pandemic and immunity gaps-Bangladesh Source: Monthly routine immunization data in the context of COVID-19 submitted by Member States Source: Calculation based on Population under one year population provided by Member States and WUENIC coverage estimates (draft) for 2019-2021 Immunity profile MCV2 coverage following the COVID-19 pandemic and immunity gaps- India Source: Monthly routine immunization data in the context of COVID-19 submitted by Member States Source: Calculation based on Population under one year population provided by Member States and WUENIC coverage estimates (draft) for 2019-2021 Immunity profile MCV2 coverage following the COVID-19 pandemic and immunity gaps- Indonesia Source: Monthly routine immunization data in the context of COVID-19 submitted by Member States Source: Calculation based on Population under one year population provided by Member States and WUENIC coverage estimates for 2019-2021 Immunity profile MCV2 coverage following the COVID-19 pandemic and immunity gaps- Myanmar Source: Monthly routine immunization data in the context of COVID-19 submitted by Member States Source: Calculation based on Population under one year population provided by Member States and WUENIC coverage estimates (draft) for 2019-2021 Immunity profile MCV2 coverage following the COVID-19 pandemic and immunity gaps- Nepal Source: Monthly routine immunization data in the context of COVID-19 submitted by Member States Source: Calculation based on Population under one year population provided by Member States and WUENIC coverage estimates (draft) for 2019-2021 Immunity profile MCV2 coverage following the COVID-19 pandemic and immunity gaps- Thailand Source: Monthly routine immunization data in the context of COVID-19 submitted by Member States Source: Calculation based on Population under one year population provided by Member States and WUENIC coverage estimates (draft) for 2019-2021 Immunity profile The BIG SIX countries Measles Measles cases: Bangladesh *Dots are randomly placed within districts 40 Spot map of Measles cases Measles cases distribution by month Age distribution by vaccination status – Measles cases 2020 2021 2022 Data as of 17 October 2022 Measles cases: India *Dots are randomly placed within districts 41 Spot map of Measles cases Measles cases distribution by month 2020 2021 Age distribution by vaccination status – Measles cases 2022 Data as of 17 October 2022 Measles cases: Indonesia *Dots are randomly placed within districts 42 Spot map of Measles cases Measles cases distribution by month 2020 2021 Age distribution by vaccination status – Measles cases 2022 Data as of 17 October 2022 Measles cases: Myanmar *Dots are randomly placed within districts 43 Spot map of Measles cases Measles cases distribution by month 2020 2021 Age distribution by vaccination status – Measles cases 2022 Data as of 17 October 2022 Measles cases: Nepal *Dots are randomly placed within districts 44 Spot map of Measles cases Measles cases distribution by month 2020 2021 Age distribution by vaccination status – Measles cases 2022 Data as of 17 October 2022 Measles cases: Thailand *Dots are randomly placed within districts 45 Spot map of Measles cases Measles cases distribution by month 2020 2021 Age distribution by vaccination status – Measles cases 2022 Data as of 17 October 2022 The BIG SIX countries Rubella Rubella cases: Bangladesh *Dots are randomly placed within districts 2020 47 2021 Spot map of Rubella cases Rubella cases distribution by month Age distribution by vaccination status – Rubella cases 2022 Data as of 17 October 2022 Rubella cases: India *Dots are randomly placed within districts 2020 48 Spot map of Rubella cases Rubella cases distribution by month 2021 Age distribution by vaccination status – Rubella cases 2022 Data as of 17 October 2022 Rubella cases: Indonesia *Dots are randomly placed within districts 2020 49 2021 Spot map of Rubella cases Rubella cases distribution by month Age distribution by vaccination status – Rubella cases 2022 Data as of 17 October 2022 Rubella cases: Myanmar *Dots are randomly placed within districts 50 Spot map of Rubella cases Rubella cases distribution by month 2019 2021 Age distribution by vaccination status – Rubella cases 2022 Data as of 17 October 2022 Rubella cases: Nepal *Dots are randomly placed within districts 51 Spot map of Rubella cases Rubella cases distribution by month 2020 2021 Age distribution by vaccination status – Rubella cases 2022 Data as of 17 October 2022 Rubella cases: Thailand 52 Spot map of Rubella cases Rubella cases distribution by month 2019 2021 Age distribution by vaccination status – Rubella cases 2022 *Dots are randomly placed within province Data as of 17 October 2022 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 53 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 Diseases (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 54