Nilanjan Mitra

1. Dr.Nilanjan Mitra Sub-Regional Team Leader - WB WHO-NPSP Status of Measles Surveillance

2. Measles Surveillance-India Source: DLHS-3 (2007-08); Gujarat – NFHS-3 (2005-2006) States Measles Immunization coverage (%) Fully Immunized (%) Year of introduction of measles surveillance Andhra Pradesh 88.6 67.1 2006 Karnataka 85.2 76.7 2006 Kerala 87.9 79.5 2007 Tamil Nadu 97.6 83.2 2006 West Bengal 82.8 75.8 2007 Gujarat * 65.7 45.2 2007 Rajasthan 67.5 48.8 2009

3. 2007 16478 cases 2008 Clinical measles cases through routine weekly reporting * data as on 15 th Feb, 2010 24258 cases

4. Clinical measles cases through routine weekly reporting 2009 * data as on 15 th Feb, 2010 2046 cases 2010* 32921 cases More clinical measles cases are pouring over the years

5. Measles Seasonal Trend (6 states) -2008-09 Source: Routine weekly reports – cases of clinical measles Among 6 states - WB dictates the seasonality

6. Death Source – Routine weekly reports

7. Source – Routine weekly reports

8. Popln. density / sq.km WB – 903 KOL – 24718 HRA – 2913 BBM – 663 BDN - 982 Source – Routine weekly reports Measles immunization coverage – 61% (DLHS-3)

9. Serologically confirmed measles, rubella and mixed outbreaks India (Andhra Pradesh, Gujarat, Karnataka, Kerala, Rajasthan, Tamil Nadu and West Bengal) 151 outbreaks 111 36 39 61 52 38 2008 2009* 186 outbreaks * data as on 15 th Feb, 2010 decreased increased Measles outbreaks confirmed Rubella outbreaks confirmed Mixed outbreaks confirmed

10. Summary of OBI – 6 States – 2007 - 2009 States Year No. of suspected outbreaks No. of serologically investigated outbreaks % No. of cases Identified in measles outbreaks No. of cases Identified in rubella outbreaks Deaths in serologically confirmed measles outbreaks AP 2007 54 54 100 678 0 4 2008 46 32 70 490 382 1 2009 44 32 73 1017 81 0 GUJ 2007 19 16 84 1044 0 3 2008 47 25 53 2092 0 4 2009 27 11 41 334 220 1 KAR 2007 337 52 15 2357 132 7 2008 115 51 44 1755 938 4 2009 77 27 35 768 631 1 KER 2007 76 9 12 314 153 2 2008 66 19 29 382 249 0 2009 55 15 27 128 218 1 TN 2007 101 32 32 1034 87 0 2008 32 13 41 384 0 0 2009 29 5 17 266 105 1 WB 2007 238 23 10 1704 0 19 2008 429 59 14 1967 1286 14 2009 577 67 12 951 3008 3

12. Results of OBI – 6 States – 2007 - 2009 State Year Total no. of outbreaks investigated SEROLOGICALLY CONFIRMED OUTBREAKS Measles % Rubella % Mixed % Negative % AP 2007 54 47 87.1 0 0 7 12.9 2008 32 14 43.6 6 18.8 6 18.8 6 18.8 2009 32 17 53.1 4 12.5 2 6.2 9 28.1 GUJ 2007 16 15 93.8 0 0 1 6.2 2008 25 24 96.0 0 1 4.0 0 2009 11 7 63.6 2 18.2 2 18.2 0 KAR 2007 52 42 80.8 2 3.8 3 5.8 5 9.6 2008 51 29 56.8 11 21.6 6 11.8 5 9.8 2009 27 14 51.8 6 22.2 6 22.2 1 3.8 KER 2007 9 6 66.7 3 33.3 0 0 2008 19 9 47.4 4 21.0 6 31.6 0 2009 15 6 40.0 6 40.0 2 13.3 1 6.7 TN 2007 32 29 90.7 1 3.1 1 3.1 1 3.1 2008 13 8 61.5 0 5 38.5 0 2009 5 3 60.0 2 40.0 0 0 WB 2007 23 19 82.7 0 3 13.0 1 4.3 2008 59 27 45.8 15 25.4 15 25.4 2 3.4 2009 69 10 14.5 33 47.8 26 37.7 0

13. Measles Outbreak – 2007 (from1 st July – Dec 07) Confirmed Measles Outbreak - 19 Measles & Rubella Outbreak - 3 Outbreak – neither Measles nor Rubella - 1 Kalimpong II (2) Dhupguri Kharibari-Phansidewa Jalpaiguri Rajganj Karandighi Ratua I & Harishchandrapur II Farakka Sagardighi Murarai II Katwa I Andal-Pandebswar Raghunathpur II Kulpi Nandigram II (2) – 1 mixed & 1 measles Ramnagar II Canning I Goalpokhar II Total outbreaks investigated - 23 Raghunathganj II Baruipur Mathurapur II

14. Measles Outbreak – 2008 Confirmed Measles Outbreak (27) Measles & Rubella Outbreak (15) Outbreak – neither Measles nor Rubella (2) Total outbreaks investigated - 59 Confirmed Rubella Outbreak (15) Result Pending (0) Data as on 08.04.09 Nakashipara (2) – 1 Mixed & 1 measles Patashpur -I (2) 1 Rubella + 1 Mixed Jalpaiguri ( 2 ) 1 Rubella + 1 Measles Basirhat – I (2) 1 Mixed + 1 Rubella Raiganj (3) 2 Measles + 1 Mixed Arambagh (2) - 1 Negative + 1 Measles Swarupnagar (2) 1 Mixed+ 1 Rubella Basirhat – M (2) 1Measles+ 1Mixed ? ? ? KOLKATA

15. Measles Outbreak – 2009 Total outbreaks investigated - 71 Data as on 22.02.2010 Confirmed Measles Outbreak – (10) Measles & Rubella Outbreak – (26) Confirmed Rubella Outbreak (33) Neither Measles nor Rubella (0) Result Pending (2) Kaliganj (2) - 1 Rubella + 1Mixed Goalpokhar-II(2) Egra – II (2) - 1 Rubella + 1Pending ? ?

16. Average TIME-LAG Analysis (in days) - 2007-2009

17. Vaccination status of measles cases – serologically confirmed measles outbreaks, India, 2009

18. OBI (23) - Cases by vaccination status, 2007 N=783 West Bengal <1 Years of age 1-4 Years of age 5-9 Years of age 10-14 Years of age >15 Years of age N=200 N=788 N=153 N=89 N=644 Cases from serologically confirmed measles outbreaks Vaccinated Not Vaccinated Unknown

19. OBI (59) - Cases by vaccination status, 2008 N=783 West Bengal <1 Years of age 1-4 Years of age 5-9 Years of age 10-14 Years of age >15 Years of age N=397 N=1203 N=734 N=485 N=1588 Cases from serologically confirmed measles outbreaks Vaccinated Not Vaccinated Unknown

20. OBI (67) - Cases by vaccination status, 2009* N=783 West Bengal <1 Years of age 1-4 Years of age 5-9 Years of age 10-14 Years of age >15 Years of age N=425 N=1681 N=1131 N=821 N=2178 Cases from serologically confirmed measles outbreaks Vaccinated Not Vaccinated Unknown

21. 2009

22. 2009

23. Total cases- 1060 Total cases- 431 Total cases- 266 Andhra Pradesh Gujarat Tamil Nadu Total cases- 236 Kerala Total cases- 3228 West Bengal Total cases- 1238 Karnataka Measles cases by age, 2009* Cases from serologically confirmed measles outbreaks % % % % % % Total cases- 146 Rajasthan % * data as on 15 th Feb, 2010

24. Total cases- 1967

25. Total cases- 991 77% Measles cases in 1-10 yrs age group

26. SILENT AREAS and AREAS with < 10 cases of Clinical Measles Weekly Reporting of Measles Surveillance -2008 - WB

27. SILENT AREAS and AREAS reported < 10 cases of Clinical measles in 2009 - WB Source: Routine weekly Reports -data up to 53 wks

29. 51% Urban areas under-represented 23% Rural areas under-represented

32. END

33. Blocks with poor RI Source: Analysis of 2250 AFP cases in 2007 SUMMARY 63 AFP cases in with less than 3 RI doses in 6-24mns. age group in 35 blocks & 12 Municipalities in 13 districts Total AFP cases in 6-24 mns age group - 372

34. Blocks with poor RI Source: Analysis of 1853 AFP cases in 2008 SUMMARY 83 AFP cases in with less than 3 RI doses in 6-24mns. age group in 41 blocks & 15 Municipalities in 16 districts Total AFP cases in 6-24 mns age group - 449

35. N=237 Andhra Pradesh N=913 Gujarat N=151 Tamil Nadu N=174 Kerala N=930 West Bengal N=883 Karnataka Measles cases (1-4 years) by vaccination status, 2008 Cases from serologically confirmed measles outbreaks Vaccinated Not Vaccinated Unknown

36. N=327 Andhra Pradesh N=142 Gujarat N=84 Tamil Nadu N=43 Kerala N=1049 West Bengal N=534 Karnataka Measles cases (1-4 years) by vaccination status, 2009* Cases from serologically confirmed measles outbreaks N=59 Rajasthan * data as on 15 th Jan, 2010 Vaccinated Not Vaccinated Unknown

37. Total cases- 1498 (22 + ve Outbreak) Data as on 12.11.08