measles and rubella fact sheet sear 2008-2009 · 2009. 9. 7. · sear measles & rubella fact...

SEAR Measles & Rubella Fact Sheet • World Health Organization • IVD of 6 #Updated & Published 7-Sep-2009

Measles and Rubella Fact Sheet SEAR 2008-2009 #

Table 1: South-East Asia Regional (SEAR) Strategic Plan 2007-2011 Goal: To reduce the number of measles deaths by 90% in 2010 relative to 2000 estimates. Objectives: • Achieve at least 90% national Measles Containing Vaccine (MCV1) coverage and at least 80% MCV1 coverage in all

districts in member countries by 2010; • Conduct case-based measles surveillance within an integrated vaccine preventable disease surveillance system in countries

that have conducted measles catch-up campaigns; • Achieve full investigation and appropriate clinical case management of all measles outbreaks by all member countries by

2009; and • Provide a second opportunity for measles immunization to eligible children in all member States by 2010 while ensuring

more than 90% coverage.

Figure 1: Accelerated Measles Control in SEAR, 2000-2008

Figure 2: Implementation of Measles Control Activities in SEAR Countries, 2009

Table 2: Measles Incidence per 100,000 population, SEAR, 1999-2008 Table 3: MCV Immunization Schedule and Percentage Coverage, 1990-2008

0

50000

100000

150000

200000

250000

2000 2001 2002 2003 2004 2005 2006 2007 2008

Est

imat

ed d

eath

s

50

55

60

65

70

75

80

85

90

95

100

MC

V1 C

over

age

(%)

Estimated Measles Deaths MCV1 coverage

6.3 40.71.5 5.2 10 10.4 42.4

SIA achievement in millionsSIA achievement in millions

42 % reduction of mortality, 2000 - 2007

Over 120 million vaccinated through SIA

3.6

Source: IVD/ WHO-SEAR

Advanced stage of mortality reduction

Implementing elimination strategies

Bhutan, DPR Korea, Maldives and Sri Lanka

Bangladesh, Indonesia, Myanmar, Nepal and Timor-Leste

Partial Implementation of mortality reduction strategies

India and Thailand Sources: Mortality estimate: WHO/HQ, MCV1 coverage: WHO/UNICEF best estimates, SIA coverage: WHO/UNICEF JRF

Country 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008Bangladesh 4.20 3.70 3.13 2.66 3.06 7.24 18.64 4.37 2.03 1.81

Bhutan 495.09 20.26 35.58 3.77 0.00 0.40 1.46 0.00 1.67 1.04

DPR Korea 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 14.94 0.34

India 5.10 3.82 5.01 3.84 4.40 5.01 5.10 5.46 3.59 4.68

Indonesia 2.28 22.59 10.07 9.21 11.44 13.48 7.23 9.21 8.62 6.73

Maldives 0.00 6.87 0.00 342.83 26.73 12.78 474.90 15.72 6.56 0.00

Myanmar 1.69 1.81 0.00 1.41 1.56 2.35 0.55 1.30 1.88 0.56

Nepal 0.00 39.96 45.09 27.94 53.78 49.25 20.02 11.06 5.39 7.79

Sri Lanka 13.11 88.88 1.65 0.74 0.34 0.18 0.02 0.00 0.21 0.16

Thailand 5.25 6.69 11.89 16.31 7.25 6.20 5.35 5.63 6.22 11.10

Timor-Leste 0.00 0.00 0.00 0.00 0.00 4.83 21.99 9.15 0.00 0.00

SEAR 5.12 7.98 6.19 5.22 5.90 6.89 6.64 5.68 4.35 4.74Source: Population: 1999-2001-United Nations Population Division, Department of Economic and Social Affairs, W orld Population Prospects the 2002 revision; 2002 onwards - W HO/SEARO Annual EPI Reporting Form (AERF); Measles Cases: W HO/UNICEF JRF

Country Schedule 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008Bangladesh 38 W 65 68 69 74 78 79 69 72 72 76 76 77 75 76 81 88 83 89 89Bhutan 9, 24 M 93 89 86 84 81 85 85 84 71 76 76 78 78 88 87 93 90 95 99DPR Korea 9M 98 98 99 99 83 67 50 34 49 63 78 92 98 95 95 96 96 99 98India 9-12 M 56 43 51 59 67 72 66 55 51 52 54 55 56 59 61 64 70 70 70Indonesia 9M, 6Y 58 61 65 68 66 63 79 77 75 74 72 70 72 74 76 78 80 80 83Maldives 9, 18 M 96 97 98 86 97 96 95 96 98 99 99 98 97 96 97 97 97 97 97Myanmar 9, 18 M 68 67 68 71 77 82 86 88 89 86 84 73 77 76 78 72 78 81 82Nepal 9 M 57 57 58 58 58 56 65 73 72 72 71 71 71 75 73 74 85 81 79Sri Lanka 9 M 80 79 82 86 84 87 89 94 94 95 99 99 99 99 96 99 99 98 98Thailand 9-12 M 80 79 74 80 86 91 92 93 94 96 94 94 94 96 96 96 96 96 98Timor Leste 9 M ND ND ND ND ND ND ND ND ND ND ND ND 56 55 55 48 64 63 73Source - 1990-2008: WHO/UNICEF Coverage Estimates



Figure 7: MCV Coverage, Suspected Measles Cases and SIAs, Indonesia, 1990-2008

Figure 8: MCV Coverage, Suspected Measles Cases and SIAs, Maldives, 1990-2008

Figure 3: MCV1 Coverage, Suspected Measles Cases and SIAs, Bangladesh, 1990-2008

Figure 4: MCV Coverage, Suspected Measles Cases and SIAs, Bhutan, 1990-2008

Figure 5: MCV Coverage, Suspected Measles Cases and SIAs, DPR Korea, 1990-2008

Figure 6: MCV Coverage, Suspected Measles Cases and SIAs, India, 1990-2008

0

500

1000

1500

2000

2500

3000

3500

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

Year

Cas

es

0

20

40

60

80

100

% C

over

age

Measles Cases MCV1 Coverage MCV2 Coverage

6-25y & 25-34 y (f)

85 %

SIA

0

5000

10000

15000

20000

25000

30000

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

Year

Case

s

0

20

40

60

80

100

% C

over

age

Measles Cases MCV1 Coverage

93 %

101 %

SIA

9m-10y

Source: WHO/UNICEF JRF & Estimated Coverage, 1997-2008; For MCV2 Coverage: Country Official Estimates used

Source: WHO/UNICEF JRF & Estimated Coverage, 1997-2008

Source: WHO/UNICEF JRF & Estimated Coverage, 1997-2008 Source: WHO/UNICEF JRF & Estimated Coverage, 1997-2008; For MCV2 Coverage: Country Official Estimates used

0

200

400

600

800

1000

1200

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

Year

Case

s

0

20

40

60

80

100

120

% C

over

age


9920

SIA

98 %

9m-15y; 15y-45y(f)

0

500

1000

1500

2000

2500

3000

3500

4000

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

Year

Case

s

0

20

40

60

80

100

% C

over

age


SIA

100 %

6m-45y


Source: WHO/UNICEF JRF & Estimated Coverage, 1997-2008

0

20000

40000

60000

80000

100000

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

Year

Cas

es

0

20

40

60

80

100

% C

over

age


0

10000

20000

30000

40000

50000

60000

70000

80000

90000

100000

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

Year

Case

s

0

20

40

60

80

100

% C

over

age


95 %

6y-12y 6m-15y 6m-12y

95 %

94 %

96 %

94 %

94 %

SIA



Figure 9: MCV Coverage, Suspected Measles Cases and SIAs, Myanmar, 1990-2008

Figure 10: MCV Coverage, Suspected Measles Cases and SIAs, Nepal, 1990-2008

Figure 11: MCV Coverage, Suspected Measles Cases and SIAs, Sri Lanka, 1990-2008

Figure 12: MCV Coverage, Suspected Measles Cases and SIAs, Thailand, 1990-2008

Figure 13: MCV Coverage, Suspected Measles Cases and SIAs, Timor-Leste, 1990-2008

Figure 14: Measles/Rubella Surveillance Network, SEAR, 2009*

0

50

100

150

200

250

2002 2003 2004 2005 2006 2007 2008

Year

Cas

es

0

20

40

60

80

100

% C

over

age


99 %

40 %

9m-5y 6m-15y

SIA

05000

1000015000200002500030000350004000045000

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

Year

Case

s

0

20

40

60

80

100

% C

over

age


02000

40006000

800010000

1200014000

16000

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

Year

Case

s

0102030405060708090

% C

over

age


102 %

107 %

9m-15y

SIA

9m-5y

93 %

0100020003000400050006000700080009000

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

Year

Cas

es

0102030405060708090100

% C

over

age


79 %

9m-5y

90 %

94 %

88 %

SIA

Source: WHO/UNICEF JRF & Estimated Coverage, 1997-2008 Source: WHO/UNICEF JRF & Estimated Coverage, 1997-2008



Source: WHO/UNICEF JRF & Estimated Coverage, 1997-2008 Govt. Network Govt. Network Supported by WHO *Updated on Aug 2009

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

Year

Case

s

010

2030

405060

7080

90100

% C

over

age


SIA

95 %

72 %

10-14y16-20y



Figure 15: MCV1 Coverage by Country, 2004-2008 Figure 16: Percent of Districts Achieving >80%

MCV1 Coverage by Country, 2004-2008

Figure 17: Percent of BCG-Measles Drop Out by Country, 2004-2008

Table 4: Status of implementation of case-based surveillance of suspected measles cases 2008

Table 5: Measles and Rubella Outbreaks and Age Distribution of the Cases, SEAR, 2008

16

5

0

23

12

1

8

14

3 3

24

9

6

-2

21

12

2

5

15

0

3

31

9

2

0

21

12

2

8 9

0

3

119

-1-3

21

12

2

6

9

13

15

9

0

-1

20

7

2

79

1 1

14

-5

0

5

10

15

20

25

30

35

40

BAN BHU DPRK IND INO MAV MMR NEP SRL THA TLS

% D

ropo

ut

2004 2005 2006 2007 2008

0

10

20

30

40

50

60

70

80

90

100

BAN BHU* DPRK IND* INO MAV MMR NEP SRL THA* TLS

% o

f Dis

tric

ts

2004 2005 2006 2007 2008

0

20

40

60

80

100

BAN BHU DPRK IND INO MAV MMR NEP SRL THA TLS

MC

V1 C

over

age

(%)

2004 2005 2006 2007 2008

Target 80% Coverage in all districts

BCG Coverage – MCV1 Coverage BCG Coverage

Drop Out = x 100

Source: 2004- 2008: WHO/UNICEF Estimates; 2006: Country Official Coverage Estimate for India.

Minimum Target 90%

Source: 2004- 2008: WHO/UNICEF Estimates. 2006: Country Official Coverage Estimate for India.

Source: WHO/UNICEF JRF. *No district level data – IND 2004-2006; THA 2004-2008.

Source: IVD / WHO, SEAR

Country Outbreak From health

Data collection Serology Data collection Serology

Bangladesh Case based All outbreaks Case based Initiated nationally in 2008

Bhutan Case based All outbreaks Case based Some cases

DPR Korea Case based All outbreaks Case based Some cases

India Case based in 6 states

In 6 states Aggregate Not done

Indonesia Case based In some outbreaks Case based data to districts, then aggregated

To be started in two provinces

Maldives Case based All outbreaks Case based Some cases

Myanmar Case based All outbreaks Aggregate Not done

Nepal Case based All outbreaks Case based in 73 active AFP surveillance sites

In 30 sites since 2007

Sri Lanka Case based All outbreaks Case based Some cases

Thailand Case based All outbreaks Case based Some cases

Timor-Leste Case based In few outbreaks Aggregate Not done

Reported % Investigated

Lab Confirmed Measles

Lab Confirmed

Rubella< 1 yr 1-4 yrs 5-9 yrs 10-14

yrs= >15

yrsUn

known < 1 yr 1-4 yrs 5-9 yrs 10-14 yrs

= >15 yrs

Un known

Bangladesh 81 100 1 59 132 5526 16.7 45.5 25.8 6.1 6.1 0.0 9.6 23.1 30.9 17.5 18.9 0.0

Bhutan 0 0 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 0 0

India 174 94.8 101 24 6364 1615 7.7 37.3 39.8 11.5 3.7 0 5.4 30.3 38.3 16.7 9.3 0.0

Indonesia 96 46.9 24 15 630 182 8.7 46.0 40.3 4.4 0.5 0.0 4.9 10.4 39.0 31.9 13.7 0.0

Maldives 0 0.0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Myanmar 9 100.0 9 0 275 0 2.9 17.1 26.5 34.9 18.5 0 0 0 0 0 0 0

Nepal 39 92.3 6 27 205 601 5.9 73.7 18.0 2.0 0.5 0.0 2.0 33.8 44.4 14.6 5.2 0

Sri Lanka 2 100 0 2 0 52 0 0 0 0 0 0 0 0 0 0 0 0

Thailand 22 100 0 0 0 0 ND ND ND ND ND ND ND ND ND ND ND ND

Timore-Leate 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

SEAR 423 85.1 141 127 7606 7976 7.7 38.4 38.5 11.4 4.0 0.0 8.0 24.9 33.4 17.3 16.3 0.0Source: Annual EPI Reporting Form (AERF) 2008; ND- No Data

Number of Suspected Measles OutbreaksCountry

Total Rubella Cases

% Measles Cases (Outbreak Reporting)Total Measles Cases

% Rubella Cases (Outbreak Reporting)



Figure 18: Second Dose for Measles Immunization, SEAR, 2009

Table 6: Measles SIA Target and Achievement, 2000-2009* Table 7: Measles SIA Schedule, 2008-2010

Through Routine Immunization

Through SIA

Provide MR/MMR vaccine

Provide Measles Vaccine


Catch-up campaign

Catch-up & Follow-up campaigns

J F M A M J J A S O N D J F M A M J J A S O N D J F M A M J J A S OBangladeshBhutanDPR KoreaIndiaIndonesiaMaldives MyanmarNepalSri LankaThailandTimor-LesteSource: IVD/WHO-SEAR Updated on 19 Aug 2009 Roll-over follow-up measles campaigns National follow-up measles campaigns

Planned 20102009Country

2008

Vaccinated % Vaccinated %

2005 2 districts 9m -10 Y 1,374,390 93 Indonesia 2007 Aug Measles Ynder 5 y campaign in 5 Provinces 6M-5 Y 3,413,010 93

2006 All remaining districts 9m -10 Y 34,637,764 101 Maldives 2005/06 National 6-25 Y & 25-34Y( F) 123,642 85

Bhutan 2006 National 9M-15 Y & 15-44Y( F) 332,041 98 2002 6 of 17 states/divisions 9 M – 5 Y 1,577,169 88

DPR Korea 2007 National 6 M-45 Y 16,109,432 100 2003 5 of 17 states/divisions 9 M – 5 Y 2,248,422 90

2000 School based campaign in 3 provinces 6-12 Y 6,341,407 95 2004 6 of 17 states/divisions 9 M – 5 Y 1,085,359 79

2003 School based campaign in 4 provinces 6-12 Y 980,754 95 2007 National 9 M – 5 Y 5,706,351 94

2004 School based campaign in 7 provinces 6-12 Y 2,062,556 94 2004 2 of 5 Regions 9M – 15 Y 5,490,931 102

2005 Measles catch-up campaign in 2 provinces 6 M – 15 Y 4,642,650 96 2005 3 of 5 Regions 9 M –15 Y 4,348,792 107

2006 Measles catch-up campaign in 2 province 6 M – 15 Y 615,577 91 2008 Sep 29 of 75 districts 9 M- 5 Yrs 909,421 94

2006 Measles Under 5 y campaign in 2 Provinces 6M-5 Y 220,777 94 2008 Dec 46 of 75 districts 9 M- 5 Yrs 2,724,856 93

2006 School based campaign in 5 provinces 6 Y -12 Y 3,049,844 96 Sri Lanka 2003 National 10-14 Y 1,897,173 95

2006 Measles Under 5 y campaign in 9 Provinces 6M-5 Y 3,440,698 92 2004 National 16-20 Y 1,362,108 72

2007 Feb School based campaign in 3 provinces 6 Y -12 Y 2,863,068 106 2003 National 9 M-5 Y 127,453 99

2007 Feb Measles Ynder 5 y campaign in 5 Provinces 6M-5 Y 10,075,758 90 2006 National 6M-15Y 157,673 40

2007 Aug School based campaign in 6 provinces 6 Y -12 Y 2,609,990 102 2009 National 9-59 M 126,823 76

120,655,889 97Souce: IVD/WHO-SEAR *Updated on 2 Sep 2009 Follow-up campaigns are highlighted

Age groupCoverage

Total

Year

Nepal

Myanmar

Timor-Leste

Indonesia

Type Type

Bangladesh

CountryAge groupCoverage

Country Year



Figure 19: SEAR Measles and Rubella Laboratory Network, 2009

Figure 20: Distribution of Measles/Rubella Genotypes in SEAR

Table 8: Measles & Rubella Laboratory Network Serology Results, 2008-2009

D4,D7,D8

D9,G2,G3

D8

D4,D8

D5,G2

D5

D5

H1

2B

H1

Measles GenotypeRubella Genotype

D4,D7,D8

D9,G2,G3

D8

D4,D8

D5,G2

D5

D5

H1

2B

H1

Measles GenotypeRubella Genotype

Primary Data Sources: WHO/UNICEF Joint Reporting Form (JRF); SEAR Annual EPI Reporting Form (AERF); Government and Ministries of Health, and EPI Program Managers; Monthly VPD and EPI Reporting System

IVD Internet: http://www.searo.who.int/EN/Section1226.asp EPI fact sheets available: http://www.searo.who.int/en/Section1226/Section1635/Section1657.htm IVD VPD surveillance bulletin: http://www.searo.who.int/EN/Section1226/showfiles.asp Weekly IVD VPD/AFP update: http://www.searo.who.int/EN/Section1226/showafpfiles.asp Monthly IVD VPD/AFP update: http://www.searo.who.int/EN/Section1226/showafpmonth.asp

Prepared by: Immunization and Vaccine Development (IVD) Department of Family Health and Research (FHR) World Health Organization, South East-Asia Regional Office IP Estate, Mahatma Gandhi Road, New Delhi 110002, India. Tel: +91 11 23370804, Direct Fax: +91 11 23370251, 23370106


# % # % # % # %Bangladesh Dhaka 791 788 16 2.0 243 30.8 909 895 15 1.7 564 63.0Bhutan Thimphu 69 68 7 10.3 1 1.5 36 36 2 5.6 1 2.8DPR Korea Pyongyang 82 82 0 0.0 0 0.0 29 29 0 0.0 0 0.0

Ahmedabad 154 154 109 70.8 1 0.6 64 62 34 54.8 9 14.5Bangalore 348 348 158 45.4 70 20.1 234 216 87 40.3 68 31.5Chennai 103 92 56 60.9 17 18.5 28 28 15 53.6 0 0.0Hyderabad 154 152 56 36.8 19 12.5 175 167 61 36.5 13 7.8Kolkata 209 203 131 64.5 35 17.2 553 553 178 32.2 312 56.4

968 949 510 53.7 142 15.0 1054 1026 375 36.5 402 39.2Bandung 104 104 1 1.0 50 48.1 62 62 6 9.7 37 59.7Jakarta 261 248 130 52.4 69 27.8 226 226 26 11.5 142 62.8Surabaya 80 80 38 47.5 14 17.5 109 109 53 48.6 39 35.8Yogyakarta 44 44 0 0.0 32 72.7 83 83 19 22.9 56 67.5

489 476 169 35.5 165 34.7 480 480 104 21.7 274 57.1Maldives Male 2 217 217 1 0.5 3 1.4 135 135 0 0.0 1 0.7Myanmar Yangon 116 99 74 74.7 5 5.1 35 33 21 63.6 2 6.1Nepal Kathmandu 695 686 66 9.6 267 38.9 673 639 9 1.4 361 56.5Sri Lanka Colombo 146 116 2 1.7 36 31.0 62 62 2 3.2 19 30.6Thailand Bangkok 824 790 389 49.2 51 6.5 869 533 206 38.6 56 10.5Timor-Leste Dilli - - - - - - 6 6 0 0.0 1 16.7

4397 4271 1234 28.9 913 21.4 4288 3874 734 18.9 1681 43.4Source: Reported by SEAR Measles Laboratory Network *Data as of 30 Jun 20091 Percentages may not add to 100%; Equivocal results not included and some samples are in process with results pending. Some countries test samples for both Measles and Rubella.2 210 and 131 samples were received for Rubella testing from the hospital (routine Antenatal cases) in 2008 and 2009 respectively. NR=No Report

Number of Serum

Samples Received

Number Tested for Measles &

Rubella

Positive Results 1

Measles Rubella

Total

Indonesia

Indonesia Total from four labs

India Total from five labs

India

Country LaboratoriesMeasles Rubella

Number of Serum

Samples Received

Number Tested for Measles &

Rubella

Positive Results 12009*2008

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