Volume 6 • Issue 3 • March 2012
ISSN 1814 3601
This issue of the Measles-Rubella Bulletin includes data on cases with rash onset in 2012 through February that were reported to the Regional Office in March. Detailed explanations of the indicators used in this Bulletin may be found in Measles Bulletin, Vol. 1, Issue 13 (September 2007) and Measles Bulletin, Vol. 2, Issue 4 (December 2008). These indicators are consistent with those recommended in the “Monitoring Progress towards Measles Elimination” (Weekly Epidemiological Record, No. 49, 2010, 85:490–4). In the Measles Bulletin, Vol. 1, Issue 13 (September 2007), we described several surveillance performance indicators, including “percentage of suspected cases with an adequate investigation conducted within 48 hours of notification” (target ≥ 80%). Adequate investigation was defined as the presence of case data on the following core variables: district of recent residence or infection, sex, date of birth or age, date of rash onset, date of notification, date of case investigation, vaccination status (number of prior doses of measles containing vaccine), date of last vaccination (for previously vaccinated cases), and date of specimen collection. In past issues of the Measles-Rubella Bulletin, Table 2B included the adequate investigation indicator without the timeliness component (i.e., cases investigated within 48 hours of notification). In light of recent global guidelines (“Monitoring Progress towards Measles Elimination”. Weekly Epidemiological Record, No. 49, 2010, 85:490–4), the Measles-Rubella Bulletin henceforth will include timeliness of investigation (i.e., within two days of notification) as a component criterion of adequate investigation in Table 2B. Decreases in this indicator for 2011 reported in this and future issues therefore may occur for some countries and areas. Table 1A. Completeness and timeliness of epidemiologic reporting, Western Pacific Region, 2010—2012 2010 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 1 2 3
2011 Completeness 100% 100% 100% 100% 100% 100% 92% 100% 100% 100% 100% 75% 100% 100% 100% 75% 75% 95.1% 78.9% 88.7% Timeliness 100% 100% 92% 100% 100% 100% 92% 100% 92% 100% 83% 42% 92% 92% 92% 50% 67% 07 Feb 07 Feb 03 Feb 01 Mar 04 Feb 94% 82% 03 Mar 06 Mar 07 Mar 01 Mar 10 Mar 94% 88% Jan 10 Feb 02 Feb 08 Feb 10 Feb 15 Feb 06 Feb 07 Feb 15 Feb 07 Feb 10 Feb 08 Feb 07 Feb Feb 10 Mar 08 Mar 07 Mar 10 Mar 20 Mar 02 Mar 02 Mar 10 Mar 08 Mar 07 Mar 10 Mar 06 Mar
2012 1 Completeness 2 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 0% 100% 100% 100% 100% 100% 94.1% 85.3% Timeliness 3 100% 100% 100% 50% 100% 100% 50% 100% 100% 100% 100% 0% 100% 100% 100% 50% 100%
Completeness 100% 100% 75% 100% 100% 100% 83% 100% 92% 100% 100% 67% 100% 92% 100% 92% 92% 93.6%
Timeliness 100% 100% 42% 58% 100% 100% 75% 100% 83% 92% 92% 33% 92% 92% 100% 25% 58%
Monthly reports as of March 2012
Legend: black = timely report; red = untimely report
Completeness is defined as the number of reports received by the end of the reporting month divided by the number of expected reports for the year Countries and areas should submit reports by the 10th (or the next working day) of the following month; Pacific island countries and China
Table 1B. Completeness and timeliness of laboratory reporting, Western Pacific Region, 2010—2012 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 1 2 3
2010 Completeness 100% 42% 0% 100% 0% 58% 100% 92% 100% 100% 75% 100% 100% 100% 100% 83% 67% 77.5% 61.8% Timeliness 100% 25% 0% 100% 0% 58% 100% 58% 100% 33% 33% 83% 100% 100% 58% 50% 50% 100% 100% 0% 100% 100% 100% 100% 100% 100% 100% 83% 100% 100% 100% 100% 100% 92% 92.6%
2011 Completeness Timeliness 100% 100% 0% 100% 100% 100% 100% 100% 100% 92% 67% 100% 100% 100% 75% 100% 58% 88.2% Jan
2012 1 Feb 06 Mar 08 Mar 11 Mar 02 Mar 10 Mar 09 Mar 11 Mar 07 Mar 09 Mar 08 Mar 08 Mar 10 Mar 10 Mar 10 Mar 08 Mar 10 Mar 94% 82% 09 Feb 06 Feb 08 Feb 07 Feb 10 Feb 07 Feb 13 Feb 08 Feb 09 Feb 13 Feb 10 Feb 07 Feb 10 Feb 10 Feb 10 Feb 04 Feb 94% 82%
Completeness 100% 100% 0% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 94.1%
2
Timeliness 3 100% 100% 0% 50% 100% 100% 100% 0% 100% 100% 50% 100% 100% 100% 100% 100% 100% 82.4%
Monthly reports as of March 2012 Completeness is defined as the number of reports received by the end of the reporting month divided by the number of expected reports for the year National measles and rubella laboratories should submit monthly reports by the 10th (or the next working day) of the following month
Table 2A. Measles case classification and incidence, by country and area, Western Pacific Region, 2011—2012 1 2011 Country
2012 Discarded cases 0 6 2885 24 692 222 399 326 15 3341 183 0 44 2952 131 0 14 208 0 0 515 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 49 919
1
Population (in millions) 2
Suspected measles 3 cases No data
Confirmed measles cases Lab 164 4 319 8951 6 322 12 1 1445 0 428 0 3239 40 143 22 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 15 098
Epi-linked 24 0 0 13 1 9 17 0 82 0 105 0 171 0 0 81 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 503
Clinical 0 0 402 979 6 79 84 0 42 0 66 0 3144 3 0 642 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5447
Total 188 4 721 9943 13 410 113 1 1569 0 599 0 6554 43 143 745 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 21 048
Measles Pending Deaths due to incidence per classification measles 1 million pop. 0 0 7 7 0 0 0 0 0 0 4 6 0 0 0 0 0 0 21 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 45 0 0 1 10 0 0 0 0 4 0 0 0 28 0 0 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 47 8.3 9.9 50.4 7.4 1.8 3.2 18.0 1.8 54.4 0.0 135.7 0.0 69.1 0.9 27.6 8.4 0.0 0.0 2.3 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 11.6 Green Yellow Red
Population (in millions) 2 22.92 0.41 14.48 1353.60 7.20 126.43 6.37 0.57 29.32 2.84 4.46 7.17 96.47 48.59 5.26 89.73 0.07 0.02 0.88 0.28 0.18 0.10 0.06 0.11 0.01 0.26 0.00 0.06 0.02 0.18 0.57 0.00 0.10 0.01 0.25 0.01 1819.01
Suspected measles 3 cases No data
Confirmed measles cases Lab 2 0 0 464 1 51 0 1 243 0 29 0 69 0 12 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 872
Epi-linked 0 0 0 0 0 1 0 0 24 0 3 0 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 33
Clinical 0 0 0 21 0 2 60 0 33 0 0 0 41 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 157
Total 2 0 0 485 1 54 60 1 300 0 32 0 115 0 12 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1062
Discarded cases 0 1 110 1944 27 13 81 1 503 32 0 0 117 14 0 2 0 0 69 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2914
Pending Deaths due to classification measles 0 2 68 73 0 0 0 0 299 0 12 0 198 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 654 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Measles incidence per 1 million pop. 0.5 0.0 0.0 2.1 0.8 2.6 56.5 10.6 61.4 0.0 43.0 0.0 7.2 0.0 13.7 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 3.5
Australia 22.61 Brunei Darussalam 0.41 Cambodia 14.31 China 1347.57 Hong Kong (China) 7.12 Japan 126.50 Lao PDR 6.29 Macao (China) 0.56 Malaysia 28.86 Mongolia 2.80 New Zealand 4.41 Papua New Guinea 7.01 Philippines 94.85 Republic of Korea 48.39 Singapore 5.19 Viet Nam 88.79 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 4 4
10 3613 34 642 232 809 439 16 4910 183 No data
3 178 2502 28 67 141 2 1102 32 No data
50 9506 174 No data
0 430 16 No data
14 954 0 0 538 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 70 076
2 0 0 69 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4572
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
Monthly reports as of March 2012 Population figures from United Nations World Population Prospects: The 2010 Revision Australia, New Zealand and Singapore report only confirmed cases Classification is provisional based on laboratory data only
<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
2
Table 2B. Measles surveillance performance indicators, by country and area, Western Pacific Region, 2011—2012 1 2011 Country Discarded measles rate per 100 000 pop ≥2 Australia 4 Insufficient data Brunei Darussalam 1.5 Cambodia 20.2 China 1.8 Hong Kong (China) 3.1 Japan 0.3 Lao PDR 5.2 Macao (China) 2.7 Malaysia 11.6 Mongolia 6.5 New Zealand 4 Insufficient data Papua New Guinea 0.6 Philippines 3.1 Republic of Korea 0.3 Singapore 4 Insufficient data Viet Nam 16.0 Pacific island countries and areas American Samoa 0.0 Cook Islands 0.0 Fiji 59.3 French Polynesia 0.0 Guam 0.0 Kiribati 0.0 Marshall Islands 0.0 Micronesia, Federated States of 0.0 Nauru 0.0 New Caledonia 0.0 Niue 0.0 Northern Mariana Islands 0.0 Palau 0.0 Samoa 0.0 Solomon Islands 0.0 Tokelau 0.0 Tonga 0.0 Tuvalu 0.0 Vanuatu 0.0 Wallis and Futuna 0.0 Western Pacific Region 2.8 Second level units with ≥ 1 discarded cases per 100 000 pop ≥ 80% Insufficient data
2012 Suspected cases with adequate blood specimens ≥ 80% Insufficient data 2
1
Suspected cases with adequate investigation ≥ 80% Insufficient data
Percent clinically confirmed Discarded measles rate per 3 100 000 pop cases ≤ 10% Insufficient data Not applicable
Annualized discarded measles rate per 100 000 pop ≥2 Insufficient data
Second level units with ≥ 1 discarded cases per 100 000 pop (annualized) ≥ 80% Insufficient data
Suspected cases with adequate investigation ≥ 80% Insufficient data
Suspected cases with adequate blood specimens ≥ 80% Insufficient data 2
Percent clinically confirmed cases 3
≥2 Insufficient data
≤ 10% Insufficient data Not applicable Not applicable
100.0% 75.0% 71.0% 100.0% 4.3% 70.6% 100.0% 93.8% 36.4% Insufficient data
50.0% 14.1% 94.4% 74.6% Insufficient data
90.0% 84.9% 88.0% 97.8% Insufficient data
22.6% 100.0% 42.6% 59.6% Insufficient data
43.1% 100.0% 83.8% 100.0% Insufficient data
55.8% 9.8% 46.2% 19.3% 74.3% Not applicable
2.7% Not applicable
0.2 0.8 0.1 0.4 0.0 1.3 0.2 1.7 1.1 Insufficient data
1.5 4.6 0.9 2.3 0.1 7.6 1.1 10.3 6.8 Insufficient data
100.0% 33.3% 3.2% 100.0% 0.0% 47.1% 100.0% 93.8% 4.5% Insufficient data Not applicable
33.3% 21.9% 96.6% 60.7% Insufficient data
66.7% 61.2% 91.6% 100.0% Insufficient data
36.2% 100.0% 6.5% 75.0% Insufficient data Not applicable
48.9% 100.0% 20.9% 100.0% Insufficient data Not applicable
4.3% 0.0% 3.7% 100.0% 0.0% 11.0% Not applicable
11.0% Not applicable
0.0% Not applicable
20.0% 88.2% 0.0% Insufficient data
28.0% 47.0% 58.6% Insufficient data
82.0% 76.3% 85.6% Insufficient data
48.0% 7.0% Insufficient data
0.0 0.1 0.0 Insufficient data
0.0 0.7 0.2 Insufficient data
29.4% 6.3% Insufficient data Not applicable
47.6% 68.8% Insufficient data Not applicable Not applicable Not applicable
82.8% 100.0% Insufficient data 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 Not applicable
35.7% 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 Not applicable Not applicable Not applicable
84.4% 0.0% 0.0% 100.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 52.3%
20.7% Not applicable Not applicable
31.7% 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
86.2% 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
0.0 0.0 0.0 7.9 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.2
0.0 0.0 0.0 47.3 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.0
0.0% 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
62.6%
73.5% Green Yellow Red
26.3%
0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 14.0%
0.0% 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
62.5%
71.0%
15.0%
Monthly reports as of March 2012 2 Excludes epi-linked cases 3 4
1
Among all confirmed cases Reports only confirmed cases
Reached or surpassed target Nearly reached target: 1.00-1.99 for non-measles suspected case rate; 10.1-25% for percent clinically confirmed cases; 60-79% for other indicators Substantially below target
3
Table 3. Measles and rubella laboratory performance, Western Pacific Region, 20121 Measles Measles and rubella Serum Country Samples tested for measles Total number Total number IgM of samples of cases received tested No. Measles IgM (+) Measles IgM equiv Measles IgM (-) Measles IgM pending Serology Blood Results ≤ 7 days Virus detection Measles Virus isolation/ detection (swab, urine, PBMC) No. of samples tested 0 5 Rubella Serum and blood (includes DBS) Samples Total number tested for of lab rubella IgM confirmed cases No. Rubella IgM (+) Rubella IgM pending
DBS samples
Measles RT - PCR
Rubella IgM equiv
No.
No.
No.
%
No.
No. received 0 0
No. (+) -
%
No. of isolates 0 0
No. of samples tested 4 5
No. of (+)
No.
No.
No.
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
9 125
11 126
5 120
2 0
1 0
2 120
40.0% 100.0%
0 0
100% 100.0%
3 0
4 0
5 120
2 33
0 0
0 0
56
65
54
2
0
52
96.3%
0
0
-
98.1%
3
2
5
4
2
55
5
1
0
121 7 1220 33 94 1 468 40 116 12 14 68 2 384
121 7 1226 33 102 1 469 41 134 12 14 68 2 430
121 7 447 33 31 1 464 40 62 11 14 68 1 478
0 1 162 0 2 0 170 5 8 0 0 0 352
0 0 8 0 1 0 32 3 3 0 0 0 48
121 6 277 33 28 1 260 32 51 4 13 68 1 068
100% 85.7% 62.0% 100% 90.3% 100% 56.0% 80.0% 82.3% 36.4% 92.9% 100% 72.3%
0 0 0 0 0 0 2 0 0 7 1 0 10
0 0 0 0 0 0 0 0 0 0 0 0 0
0
96.4% 100% 100% 100% 100% 100% 96.6% 100% 92.5% 75.0% 100% 91.0% 98.3%
0 0 94 0 0 0 2 0 41 0 0 0 145
0 0 11 0 0 0 0 0 4 0 0 0 17
0 0 0 0 64 0 0 6 0 0 0 0 84
0 0 0 0 28 0 0 0 0 0 0 0 35
0 1 162 0 29 0 170 5 10 0 0 0 383
121 7 277 33 9 1 292 40 66 12 14 68 1 120
25 1 23 4 1 0 36 3 3 3 3 21 163
18 0 17 2 1 0 25 5 2 0 1 7 79
0 0 0 0 0 0 2 0 0 7 2 0 11
Monthly reports as of March 2012
4
Table 4A. Measles genotype distribution, Western Pacific Region, 2011—20121 2011 Country Total confirmed cases 2 188 4 721 9943 13 410 113 1 1569 0 599 0 6554 43 143 745 2 21 048
2012 Total confirmed cases 2 2 0 0 485 1 54 60 1 300 0 32 0 115 0 12 0 0 1062
1
GENOTYPES 3 Total Lab confirmed 2 Pending B3 -
GENOTYPES 3 Total Lab confirmed 2 Pending B3 -
Total
Total
D4 31 51 22 1 105
D8 25 1 7 1 9 3 9 55
D9 38 2 3 35 33 12 24 12 33 192
D11 1 1
G3 1 1 1 3
H1 1 3 175 1 6 2 188
A 5 2 4 1 1 13 3 2 5 103 0 5 178 5 98 6 1 44 0 37 0 24 13 46 2 0 562
D4 4 4
D8 24 24
D9 2 2 7 1 12
D11 0
G3 1 1
H1 6 6
A 1 1 3 3 3 0 0 6 2 35 0 0 0 0 1 0 0 0 4 0 0 51
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 Total 1 2 3
164 4 319 8951 6 322 12 1 1445 0 428 0 3239 40 143 22 2 15 098
2 0 0 464 1 51 0 1 243 0 29 0 69 0 12 0 0 872
Monthly reports as of March 2012 Source: National measles surveillance reports (Table 2A) Sources: National and regional reference laboratory reports to WHO and to the Measles Nucleotide Sequence online database (MeaNS), whichever has the greater number
5
Table 4B. Rubella genotypes distribution, Western Pacific Region, 2011—20121 2011 Country Samples tested for rubella IgM 2 40
2012 1 Samples tested for rubella IgM 2 5
Rubella IgM positive 2 5
Genotypes 3 Total 1E -
1j 1 -
2B 18 8 2 4 5 2 15 2 0 0 0 172 15 5 1 0 4 0 5 2 0 0 0 15 2
Rubella IgM positive 2 2
Genotypes 3 Pending 1E -
Total
1j -
2B 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0
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
3038
1048
154
120
33
-
352
41
7 2
55
5
-
181 47 3360 182 95 144 3831 227 376 4186 527
37 1 383 14 4 8 1115 19 9 2497 151
1 -
121 7 277 33 9 1 292 40 66 26 68
25 1 23 4 1 0 36 3 3 6 21
-
Pacific island countries Total 1 2 3
16 586
5332
164
1
56
221
1120
163
0
0
1
0
1
Monthly reports as of March 2012 Source: National laboratory reports to WHO (Table 3) Sources: National and regional reference laboratory reports to WHO and to the Measles Nucleotide Sequence online database (MeaNS), whichever has the greater number
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
6