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Measles elimination and Rubella/CRS control

(Global-Regional & National Progress)

District case-based MR surveillance transitioning


and VPD surveillance launch workshop
Measles and Rubella Elimination Goals by WHO - Region

Measles elimination-2015
Rubella elimination-2015

Measles elimination-2012
Measles elimination-2000 Measles elimination-2015
Rubella elimination-2010

Measles elimination- 2020

Measles elimination-2020

Measles elimination goal for all six WHO regions in the world
Rubella elimination goal for two (Americas, Europe) regions
Key strategic objectives to achieve: MR elimination
1. Immunization:
Achieve and maintain at least 95% vaccination coverage with two doses of
measles and rubella containing vaccines within every district
A strong routine immunization system delivery mechanism in every
district critical for achieving this goal
2. Surveillance:
Develop and sustain a sensitive and timely case-based measles and
rubella surveillance system and CRS surveillance that fulfils recommended
surveillance performance indicators
3. Laboratory:
Develop, sustain and expand an accredited measles and rubella laboratory
network that supports case based MR surveillance across the country
4. Support & Linkages:
Case-outbreak investigation, management and response
Develop linkages with other child health interventions and programs
Global Measles and Rubella midterm-Targets
Global targets by 2015:
Measles vaccination coverage 90% national and 80% district
Measles reported incidence <5 cases per million
Measles mortality reduction of 95% vs. 2000
Regional targets:
Measles Elimination goals:
2000 AMRO
2012 WPRO
2015 EURO, EMRO
2020 AFRO, SEARO
Rubella Elimination goals:
2010 AMRO, 2015 EURO
Global Vaccine Action Plan (GVAP):
2020 - Measles and rubella elimination in 5 WHO regions
Progress Report at the end of 2015

Milestone/Goal Achieved Not Achieved


Global control milestones:
Measles mortality reduction >95% vs. 2000 79%* Further 16% reduction

National MCV1 coverage >90% 119 (61%) 75 (39%) countries


countries
Reported measles incidence <5 per million 133 (69%) 61 (31%) countries
countries
Regional elimination goals:
Elimination of measles in 4 WHO Regions None American, European,
E. Mediterranean, W..
Pacific
Elimination of rubella in 2 WHO Regions American European Region
Region
*Data source: Progress toward regional measles elimination worldwide, 2000-2014, MMWR. 2015. 64(44): 1246-1251.

5
Annual reported measles cases and MCV1 and MCV2**
coverage*, 1980-2015

4.5 100
4 90
3.5 80

MCV Coverage* (%)


No. of reported cases

3 70
60
2.5
Millions

50
2
40
1.5 30
1 20
0.5 10
0 0
1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008
2010
2012
2014
Number of cases MCV1 Coverage* MCV2 Coverage*

* Coverage as estimated by WHO and UNICEF.


**MCV2 estimates is only available from 2000 when global data collection started, however some countries have introduced the vaccine earlier.
Six countries account for 1/2 of unvaccinated infants
and 2/3 of estimated measles deaths

20.6 million. infants missed MCV1 in 2014


Stronger emphasis on
building health
infrastructure to sustain
India, 4.16 high routine immunization
Rest of
the world,
Coordinated strategic
7.50 approach to support those
Nigeria, countries most in need
3.32 Remove barriers to measles
Afghanista Pakistan, / MR vaccination
n, 0.33 1.59 Reluctance to vaccinate
Banglades children >12m
h, 0.33
Challenges to reporting doses
USA, 0.38 Indonesia,
DR Congo, 1.04
10-dose measles vial, fear of
Ethiopia,
Iraq, 0.45 0.60 0.90
wastage, and missed
opportunities
Global Measles Incidence by WHO Regions 2000-2015*

1,000.0
Measles incidence per million population

Projected
146 trend GOAL
100.0 AFR
39 AMR
(log scale)

EMR
10.0
EUR
5.0
SEAR
1.0 2015 Goal Trend to WPR
reach 5/ GLOBAL
million
projected
0.1 2012 needed
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011

2013
2014
2015
2016
2017
2018
2019
2020
Reported Measles Incidence Rate*
Aug 2015 to Jul 2016 (12M period)

*Rate per 1'000'000 population


<1 (94 countries or 48%)
The boundaries and names shown and the designations used 1 - <5 (31 countries or 16%)
on this map do not imply the expression of any opinion 5 - <10
whatsoever on the part of the World Health Organization
(20 countries or 10%)
concerning the legal status of any country, territory, city or 10 - <50 (29 countries or 15%)
area or of its authorities, or concerning the delimitation of its 50 (11 countries or 6%)
frontiers or boundaries. Dotted lines on maps represent
No data reported (9 countries or 5%)
approximate border lines for which there may not yet be full
to WHO HQ
agreement. WHO 2016. All rights reserved.
Not applicable
Data source: surveillance DEF file

Data in HQ as of 5 September 2016


Reduction in Estimated Measles Deaths
by WHO Regions, 2000 to 2015*

0
AMR EUR AFR EMR SEAR SEAR India WPR Global
10 Including Excluding
India India

20 51%
30 66%
% Reduction

76% 91% 80%


40
50 100% 79% 79%
60 85%
70
80
90
100 2015 reduction goal (95%)
* Source: WER: Progress towards regional measles elimination worldwide, 20002015; No. 45, 2016, 91, 525536, 11 NOVEMBER 2016
Measles Surveillance System Sensitivity
Aug 2015 to Jul 2016 (12M period)
reporting rate of discarded cases* per 100'000 population**

Target: at least 2 discarded cases


per 100'000 population by country
in last 12 month period.

*discarded cases are suspected


measles cases which have been investigated 2
and discarded as non-measles cases using >1 - <2
laboratory testing and/or epidemiological- (62 countries or 32%)
1
linkage. (32 countries or 16%)
No case based
** World population prospects, 2015 revision. surveillance or(42 countries or 22%) The boundaries and names shown and the designations used on this map do not imply the
No or insufficient data reported
(59 countries or 30%) 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 2016. All
Data source: surveillance DEF file rights reserved.
Data in HQ as of 5 September 2016 Not applicable
Rubella

12
Estimates of the median incidence of CRS per 100,000
live births by country in 2010

Vynnycky E et al. (2016) Using Seroprevalence and Immunisation Coverage Data to Estimate the Global Burden of Congenital Rubella Syndrome, 1996-2010: A
Systematic Review. PLoS ONE 11(3): e0149160.
Countries with Rubella containing vaccine in the
national immunization program; by 2017

Introduced to date (149 countries or 76.8%)


Planned introductions by 2017 (14 countries or 7.2%)
Not Available, Not Introduced/No Plans
(31 countries or 16%)
Not applicable

The boundaries and names shown and the designations used on this map do not imply the
Data source: WHO/IVB Database, as of 16 December 2016 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
Map production Immunization Vaccines and Biologicals (IVB), concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent
World Health Organization approximate border lines for which there may not yet be full agreement. WHO 2016. All
rights reserved.
Annual Reported Rubella Cases, 2000-2015

2000 2015
900,000 Incidence Incidence
Number of Reported Rubella Cases

800,000 AFRO 16 5.6


700,000 AMRO 52 0
600,000 EMRO 16 3
500,000 EURO 993 0.9
400,000 SEARO 14 2.6
300,000 WPRO 27 5.1
200,000
100,000
0
2002

2015
2000

2001

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014
Year
Source: JRF, as of July 15, 2016
Rubella containing vaccine coverage by WHO region,
1980-2014

100
RCV* coverage (%)

80
46%
60

40 43 44 46
39 41 41 41

20 22 23 23 23
25 24 26 26
16 18
4 4 5 5 6 6 6 6 7 7 8 9 9 10 10 12 12 13
0
1987
1989

1998

2007
2009
1980
1981
1982
1983
1984
1985
1986
1988
1990
1991
1992
1993
1994
1995
1996
1997
1999
2000
2001
2002
2003
2004
2005
2006
2008
2010
2011
2012
2013
2014
Global AFR AMR EMR EUR SEAR WPR
Source: WHO/UNICEF coverage estimates 2014 revision. July 2015
* MCV1 was used as a proxy in the Member States that have introduced rubella Immunization Vaccines and Biologicals, (IVB), World Health Organization.
194 WHO Member States. Date of slide: 17 July 2015.
vaccine
Rubella incidence rate per million population by
country in 2013

Source: WHO/IVB Database as at 28 June 2014. 194 WHO The boundaries and names shown and the designations used on this map do
Member States. not imply the expression of any opinion whatsoever on the part of the World
Health Organization concerning the legal status of any country, territory,
Map production: Immunization Vaccines and Biologicals, city or area or of its authorities, or concerning the delimitation of its
(IVB). World Health Organization frontiers or boundaries. Dotted lines on maps represent approximate
border lines for which there may not yet be full agreement. WHO 2014.
Date of slide: 16 July 2014 All rights reserved
Verification of MR Elimination in countries and regions
Measles Elimination Status
Rubella Elimination Status
Situation in the South-East Asia Region
Immunization - Progress
All 11 countries in the region provide 2 doses of measles
containing vaccine through routine immunization
9/11 countries have introduced rubella vaccine
Most recent introduction has been in India phased
introduction
Indonesia to introduce in August 2017 phased
introduction
DPR Korea yet to introduce rubella containing vaccine
Periodic supplementary immunization activities
conducted in SEAR countries to close immunity gaps
MCV1 and MCV2 coverage & measles cases SEAR
2003-2016
120000 100

90
100000
80

70
Number of measles cases

80000
60

Coverage (%)
60000 50

40
40000
30

20
20000
10

0 0
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
MCV1 coverage MCV2 coverage

Source:
Case numbers: Joint Reporting form submissions by Member States to SEARO
Coverage data: WHO and UNICEF estimates (provisional for 2016)
However, only 5/11 countries in SEAR have achieved > 95%
coverage of first dose of measles containing vaccine (MCV1)

100

90

80

70

60
Percent

50

40

30

20

10

0
Bangladesh

Myanmar
Maldives

Sri Lanka

DPR Korea

Bhutan

India

Indonesia
Thailand

Nepal

Timor-Leste
2014 2015 2016

Source: Draft WHO/UNICEF coverage estimates, May 2017


An estimated 4.7 million children in SEAR not
1

receiving MCV1 annually


Proportion children not receiving MCV1 by
country
State.shp
Nepal Others Bangladesh 1
MCV1 coverage by district - India
District.shp
Myanmar 2% 1% 4% < 80%
2% 80% to 90%
>= 90%

Indonesia
24%

India
67%

3.1 million in India,


1.1 million in Indonesia, Data source: Most recent survey - NFHS4 (2015-16)/ AHS3 or DLHS4 (2012-13)/ DLHS3 (2007-08)
2nd dose of measles containing vaccine (MCV2) coverage
2014-2016
100

90

80

70

60
Percent

50

40

30

20

10

0
Bangladesh
Maldives
Sri Lanka

India

Nepal

Timor-Leste
DPR Korea

Thailand

Indonesia
Bhutan

Myanmar
2014 2015 2016

Nepal introduced MCV2 in Sept 2015 and Timor Leste in Feb 2016
Source 2014, 2015: WHO/UNICEF coverage estimates, July 2016 revision and 2016: Country official estimates, JRF 2016
Reported Measles Incidence Rate
SEAR, 2000-2013

80

71
70 70

60 59 59
56 56
52
Incidence per million

50
48
46
42
40
38

30 31

26

20
17

10
2015 target: 5 cases per million
0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

Incidence per million Data: WHO/UNICEF JRF (As of 15 July 2014)

27
Measles Elimination and Rubella/CRS control
South East Asia Regional Goal

66th Meeting of the SEAR Regional Committee in


September 2013 in New Delhi resolved to adopt
the goal of measles elimination and rubella/CRS
control in the South-East Asia Region by 2020

Measles elimination and rubella control is a


regional flagship programme of SEAR
Regional Committee has reviewed progress in
2017
India - Country Progress on MR
Highest Measles Mortality in India

49,200 out of 134,200 measles deaths globally,


(WER No. 45, 2016, 91, 525-536)

~ 36 % in
2015

~1000 Measles deaths

Dots are randomly distributed in countries


India Strategies, for M/R Elimination-2020

Key Strategies Elimination needs


1st dose coverage using
(M&RCV)
2nd dose coverage using > 95% population Immunity
(M&RCV)
(through either/both routine and /SIAs)
Measles-Rubella Surveillance Case-based MR surveillance
Case/outbreak Vitamin-A, Supportive Rx
Management/response and response immunization
Developing Linkages With other child health
interventions/programs
1st Dose Measles vaccine coverage India

Measles vaccination introduced in entire


country under UIP(universal Immunization
Program) since - 1985

Various strategies have been implemented for


augmenting measles vaccine coverage by
states since, across country (Example: Mission
Indradhanush).
20
40
60
80

0
100
97
GOA

96
CHANDIGARH

95
PONDICHERRY
94
CHHATTISGARH 93

SIKKIM
93

PUNJAB
93

WEST BENGAL
93

LAKSHADWEEP
91

TELANGANA
91

DELHI
89

ANDHRA PRADESH
89

KERALA
88

ODISHA
88

HIMACHAL PRADESH

*Coverage Evaluation Survey: NFHS4 2015-16 data


86

JAMMU & KASHMIR


85

TAMIL NADU
83

MAHARASHTRA
83

JHARKHAND
82

KARNATAKA
82

D&N HAVELI
81

UTTARAKHAND
80

MADHYA PRADESH
79

BIHAR
79

DAMAN & DIU


79

HARYANA
78

RAJASTHAN
76

A&N ISLANDS
75

GUJARAT
74
12-23 months, Survey data*, India

MANIPUR
72

MEGHALAYA
22 out of 36 (61% of the states having > 80% evaluated MCV-1 coverage
71

ASSAM
71

UTTAR PRADESH
70

TRIPURA
Percent Measles first dose evaluated-coverage,

61
India 81.1%

MIZORAM
55

ARUNACHAL PRADESH
50

NAGALAND
NTAGI Recommendation on MCV-2 & MR

MCV 2 introduced in - 2010


In 14 states with <80% MCV-1 coverage:
(Through measles SIAs (9months- <10 years
followed by MCV2 in Routine Immunization)
In 21 states with > 80% MCV 1 coverage:
(Directly introduced MCV2 through Routine
immunization at 16-24 months)
NTAGI recommendations-2014
2 doses of MR vaccine to replace measles
vaccine in RI, preceded by a wide age range, (9
months< 15 Yr) MR campaign in all states
* National Technical Advisory Group on Immunization
Measles vaccination campaigns & its impact

Measles cases from three 3 states (Gujarat,


Measles 2nd Dose Madhya Pradesh and Rajasthan) with surveillance
- through campaign pre and post Measles vaccination campaigns
- through RI

Cases from confirmed measles outbreaks


Measles SIA campaign

5000 Phase I Phase II Phase III


4000
3000

.
2000
1000
0
2010 2011 2012 2013 2014 2015 2016

~ 119 million children covered out of


~130 million targeted in the past
measles catch-up campaigns from
14 high burden states
*Data as on March 2016
Percent MCV-2 in RI Administrative coverage (HMIS)

2014 2015 2016*


1

64% 75% 79%

A&N ISLANDS
Target : 25.9 million children Target : 26.3 million children Target : 26.6 million children

< 50%
50% to 60%
60% to 70%
70% to 80%
> = 80%
Data not available
*HMIS data as on March 2017
Phased Measles-Rubella vaccination campaign - India

MR vaccine doses
Target pop 9m -
Phase-2 states <15 yrs. in 2016
required for Campaigns
(WMF-1.11)

ANDHRA PRADESH 13,501,000 14,986,110


CHANDIGARH 335,000 371,850
D&N HAVELI 138,000 153,180
DAMAN & DIU 74,000 82,140
HIMACHAL PRADESH 1,926,000 2,137,860
KERALA 8,274,000 9,184,140
TELANGANA 8,824,000 9,794,640
UTTARAKHAND 3,367,000 3,737,370
Total: Phase 2 36,439,000 40,447,290

Estimated Cumulative annual


MR vaccine required
MR campaign No. of Target Population (in MR vaccine
Phase for campaign (in
Year States million) required for RI (in
million doses)
(9 m - 15 yrs) million doses)

Phase 1 Feb 2017 5 35.8 39.7 6.2

Phase 2 Aug 2017 8 36.4 40.4 12.4

Phase 3 Feb 2018 16 113.9 126.4 30.8

Phase 4 Aug 2018 4 123.5 137.1 52.3

Phase 5 Oct 2018 3 99.2 110.1 70.1

Total 2017 2018 36 408.8 453.7


Source: Projected Target population (9 months to 15 years) based of 2011 census data
India Strategies, for M/R Elimination-2020

Key Strategies Elimination needs


1st dose coverage using
(M&RCV1)
2nd dose coverage using > 95% population Immunity
(M&RCV2)
(through either/both routine and /SIAs)
Measles-Rubella Surveillance Case-based MR surveillance
Case/outbreak Vitamin-A, Supportive Rx
Management/response and response immunization
Developing Linkages With other child health
interventions/programs
Current status of MR surveillance

Transition to modified case-based surveillance in 5 states


Initiated in Karnataka ,2016
Expanded to : Tamil Nadu, Puducherry, Goa, Lakshadweep,
Odisha, West Bengal and Chhattisgarh

Aggregate surveillance in remaining states


Line-list with core variables generated for all cases identified
during outbreak investigations
Active case search and case management is an integrated
component in outbreak surveillance mode

39
Surveillance reporting network in the country

Combined AFP-MR reporting

Quack Other
14% 1%

Govt.Allopathi
ISM* c
Practitioner 34%
8%

Pvt.Allopathic
44%

*Indian System of Medicine


N = 41383
Reporting Units (11,557): Send a report of AFP / suspected Measles cases, weekly
Informing Units (29,826): Inform as and when they see AFP/suspected Measles case
40
Measles / Rubella Lab-Network, WHO-India NPSP

12 - National laboratories
2 - National reference laboratories
1 Proposed laboratory

PGI, Chandigarh
SGPGI, Lucknow
PMC, Patna
NCDC, Delhi
SMS, Jaipur
GMC, Bhopal
BJMC, Ahmedabad
NIV, Bangalore
IPM, Hyderabad
KIPM, Chennai
IOS, Kolkata
MCG, Guwahati
ERC, Mumbai
NIV, Pune

WHO Accredited MR lab-net


Serologically confirmed Measles & Mixed outbreaks, 2015 & 2016
2016 2017

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Confirmed Measles outbreaks 798 outbreaks Confirmed Measles outbreaks 371 outbreaks
Confirmed Mixed outbreaks 65 outbreaks Confirmed Mixed outbreaks 14 outbreaks

*: as on 16th Aug 2017


Serologically confirmed Rubella & Mixed outbreaks, 2015 & 2016
2016 2017

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Confirmed Rubella outbreaks 267 outbreaks Confirmed Rubella outbreaks 105 outbreaks
Confirmed Mixed outbreaks 65 outbreaks Confirmed Mixed outbreaks 14 outbreaks

*: as on 16th Aug 2017


Suspected measles cases through weekly reports, 2005-2017*

Partial data may not reflect true case burden as India is in outbreak surveillance
70000 JAM MU & KASHM IR

HIMACHAL PRADESH
PUNJAB
CHANDIG ARH

61255
UT TARAKHAND
HARY ANA

DEL HI
ARUNACHAL PR.
SIKKIM
UT TAR PRADES H
RAJASTHAN
ASSAM
NAGAL AND
BIHAR
MEGHAL AYA

MANIPUR
JHARKHAND
TRIPURA
MADHYA PRADE SH

60000
MIZ ORAM

56486
WEST BENGAL
GUJARAT

CHHAT TISG ARH

DAMAN & DIU ODISHA


D&N HAV ELI
MAHARASHTRA

53216
TELANG ANA

GO A ANDHRA PRADESH
KARNAT AKA

PONDICHERRY
TAMIL NADU

LAKSHADW EEP KERALA A&N ISL ANDS

50000

40000 35985 34941


32921
30000 27873
26274
24258 23705

20000 16478

10000 7642

344
0
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
(1 state) (3 state) (6 states) (6 states) (7 states) (8 states) (11 states) (12 states) (15 states) (34 states/ (36 states/ (36 states/ (36 states/
No. of States UTs) UTs) UTs)
UTs)

Years-wise data are not comparable earlier to 2014-16


*: as on 16th Aug 2017
Measles & Rubella Cases by Year, 2005-2016

Partial data may not reflect true case burden as India is in outbreak surveillance mode

30000
JAM MU & KASHM IR
29132
HIMACHAL PRADESH
PUNJAB
CHANDIG ARH
UT TARAKHAND
HARY ANA

DEL HI

RAJASTHAN
UT TAR PRADES H
SIKKIM

ASSAM
ARUNACHAL PR.

NAGAL AND
26461
BIHAR
MEGHAL AYA

MANIPUR
JHARKHAND
TRIPURA
MADHYA PRADE SH
WEST BENGAL MIZ ORAM
GUJARAT

DAMAN & DIU


D&N HAV ELI
25000
MAHARASHTRA
CHHAT TISG ARH

ODISHA

TELANG ANA

GO A ANDHRA PRADESH
KARNAT AKA

PONDICHERRY
TAMIL NADU

LAKSHADW EEP KERALA A&N ISL ANDS

20000
No. of cases

15210
15000

10308
10000 8984
8579
7858
7131 7070

5227 4566
5000 42284454
3122 3314
2855 2734
1941
1130 1186
779
238 247 372
0
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
No. of States (1) (3) (6) (6) (7) (8) (11) (12) (15) (34) (36) (36)

Measles cases Rubella cases

Years-wise data are not comparable earlier to 2014-16


*: MR surveillance data updated till April-2017
Age distribution pattern of Measles cases, India, 2016-17*
2016 2017*

10000 10000
~ 94% Measles < 15 years of age ~ 95% Measles < 15 years of age

8000 8000
39% 37%
6000 6000

4000 4000

11% 37% 38%


2000 2000
7% 6%
8% 12%
5%
0 0
< 1 year 1-4 years 5-9 years 10-14 >= 15 < 1 year 1-4 years 5-9 years 10-14 >= 15
years years years years

Total cases- 17,739 Total cases- 6,388

(Cases from serologically confirmed measles and mixed outbreaks)

*: as on 16th Aug 2017


Age distribution pattern of Rubella cases, India, 2016-17*
2016 2017*

5000 5000
~ 92% Rubella < 15 years of age ~ 87% Rubella < 15 years of age
39%
4000 4000
32%

3000 3000

2000 2000
14%

7% 8% 37%
1000 1000
23% 20%
7% 13%
0 0
< 1 year 1-4 years 5-9 years 10-14 years >= 15 years < 1 year 1-4 years 5-9 years 10-14 years >= 15 years

Total cases- 10,772 Total cases- 2,247

(Cases from serologically confirmed rubella and mixed outbreaks)

*: as on 16th Aug 2017


Age distribution of Measles cases - India, 2015-16*
(> 90% of cases are under 15 years of age)

2015 2016
~ 96% Measles < 15 years of age ~ 95% Measles < 15 years of age
15000 15000

44%
12000 12000

35%
9000 9000

39%
38%
6000 6000

3000
8% 8% 3000
4% 7% 11%
5%
0 0

< 1 year 1-4 years 5-9 years 10-14 years >= 15 years < 1 year 1-4 years 5-9 years 10-14 years >= 15 years

Total cases- 30,606 Total cases- 17,301

Vaccinated Not Vaccinated Unknown

(Cases from serologically confirmed measles outbreaks only)

*: MR surveillance data updated till April- 2017


Measles cases by vaccination status, India, 2015-2016*

2015 2016*

26% 23%
29%
32%

51%
39%

N=30,606 N=17,301

Vaccinated
Not Vaccinated
Unknown

* data as on April 2017 Cases from serologically confirmed measles & mixed outbreaks
Country measles virus genotypes, 2014-17
2017
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*: as on 16th Aug 2017


Summary

Measles and CRS continue to be a serious public health


problem in the World, SEAR region and our country
Measles and MR vaccines have great impact on mortality
All WHO Regions have a measles elimination goal - some
have rubella elimination goal as well
SEAR region including India committed to elimination of
measles and control of rubella/CRS by the year 2020
Current Measles coverage below elimination thresholds in
the SEARO region and India
Strategies for measles elimination and rubella control are
being intensified in SEAR region including India
Polio is gone!
Measles-Rubella is next!
Thank you