MR Disease , Mortality , Distribution of Vaccine

1. GLOBAL-
REGIONAL-
COUNTRY
OVERVIEW ON MR
PROGRESS &
ELIMINATION
STRATEGIES
Training Workshop for Measles-Rubella Vaccination Campaigns

2. Measles disease
• An acute viral infection spread via
respiratory secretions or aerosols
• Classic manifestations:
– Maculopapular rash
– Fever +cough + coryza/conjuctivities
• Complications and mortality
highest in children < 2 yrs. and in
adults
• Case Fatality Ratio (CFR):
– Ranges from (0.1 – 10) %
– Up to 30% in humanitarian emergencies (A Measles case from Nagaland, District Mon)

3. Measles mortality: due to complications
Corneal scarring causing
blindness
Vitamin A deficiency
Encephalitis
Older children, adults
≈ 0.1% of cases
Chronic disability
Pneumonia &
diarrhea
Diarrhea common in developing countries
Pneumonia ~ 5-10% of cases, usually bacterial

4. Rubella & congenital Rubella syndrome
• Rubella: A mild, self limiting viral illness
• Congenital rubella syndrome (CRS): Rubella infection during
early pregnancy
– May result in spontaneous-abortion, still birth, serious
birth defects
– Public health concern
• High CRS burden in countries not using rubella vaccine
– Estimated 40-50 thousand CRS cases annually in India
• Incidence of rubella substantially reduced in many countries
through vaccination

5. Measles
5

6. Reported Measles Incidence Rate*
Aug 2015 to Jul 2016 (12 month period)
*Rate per 1'000'000 population
Data source: surveillance DEF file
Data in HQ as of 5 September 2016
<1 (94 countries or 48%)
≥1 - <5 (31 countries or 16%)
≥5 - <10 (20 countries or 10%)
≥10 - <50 (29 countries or 15%)
≥50 (11 countries or 6%)
No data reported
to WHO HQ
(9 countries or 5%)
Not applicable

7. Measles Mortality
~ 36 %
49,200 in India alone, out of 134,200 measles deaths globally,
(WER No. 45, 2016, 91, 525-536)

8. Rubella
8

9. 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.

10. Country scenario
10

11. Comfirmed rubella casesConfirmed measles casesSuspected measles casesNumber of cases
2006 2008 2009 2010 2011 2012 2013 2014 20152007 20172005
(4) (7) (7) (8) (9) (12) (13) (16) (34) (36) (36)(1)
Measles and Rubella cases – India, 2005 – 2017*
Lab-
supported
MR
surveillance
initiated
MCV2
introduction
Measles
campaigns
2016
(36)
Number of states with lab-supported MR
surveillance*: as on 7th March 2018, based on weekly surveillance reports; partial data may not reflect true case burden as India is in outbreak surveillance mode
Rubella
introduced
MR
campaigns

12. Distribution of Measles & Mixed Outbreaks, India
Measles Outbreak-
802
Measles Outbreak-
654
Measles Outbreak-
62

13. Distribution of Rubella & Mixed Outbreaks, India
Rubella Outbreak-
274
Rubella Outbreak-
132
Rubella Outbreak-
1

14. Distribution of Measles Cases, India

15. Distribution of Rubella Cases, India

16. Age Distribution Pattern of Measles Cases , India
(> 90% of cases are under 15 years of age)

17. Age Distribution Pattern of Rubella Cases , India
(~ 90% of cases are under 15 years of age)

18. Measles & Rubella cases by Gender, India

19. State scenario
19

20. Measles Outbreak Classification
2016 2017 2018*
Total Outbreaks Flagged 137 158 53
Total Outbreak Investigated 137 158 53
Measles Confirmed 86 105 22
Rubella Confirmed 19 20 1
Mix (Measles & Rubella) 4 6 0
Negative 21 16 2
Results Pending 7 5 28
Clinically Compatible 0 6 0
2016
2017
2018*
Source data : SIMS Week 20 of 2018

21. Mumbai scenario
21

22. Measles Outbreaks (Investigated) in Mumbai: 2018
• 35 outbreaks notified
• Blood samples collected in 35 outbreaks
Results of Outbreak :
• 21 Measles out breaks
• 1 Negative Outbreak
• 13 Pending for result
Measles out breaks in 17 wards out of 24
Investigated outbreaks
Year
No. of
Outbreak
reported
No. of
outbreak in
which blood
samples
collected
Confirmed
Measles
outbreak
Confirmed
Rubella
outbreak
Confirmed
Mixed
outbreak
2013 36 31 17 6 5
2014 33 20 14 0 0
2015 37 34 31 0 0
2016 36 35 21 3 2
2017 28 28 23 3 1
2018 35 35 21 0 0
Total 205 183 127 12 8

23. Key Facts on MR
• High efficacy, Measles-Rubella (MR) vaccine available:
– 85-90 % effective at 9-12 months
• Accumulation of susceptible persons → disease-outbreaks
• Above 95% population immunity essential to stop endemic
measles and rubella virus circulation
• Even at high levels of routine immunization coverage, single
dose is not enough to achieve > 95% population immunity
• Two doses of MR vaccine with 95% coverage is critical

24. Measles-Rubella is next !
Together - we will do it !
• Small pox!
• Polio!
• Maternal & Neo-natal tetanus!
• Yaws!
Together - we have done it!