Global Measles and Rubella Update - April 2024

The Global Measles and Rubella Report provides provisional data on the reported cases of measles and rubella, distributed monthly via email. Official numbers are available in July each year through the WHO/UNICEF annual data collection. The report is based on surveillance data from Member States, with epidemiologic data collected at regional and HQ levels. Differences in case numbers may occur due to various surveillance systems. The report also includes data from the Global Measles Rubella Laboratory Network, accounting for discrepancies between laboratory and epidemiological data.

• Measles
• Rubella
• Global Update
• Epidemiologic Data
• Laboratory Network

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1. Measles and Rubella Global Update April 2024

2. Distribution list This report is distributed by email on a monthly basis. To join the distribution list, please send an email to Sebastien Antoni (antonis@who.int)

3. Disclaimer Please note that all data contained within is provisional. The number of cases of measles and rubella officially reported by a member state is only available by July of each year (through the joint WHO UNICEF annual data collection exercise). If any numbers from this provisional data are quoted, they should be properly sourced with a date (i.e. "provisional data based on monthly data reported to WHO (Geneva) as of April 2024"). For official data from 1980-2023, please visit our website.

4. Data sources and limitations The Global Measles and Rubella Report is based on surveillance data reported by Member States to the regional offices weekly or monthly. The regional compilation is reported to HQ monthly. Data are to be reported from the regions on the 1stFriday of the month, and HQ attempts to release the monthly report by the 3rdMonday of the month. Please note: Numbers of cases might differ from the official numbers reported annually as part of the WHO/UNICEF Joint reporting process (JRF). The difference can be due to the time lag as the annual data might not be complete at the time of reporting. In addition, the difference can be due to multiple surveillance systems at country level. In these cases, the monthly data are extracted from the case based surveillance system while the annual data can be from the aggregated system. Epidemiologic Data: Case-based and/or Aggregate Reporting to WHO Epidemiologic data comes from Member States in one of two forms Case-based data, which is our recommendation, is provided by most member states. At WHO HQ, we collect a limited set of variables, including, age, date of onset, country reporting, 1st/2nd administrative unit of residence, vaccination status (by recall), date related to specimen collection/testing, and final classification. Regions might or might not collect more data than this. Often suspected cases with recent date of onset are not classified; however, at HQ we classify pending cases as clinically compatible and update the data if/when new data are provided to HQ. For AFR, we classify all cases that are rubella IgM+ as rubella laboratory-confirmed cases. Aggregated data on number of suspected, lab-confirmed, epi-linked, and clinically compatible cases of measles/rubella, by month/year of onset, and by subnational area (though some member states do not provide this level of disaggregation). Source for zero-reporting from some member-states though this is not a consistent process. A few member states send us both case-based and aggregated data as they have two different surveillance systems in the country. If both aggregate and case-based data are sent to HQ, numbers from aggregate surveillance are considered case counts for the country, while case-based data are used for the national slides to show age distribution, proportion vaccinated, and age-specific incidence. ELISA Laboratory Data from the Global Measles and Rubella Laboratory Network (GMRLN) The Global Measles Rubella Laboratory Network laboratories report the number of samples received as well as the number of samples tested for IgM serology, as well as the number positive, negative and equivocal. These aggregated data are collected to account for the inadequate linking between laboratory and epidemiological data in some countries. Numbers of cases reported may differ from the number of samples tested positive for various reasons Samples tested positive in a laboratory may not reported to the surveillance system IgG screening results are inappropriately included in the surveillance database Inconsistent reporting from laboratories. This is based on the number of SAMPLES tested, not the number of CASES tested. One case can have multiple samples being tested (e.g. different specimen types, repeat specimen collection based on timing of collection). Limitations Data are only from network laboratories Non-network laboratories are not included Some laboratories don t report IgG results are sometimes inappropriately reported Limitations Reporting delays: It can take 2-3 months from the time a case is reported to public health in a member state to the time the data are provided to WHO HQ. Some of this is due to normal reporting delays that are expected as it takes time to get information from a health center to Geneva based on reporting frequencies set by various levels We are working to decrease the delays in reporting. Underreporting/lack of reporting Case definitions for suspect, epidemiologically linked and clinically compatible cases may vary between countries. Completeness of the data reported to WHO is unknown For this monthly update, pending cases are considered measles clinically compatible. These cases may later be discarded or confirmed based on laboratory testing in which case historical case counts may vary from one report to another. This could lead to differences between the Global monthly report and Regional or National surveillance bulletins published by WHO Offices and National authorities. Genotyping Data Genotyping data are obtained from the MeaNS2 (https://who-gmrln.org/means2) and RubeNS2 (https://who- gmrln.org/rubens2). Limitations Inadequate sample collection for genotyping challenges interpretation of the data Underreporting WHO recommends that Member States submit genotyping data to these databases, but it is not currently a requirement so there is underreporting Genotype data can t be linked to epidemiologic data at the global level

5. Measles

6. Number of reported measles cases by WHO Region 2024 Member States* Suspected cases Measles cases Date Received Region Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Region Clin Epi Lab AFR 5,652 4,027 1,466 0 0 0 0 0 0 0 0 0 AFR 35/47 14,993 11,145 432 8,253 2,460 2024-04 AMR 21 32 67 0 0 0 0 0 0 0 0 0 AMR 22/35 2,834 120 0 0 120 2024-04 EMR 10,840 11,570 6,995 0 0 0 0 0 0 0 0 0 EMR 19/21 37,785 29,405 20,560 1,897 6,948 2024-04 EUR 24,755 17,489 523 0 0 0 0 0 0 0 0 0 EUR 45/53 45,715 42,767 9,659 7,888 25,220 2024-04 SEAR 3,367 3,414 3,259 0 0 0 0 0 0 0 0 0 SEAR 10/11 29,203 10,040 4,761 1,307 3,972 2024-04 WPR 564 397 0 0 0 0 0 0 0 0 0 0 WPR 21/27 4,600 961 83 54 824 2024-04 Total 45,199 36,929 12,310 0 0 0 0 0 0 0 0 0 Total 152/194 135,130 94,438 35,495 19,399 39,544 2023 Member States* Suspected cases Measles cases Date Received Region Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Region Clin Epi Lab AFR 7,254 8,578 10,594 9,028 8,903 5,848 4,329 5,129 4,883 4,594 2,753 1,488 AFR 44/47 121,164 73,381 9,209 42,100 22,072 2024-04 AMR 0 3 0 2 5 4 0 7 2 7 12 0 AMR 27/35 10,674 42 0 0 42 2024-04 EMR 6,222 7,847 9,097 6,992 10,356 9,018 9,122 7,190 6,568 5,706 6,084 6,674 EMR 21/21 141,076 90,876 50,862 10,634 29,380 2024-04 EUR 540 1,017 1,583 2,070 3,365 4,143 4,139 4,115 5,739 8,337 8,191 17,778 EUR 44/53 84,791 61,017 9,547 10,077 41,393 2024-04 SEAR 16,754 14,203 15,174 11,358 8,227 5,274 3,701 4,225 3,240 2,707 3,369 2,736 SEAR 11/11 201,024 90,968 20,521 23,590 46,857 2024-04 WPR 96 194 221 291 355 336 407 501 781 918 780 418 WPR 25/27 56,650 5,298 2,283 187 2,828 2024-04 Total 30,866 31,842 36,669 29,741 31,211 24,623 21,698 21,167 21,213 22,269 21,189 29,094 Total 172/194 615,379 321,582 92,422 86,588 142,572 Notes: Based on data received 2024-04 - This is surveillance data, hence for the last month, the data may be incomplete. * Member States Reporting / Total Member States in Region

7. Measles/rubella verification of elimination Measles Member States Not Region Verified % Verified Eliminated Endemic classified AFR 47 0 0 0 47 0 AMR 35 30 86 0 0 5 EMR 21 4 19 0 17 0 EUR 53 33 62 8 11 1 SEAR 11 5 45 0 6 0 WPR 27 6 22 13 8 0 GLOBAL 194 78 40 21 89 6 Rubella Member States Not Region Verified % Verified Eliminated Endemic classified AFR 47 0 0 0 47 0 AMR 35 31 89 0 0 4 EMR 21 4 19 0 17 0 EUR 53 49 92 0 0 4 SEAR 11 5 45 0 6 0 WPR 27 5 19 13 9 0 GLOBAL 194 94 48 13 79 8 Notes: Based on data available at WHO HQ as of 2024-04-10 . Terms used on this slide refer to the global framework for the verification of measles and rubella elimination. These terms might differ from those used by WHO Regional Offices. Verified = Elimination verified by Regional Verification Commitee (RVC); Eliminated = Eliminated transmission but no RVC verification yet.

8. Measles case distribution by month and WHO Region (2019-2024) 2019 2020 2021 2022 2023 2024 541,401 cases 93,840 cases 59,619 cases 171,153 cases 321,582 cases 94,481 cases 100,000 AFR AMR EMR EUR SEAR WPR 50,000 0 May May May May May May Aug Aug Aug Aug Aug Aug Dec Dec Dec Dec Dec Dec Mar Mar Mar Mar Mar Mar Nov Nov Nov Nov Nov Nov Sep Sep Sep Sep Sep Sep Jan Jan Jan Jan Jan Jan Feb Feb Feb Feb Feb Feb Jun Jun Jun Jun Jun Jun Oct Oct Oct Oct Oct Oct Apr Apr Apr Apr Apr Apr Jul Jul Jul Jul Jul Jul Notes: Based on data received 2024-04 - Data Source: IVB Database - This is surveillance data, hence for the last month(s), the data may be incomplete.

9. Measles case distribution by month and WHO Region (2016-2024) 2018 2019 2016 2017 2020 2021 2022 2023 2024 180,015 cases 168,190 cases 276,157 cases 541,401 cases 93,840 cases 59,619 cases 171,153 cases 321,582 cases 94,481 cases 100,000 50,000 0 May May May May May May May May May Aug Aug Aug Aug Aug Aug Aug Aug Aug Dec Dec Dec Dec Dec Dec Dec Dec Dec Nov Nov Nov Nov Nov Nov Nov Nov Nov Mar Mar Mar Mar Mar Mar Mar Mar Mar Sep Sep Sep Sep Sep Sep Sep Sep Sep Jan Jan Jan Jan Jan Jan Jan Jan Jan Jun Jun Jun Jun Jun Jun Jun Jun Jun Feb Feb Feb Feb Feb Feb Feb Feb Feb Oct Oct Oct Oct Oct Oct Oct Oct Oct Apr Apr Apr Apr Apr Apr Apr Apr Apr Jul Jul Jul Jul Jul Jul Jul Jul Jul 2022 2023 2024 Total = 171,153 cases Total = 321,582 cases Total = 94,481 cases 40,000 AFR AMR EMR EUR SEAR WPR 30,000 20,000 10,000 0 May May May Aug Aug Aug Dec Dec Dec Mar Mar Mar Nov Nov Nov Sep Sep Sep Jan Jan Jan Feb Feb Feb Jun Jun Jun Oct Oct Oct Apr Apr Apr Jul Jul Jul Notes: Based on data received 2024-04 - Data Source: IVB Database - This is surveillance data, hence for the last month(s), the data may be incomplete.

10. Measles Incidence Rate per Million (12M period) Highest incidence rates Country Cases Rate Azerbaijan 26765 2,570.43 Kyrgyzstan 12252 1,819.06 Kazakhstan 31718 1,617.72 Yemen 41679 1,209.85 Liberia 3135 578.59 Iraq 24001 527.44 Central African Republic 1448 252.16 Armenia 661 237.94 Romania 4602 231.34 Burundi 2874 217.09 Notes: Based on data received 2024-04 - Surveillance data from 2023-03 to 2024-02 - Incidence: Number of cases / population * 1,000,000 - Population data: World population prospects, 2019 revision

11. Immunization Agenda 2030 - Impact Goal 1.3 Countries provisionally meeting the large and disruptive outbreaks definition - Data from 2022-12 to 2023-11 included Country Cases Rate/M Clinical* Country Cases Rate/M Clinical* Yemen 49,797 1,445.49 84% Lebanon 341 63.69 42% Kyrgyzstan 5,787 859.20 26% Congo 388 63.54 2% Liberia 4,365 805.59 5% Afghanistan 2,682 63.49 2% Kazakhstan 13,677 697.57 2% Mauritania 301 61.90 0% Gabon 1,654 678.82 0% Burkina Faso 1,361 58.53 2% Central African Republic Saudi Arabia 2,131 57.68 0% 1,537 267.66 0% India 81,840 57.29 14% Azerbaijan 2,391 229.62 40% T rkiye 4,770 55.58 0% Cameroon 6,381 222.74 1% Nigeria 12,374 55.29 66% Armenia 526 189.35 0% United Arab Emirates 488 51.28 8% Iraq 6,877 151.13 72% Somalia 2,705 149.09 39% South Sudan 547 49.33 6% Equatorial Guinea Malaysia 1,690 49.26 2% 235 137.05 6% Timor-Leste 61 44.83 90% Ethiopia 16,603 131.22 0% Qatar 120 44.18 2% Romania 2,402 120.75 2% C te d'Ivoire 1,149 39.79 0% DR Congo 10,752 105.14 1% Senegal 622 35.02 10% Burundi 1,267 95.71 9% Nepal 1,073 34.73 3% Sudan 4,469 92.89 8% Benin 474 34.57 3% Russian Federation 11,408 78.98 1% Sri Lanka 749 34.21 3% Zambia 696 33.84 4% Chad 1,421 77.74 17% Syrian Arab Republic Indonesia 20,325 73.23 46% Total: 51 countries 785 33.80 0% Djibouti 83 73.03 12% Tajikistan 311 30.66 0% Pakistan 17,148 71.31 8% Uzbekistan 1,029 29.26 1% Togo 641 70.80 8% Libya 187 27.15 0% Angola 2,577 70.25 1% Niger 716 26.32 8% Ghana 2,233 65.44 2% In the frame of tracking progress towards the goals of Immunization Agenda 2030 (IA2030), an indicator has been developed by a working group in order to represent large and disruptive measles outbreaks. This indicator is defined as an incidence equal or greater than 20 reported measles cases per million population over a period of 12 months. It is important to note that measles outbreak definitions vary between countries and regions according to local context and level of progress towards regional elimination goals. This definition of large and disruptive outbreaks aims to complement and not replace the national and regional definitions, while also providing a degree of global standardization and permitting tracking of progress against a common metric. Notes: Based on data received 2024-04 and covering the period between 2022-12 and 2023-11 - Incidence: Number of cases / 1M population - Population Data: World population prospects, 2019 revision - A high proportion of clinical cases indicates a high level of uncertainty associated with the incidence rates and the inclusion of countries in this list.

12. Number of Reported Measles Cases (Last 6 months) Country Cases* Kazakhstan 27,280 Azerbaijan 26,744 Iraq 20,469 India** 13,523 Yemen 12,785 Kyrgyzstan 10,024 Pakistan 9,575 Russian Federation 9,373 Ethiopia 6,724 Indonesia 4,380 Notes: Based on data received 2024-04 - Surveillance data from 2023-09 to 2024-02 - * Countries with highest number of cases for the period - **WHO classifies all suspected measles cases reported from India as measles clinically compatible if a specimen was not collected as per the algorithm for classification of suspected measles in the WHO VPD Surveillance Standards. Thus numbers might be different between what WHO reports and what India reports.

13. Surveillance sensitivity reporting rate of measles and rubella (12 months, discarded cases* per 100,000 population) Notes: Based on data received 2024-04 - Surveillance data from 2023-03 to 2024-02 - Target: >= 2 discarded cases* / 100,000 population** - * Suspected cases investigated and discarded as non-measles non-rubella using laboratory testing and/or epidemiological linkage to another etiology ** World population prospects, 2019 revision

14. Disclaimer This document contains data provided to WHO by member states. Note that some member states only provide aggregate data to WHO, and for these, we are unable to generate a country profile. Some member states report all cases at one time point for the entire year, and thus epidemiologic curves generated are not accurate and a reporting artifact. For some countries, cases are reported by age category, not by exact age in months and/or years. Thus, age distribution/incidence is approximate. Cases classified as pending by countries are classified at WHO as clinically compatible at this time, and thus numbers might different between data shown here and provided by the member state or WHO country/regional offices. *UN population data is used as the denominator for calculating incidence.

15. Measles case distribution (AFR), 2022-2024 2022 2023 2024 12,000 Total = 64,922 cases Total = 73,381 cases Total = 11,145 cases 9,000 6,000 3,000 0 May May May Aug Aug Aug Dec Dec Dec Mar Mar Mar Nov Nov Nov Sep Sep Sep Jan Jan Jan Feb Feb Feb Jun Jun Jun Oct Oct Oct Apr Apr Apr Jul Jul Jul DR Congo Cameroon Ethiopia Nigeria Liberia Others Notes: Based on data received 2024-04 - Data Source: IVB Database

16. ELIMINATION STATUS: ENDEMIC Measles cases: Burkina Faso 2020 2021 2022 2023 2024 1,500 1,531 cases 1,019 cases 1,578 cases 3,062 cases 456 cases Number of measles cases 1,000 500 0 Jan Jan Jan Jan Jan May Aug May Aug May Aug May Aug May Aug Oct Oct Oct Oct Oct Jun Jun Jun Jun Jun Mar Mar Mar Mar Mar Dec Dec Dec Dec Dec Apr Apr Apr Apr Apr Jul Jul Jul Jul Jul Nov Nov Nov Nov Nov Sep Sep Sep Sep Sep Feb Feb Feb Feb Feb Epi SIA Clinical Discarded Lab Age distribution, vaccination status and incidence (last 12 months) WHO/UNICEF Coverage Estimates (WUENIC) 100 Incidence rate per M Number of cases 750 80 1000 % Coverage 500 60 500 250 40 0 0 20 0 Age at onset (in years) MCV1 MCV2 2+ doses 1 dose 0 doses Unknown Incidence Based on data received 2024-04 - Data Source: IVB Database. Main epi curve was built using case-based surveillance data. Age distribution curve was built using case-based surveillance data. Coverage data from WHO/UNICEF Estimates of National Immunization Coverage (WUENIC)

17. ELIMINATION STATUS: ENDEMIC Measles cases: Burundi 2020 2021 2022 2023 2024 800 1,701 cases 1,692 cases 1,451 cases 222 cases 371 cases Number of measles cases 600 400 200 0 Jan Jan Jan Jan Jan May Aug May Aug May Aug May Aug May Aug Oct Oct Oct Oct Oct Jun Jun Jun Jun Jun Mar Mar Mar Mar Mar Dec Dec Dec Dec Dec Apr Apr Apr Apr Apr Jul Jul Jul Jul Jul Nov Nov Nov Nov Nov Sep Sep Sep Sep Sep Feb Feb Feb Feb Feb Epi SIA Clinical Discarded Lab Age distribution, vaccination status and incidence (last 12 months) WHO/UNICEF Coverage Estimates (WUENIC) 1,500 100 Incidence rate per M Number of cases 3000 80 1,000 % Coverage 2000 60 500 1000 40 0 0 20 0 Age at onset (in years) MCV1 MCV2 2+ doses 1 dose 0 doses Unknown Incidence Based on data received 2024-04 - Data Source: IVB Database. Main epi curve was built using case-based surveillance data. Age distribution curve was built using case-based surveillance data. Coverage data from WHO/UNICEF Estimates of National Immunization Coverage (WUENIC)

18. ELIMINATION STATUS: ENDEMIC Measles cases: C te d'Ivoire 2020 2021 2022 2023 2024 1,500 1,482 cases 1,575 cases 1,338 cases 1,222 cases 588 cases Number of measles cases 1,000 500 0 Jan Jan Jan Jan Jan May Aug May Aug May Aug May Aug May Aug Oct Oct Oct Oct Oct Jun Jun Jun Jun Jun Mar Mar Mar Mar Mar Dec Dec Dec Dec Dec Apr Apr Apr Apr Apr Jul Jul Jul Jul Jul Nov Nov Nov Nov Nov Sep Sep Sep Sep Sep Feb Feb Feb Feb Feb Epi SIA Clinical Discarded Lab Age distribution, vaccination status and incidence (last 12 months) WHO/UNICEF Coverage Estimates (WUENIC) 100 Incidence rate per M 300 Number of cases 900 80 % Coverage 200 600 60 100 300 40 0 0 20 0 Age at onset (in years) MCV1 MCV2 2+ doses 1 dose 0 doses Unknown Incidence Based on data received 2024-04 - Data Source: IVB Database. Main epi curve was built using case-based surveillance data. Age distribution curve was built using case-based surveillance data. Coverage data from WHO/UNICEF Estimates of National Immunization Coverage (WUENIC)

19. ELIMINATION STATUS: ENDEMIC Measles cases: Democratic Republic of the Congo 2020 2021 2022 2023 2024 14,577 cases 3,443 cases 4,365 cases 10,640 cases 232 cases Number of measles cases 7,500 5,000 2,500 0 Jan Jan Jan Jan Jan May Aug May Aug May Aug May Aug May Aug Oct Oct Oct Oct Oct Jun Jun Jun Jun Jun Mar Mar Mar Mar Mar Dec Dec Dec Dec Dec Apr Apr Apr Apr Apr Jul Jul Jul Jul Jul Nov Nov Nov Nov Nov Sep Sep Sep Sep Sep Feb Feb Feb Feb Feb Epi SIA Clinical Discarded Lab Age distribution, vaccination status and incidence (last 12 months) WHO/UNICEF Coverage Estimates (WUENIC) 100 5,000 400 Incidence rate per M Number of cases 4,000 80 300 3,000 % Coverage 60 200 2,000 40 100 1,000 0 0 20 0 Age at onset (in years) MCV1 MCV2 2+ doses 1 dose 0 doses Unknown Incidence Based on data received 2024-04 - Data Source: IVB Database. Main epi curve was built using case-based surveillance data. Age distribution curve was built using case-based surveillance data. Coverage data from WHO/UNICEF Estimates of National Immunization Coverage (WUENIC)

20. ELIMINATION STATUS: ENDEMIC Measles cases: Ethiopia 2020 2021 2022 2023 2024 4,000 1,947 cases 1,947 cases 8,216 cases 16,505 cases Number of measles cases 3,000 2,000 1,000 0 Jan Jan Jan Jan Jan May Aug May Aug May Aug May Aug May Aug Oct Oct Oct Oct Oct Jun Jun Jun Jun Jun Mar Mar Mar Mar Mar Dec Dec Dec Dec Dec Apr Apr Apr Apr Apr Jul Jul Jul Jul Jul Nov Nov Nov Nov Nov Sep Sep Sep Sep Sep Feb Feb Feb Feb Feb Epi SIA Clinical Discarded Lab Age distribution, vaccination status and incidence (last 12 months) WHO/UNICEF Coverage Estimates (WUENIC) 6,000 100 Incidence rate per M 400 Number of cases 80 4,000 300 % Coverage 60 200 2,000 40 100 0 0 20 0 Age at onset (in years) MCV1 MCV2 2+ doses 1 dose 0 doses Unknown Incidence Based on data received 2024-04 - Data Source: IVB Database. Main epi curve was built using case-based surveillance data. Age distribution curve was built using case-based surveillance data. Coverage data from WHO/UNICEF Estimates of National Immunization Coverage (WUENIC)

21. ELIMINATION STATUS: ENDEMIC Measles cases: Ghana 2020 2021 2022 2023 2024 1,200 2,279 cases 242 cases 97 cases 58 cases 330 cases Number of measles cases 900 600 300 0 Jan Jan Jan Jan Jan May Aug May Aug May Aug May Aug May Aug Oct Oct Oct Oct Oct Jun Jun Jun Jun Jun Mar Mar Mar Mar Mar Dec Dec Dec Dec Dec Apr Apr Apr Apr Apr Jul Jul Jul Jul Jul Nov Nov Nov Nov Nov Sep Sep Sep Sep Sep Feb Feb Feb Feb Feb Epi Clinical Discarded Lab Age distribution, vaccination status and incidence (last 12 months) WHO/UNICEF Coverage Estimates (WUENIC) 500 100 Incidence rate per M 400 Number of cases 600 80 300 % Coverage 400 60 200 200 40 100 0 0 20 0 Age at onset (in years) MCV1 MCV2 2+ doses 1 dose 0 doses Unknown Incidence Based on data received 2024-04 - Data Source: IVB Database. Main epi curve was built using case-based surveillance data. Age distribution curve was built using case-based surveillance data. Coverage data from WHO/UNICEF Estimates of National Immunization Coverage (WUENIC)

22. ELIMINATION STATUS: ENDEMIC Measles cases: Nigeria 2020 2021 2022 2023 2024 10,227 cases 10,871 cases 20,748 cases 12,224 cases 2,840 cases Number of measles cases 7,500 5,000 2,500 0 Jan Jan Jan Jan Jan May Aug May Aug May Aug May Aug May Aug Oct Oct Oct Oct Oct Jun Jun Jun Jun Jun Mar Mar Mar Mar Mar Dec Dec Dec Dec Dec Apr Apr Apr Apr Apr Jul Jul Jul Jul Jul Nov Nov Nov Nov Nov Sep Sep Sep Sep Sep Feb Feb Feb Feb Feb Epi SIA Clinical Discarded Lab Age distribution, vaccination status and incidence (last 12 months) WHO/UNICEF Coverage Estimates (WUENIC) 100 Incidence rate per M 6,000 Number of cases 200 80 4,000 % Coverage 60 100 2,000 40 0 0 20 0 Age at onset (in years) MCV1 MCV2 2+ doses 1 dose 0 doses Unknown Incidence Based on data received 2024-04 - Data Source: IVB Database. Main epi curve was built using case-based surveillance data. Age distribution curve was built using case-based surveillance data. Coverage data from WHO/UNICEF Estimates of National Immunization Coverage (WUENIC)

23. Measles case distribution (AMR), 2022-2024 2022 2023 2024 Total = 169 cases Total = 42 cases Total = 120 cases 60 40 20 0 May May May Aug Aug Aug Dec Dec Dec Mar Mar Mar Nov Nov Nov Sep Sep Sep Jan Jan Jan Feb Feb Feb Jun Jun Jun Oct Oct Oct Apr Apr Apr Jul Jul Jul Argentina Brazil Canada Mexico USA Others Notes: Based on data received 2024-04 - Data Source: IVB Database

24. Measles case distribution (EMR), 2022-2024 2022 2023 2024 Total = 54,245 cases Total = 90,876 cases Total = 29,448 cases 10,000 5,000 0 May May May Aug Aug Aug Dec Dec Dec Mar Mar Mar Nov Nov Nov Sep Sep Sep Jan Jan Jan Feb Feb Feb Jun Jun Jun Oct Oct Oct Apr Apr Apr Jul Jul Jul Afghanistan Iraq Others Pakistan Somalia Yemen Notes: Based on data received 2024-04 - Data Source: IVB Database

25. ELIMINATION STATUS: ENDEMIC Measles cases: Afghanistan 2020 2021 2022 2023 2024 3,028 cases 5,111 cases 2,529 cases 2,694 cases 548 cases Number of measles cases 2,000 1,500 1,000 500 0 Jan Jan Jan Jan Jan May Aug May Aug May Aug May Aug May Aug Oct Oct Oct Oct Oct Jun Jun Jun Jun Jun Mar Mar Mar Mar Mar Dec Dec Dec Dec Dec Apr Apr Apr Apr Apr Jul Jul Jul Jul Jul Nov Nov Nov Nov Nov Sep Sep Sep Sep Sep Feb Feb Feb Feb Feb Epi SIA Clinical Discarded Lab Age distribution, vaccination status and incidence (last 12 months) WHO/UNICEF Coverage Estimates (WUENIC) 1,500 800 100 Incidence rate per M Number of cases 600 80 1,000 % Coverage 400 60 500 200 40 0 0 20 0 Age at onset (in years) MCV1 MCV2 2+ doses 1 dose 0 doses Unknown Incidence Based on data received 2024-04 - Data Source: IVB Database. Main epi curve was built using case-based surveillance data. Age distribution curve was built using case-based surveillance data. Coverage data from WHO/UNICEF Estimates of National Immunization Coverage (WUENIC)

26. ELIMINATION STATUS: ENDEMIC Measles cases: Iraq 2020 2021 2022 2023 2024 10,000 9,666 cases 20,040 cases 312 cases 20 cases 47 cases Number of measles cases 7,500 5,000 2,500 0 Jan Jan Jan Jan Jan May Aug May Aug May Aug May Aug May Aug Oct Oct Oct Oct Oct Jun Jun Jun Jun Jun Mar Mar Mar Mar Mar Dec Dec Dec Dec Dec Apr Apr Apr Apr Apr Jul Jul Jul Jul Jul Nov Nov Nov Nov Nov Sep Sep Sep Sep Sep Feb Feb Feb Feb Feb Epi Clinical Discarded Lab Age distribution, vaccination status and incidence (last 12 months) WHO/UNICEF Coverage Estimates (WUENIC) 100 8000 Incidence rate per M 7,500 Number of cases 80 6000 % Coverage 5,000 60 4000 2,500 40 2000 0 0 20 0 Age at onset (in years) MCV1 MCV2 2+ doses 1 dose 0 doses Unknown Incidence Based on data received 2024-04 - Data Source: IVB Database. Main epi curve was built using case-based surveillance data. Age distribution curve was built using case-based surveillance data. Coverage data from WHO/UNICEF Estimates of National Immunization Coverage (WUENIC)

27. ELIMINATION STATUS: ENDEMIC Measles cases: Pakistan 2020 2021 2022 2023 2024 6,000 2,863 cases 9,313 cases 7,957 cases 17,515 cases 4,826 cases Number of measles cases 4,000 2,000 0 Jan Jan Jan Jan Jan May Aug May Aug May Aug May Aug May Aug Oct Oct Oct Oct Oct Jun Jun Jun Jun Jun Mar Mar Mar Mar Mar Dec Dec Dec Dec Dec Apr Apr Apr Apr Apr Jul Jul Jul Jul Jul Nov Nov Nov Nov Nov Sep Sep Sep Sep Sep Feb Feb Feb Feb Feb Epi SIA Clinical Discarded Lab Age distribution, vaccination status and incidence (last 12 months) WHO/UNICEF Coverage Estimates (WUENIC) 100 Incidence rate per M 9,000 900 Number of cases 80 % Coverage 6,000 600 60 3,000 300 40 0 0 20 0 Age at onset (in years) MCV1 MCV2 2+ doses 1 dose 0 doses Unknown Incidence Based on data received 2024-04 - Data Source: IVB Database. Main epi curve was built using case-based surveillance data. Age distribution curve was built using case-based surveillance data. Coverage data from WHO/UNICEF Estimates of National Immunization Coverage (WUENIC)

28. ELIMINATION STATUS: ENDEMIC Measles cases: Somalia 2020 2021 2022 2023 2024 3,000 2,382 cases 6,029 cases 17,361 cases 1,781 cases 361 cases Number of measles cases 2,000 1,000 0 Jan Jan Jan Jan Jan May Aug May Aug May Aug May Aug May Aug Oct Oct Oct Oct Oct Jun Jun Jun Jun Jun Mar Mar Mar Mar Mar Dec Dec Dec Dec Dec Apr Apr Apr Apr Apr Jul Jul Jul Jul Jul Nov Nov Nov Nov Nov Sep Sep Sep Sep Sep Feb Feb Feb Feb Feb Epi SIA Clinical Discarded Lab Age distribution, vaccination status and incidence (last 12 months) WHO/UNICEF Coverage Estimates (WUENIC) 100 600 Incidence rate per M Number of cases 600 80 400 % Coverage 400 60 200 200 40 0 0 20 0 Age at onset (in years) MCV1 MCV2 2+ doses 1 dose 0 doses Unknown Incidence Based on data received 2024-04 - Data Source: IVB Database. Main epi curve was built using a combination of case-based and aggregate surveillance data. Age distribution curve was built using case-based surveillance data. Coverage data from WHO/UNICEF Estimates of National Immunization Coverage (WUENIC)

29. Measles case distribution (EUR), 2022-2024 2022 2023 2024 Total = 61,017 cases Total = 42,767 cases Total = 934 cases 20,000 10,000 0 May May May Aug Aug Aug Dec Dec Dec Mar Mar Mar Nov Nov Nov Sep Sep Sep Jan Jan Jan Feb Feb Feb Jun Jun Jun Oct Oct Oct Apr Apr Apr Jul Jul Jul Azerbaijan Kazakhstan Others T rkiye Kyrgyzstan Russian Federation Notes: Based on data received 2024-04 - Data Source: IVB Database

30. ELIMINATION STATUS: VERIFIED Measles cases: Azerbaijan 2020 2021 2022 2023 2024 13,728 cases 13,046 cases 2 cases 1 cases 0 cases Number of measles cases 15,000 10,000 5,000 0 Jan Jan Jan Jan Jan May Aug May Aug May Aug May Aug May Aug Oct Oct Oct Oct Oct Jun Jun Jun Jun Jun Mar Mar Mar Mar Mar Dec Dec Dec Dec Dec Apr Apr Apr Apr Apr Jul Jul Jul Jul Jul Nov Nov Nov Nov Nov Sep Sep Sep Sep Sep Feb Feb Feb Feb Feb Epi Clinical Discarded Lab Age distribution, vaccination status and incidence (last 12 months) WHO/UNICEF Coverage Estimates (WUENIC) 100 Incidence rate per M 7,500 Number of cases 9000 80 5,000 % Coverage 6000 60 2,500 3000 40 0 0 20 0 Age at onset (in years) MCV1 MCV2 2+ doses 1 dose 0 doses Unknown Incidence Based on data received 2024-04 - Data Source: IVB Database. Main epi curve was built using case-based surveillance data. Age distribution curve was built using case-based surveillance data. Coverage data from WHO/UNICEF Estimates of National Immunization Coverage (WUENIC)

31. ELIMINATION STATUS: ENDEMIC Measles cases: Kazakhstan 2020 2021 2022 2023 2024 12,000 3,269 cases 15,111 cases 16,614 cases 2 cases 4 cases Number of measles cases 8,000 4,000 0 Jan Jan Jan Jan Jan May Aug May Aug May Aug May Aug May Aug Oct Oct Oct Oct Oct Jun Jun Jun Jun Jun Mar Mar Mar Mar Mar Dec Dec Dec Dec Dec Apr Apr Apr Apr Apr Jul Jul Jul Jul Jul Nov Nov Nov Nov Nov Sep Sep Sep Sep Sep Feb Feb Feb Feb Feb Epi Clinical Discarded Lab WHO/UNICEF Coverage Estimates (WUENIC) 100 80 % Coverage 60 40 20 0 MCV1 MCV2 Based on data received 2024-04 - Data Source: IVB Database. Main epi curve was built using aggregate surveillance data. Coverage data from WHO/UNICEF Estimates of National Immunization Coverage (WUENIC)

32. ELIMINATION STATUS: ENDEMIC Measles cases: Kyrgyzstan 2020 2021 2022 2023 2024 7,463 cases 4,799 cases 715 cases 23 cases 4 cases Number of measles cases 3,000 2,000 1,000 0 Jan Jan Jan Jan Jan May Aug May Aug May Aug May Aug May Aug Oct Oct Oct Oct Oct Jun Jun Jun Jun Jun Mar Mar Mar Mar Mar Dec Dec Dec Dec Dec Apr Apr Apr Apr Apr Jul Jul Jul Jul Jul Nov Nov Nov Nov Nov Sep Sep Sep Sep Sep Feb Feb Feb Feb Feb Epi SIA Clinical Discarded Lab Age distribution, vaccination status and incidence (last 12 months) WHO/UNICEF Coverage Estimates (WUENIC) 5,000 100 Incidence rate per M Number of cases 4,000 20000 80 3,000 % Coverage 60 2,000 10000 40 1,000 0 0 20 0 Age at onset (in years) MCV1 MCV2 2+ doses 1 dose 0 doses Unknown Incidence Based on data received 2024-04 - Data Source: IVB Database. Main epi curve was built using case-based surveillance data. Age distribution curve was built using case-based surveillance data. Coverage data from WHO/UNICEF Estimates of National Immunization Coverage (WUENIC)

33. ELIMINATION STATUS: ENDEMIC Measles cases: Romania 2020 2021 2022 2023 2024 3,497 cases 1,145 cases 1 cases 976 cases 9 cases Number of measles cases 1,000 500 0 Jan Jan Jan Jan Jan May Aug May Aug May Aug May Aug May Aug Oct Oct Oct Oct Oct Jun Jun Jun Jun Jun Mar Mar Mar Mar Mar Dec Dec Dec Dec Dec Apr Apr Apr Apr Apr Jul Jul Jul Jul Jul Nov Nov Nov Nov Nov Sep Sep Sep Sep Sep Feb Feb Feb Feb Feb Epi Clinical Discarded Lab Age distribution, vaccination status and incidence (last 12 months) WHO/UNICEF Coverage Estimates (WUENIC) 100 Incidence rate per M 3000 Number of cases 1,500 80 2000 % Coverage 1,000 60 1000 500 40 0 0 20 0 Age at onset (in years) MCV1 MCV2 2+ doses 1 dose 0 doses Unknown Incidence Based on data received 2024-04 - Data Source: IVB Database. Main epi curve was built using case-based surveillance data. Age distribution curve was built using case-based surveillance data. Coverage data from WHO/UNICEF Estimates of National Immunization Coverage (WUENIC)

34. ELIMINATION STATUS: ELIMINATED Measles cases: Russian Federation 2020 2021 2022 2023 2024 1,100 cases 12,885 cases 4,640 cases 1 cases 117 cases Number of measles cases 3,000 2,000 1,000 0 Jan Jan Jan Jan Jan May Aug May Aug May Aug May Aug May Aug Oct Oct Oct Oct Oct Jun Jun Jun Jun Jun Mar Mar Mar Mar Mar Dec Dec Dec Dec Dec Apr Apr Apr Apr Apr Jul Jul Jul Jul Jul Nov Nov Nov Nov Nov Sep Sep Sep Sep Sep Feb Feb Feb Feb Feb Epi Clinical Discarded Lab Age distribution, vaccination status and incidence (last 12 months) WHO/UNICEF Coverage Estimates (WUENIC) 100 Incidence rate per M 4,000 900 Number of cases 80 3,000 % Coverage 600 60 2,000 300 40 1,000 0 0 20 0 Age at onset (in years) MCV1 MCV2 2+ doses 1 dose 0 doses Unknown Incidence Based on data received 2024-04 - Data Source: IVB Database. Main epi curve was built using case-based surveillance data. Age distribution curve was built using case-based surveillance data. Coverage data from WHO/UNICEF Estimates of National Immunization Coverage (WUENIC)

35. Measles case distribution (SEAR (excl. India)), 2022-2024 2022 2023 2024 Total = 5,914 cases Total = 22,032 cases Total = 1,839 cases 3,000 2,000 1,000 0 May May May Aug Aug Aug Dec Dec Dec Mar Mar Mar Nov Nov Nov Sep Sep Sep Jan Jan Jan Feb Feb Feb Jun Jun Jun Oct Oct Oct Apr Apr Apr Jul Jul Jul Bangladesh Indonesia Others Nepal Sri Lanka Thailand Notes: Based on data received 2024-04 - Data Source: IVB Database

36. ELIMINATION STATUS: ENDEMIC Measles cases: Indonesia 2020 2021 2022 2023 2024 8,000 5,362 cases 19,879 cases 1,223 cases 393 cases 290 cases Number of measles cases 6,000 4,000 2,000 0 Jan Jan Jan Jan Jan May Aug May Aug May Aug May Aug May Aug Oct Oct Oct Oct Oct Jun Jun Jun Jun Jun Mar Mar Mar Mar Mar Dec Dec Dec Dec Dec Apr Apr Apr Apr Apr Jul Jul Jul Jul Jul Nov Nov Nov Nov Nov Sep Sep Sep Sep Sep Feb Feb Feb Feb Feb Epi SIA Clinical Discarded Lab Age distribution, vaccination status and incidence (last 12 months) WHO/UNICEF Coverage Estimates (WUENIC) 100 Incidence rate per M 6 90 Number of cases 80 4 % Coverage 60 60 2 30 40 0 0 20 0 Age at onset (in years) MCV1 MCV2 2+ doses 1 dose Unknown Incidence Based on data received 2024-04 - Data Source: IVB Database. Main epi curve was built using aggregate surveillance data. Age distribution curve was built using case-based surveillance data. Coverage data from WHO/UNICEF Estimates of National Immunization Coverage (WUENIC)

37. ELIMINATION STATUS: ENDEMIC Measles cases: Nepal 2020 2021 2022 2023 2024 388 cases 143 cases 132 cases 978 cases 126 cases Number of measles cases 600 400 200 0 Jan Jan Jan Jan Jan May Aug May Aug May Aug May Aug May Aug Oct Oct Oct Oct Oct Jun Jun Jun Jun Jun Mar Mar Mar Mar Mar Dec Dec Dec Dec Dec Apr Apr Apr Apr Apr Jul Jul Jul Jul Jul Nov Nov Nov Nov Nov Sep Sep Sep Sep Sep Feb Feb Feb Feb Feb Epi SIA Clinical Discarded Lab Age distribution, vaccination status and incidence (last 12 months) WHO/UNICEF Coverage Estimates (WUENIC) 100 Incidence rate per M 90 Number of cases 100 80 % Coverage 60 60 50 30 40 0 0 20 0 Age at onset (in years) MCV1 MCV2 2+ doses 1 dose 0 doses Unknown Incidence Based on data received 2024-04 - Data Source: IVB Database. Main epi curve was built using case-based surveillance data. Age distribution curve was built using case-based surveillance data. Coverage data from WHO/UNICEF Estimates of National Immunization Coverage (WUENIC)

38. ELIMINATION STATUS: VERIFIED Measles cases: Sri Lanka 2020 2021 2022 2023 2024 2 cases 21 cases 0 cases 750 cases 107 cases Number of measles cases 400 300 200 100 0 Jan Jan Jan Jan Jan May Aug May Aug May Aug May Aug May Aug Oct Oct Oct Oct Oct Jun Jun Jun Jun Jun Mar Mar Mar Mar Mar Dec Dec Dec Dec Dec Apr Apr Apr Apr Apr Jul Jul Jul Jul Jul Nov Nov Nov Nov Nov Sep Sep Sep Sep Sep Feb Feb Feb Feb Feb Epi Clinical Discarded Lab Age distribution, vaccination status and incidence (last 12 months) WHO/UNICEF Coverage Estimates (WUENIC) 100 200 400 Incidence rate per M Number of cases 80 150 300 % Coverage 60 100 200 40 50 100 0 0 20 0 Age at onset (in years) MCV1 MCV2 2+ doses 1 dose 0 doses Unknown Incidence Based on data received 2024-04 - Data Source: IVB Database. Main epi curve was built using case-based surveillance data. Age distribution curve was built using case-based surveillance data. Coverage data from WHO/UNICEF Estimates of National Immunization Coverage (WUENIC)

39. Measles case distribution (SEAR, India), 2022-2024 2022 2023 2024 Total = 43,578 cases Total = 68,936 cases Total = 8,201 cases 15,000 10,000 5,000 0 May May May Aug Aug Aug Dec Dec Dec Mar Mar Mar Nov Nov Nov Sep Sep Sep Jan Jan Jan Feb Feb Feb Jun Jun Jun Oct Oct Oct Apr Apr Apr Jul Jul Jul India Notes: Based on data received 2024-04 - Data Source: IVB Database

40. ELIMINATION STATUS: ENDEMIC Measles cases: India 2020 2021 2022 2023 2024 5,598 cases 6,025 cases 43,578 cases 68,936 cases 8,201 cases 30,000 Number of measles cases 20,000 10,000 0 Jan Jan Jan Jan Jan May Aug May Aug May Aug May Aug May Aug Oct Oct Oct Oct Oct Jun Jun Jun Jun Jun Mar Mar Mar Mar Mar Dec Dec Dec Dec Dec Apr Apr Apr Apr Apr Jul Jul Jul Jul Jul Nov Nov Nov Nov Nov Sep Sep Sep Sep Sep Feb Feb Feb Feb Feb Epi Clinical Discarded Lab Age distribution, vaccination status and incidence (last 12 months) WHO/UNICEF Coverage Estimates (WUENIC) 400 100 Incidence rate per M 15,000 Number of cases 300 80 % Coverage 10,000 200 60 5,000 100 40 0 0 20 0 Age at onset (in years) MCV1 MCV2 2+ doses 1 dose 0 doses Unknown Incidence Based on data received 2024-04 - Data Source: IVB Database. Main epi curve was built using a combination of case-based and aggregate surveillance data. Age distribution curve was built using case-based surveillance data. Coverage data from WHO/UNICEF Estimates of National Immunization Coverage (WUENIC)

41. Measles case distribution (WPR), 2022-2024 2022 2023 2024 Total = 1,391 cases Total = 5,298 cases Total = 961 cases 1,000 750 500 250 0 May May May Aug Aug Aug Dec Dec Dec Mar Mar Mar Nov Nov Nov Sep Sep Sep Jan Jan Jan Feb Feb Feb Jun Jun Jun Oct Oct Oct Apr Apr Apr Jul Jul Jul China Australia Malaysia Others Philippines Viet Nam Notes: Based on data received 2024-04 - Data Source: IVB Database

42. ELIMINATION STATUS: ENDEMIC Measles cases: Malaysia 2020 2021 2022 2023 2024 2,002 cases 128 cases 209 cases 863 cases 477 cases Number of measles cases 1,500 1,000 500 0 Jan Jan Jan Jan Jan May Aug May Aug May Aug May Aug May Aug Oct Oct Oct Oct Oct Jun Jun Jun Jun Jun Mar Mar Mar Mar Mar Dec Dec Dec Dec Dec Apr Apr Apr Apr Apr Jul Jul Jul Jul Jul Nov Nov Nov Nov Nov Sep Sep Sep Sep Sep Feb Feb Feb Feb Feb Epi SIA Clinical Discarded Lab Age distribution, vaccination status and incidence (last 12 months) WHO/UNICEF Coverage Estimates (WUENIC) 1000 100 Incidence rate per M Number of cases 600 750 80 % Coverage 400 500 60 200 250 40 0 0 20 0 Age at onset (in years) MCV1 MCV2 2+ doses 1 dose 0 doses Unknown Incidence Based on data received 2024-04 - Data Source: IVB Database. Main epi curve was built using case-based surveillance data. Age distribution curve was built using case-based surveillance data. Coverage data from WHO/UNICEF Estimates of National Immunization Coverage (WUENIC)

43. Distribution of measles genotypes (last 12 months) Data Source: MeaNS2 database (Genotypes) and IVB Database (Incidence) as of 2024-04-10 and covering the period between 2023-03 and 2024-02 - Pie charts proportional to the number of sequenced viruses

44. Rubella

45. Number of reported rubella cases by WHO Region 2024 Member States* Rubella cases Date Received Region Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Region Clin Epi Lab AFR 463 635 58 0 0 0 0 0 0 0 0 0 AFR 34/47 1,156 0 0 1,156 2024-04 AMR 0 0 0 0 0 0 0 0 0 0 0 0 AMR 18/35 0 0 0 0 2024-04 EMR 52 51 33 0 0 0 0 0 0 0 0 0 EMR 19/21 136 1 0 135 2024-04 EUR 26 30 0 0 0 0 0 0 0 0 0 0 EUR 26/53 56 44 0 12 2024-04 SEAR 254 273 74 0 0 0 0 0 0 0 0 0 SEAR 10/11 601 0 34 567 2024-04 WPR 36 32 0 0 0 0 0 0 0 0 0 0 WPR 11/27 68 22 0 46 2024-04 Total 831 1,021 165 0 0 0 0 0 0 0 0 0 Total 118/194 2,017 67 34 1,916 2023 Member States* Rubella cases Date Received Region Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Region Clin Epi Lab AFR 459 637 749 607 411 312 246 179 189 193 159 106 AFR 43/47 4,247 0 0 4,247 2024-04 AMR 0 0 0 0 0 0 0 0 0 0 0 0 AMR 24/35 0 0 0 0 2024-04 EMR 206 252 204 150 165 164 109 63 75 72 68 58 EMR 21/21 1,586 77 353 1,156 2024-04 EUR 29 28 37 40 30 43 33 35 27 25 24 33 EUR 31/53 384 261 4 119 2024-04 SEAR 424 344 373 357 338 213 200 252 253 243 288 227 SEAR 11/11 3,512 0 137 3,375 2024-04 WPR 25 43 83 78 89 79 82 72 57 82 71 48 WPR 16/27 809 87 0 722 2024-04 Total 1,143 1,304 1,446 1,232 1,033 811 670 601 601 615 610 472 Total 146/194 10,538 425 494 9,619 Notes: Based on data received 2024-04 - This is surveillance data, hence for the last month, the data may be incomplete. * Member States Reporting / Total Member States in Region

46. Rubella case distribution by month and WHO Region (2016-2024) 2018 2019 2016 2017 2020 2021 2022 2023 2024 12,000 Total = 18,679 cases Total = 10,712 cases Total = 17,045 cases Total = 47,766 cases Total = 7,501 cases Total = 7,410 cases Total = 12,010 cases Total = 10,538 cases Total = 2,017 cases 9,000 AFR AMR EMR EUR SEAR WPR 6,000 3,000 0 May May May May May May May May May Aug Aug Aug Aug Aug Aug Aug Aug Aug Dec Dec Dec Dec Dec Dec Dec Dec Dec Mar Mar Mar Mar Mar Mar Mar Mar Mar Nov Nov Nov Nov Nov Nov Nov Nov Nov Sep Sep Sep Sep Sep Sep Sep Sep Sep Jan Jan Jan Jan Jan Jan Jan Jan Jan Feb Feb Feb Feb Feb Feb Feb Feb Feb Jun Jun Jun Jun Jun Jun Jun Jun Jun Oct Oct Oct Oct Oct Oct Oct Oct Oct Apr Apr Apr Apr Apr Apr Apr Apr Apr Jul Jul Jul Jul Jul Jul Jul Jul Jul Notes: Based on data received 2024-04 - Data Source: IVB Database - This is surveillance data, hence for the last month(s), the data may be incomplete.

47. Rubella case distribution by month and WHO Region (2022-2024) 2022 2023 2024 Total = 12,010 cases Total = 10,538 cases Total = 2,017 cases 1,500 AFR EMR EUR SEAR WPR 1,000 500 0 May May May Aug Aug Aug Dec Dec Dec Mar Mar Mar Nov Nov Nov Sep Sep Sep Jan Jan Jan Feb Feb Feb Jun Jun Jun Oct Oct Oct Apr Apr Apr Jul Jul Jul Notes: Based on data received 2024-04 - Data Source: IVB Database - This is surveillance data, hence for the last month(s), the data may be incomplete.

48. Rubella Incidence Rate per Million (12M period) Highest incidence rates Country Cases Rate Eq. Guinea 84 48.99 Botswana 54 20.18 Libya 136 19.74 Guinea-Bissau 38 17.67 Gabon 25 10.26 Central African Republic 55 9.58 Madagascar 281 9.27 DR Congo 803 7.85 Zimbabwe 128 7.68 Poland 269 6.56 Notes: Based on data received 2024-04 - Surveillance data from 2023-09 to 2024-02 - Incidence: Number of cases / population * 1,000,000 - Population data: World population prospects, 2019 revision

49. Rubella cases (AFR) AFR Rubella Case Distribution (January 2022-April 2024) Top 10 countries (last 12 M) 2022 2023 2024 RCV in RI % of Total (lab + epi-linked + clinical) Country Cases 750 Number of cases Nigeria No 839 24 DR Congo No 731 21 500 Others - 580 16 250 Ethiopia No 460 13 Madagascar No 265 7 0 United Republic of Tanzania 2014 185 5 May May May Aug Aug Aug Dec Dec Dec Mar Mar Mar Nov Nov Nov Sep Sep Sep Jan Jan Jan Feb Feb Feb Jun Jun Jun Oct Oct Oct Apr Apr Apr Jul Jul Jul South Africa No 158 4 Introduced less than 5 years ago (after 2019) Introduced more than 5 years ago (2019 and before) Not introduced in EPI NA Zimbabwe 2015 122 3 Eq. Guinea No 84 2 AFR Age distribution of Rubella IgM+ cases by vaccine introduction status in the National EPI Programme (last 12 Months) Ghana 2013 71 2 400 Niger No 63 2 Number of cases 300 (IgM+ only) 200 100 0 0 10 20 30 40 Age at onset (in years) Rubella vaccine introduced before 1 January 2024 Rubella vaccine not introduced before 1 January 2024 Notes: Based on data received 2024-04 Data Source: IVB Database.

50. Rubella cases (EMR) EMR Rubella Case Distribution (January 2022-April 2024) Top 10 countries (last 12 M) 2022 2023 2024 RCV in RI % of Total (lab + epi-linked + clinical) Country Cases 300 Number of cases Afghanistan No 220 21 200 Pakistan 2022 209 20 Libya 1993 133 13 100 Yemen 2015 117 11 Sudan No 112 11 0 Saudi Arabia 1982 84 8 May May May Aug Aug Aug Dec Dec Dec Mar Mar Mar Nov Nov Nov Sep Sep Sep Jan Jan Jan Feb Feb Feb Jun Jun Jun Oct Oct Oct Apr Apr Apr Jul Jul Jul Others - 58 5 Introduced less than 5 years ago (after 2019) Introduced more than 5 years ago (2019 and before) Iraq 1989 46 4 Not introduced in EPI NA Morocco 2003 32 3 Tunisia 2012 28 3 EMR Age distribution of Rubella IgM+ cases by vaccine introduction status in the National EPI Programme (last 12 Months) Syrian Arab Republic 1999 21 2 150 Number of cases (IgM+ only) 100 50 0 0 10 20 30 40 Age at onset (in years) Rubella vaccine introduced before 1 January 2024 Rubella vaccine not introduced before 1 January 2024 Notes: Based on data received 2024-04 Data Source: IVB Database.

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