Volume 5 • Issue 3 • July 2011
ISSN 1814 3601
News in Brief Progress towards measles elimination: The Western Pacific Region is making unprecedented progress towards measles elimination as it closes in on its 2012 goal. Although the annualized incidence from January–June 2011 is 17.0 per million population, high-quality, large-scale supplementary immunization activities (SIAs) conducted in high-priority countries over the past 12 months should substantially reduce transmission across the Region. These countries include Papua New Guinea (June 2010–July 2011), China (September 2010), Viet Nam (September–November 2010), Cambodia (February–April 2011) and Philippines (April–June 2011). Cambodia will conduct a second phase of its SIA in October–November 2011, targeting children 5 – 9 years old in high risk areas. Lao People's Democratic Republic will conduct a national SIA in November–December 2011, targeting people 9 months to 19 years with measles-rubella (MR) vaccine. Malaysia is planning a subnational SIA to address immunity gaps among children in high-risk areas. WHO position on rubella vaccine: WHO published a new position paper on rubella vaccine (Weekly Epidemiological Record. 2011; 86:301–316) on 15 July 2011 that provides countries updated guidance for use of rubella containing vaccine (RCV). WHO recommends that countries use the opportunity of accelerated measles control and elimination activities to introduce RCV. All countries that have not yet introduced RCV and are providing two doses of measles vaccine using routine immunization and/or SIAs should consider the inclusion of RCV in their immunization programmes. To avoid the potential increased risk of congenital rubella syndrome after RCV introduction, countries should achieve and maintain immunization coverage of 80% or greater with at least one dose of RCV delivered through routine services or regular SIAs, or both.
Timeliness and completeness of monthly data reporting National reports (Table 1A) From January to June 2011, completeness and timeliness of monthly reporting of measles and rubella cases to the Western Pacific Regional Office was 92% and 87%, respectively. Completeness of reporting for the Region ranged from 82% to 100% by month and varied from 50% to 100% by country and area. Completeness of monthly reporting was particularly low for the Pacific island countries and areas and Papua New Guinea (50% each) and Viet Nam (67%). Timeliness of monthly reporting for the Region ranged from 76% to 94% by month and from 0% to 100% by country and area. Timeliness was particularly low for Papua New Guinea (0%), the Pacific island countries and areas (33%), and Viet Nam (67%). National measles laboratory reports (Table 1B) From January to June 2011, completeness and timeliness of data submitted by national measles laboratories (NMLs) to the Regional Office was 86% and 78% respectively. All other NMLs achieved at least 80% completeness. Timeliness of monthly reporting was particularly low for NMLs in Fiji and Viet Nam (northern) (50% each) and Papua New Guinea (67%). Laboratories from China and Japan do not report laboratory data directly to the Western Pacific Regional Office.
Incidence and Deaths (Table 2A) A total of 15 342 confirmed measles cases were reported in the Region from January–June 2011, corresponding to an annualized measles incidence of 17.0 per million population, a 37% decrease compared to the 27.0 per million incidence in 2010. The countries with the highest annualized measles incidence were Philippines (119.8), New Zealand (45.8), Cambodia (35.1), Malaysia (22.8) and Singapore (19.7). Thirty-six measles related deaths were reported from January–June 2011 (case fatality rate [CFR]=0.2%): 25 were reported from the Philippines (CFR=0.4%), 8 from China (CFR=0.1%), two from Viet Nam (CFR=1.4%), and one from Cambodia (CFR=0.4%). Clinically confirmed cases accounted for 4425 (29.1%) of all confirmed cases in the Region with classification data. Countries and areas with over 10% of confirmed measles cases that were clinically confirmed include Lao People's Democratic Republic (100%), Viet Nam (69%), Philippines (56%), Hong Kong (China) (33%), Cambodia (32%), Japan (24%) and China (11%). Clinically confirmed cases are considered failures of surveillance because either specimens were not collected or contact tracing was inadequate to establish epidemiologic linkage to other confirmed cases.
Table 1A. Completeness and timeliness of national reporting, Western Pacific Region, 2009 - 2011 2009 Country Australia Brunei Darussalam Cambodia China Hong Kong (China) Japan Lao PDR Macao (China) Malaysia Mongolia New Zealand Papua New Guinea Philippines Republic of Korea Singapore Viet Nam Pacific island countries* Completeness Timeliness Completeness 100% 100% 100% 92% 100% 100% 58% 100% 58% 100% 100% 67% 75% 50% 100% 83% 67% 85.3% 60.8% Timeliness 100% 100% 83% 0% 100% 92% 42% 83% 42% 75% 92% 17% 58% 17% 67% 25% 42% 2010 Completeness 100% 100% 75% 100% 100% 100% 83% 100% 92% 100% 100% 67% 100% 92% 100% 92% 92% 93.6% 78.9% Timeliness 100% 100% 42% 58% 100% 100% 75% 100% 83% 92% 92% 33% 92% 92% 100% 25% 58% Jan 10 Feb 08 Feb 08 Feb 10 Feb 14 Feb 09 Feb 04 Feb 09 Feb 07 Feb 09 Feb 09 Feb 07 Feb 16 Feb 06 Feb 10 Feb 02 Feb 10 Feb 10 Feb 100% 94% 10 Mar 94% 88% 88% 88% 82% 76% 88% 88% Feb 10 Mar 10 Mar 09 Mar 10 Mar 10 Mar 09 Mar 07 Mar 10 Mar 04 Mar 07 Mar 07 Mar 07 Mar 29 Mar 14 Mar 08 Mar 01 Mar 10 Apr 07 Apr 06 Apr 10 Apr 03 May 09 May 05 May 03 Jun 10 Jun 06 Jun 02 Jun Mar 10 Apr 08 Apr 07 Apr 10 Apr 12 Apr 07 Apr 05 Apr 08 Apr 06 Apr 08 Apr 09 Apr 05 Apr Apr 10 May 06 May 09 May 10 May 11 May 06 May 06 May 10 May 05 May 06 May 05 May 12 May 2011† May 10 Jun 09 Jun 07 Jun 08 Jun 13 Jun 09 Jun 10 Jun 10 Jun 07 Jun 09 Jun 07 Jun 08 Jun Jun 10 Jul 07 Jul 09 Jul 10 Jul 10 Jul 08 Jul 08 Jul 10 Jul 01 Jul 15 Jul 10 Jul 05 Jul 14 Jul 07 Jul 10 Jul 04 Jul 10 Jul 22 Jul 100% 88% Completeness 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 50% 100% 100% 100% 67% 50% 92.2% 87.3% Timeliness 100% 100% 83% 83% 100% 100% 100% 100% 83% 100% 83% 0% 83% 100% 100% 67% 33%
Legend: black = timely report; red = untimely report † Surveillance data through June 2011 * PICs and China are expected to report to the Regional Office by 15th (or the next working day) of the following month; all other countries and areas should submit reports by the 10th of the following month
Table 1B. Completeness and timeliness of laboratory reporting, Western Pacific Region, 2009 - 2011 Country Australia Cambodia China Hong Kong (China) Japan Lao PDR Macao (China) Malaysia Mongolia New Zealand Papua New Guinea Philippines Republic of Korea Singapore Viet Nam (northern) Viet Nam (southern) Fiji Completeness Timeliness 2009 Completeness 100% 50% 0% 100% 0% 8% 100% 75% 92% 83% 0% 100% 75% 100% 92% 92% 67% 66.7% 45.6% Timeliness 83% 17% 0% 100% 0% 0% 92% 8% 92% 8% 0% 33% 50% 100% 58% 75% 58% 100% 42% 0% 100% 0% 58% 100% 92% 100% 100% 75% 100% 100% 100% 100% 83% 67% 77.5% 61.8% 2010 Completeness Timeliness 100% 25% 0% 100% 0% 58% 100% 58% 100% 33% 33% 83% 100% 100% 58% 50% 50% 10 Feb 07 Feb 09 Feb 08 Feb 09 Feb 10 Feb 08 Feb 10 Feb 07 Feb 08 Feb 09 Feb 09 Feb 88% 88% †
2011 Jan 08 Feb 07 Feb 09 Feb Feb 03 Mar 07 Mar 09 Mar 10 Mar 04 Mar 07 Mar 04 Mar 11 Mar 08 Mar 10 Mar 09 Mar 07 Mar 21 Mar 10 Mar 10 Mar 88% 76% Mar 05 Apr 07 Apr 09 Apr 08 Apr 07 Apr 08 Apr 06 Apr 08 Apr 12 Apr 08 Apr 08 Apr 08 Apr 09 Apr 08 Apr 11 Apr 88% 76% Apr 04 May 09 May 09 May 10 May 05 May 10 May 04 May 10 May 09 May 10 May 10 May 06 May 10 May 10 May 04 May 88% 88% 76% 71% 25 May 08 Jun 07 Jun 16 Jun 08 Jun May 03 Jun 09 Jun 09 Jun 10 Jun 08 Jun 09 Jun 07 Jun 10 Jun Jun 01 Jul 09 Jul 09 Jul 20 Jul 07 Jul 10 Jul 09 Jul 07-Jul 01 Jul 10 Jul 10 Jul 08 Jul 12 Jul 08 Jul 22 Jul 88% 71%
Completeness 100% 100% 0% 100% 0% 100% 100% 100% 100% 100% 83% 100% 100% 100% 100% 100% 83% 86.3%
†
Timeliness* 100% 100% 0% 100% 0% 83% 100% 100% 100% 83% 67% 100% 100% 100% 50% 100% 50% 78.4%
Same standard for completeness is applied for both national and laboratory reporting. * Deadline for submission is on the 10th of the following month.
Surveillance Performance Indicators (Table 2B) Case reporting rate The annualized discarded measles rate from January– June 2011 was 2.9 per 100 000 population for the Region, exceeding the target of 2 per 100 000. Countries and areas achieving or exceeding the target included Viet Nam (11.6), Cambodia (10.3), Malaysia (7.1), Mongolia (5.8), Philippines (4.4), Lao Peoples Democratic Republic (3.0), Hong Kong (China) (2.6), China (2.4), and Macau (China) (2.2). Countries with discarded measles rates below the target included Brunei Darussalam, Japan, Papua New Guinea, and Republic of Korea. None of the Pacific island countries reported any discarded measles cases. Australia, New Zealand and Singapore do not report discarded measles cases. Surveillance sensitivity was not uniform at subnational levels. Only 37% of second-level administrative reporting units reported > 1 discarded measles cases per 100 000 population (target ≥ 80%). Four countries and areas achieved or exceeded the target: Hong Kong (China), Macao (China), Malaysia and the Philippines.
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Table 2A. Measles case classification and incidence, by country and area, Western Pacific Region, 2010 - 2011 1 2010 Country
2011 Discarded cases 0 7 2416 18 529 13 31 179 28 1023 153 0 26 3986 132 0 2915 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 29 438
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Population (in millions) 2
Suspected measles 3 cases No data
Confirmed measles cases Lab 65 0 451 26 297 4 306 6 0 69 0 15 0 2881 95 54 757 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 31 000
Epi-linked 5 0 0 116 0 3 0 0 2 0 21 0 137 16 0 89 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 389
Clinical 0 0 705 11 768 7 121 147 0 4 7 12 0 3366 3 0 977 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 17 117
Total 70 0 1 156 38 181 11 430 153 0 75 7 48 0 6384 114 54 1823 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 48 506
Measles Population (in Pending Deaths due to incidence per 1 classification measles millions) 2 million pop. 0 0 0 56 0 0 0 0 0 0 0 0 0 0 0 1681 0 0 72 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1809 0 0 6 39 0 0 0 0 0 0 0 0 34 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 80 3.1 0 81.8 28.5 1.6 3.4 24.7 0 2.6 2.5 11.0 0 68.5 2.4 10.6 20.8 0 0 N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 27.0 Green Yellow Red 22.61 0.41 14.31 1347.57 7.12 126.50 6.29 0.56 28.86 2.80 4.41 7.01 94.85 48.39 5.19 88.79 0.07 0.02 0.87 0.27 0.18 0.10 0.05 0.11 0.01 0.25 0.00 0.06 0.02 0.18 0.55 0.00 0.10 0.01 0.25 0.01 1808.80
Suspected measles 3 cases No data
Confirmed measles cases Lab 97 2 170 7 382 3 223 0 1 234 0 75 0 2384 12 51 16 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10 650
Epi-linked 10 0 0 11 1 8 0 0 36 0 26 0 147 0 0 28 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 267
Clinical 0 0 81 954 2 72 3 0 59 0 0 0 3153 3 0 98 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4425
Total 107 2 251 8347 6 303 3 1 329 0 101 0 5684 15 51 142 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 15 342
Discarded cases 0 2 738 16 469 91 38 95 6 1026 81 0 0 2081 67 0 5130 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 25 824
Measles Pending Deaths due to incidence per 1 classification measles million pop. 0 1 24 304 2 0 0 0 457 0 5 41 73 5 0 977 0 0 12 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 901 0 0 1 8 0 0 0 0 0 0 0 0 25 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 36 9.5 9.9 35.1 12.4 1.7 4.8 1.0 3.6 22.8 0 45.8 N/A 119.8 0.6 19.7 3.2 0 0 N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 17.0
Australia 22.27 Brunei Darussalam 0.40 Cambodia 14.14 China 1341.34 Hong Kong (China) 7.05 Japan 126.54 Lao PDR 6.20 Macao (China) 0.54 Malaysia 28.40 Mongolia 2.76 New Zealand 4.37 Papua New Guinea 6.86 Philippines 93.26 Republic of Korea 48.18 Singapore 5.09 Viet Nam 87.85 Pacific island countries and areas American Samoa Cook Islands Fiji French Polynesia Guam Kiribati Marshall Islands Micronesia, Federated States of Nauru New Caledonia Niue Northern Mariana Islands Palau Samoa Solomon Islands Tokelau Tonga Tuvalu Vanuatu Wallis and Futuna Western Pacific Region 1 2 3
7 3572 56 766 24 461 332 28 1098 160 No data
5 1013 25 120 99 341 98 7 1 812 81 No data
26 10 370 246 No data
41 7838 87 No data
6419 0 0 72 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 79 581
6249 0 0 12 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 42 803
0.07 0.02 0.86 0.27 0.18 0.10 0.05 0.11 0.01 0.25 0.00 0.06 0.02 0.18 0.54 0.00 0.10 0.01 0.24 0.01 1798.34
Monthly reports with data through June Population figures from United Nations World Population Prospects: The 2010 Revision Australia, New Zealand and Singapore report only confirmed cases
<1 confirmed measles case / 1 000 000 population 1-9.9 confirmed measles case / 1 000 000 population >= 10 confirmed cases / 1 000 000 population
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Table 2B. Measles surveillance performance indicators, by country and area, Western Pacific Region, 2010 - 2011 1 1 2010 2011 Country Discarded measles rate per Second level units with ? 1 discarded cases per 100 000 100 000 pop ?2 Australia 4 Insufficient data Brunei Darussalam 1.8 Cambodia 17.1 China 1.4 Hong Kong (China) 0.2 Japan 0 Lao PDR 2.9 Macao (China) 5.2 Malaysia 3.6 Mongolia 5.6 New Zealand 4 Insufficient data Papua New Guinea 0.4 Philippines 4.3 Republic of Korea 0.3 Singapore 4 Insufficient data Viet Nam 3.3 Pacific island countries and areas American Samoa 0 Cook Islands 0 Fiji 0 French Polynesia 0 Guam 0 Kiribati 0 Marshall Islands 0 Micronesia, Federated States of 0 Nauru 0 New Caledonia 0 Niue 0 Northern Mariana Islands 0 Palau 0 Samoa 0 Solomon Islands 0 Tokelau 0 Tonga 0 Tuvalu 0 Vanuatu 0 Wallis and Futuna 0 Western Pacific Region 1.7 ? 80% Insufficient data
Suspected cases with adequate investigation ? 80% Insufficient data
Suspected cases with Percent clinically confirmed Discarded measles rate per 3 100 000 pop adequate blood specimens 2 cases ? 80% Insufficient data
Second level units with ? 1 Annualized discarded measles rate per 100 000 discarded cases per 100 000 (annualized) pop ?2 Insufficient data
Suspected cases with adequate investigation ? 80% Insufficient data
Suspected cases with Percent clinically confirmed 3 adequate blood specimens 2 cases ? 80% Insufficient data
? 10% Insufficient data Not applicable
?2 Insufficient data
? 80% Insufficient data
? 10% Insufficient data
100% 75.0% 51.6% 0% 0% 35.3% 100% 87.5% 31.8% Insufficient data
85.7% 60.1% 91.1% 45.8% Insufficient data
100% 79.3% 72.6% 66.7% Insufficient data
19.3% 100% 71.9% 65.0% Insufficient data
23.8% 100% 82.0% 92.5% Insufficient data
61.0% 30.8% 63.6% 28.1% 96.1% Not applicable
5.3% 100% 25.0% Not applicable
0.5 5.2 1.2 1.3 0 1.5 1.1 3.6 2.9 Insufficient data
1.0 10.3 2.4 2.6 0.1 3.0 2.2 7.1 5.8 Insufficient data
0% 50.0% 77.4% 100% 0.0% 41.2% 100% 93.8% 31.8% Insufficient data
60.0% 57.1% 92.1% 30.3% Insufficient data
100% 86.5% 85.4% 90.8% Insufficient data
29.6% 100% 40.3% 72.8% Insufficient data
61.2% 100% 72.1% 100% Insufficient data
0% 32.3% 11.4% 33.3% 23.8% 100% 0% 17.9% Not applicable
0% Not applicable
5.0% 94.1% 6.3% Insufficient data
46.2% 14.5% 61.8% Insufficient data
100% 67.8% 73.9% Insufficient data
52.7% 2.6% Insufficient data
0 2.2 0.1 Insufficient data
0 4.4 0.3 Insufficient data
0% 94.1% 0% Insufficient data
12.2% 36.9% 62.1% Insufficient data
51.2% 68.2% 75.9% Insufficient data
55.5% 20.0% Insufficient data
53.1% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 38.3%
59.0% Not applicable Not applicable
59.9% Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable
53.6% Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable
5.8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1.5
11.6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2.9
45.3% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 37.3%
33.7% Not applicable Not applicable
48.5% Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable
69.0% Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable
0% Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable
0% Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable
76.3%
71.3% Green Yellow Red
35.4%
69.8%
76.2%
29.1%
Monthly reports with data through June 2 Excludes epi-linked cases 3 4
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Among all confirmed cases Reports only confirmed cases
Reached or surpassed target Nearly reached target: 1.00-1.99 for discarded measles rate; 10.1-25% for percent clinically confirmed cases; 60-79% for other indicators Substantially below target
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Table 3. Measles and rubella laboratory performance, Western Pacific Region, 20111 Measles Measles and rubella Serum and blood Country Samples tested for measles Total number Total number IgM of cases of samples tested received No. Measles IgM (+) Measles IgM equiv Measles IgM (-) Measles IgM pending Serology DBS Results ≤ 7 days Measles Virus isolation/ detection (swab, urine, PBMC) No. of samples tested 0 97 Virus detection Samples Total number tested for of lab rubella IgM confirmed cases No. Serum and blood Rubella IgM (+) Rubella IgM pending Rubella Virus detection
DBS samples
Measles RT - PCR
Measles genotypes No. of samples with genotype2 78 0 180
Rubella IgM equiv
Rubella genotypes No. of samples with genotype 0 0 157
No.
No.
No.
%
No.
No. received 0 1
No. (+) 0
%
No. of isolates 0 0
No. of samples tested 116 97
No. of (+)
Genotypes A, D4, D8, D9, H1 D8, D11,D9,H1 D8, D9 A, D4, D8, D9, G3, UT D8 A, D9, G3 D4, D8, D9 D9 A, D9 D4, D8, D9, G3 0 1 406 0 71 0 3376 15 48 8 4 0 4238 3
No.
No.
No.
Genotypes
Australia Cambodia China Hong Kong (China) Japan Lao PDR Macao (China) Malaysia Mongolia New Zealand Papua New Guinea Philippines Republic of Korea Singapore Viet Nam (northern) Viet Nam (southern) Fiji Total 1 2
106 2220
180 2226
54 2128
22 228
4 0
28 1375
51.9% 64.6%
0 525
100% 75.9%
96 0
78 228
23 2128
2 486
1 1
0 525
1E, 2B 1E, 2B 1E, 1j, 2B 1E 1i, 2B -
158
183
150
3
2
145
96.7%
0
0
-
97.3%
6
2
9
3
2 107
155
18
2
4
10 3
60 19 1843 81 286 36 6302 102 293 2345 1587 10 15 448
60 19 1896 81 346 36 6302 123 423 2345 1596 10 15 826
60 19 1879 81 224 36 6189 89 126 1341 1376 4 13 756
0 1 406 0 34 0 3376 15 29 8 4 0 4126
0 0 32 0 4 0 335 12 1 4 9 0 403
60 18 1441 81 186 36 2472 62 96 1293 1359 4 8656
100% 94.7% 76.7% 100% 83.0% 100% 39.9% 69.7% 76.2% 96.4% 98.8% 100% 62.9%
0 0 0 0 0 0 6 0 0 36 4 0 571
0 0 0 0 0 0 0 0 0 0 0 6 7
0 0
100% 94.7% 100% 100% 97.7% 100% 67.6% 100% 97.1% 61.6% 93.7% 14.3% 77.2%
0 0 0 0 1 0 0 13 142 0 9 0 268
0 0 0 0 0 0 0 1 20 0 0 0 23
0 0 0 0 124 0 0 43 3 0 9 0 401
0 0 0 0 58 0 0 1 3 0 0 0 161
0 1 29 0 26 0 6 4 27 0 0 0 460
60 19 1460 81 26 36 2846 89 191 2345 1583 10 11 052
9 0 188 11 3 16 959 8 8 1349 1043 0 4100
7 1 116 3 0 1 226 17 13 172 91 0 651
0 0 1 0 0 0 12 0 2 13 3 0 560
1 0 3 0 0 0 0 0 0 0 0 0 174
Monthly reports with data through June Sources include national and regional reference laboratory reports to WHO and to the Measles Nucleotide Sequence (MeaNS) database; in case of discrepant reports, the larger number is included in Table 3.
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Adequate case investigation A case is considered adequately investigated if it is investigated within 48 hours of report and 10 core data variables are completed in the case investigation form. From January–June 2011, 70% of suspected cases were adequately investigated. China and Macau (China) achieved or exceeded the 80% target. Countries and areas with a 60%–79% adequate investigation rate included Mongolia (73%), Republic of Korea (62%) and Brunei Darussalam (60%). Australia, Japan, New Zealand and Singapore do not report data in the standard format.
Adequate specimens Adequate specimens were collected from 76% of suspected cases from January–June 2011. Six countries and areas (Brunei Darussalam, Cambodia, China, Hong Kong [China], Macao [China], and Mongolia) achieved or exceeded the 80% target. Countries and areas with 60%–79% adequate specimen rate included Republic of Korea (76%), Malaysia (72%), Philippines (68%) and the Lao People's Democratic Republic (61%). Those with less than 60% included Papua New Guinea (51%) and Viet Nam (49%). Australia, Japan, New Zealand and Singapore do not report specimen collection among suspected cases.
Performance of national measles laboratory (Table 3) Laboratory results within seven days From January–June 2011, among 13 756 serum or blood and seven dried blood spot (DBS) specimens received for testing of anti-measles IgM antibody, 77% had results within seven days after receipt of specimens by laboratory (target ≥ 80%). Reporting timeliness from Fiji was particularly low (14%). Virus detection Among 268 samples evaluated for virus isolation or detection in regional reference laboratories (RRLs) in Australia and Hong Kong (China) and in NMLs in New Zealand, Singapore, the Republic of Korea and Viet Nam in 2011, 23 (8.6%) measles virus isolates were obtained. Measles virus was isolated among samples from Singapore (20), Hong Kong (China) (2) and Republic of Korea (1). Genotypes may be determined from genetic sequence data collected by reverse transcriptase polymerase chain reaction (RT-PCR) following virus isolation or directly from specimens without virus isolation. Among 401 specimens undergoing RT-PCR testing, 161 were positive from labs in Australia (96), New Zealand (58), Hong Kong (China) (3), Singapore (3) and the Republic of Korea (1). Genotyping Measles genotypes were identified from 460 samples reported from 10 countries and areas, including China (N=180: 174 H1, 2 D8, 2 A, 1 D9, 1 D11), Japan (N=107: 51 D4, 38 D9, 5 D8, 2 A, 1 G3, 10 untypable), followed by Australia (N=78: 36 D9, 20 D8, 14 D4, 4 A, 1 H1, 3 pending), Malaysia (N=29: 25 D9, 2 G3, 2 A), Singapore (N=27: 21 D9, 4 D8, 1 D4, 1 G3), New Zealand (N=26: 12 D4, 11 D9, 3 D8), Philippines (N=6: 6 D9), Republic of Korea (N=4: 2 D9, 1 A, 1 pending), Hong Kong (China) (N=2: 1 D8, 1 D9) and Macau (China) (N=1: D8). Genotypes of measles virus identified from the Region in 2011 therefore included A (vaccine type), D4, D8, D9, D11, G3 and H1.
Rubella From January–June 2011, among 11 052 specimens received for rubella testing, 560 have pending results; 525 of these are from Cambodia. Among the remaining 10 492, 4100 (39%) samples were positive and 651 (6%) were equivocal for anti-rubella IgM antibody. Countries with the largest number of IgM-positive rubella specimens included Viet Nam (2392: 1349 from the north and 1043 from the south), Philippines (959), Cambodia (486) and Malaysia (188). Rubella genotypes were identified from 174 samples from 6 countries and areas, including China (N=157: 136 1E, 21 2B), Hong Kong (China) (N=10: 4 1E, 3 2B, 3 pending), Japan (N=3: 1 1E, 1 1j, 1 2B), Malaysia (N=3: 2 1i, 2 2B), Lao People’s Democratic Republic (N=1: 1E). Genotypes of rubella virus identified in the Region therefore included 1E, 1i, 1j and 2B.
Expanded Programme on Immunization Regional Office for the Western Pacific World Health Organization P.O. Box 2932, 1000 Manila, Philippines Tel. No. (63 2) 5288001 Fax No. (63 2) 5211036, 5260279 Please send your comments and monthly data before the 10th of the month to: WPR_EPIdata@wpro.who.int
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