Measles and Rubella Fact Sheet SEAR #

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and Fact Sheet SEAR 8-9 Table : South-East Asia Regional (SEAR) Strategic Plan 7- Goal: To reduce the number of measles deaths by 9 in relative to estimates. Objectives: Achieve at least 9 national Containing Vaccine (MCV) coverage and at least 8 MCV coverage in all districts in member countries by ; 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 9; and Provide a second opportunity for measles immunization to eligible children in all member States by while ensuring more than 9 coverage. Figure : Accelerated Control in SEAR, -8 Over million vaccinated through Figure : Implementation of Control Activities in SEAR Countries, 9 Estimated deaths.3...4 4.4 4.7 4 reduction of mortality, - 7 3. 9 9 8 8 7 7 MCV Coverage () Implementing elimination strategies Bhutan, DPR Korea, Maldives and Sri Lanka Advanced stage of mortality reduction Bangladesh, Indonesia, Myanmar, Nepal and Timor-Leste 3 4 7 8 Estimated Deaths MCV coverage achievement in millions Sources: Mortality estimate: WHO/HQ, MCV coverage: WHO/UNICEF best estimates, coverage: WHO/UNICEF JRF Table : Incidence per, population, SEAR, -8 Table 3: MCV Immunization Schedule and Percentage Coverage, 99-8 Source: IVD/ WHO-SEAR Partial Implementation of mortality reduction strategies India and Thailand Country 3 4 7 8 Bangladesh 4. 3.7 3.3. 3. 7.4 8.4 4.37.3.8 Bhutan 49.9. 3.8 3.77..4.4..7.4 DPR Korea........ 4..34 India. 3.8. 3.84 4.4...4 3.9 4.8 Indonesia.8.9.7 9..44 3.48 7.3 9. 8..73 Maldives..87. 34.83.73.78 474.9.7.. Myanmar.9.8..4..3..3.88. Nepal. 39.9 4.9 7. 3.78 49....39 7.79 Sri Lanka 3. 88.88..74.34.8.... Thailand..9.89.3 7...3.3.. Timor-Leste..... 4.83.99 9... SEAR. 7.98.9..9.89.4.8 4.3 4.74 Source: Population: --United Nations Population Division, Department of Economic and Social Affairs, World Population Prospects the revision; onwards - WHO/SEARO Annual EPI Reporting Form (AERF); : WHO/UNICEF JRF Country Schedule 99 3 4 7 8 Bangladesh 38 W 8 9 74 78 79 9 7 7 7 7 77 7 7 8 88 83 89 89 Bhutan 9, 4 M 93 89 8 84 8 8 8 84 7 7 7 78 78 88 87 93 9 9 99 DPR Korea 9M 98 98 99 99 83 7 34 49 3 78 9 98 9 9 9 9 99 98 India 9- M 43 9 7 7 4 9 4 7 7 7 Indonesia 9M, Y 8 8 3 79 77 7 74 7 7 7 74 7 78 8 8 83 Maldives 9, 8 M 9 97 98 8 97 9 9 9 98 99 99 98 97 9 97 97 97 97 97 Myanmar 9, 8 M 8 7 8 7 77 8 8 88 89 8 84 73 77 7 78 7 78 8 8 Nepal 9 M 7 7 8 8 8 73 7 7 7 7 7 7 73 74 8 8 79 Sri Lanka 9 M 8 79 8 8 84 87 89 9 99 99 99 99 9 99 99 98 98 Thailand 9- M 8 79 74 8 8 9 9 93 9 9 9 9 9 9 98 Timor Leste 9 M ND ND ND ND ND ND ND ND ND ND ND ND 48 4 3 73 Source - 99-8: WHO/UNICEF Coverage Estimates SEAR & Fact Sheet World Health Organization IVD Page of Updated & Published 7-Sep-9

and Fact Sheet SEAR 8-9 Figure 3: MCV Coverage, Suspected and s, Bangladesh, 99-8 Figure 4: MCV Coverage, Suspected and s, Bhutan, 99-8 9m-y 3 93 8 99 9m-y; y-4y(f) 98 4 Coverage 8 4 8 4 Coverage 99 3 4 7 8 MCV Coverage 99 3 4 MCV Coverage MCV Coverage 7 8 Source: WHO/UNICEF JRF & Estimated Coverage, -8 Figure : MCV Coverage, Suspected and s, DPR Korea, 99-8 Source: WHO/UNICEF JRF & Estimated Coverage, -8; For MCV Coverage: Country Official Estimates used Figure : MCV Coverage, Suspected and s, India, 99-8 m-4y 4 3 3 8 8 8 4 Coverage 4 4 Coverage 99 3 4 7 8 MCV Coverage MCV Coverage 99 3 4 7 8 MCV Coverage Source: WHO/UNICEF JRF & Estimated Coverage, -8; For MCV Coverage: Country Official Estimates used Figure 7: MCV Coverage, Suspected and s, Indonesia, 99-8 9 8 7 4 3 99 3 4 7 8 MCV Coverage MCV Coverage Source: WHO/UNICEF JRF & Estimated Coverage, -8; For MCV Coverage: Country Official Estimates used 9 y-y 9 m-y m-y 9 8 4 Coverage Figure 8: MCV Coverage, Suspected and s, Maldives, 99-8 3 3 Source: WHO/UNICEF JRF & Estimated Coverage, -8 99 3 4 7 8 -y & -34 y (f) MCV Coverage MCV Coverage Source: WHO/UNICEF JRF & Estimated Coverage, -8 8 8 4 Coverage SEAR & Fact Sheet World Health Organization IVD Page of Updated & Published 7-Sep-9

and Fact Sheet SEAR 8-9 Figure 9: MCV Coverage, Suspected and s, Myanmar, 99-8 Figure : MCV Coverage, Suspected and s, Nepal, 99-8 9 8 7 4 3 99 3 4 7 8 88 9 9m-y 79 MCV Coverage 9 8 7 4 3 Coverage 4 8 4 99 3 4 7 8 9m-y 7 MCV Coverage Source: WHO/UNICEF JRF & Estimated Coverage, -8 Source: WHO/UNICEF JRF & Estimated Coverage, -8 9m-y 93 9 8 7 4 3 Coverage Figure : MCV Coverage, Suspected and s, Sri Lanka, 99-8 Figure : MCV Coverage, Suspected and s, Thailand, 99-8 8 4 8 4 99-4y-y 9 7 3 4 7 8 MCV Coverage MCV Coverage 9 8 7 4 3 Coverage 4 4 3 3 99 3 4 7 8 MCV Coverage MCV Coverage 8 4 Coverage Source: WHO/UNICEF JRF & Estimated Coverage, -8; For MCV Coverage: Country Official Estimates used Figure 3: MCV Coverage, Suspected and s, Timor-Leste, 99-8 Source: WHO/UNICEF JRF & Estimated Coverage, -8; For MCV Coverage: Country Official Estimates used Figure 4: / Surveillance Network, SEAR, 9* 9m-y 99 m-y 4 8 4 Coverage 3 4 7 8 MCV Coverage Source: WHO/UNICEF JRF & Estimated Coverage, -8 Govt. Network Govt. Network Supported by WHO *Updated on Aug 9 SEAR & Fact Sheet World Health Organization IVD Page 3 of Updated & Published 7-Sep-9

and Fact Sheet SEAR 8-9 Figure : MCV Coverage by Country, 4-8 Figure : Percent of Districts Achieving >8 MCV Coverage by Country, 4-8 Minimum Target 9 Target 8 Coverage in all districts MCV Coverage () 8 4 of Districts 9 8 7 4 3 BAN BHU DPRK IND INO MAV MMR NEP SRL THA TLS 4 7 8 BAN BHU* DPRK IND* INO MAV MMR NEP SRL THA* TLS Source: 4-8: WHO/UNICEF Estimates; : Country Official Coverage Estimate for India. Figure 7: Percent of BCG- Drop Out by Country, 4-8 4 7 8 Source: WHO/UNICEF JRF. *No district level data IND 4-; THA 4-8. Table 4: Status of implementation of case-based surveillance of suspected measles cases 8 Dropout 4 3 3 - Drop Out = BCG Coverage MCV Coverage x BCG Coverage 9 9 9 9 3 7 8 4 3 3 3 3 3 BAN BHU- DPRK - - IND INO MAV MMR NEP SRL THA TLS -3 8 9 7 9 9 4 7 8 Source: 4-8: WHO/UNICEF Estimates. : Country Official Coverage Estimate for India. Table : and Outbreaks and Age Distribution of the, SEAR, 8 Country Number of Suspected Outbreaks Reported Investigated Lab Confirmed Lab Confirmed 4 3 4 Country Outbreak From health Data collection Serology Data collection Serology Bangladesh Case based All outbreaks Case based Initiated nationally in 8 Bhutan Case based All outbreaks Case based Some cases DPR Korea Case based All outbreaks Case based Some cases India Case based in states In states Aggregate Not done Indonesia Case based In some outbreaks Case based data to districts, then aggregated Source: IVD / WHO, SEAR 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 3 sites since 7 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 (Outbreak Reporting) < yr -4-9 -4 = > Un known (Outbreak Reporting) < yr -4-9 -4 Bangladesh 8 9 3.7 4..8... 9. 3. 3.9 7. 8.9. Bhutan DPR Korea India 74.8 4 34 7.7 37.3 39.8. 3.7.4 3.3 38.3.7 9.3. Indonesia 9 4.9 4 3 8 8.7 4. 4.3 4.4.. 4.9.4 39. 3.9 3.7. Maldives. Myanmar 9. 9 7.9 7.. 34.9 8. Nepal 39 9.3 7.9 73.7 8..... 33.8 44.4 4.. Sri Lanka Thailand ND ND ND ND ND ND ND ND ND ND ND ND Timore-Leate SEAR 43 8. 4 7 7 797 7.7 38.4 38..4 4.. 8. 4.9 33.4 7.3.3. Source: Annual EPI Reporting Form (AERF) 8; ND- No Data = > Un known SEAR & Fact Sheet World Health Organization IVD Page 4 of Updated & Published 7-Sep-9

and Fact Sheet SEAR 8-9 Figure 8: Second Dose for Immunization, SEAR, 9 Through Routine Immunization Through Provide MR/MMR vaccine Provide Vaccine Catch-up campaign Catch-up & Follow-up campaigns Source: IVD / WHO, SEAR Table : Target and Achievement, -9* Coverage Coverage Country Type Age group Country Type Age group Vaccinated Vaccinated districts 9m - Y,374,39 93 Indonesia 7 Aug Ynder y campaign in Provinces M- Y 3,43, 93 Bangladesh All remaining districts 9m - Y 34,37,74 Maldives / National - Y & -34Y( F) 3,4 8 Bhutan National 9M- Y & -44Y( F) 33,4 98 of 7 states/divisions 9 M Y,77,9 88 DPR Korea 7 National M-4 Y,9,43 3 of 7 states/divisions 9 M Y,48,4 9 Myanmar School based campaign in 3 provinces - Y,34,47 9 4 of 7 states/divisions 9 M Y,8,39 79 3 School based campaign in 4 provinces - Y 98,74 9 7 National 9 M Y,7,3 4 School based campaign in 7 provinces - Y,, 4 of Regions 9M Y,49,93 catch-up campaign in provinces M Y 4,4, 9 3 of Regions 9 M Y 4,348,79 7 Nepal catch-up campaign in province M Y,77 9 8 Sep 9 of 7 districts 9 M- Yrs 99,4 Indonesia Under y campaign in Provinces M- Y,777 8 Dec 4 of 7 districts 9 M- Yrs,74,8 93 School based campaign in provinces Y - Y 3,49,844 9 Sri Lanka 3 National -4 Y,897,73 9 Under y campaign in 9 Provinces M- Y 3,44,98 9 4 National - Y,3,8 7 7 Feb School based campaign in 3 provinces Y - Y,83,8 3 National 9 M- Y 7,43 99 7 Feb Ynder y campaign in Provinces M- Y,7,78 9 Timor-Leste National M-Y 7,73 4 7 Aug School based campaign in provinces Y - Y,9,99 9 National 9-9 M,83 7 Souce: IVD/WHO-SEAR *Updated on Sep 9 Follow-up campaigns are highlighted,,889 97 Table 7: Schedule, 8-8 9 Planned Country 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 O Bangladesh Bhutan DPR Korea India Indonesia Maldives Myanmar Nepal Sri Lanka Thailand Timor-Leste Source: IVD/WHO-SEAR Updated on 9 Aug 9 Roll-over follow-up measles campaigns National follow-up measles campaigns SEAR & Fact Sheet World Health Organization IVD Page of Updated & Published 7-Sep-9

and Fact Sheet SEAR 8-9 Figure 9: SEAR and Laboratory Network, 9 Figure : Distribution of / Genotypes in SEAR H H D4,D8 D4,D7,D8 D8 D D,G B D,G D9,G 3 Genotype Genotype Source: IVD / WHO, SEAR Table 8: & Laboratory Network Serology Results, 8-9 8 Country Laboratories Bangladesh Bhutan DPR Korea Dhaka Thimphu Pyongyang Ahmedabad Bangalore India Chennai Hyderabad Kolkata India from five labs Bandung Jakarta Indonesia Surabaya Yogyakarta Indonesia from four labs Maldives Male Yangon Myanmar Nepal Kathmandu Sri Lanka Colombo Bangkok Thailand Dilli Timor-Leste Number of Serum Samples Received Number Tested for & 79 9 8 4 348 3 4 9 98 4 8 44 489 7 9 4 84 4397 788 8 8 4 348 9 3 9 4 48 8 44 47 7 99 8 79 47 Source: Reported by SEAR Laboratory Network 9* Positive Results 7 9 8 3 3 38 9 74 389 34..3. 7.8 4.4.9 3.8 4. 3.7..4 47.. 3.. 74.7 9..7 49. 8.9 43 7 7 9 3 4 9 4 3 3 7 3 93 3.8.... 8.. 7.. 48. 7.8 7. 7.7 34.7.4. 38.9 3...4 Number of Serum Samples Received Number Tested for & 99 3 9 4 34 8 7 3 4 9 83 48 3 3 73 89 488 89 3 9 8 7 3 9 83 48 3 33 39 33 3874 Positive Results 34 87 78 37 3 9 4 9 734.7.. 4.8 4.3 3. 3. 3. 3. 9.7. 48..9.7. 3..4 3. 38.. 8.9 Percentages may not add to ; Equivocal results not included and some samples are in process with results pending. Some countries test samples for both and. and 3 samples were received for testing from the hospital (routine Antenatal cases) in 8 and 9 respectively. 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 3..8. 4. 3.. 7.8.4 39. 9.7.8 3.8 7. 7..7.. 3...7 43.4 *Data as of 3 Jun 9 Primary Data Sources: 4 9 8 3 3 4 37 4 39 74 3 9 8 NR=No Report 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, India. Tel: +9 33784, Direct Fax: +9 337, 337 IVD Internet: http://www.searo.who.int/en/section.asp EPI fact sheets available: http://www.searo.who.int/en/section/section3/section7.htm IVD VPD surveillance bulletin: http://www.searo.who.int/en/section/showfiles.asp Weekly IVD VPD/AFP update: http://www.searo.who.int/en/section/showafpfiles.asp Monthly IVD VPD/AFP update: http://www.searo.who.int/en/section/showafpmonth.asp SEAR & Fact Sheet World Health Organization IVD Page of Updated & Published 7-Sep-9