Measles and Rubella Global Update December 2023

Stay informed with the latest data on measles and rubella cases worldwide with this report. Surveillance data, epidemiologic data, and laboratory reports are analyzed and updated monthly. For accurate and up-to-date information on the global status of measles and rubella, access this report. To receive updates regularly, join the distribution list by emailing Sebastien Antoni. Note: Data in the report is provisional.

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1. Measles and Rubella Global Update December 2023

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 December 2023"). For official data from 1980-2022, 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 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 7,211 8,262 10,309 8,911 8,845 5,757 4,236 4,936 4,664 3,612 326 0 AFR 44/47 104,925 67,069 2,899 45,951 18,219 2023-12 AMR 1 5 0 5 5 5 0 7 2 7 12 0 AMR 26/35 10,543 49 0 0 49 2023-12 EMR 6,013 8,174 8,991 6,703 10,115 8,484 7,752 6,949 6,193 1,865 10 0 EMR 21/21 108,804 71,249 44,976 3,582 22,691 2023-12 EUR 529 996 1,542 1,838 2,834 3,475 4,539 3,751 4,725 6,161 211 0 EUR 42/53 31,577 30,601 1,387 2,429 26,785 2023-12 SEAR 16,585 13,439 14,390 10,286 7,088 5,365 3,219 1,943 1,128 428 0 0 SEAR 10/11 150,481 73,871 16,336 22,080 35,455 2023-12 WPR 113 213 285 340 475 381 503 569 857 684 0 0 WPR 24/27 43,781 4,420 2,712 104 1,604 2023-12 30,45 28,08 Total 31,089 35,517 29,362 23,467 20,249 18,155 17,569 12,757 559 0 Total 167/194 450,111 247,259 68,310 74,146 104,803 2 3 2022 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 8,253 9,882 10,183 5,814 5,156 4,017 3,854 5,933 3,605 3,219 3,247 1,759 AFR 44/47 106,305 64,922 18,338 27,459 19,125 2023-12 AMR 6 7 13 13 9 3 2 7 14 11 57 27 AMR 27/35 12,816 169 0 0 169 2023-12 EMR 3,727 4,334 5,930 4,795 5,437 5,007 3,258 3,713 4,029 4,344 4,882 4,789 EMR 21/21 70,583 54,245 39,350 0 14,895 2023-12 EUR 34 34 77 84 70 105 88 58 72 89 86 141 EUR 39/53 6,770 938 94 61 783 2023-12 SEAR 988 1,000 1,568 1,725 1,534 1,507 2,306 2,092 2,958 4,468 13,183 16,163 SEAR 11/11 135,967 49,492 8,711 22,394 18,387 2023-12 WPR 54 54 107 97 175 160 170 175 185 223 176 102 WPR 24/27 37,039 1,678 927 1 750 2023-12 Total 13,062 15,311 17,878 12,528 12,381 10,799 9,678 11,978 10,863 12,354 21,631 22,981 Total 166/194 369,480 171,444 67,420 49,915 54,109 Notes: Based on data received 2023-12 - 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 32 91 0 1 2 EMR 21 4 19 0 17 0 EUR 53 33 62 1 16 3 SEAR 11 5 45 0 6 0 WPR 27 6 22 0 21 0 GLOBAL 194 80 41 1 108 5 Rubella Member States Not Region Verified % Verified Eliminated Endemic classified AFR 47 0 0 0 47 0 AMR 35 35 100 0 0 0 EMR 21 4 19 0 17 0 EUR 53 48 91 0 0 5 SEAR 11 5 45 0 6 0 WPR 27 5 19 0 22 0 GLOBAL 194 97 50 0 92 5 Notes: Based on data available at WHO HQ as of 2023-12-05 . 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 (2018-2023) 2018 2019 2020 2021 2022 2023 Total = 276,157 cases Total = 541,401 cases Total = 93,840 cases Total = 59,619 cases Total = 171,444 cases Total = 247,289 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 2023-12 - 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 (2015-2023) 2018 2019 2015 2016 2017 2020 2021 2022 2023 247,474 cases 180,015 cases 168,190 cases 276,157 cases 541,401 cases 93,840 cases 59,619 cases 171,444 cases 247,289 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 2021 2022 2023 Total = 59,619 cases Total = 171,444 cases Total = 247,289 cases 30,000 AFR AMR EMR EUR SEAR WPR 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 2023-12 - 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 Yemen 48660 1,444.06 Liberia 4351 820.53 Gabon 1949 815.83 Kazakhstan 13254 683.27 Kyrgyzstan 3639 548.82 Central African Republic 1379 247.17 Cameroon 6589 236.04 Somalia 3569 202.81 Armenia 487 175.15 Eq. Guinea 246 146.87 Notes: Based on data received 2023-12 - Surveillance data from 2022-11 to 2023-10 - 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 2022-08 to 2023-07 included Country Cases Rate/M Clinical* Country Cases Rate/M Clinical* Yemen 46,003 1,335.36 90% Lebanon 318 59.40 42% Gabon 2,103 863.10 0% Nigeria 12,076 53.96 8% Liberia 3,894 718.67 14% Saudi Arabia 1,829 49.50 0% Somalia 6,148 338.86 82% Zambia 1,011 49.15 10% Kyrgyzstan 1,789 265.61 24% Burkina Faso 1,127 48.47 6% Cameroon 6,810 237.72 2% Indonesia 12,303 44.33 30% Zimbabwe 3,565 213.92 4% T rkiye 3,776 44.00 0% Central African Republic Mauritania 211 43.39 0% 1,223 212.98 0% Senegal 721 40.59 11% Djibouti 234 205.90 4% United Arab Emirates 377 39.61 9% Kazakhstan 3,835 195.60 6% Equatorial Guinea Syrian Arab Republic 242 141.13 11% 851 36.64 0% Armenia 381 137.15 0% C te d'Ivoire 1,055 36.54 0% South Sudan 1,375 124.00 2% Benin 491 35.81 21% DR Congo 10,757 105.19 1% Burundi 473 35.73 11% Angola 3,758 102.44 1% Qatar 94 34.60 0% Togo 783 86.48 16% Nepal 1,057 34.21 6% Ethiopia 10,874 85.94 1% Russian Federation 4,401 30.47 0% Afghanistan 3,289 77.86 2% Ghana 988 28.95 50% Chad 1,227 67.13 17% Libya 183 26.57 0% Total: 49 countries India 95,404 66.78 16% Niger 696 25.59 15% Tajikistan 650 64.08 0% Mozambique 825 24.34 3% Congo 384 62.88 1% Romania 467 23.48 1% Iraq 2,760 60.65 67% Sudan 1,085 22.55 44% Pakistan 14,367 59.74 14% Mali 514 22.07 18% 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 2023-12 and covering the period between 2022-08 and 2023-07 - 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* Yemen 25,216 India** 14,927 Kazakhstan 12,985 Ethiopia 11,227 Pakistan 8,316 DR Congo*** 5,989 Russian Federation 4,305 Iraq 4,164 Indonesia 3,827 Nigeria 3,683 Notes: Based on data received 2023-12 - Surveillance data from 2023-05 to 2023-10 - * 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. - ** DRC typically reports more cases through IDSR

13. Surveillance sensitivity reporting rate of measles and rubella (12 months, discarded cases* per 100,000 population) Notes: Based on data received 2023-12 - Surveillance data from 2022-11 to 2023-10 - 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), 2021-2023 2021 2022 2023 Total = 26,492 cases Total = 64,922 cases Total = 67,069 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 Liberia Others Cameroon Ethiopia Nigeria Notes: Based on data received 2023-12 - Data Source: IVB Database

16. ELIMINATION STATUS: ENDEMIC Measles cases: Burundi 2020 2021 2022 2023 2019 1,701 cases 222 cases 106 cases 371 cases 796 cases Number of measles cases 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 SIA Discarded Lab Age distribution, vaccination status and incidence (last 12 months) WHO/UNICEF Coverage Estimates (WUENIC) 100 Incidence rate per M 300 750 Number of cases 80 200 500 % Coverage 60 100 250 40 0 0 20 0 Age at onset (in years) MCV1 MCV2 2+ doses 1 dose 0 doses Unknown Incidence Based on data received 2023-12 - 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: Democratic Republic of the Congo 2020 2021 2022 2023 2019 18,467 cases 14,577 cases 3,443 cases 4,365 cases 10,608 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 6,000 Incidence rate per M Number of cases 80 400 4,000 % Coverage 60 200 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 2023-12 - 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: Equatorial Guinea 2020 2021 2022 2023 2019 17 cases 80 cases 243 cases 47 cases 4 cases Number of measles cases 100 50 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) 100 100 Incidence rate per M Number of cases 600 80 75 % Coverage 400 60 50 200 40 25 0 0 20 0 Age at onset (in years) MCV1 MCV2 2+ doses 1 dose 0 doses Unknown Incidence Based on data received 2023-12 - 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: Ethiopia 2020 2021 2022 2023 2019 4,000 3,610 cases 1,947 cases 1,947 cases 8,216 cases 15,530 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 SIA 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 80 400 4,000 % Coverage 60 200 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 2023-12 - 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: Liberia 2020 2021 2022 2023 2019 1,044 cases 5,402 cases 4,357 cases 836 cases 456 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 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 80 2000 1,000 % Coverage 60 1000 500 40 0 0 20 0 Age at onset (in years) MCV1 MCV2 2+ doses 1 dose Unknown Incidence Based on data received 2023-12 - 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: Nigeria 2020 2021 2022 2023 2019 12,000 28,302 cases 10,227 cases 10,871 cases 20,748 cases 11,323 cases Number of measles cases 9,000 6,000 3,000 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 SIA Discarded Lab Age distribution, vaccination status and incidence (last 12 months) WHO/UNICEF Coverage Estimates (WUENIC) 100 200 Incidence rate per M Number of cases 80 4,000 150 % Coverage 60 100 2,000 40 50 0 0 20 0 Age at onset (in years) MCV1 MCV2 2+ doses 1 dose 0 doses Unknown Incidence Based on data received 2023-12 - 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. Measles case distribution (AMR), 2021-2023 2021 2022 2023 Total = 712 cases Total = 169 cases Total = 49 cases 150 100 50 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 Canada Others Brazil Chile USA Notes: Based on data received 2023-12 - Data Source: IVB Database

23. Measles case distribution (EMR), 2021-2023 2021 2022 2023 Total = 24,329 cases Total = 54,245 cases Total = 71,249 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 Afghanistan Others Somalia Iraq Pakistan Yemen Notes: Based on data received 2023-12 - Data Source: IVB Database

24. ELIMINATION STATUS: ENDEMIC Measles cases: Afghanistan 2020 2021 2022 2023 2019 2,000 3,028 cases 5,111 cases 2,127 cases 212 cases 548 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 Clinical SIA Discarded Lab Age distribution, vaccination status and incidence (last 12 months) WHO/UNICEF Coverage Estimates (WUENIC) 600 100 Incidence rate per M Number of cases 1,000 80 400 % Coverage 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 2023-12 - 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)

25. ELIMINATION STATUS: ENDEMIC Measles cases: Iraq 2020 2021 2022 2023 2019 1,500 3,619 cases 4,406 cases 312 cases 20 cases 47 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) 100 800 Incidence rate per M 1,500 Number of cases 80 600 % Coverage 1,000 60 400 500 40 200 0 0 20 0 Age at onset (in years) MCV1 MCV2 2+ doses 1 dose 0 doses Unknown Incidence Based on data received 2023-12 - 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: Pakistan 2020 2021 2022 2023 2019 6,000 2,066 cases 2,863 cases 9,313 cases 7,957 cases 14,758 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 Clinical SIA 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 750 80 5,000 % Coverage 500 60 2,500 250 40 0 0 20 0 Age at onset (in years) MCV1 MCV2 2+ doses 1 dose 0 doses Unknown Incidence Based on data received 2023-12 - 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: Saudi Arabia 2020 2021 2022 2023 2019 1,035 cases 1,987 cases 30 cases 91 cases 173 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) 100 800 Incidence rate per M 750 Number of cases 80 600 % Coverage 500 60 400 250 40 200 0 0 20 0 Age at onset (in years) MCV1 MCV2 2+ doses 1 dose 0 doses Unknown Incidence Based on data received 2023-12 - 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 2019 3,000 4,504 cases 2,382 cases 6,029 cases 17,361 cases 1,351 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 Clinical SIA Discarded Lab Age distribution, vaccination status and incidence (last 12 months) WHO/UNICEF Coverage Estimates (WUENIC) 100 400 Incidence rate per M 600 Number of cases 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 2023-12 - 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. ELIMINATION STATUS: ENDEMIC Measles cases: Syrian Arab Republic 2020 2021 2022 2023 2019 400 27 cases 11 cases 714 cases 15 cases 213 cases Number of measles cases 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 SIA Discarded Lab Age distribution, vaccination status and incidence (last 12 months) WHO/UNICEF Coverage Estimates (WUENIC) 400 100 300 Incidence rate per M Number of cases 300 80 200 % Coverage 200 60 100 100 40 0 0 20 0 Age at onset (in years) MCV1 MCV2 2+ doses 1 dose 0 doses Unknown Incidence Based on data received 2023-12 - 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)

30. ELIMINATION STATUS: ENDEMIC Measles cases: United Arab Emirates 2020 2021 2022 2023 2019 186 cases 50 cases 35 cases 93 cases 419 cases Number of measles cases 150 100 50 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) 100 150 Incidence rate per M 750 Number of cases 80 100 500 % Coverage 60 50 250 40 0 0 20 0 Age at onset (in years) MCV1 MCV2 2+ doses 1 dose 0 doses Unknown Incidence Based on data received 2023-12 - 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: Yemen 2020 2021 2022 2023 2019 8,000 9,335 cases 3,016 cases 4,825 cases 21,252 cases 43,675 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 Clinical SIA Discarded Lab Age distribution, vaccination status and incidence (last 12 months) WHO/UNICEF Coverage Estimates (WUENIC) 30,000 100 8000 Incidence rate per M Number of cases 80 6000 20,000 % Coverage 60 4000 10,000 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 2023-12 - 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)

32. Measles case distribution (EUR), 2021-2023 2021 2022 2023 Total = 30,601 cases Total = 938 cases Total = 150 cases 6,000 4,000 2,000 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 Kyrgyzstan Romania T rkiye Kazakhstan Others Russian Federation Notes: Based on data received 2023-12 - Data Source: IVB Database

33. ELIMINATION STATUS: ENDEMIC Measles cases: Kazakhstan 2020 2021 2022 2023 2019 6,000 13,326 cases 3,269 cases 13,254 cases 2 cases 4 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 Clinical Discarded Lab WHO/UNICEF Coverage Estimates (WUENIC) 100 80 % Coverage 60 40 20 0 MCV1 MCV2 Based on data received 2023-12 - Data Source: IVB Database. Main epi curve was built using aggregate surveillance data. Coverage data from WHO/UNICEF Estimates of National Immunization Coverage (WUENIC)

34. ELIMINATION STATUS: ENDEMIC Measles cases: Kyrgyzstan 2020 2021 2022 2023 2019 2,303 cases 3,811 cases 715 cases 23 cases 4 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 1,500 Incidence rate per M 6000 Number of cases 80 1,000 % Coverage 4000 60 500 2000 40 0 0 20 0 Age at onset (in years) MCV1 MCV2 2+ doses 1 dose 0 doses Unknown Incidence Based on data received 2023-12 - 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. ELIMINATION STATUS: ENDEMIC Measles cases: Romania 2020 2021 2022 2023 2019 400 1,734 cases 1 cases 976 cases 10 cases 978 cases Number of measles cases 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) 100 400 Incidence rate per M 600 Number of cases 80 300 400 % Coverage 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 2023-12 - 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)

36. ELIMINATION STATUS: ELIMINATED Measles cases: Russian Federation 2020 2021 2022 2023 2019 2,000 4,171 cases 1,100 cases 6,076 cases 1 cases 117 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 Clinical Discarded Lab Age distribution, vaccination status and incidence (last 12 months) WHO/UNICEF Coverage Estimates (WUENIC) 1,500 100 Incidence rate per M 300 Number of cases 80 1,000 200 % Coverage 60 500 100 40 0 0 20 0 Age at onset (in years) MCV1 MCV2 2+ doses 1 dose 0 doses Unknown Incidence Based on data received 2023-12 - 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)

37. Measles case distribution (SEAR (excl. India)), 2021-2023 2021 2022 2023 3,000 Total = 5,914 cases Total = 12,316 cases Total = 715 cases 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 Nepal Sri Lanka Indonesia Others Thailand Notes: Based on data received 2023-12 - Data Source: IVB Database

38. ELIMINATION STATUS: ENDEMIC Measles cases: Indonesia 2020 2021 2022 2023 2019 8,000 1,822 cases 5,362 cases 11,037 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 Clinical SIA Discarded Lab Age distribution, vaccination status and incidence (last 12 months) WHO/UNICEF Coverage Estimates (WUENIC) 400 100 Incidence rate per M 20 Number of cases 300 80 15 % Coverage 200 60 10 100 40 5 0 0 20 0 Age at onset (in years) MCV1 MCV2 2+ doses 1 dose 0 doses Unknown Incidence Based on data received 2023-12 - 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)

39. ELIMINATION STATUS: ENDEMIC Measles cases: Nepal 2020 2021 2022 2023 2019 1,013 cases 431 cases 388 cases 143 cases 132 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 Clinical Discarded Lab Age distribution, vaccination status and incidence (last 12 months) WHO/UNICEF Coverage Estimates (WUENIC) 300 100 Incidence rate per M Number of cases 80 200 200 % Coverage 60 100 100 40 0 0 20 0 Age at onset (in years) MCV1 MCV2 2+ doses 1 dose 0 doses Unknown Incidence Based on data received 2023-12 - 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)

40. ELIMINATION STATUS: ENDEMIC Measles cases: India 2020 2021 2022 2023 2019 10,708 cases 5,598 cases 6,025 cases 43,578 cases 61,555 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) 40,000 100 Incidence rate per M 600 Number of cases 30,000 80 % Coverage 400 20,000 60 200 10,000 40 0 0 20 0 Age at onset (in years) MCV1 MCV2 2+ doses 1 dose 0 doses Unknown Incidence Based on data received 2023-12 - 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), 2021-2023 2021 2022 2023 Total = 1,196 cases Total = 1,678 cases Total = 4,450 cases 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 Japan Others Viet Nam China Malaysia Philippines Notes: Based on data received 2023-12 - Data Source: IVB Database

42. ELIMINATION STATUS: ENDEMIC Measles cases: Malaysia 2020 2021 2022 2023 2019 1,077 cases 1,543 cases 128 cases 209 cases 477 cases 1,500 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 SIA Discarded Lab Age distribution, vaccination status and incidence (last 12 months) WHO/UNICEF Coverage Estimates (WUENIC) 100 Incidence rate per M 600 400 Number of cases 80 300 400 % Coverage 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 2023-12 - 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 2023-12-05 and covering the period between 2022-11 and 2023-10 - Pie charts proportional to the number of sequenced viruses

44. Rubella

45. Number of reported rubella cases by WHO Region 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 449 628 740 603 366 281 209 137 135 82 10 0 AFR 43/47 3,640 0 0 3,640 2023-12 AMR 0 0 0 0 0 0 0 0 0 0 0 0 AMR 22/35 0 0 0 0 2023-12 EMR 547 226 479 446 297 197 163 69 30 5 0 0 EMR 21/21 2,459 1,112 77 1,270 2023-12 EUR 28 25 37 40 30 43 33 35 25 20 1 0 EUR 31/53 317 214 4 99 2023-12 SEAR 328 303 356 332 293 161 147 42 22 17 0 0 SEAR 10/11 2,001 0 67 1,934 2023-12 WPR 41 73 113 98 95 112 98 98 78 105 0 0 WPR 14/27 911 349 3 559 2023-12 Total 1,393 1,255 1,725 1,519 1,081 794 650 381 290 229 11 0 Total 141/194 9,328 1,675 151 7,502 2022 Member States* Rubella cases Date Received Region Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Region Clin Epi Lab AFR 301 672 872 567 351 233 304 293 185 421 438 109 AFR 43/47 4,746 0 0 4,746 2023-12 AMR 0 0 0 0 0 0 0 0 0 0 0 0 AMR 22/35 0 0 0 0 2023-12 EMR 242 258 321 280 288 181 62 65 92 226 271 237 EMR 20/21 2,523 893 0 1,630 2023-12 EUR 12 7 21 21 10 22 17 15 15 27 20 29 EUR 30/53 216 162 0 54 2023-12 SEAR 268 271 348 302 213 178 266 268 283 272 395 455 SEAR 11/11 3,519 0 106 3,413 2023-12 WPR 54 59 72 74 157 128 86 100 81 85 70 41 WPR 14/27 1,007 164 1 842 2023-12 Total 877 1,267 1,634 1,244 1,019 742 735 741 656 1,031 1,194 871 Total 140/194 12,011 1,219 107 10,685 Notes: Based on data received 2023-12 - 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 (2015-2023) 2018 2019 2015 2016 2017 2020 2021 2022 2023 12,000 Total = 22,418 cases 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 = 12,011 cases Total = 9,328 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 2023-12 - 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 (2021-2023) 2021 2022 2023 Total = 7,410 cases Total = 12,011 cases Total = 9,328 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 2023-12 - 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 Guinea-Bissau 154 73.14 Yemen 1542 45.76 Central African Republic 123 22.05 Botswana 47 17.87 Libya 111 16.29 Madagascar 479 16.18 Chad 170 9.59 Ethiopia 1006 8.15 DR Congo 630 6.36 Poland 252 6.32 Notes: Based on data received 2023-12 - Surveillance data from 2023-05 to 2023-10 - Incidence: Number of cases / population * 1,000,000 - Population data: World population prospects, 2019 revision

49. 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.

50. Rubella cases (AFR) AFR Rubella Case Distribution (January 2021-December 2023) Top 10 countries (last 12 M) 2021 2022 2023 RCV in RI % of Total (lab + epi-linked + clinical) Country Cases 750 Number of cases Ethiopia No 935 25 Nigeria No 680 18 500 DR Congo No 519 14 250 Others - 512 14 Madagascar No 282 8 0 United Republic of Tanzania 2014 187 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 Chad No 165 4 Introduced less than 5 years ago (after 2018) Introduced more than 5 years ago (2018 and before) Not introduced in EPI Guinea-Bissau No 154 4 Central African Republic No 122 3 AFR Age distribution of Rubella IgM+ cases by vaccine introduction status in the National EPI Programme (last 12 Months) 400 C te d'Ivoire 2018 106 3 Number of cases South Africa No 87 2 300 (IgM+ only) 200 100 0 0 10 20 30 40 Age at onset (in years) Rubella vaccine introduced before 1 January 2023 Rubella vaccine not introduced before 1 January 2023 Notes: Based on data received 2023-12 Data Source: IVB Database.

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