TABLE. Reported number of measles and rubella cases, by case classification, age group and vaccination status, and surveillance indicators — India, 2017–2021.
| Characteristic | No. (%) |
||||
|---|---|---|---|---|---|
| 2017 | 2018 | 2019 | 2020 | 2021 | |
|
Measles
| |||||
|
All cases, no.
|
13,854
|
20,925
|
10,485
|
5,497
|
5,697
|
| Laboratory-confirmed* |
3,487 (25) |
5,795 (28) |
4,829 (46) |
2,572 (47) |
1,863 (33) |
| Epidemiologically linked† |
9,569 (69) |
13,470 (64) |
3,291 (31) |
629 (11) |
448 (8) |
| Clinically compatible§ |
798 (6) |
1,660 (8) |
2,365 (23) |
2,296 (42) |
3,386 (59) |
| Incidence¶ |
10.4 |
15.4 |
7.7 |
3.9 |
4.0 |
| Measles genotypes, no. |
D4 (4), D8 (204) |
D4 (1), D8 (333) |
B3 (2), D4 (5), D8 (553) |
B3 (4), D4 (64), D8 (510) |
D8 (23) |
|
Age group of patients with laboratory-confirmed and epidemiologically linked measles
| |||||
| <9 mos |
602 (5) |
1.140 (6) |
752 (9) |
357 (11) |
166 (7) |
| 9 mos–4 yrs |
5,255 (40) |
7,579 (39) |
2,840 (35) |
1,371 (43) |
981 (42) |
| 5–9 yrs |
5,144 (39) |
7,449 (39) |
2,177 (27) |
743 (23) |
552 (24) |
| 10–14 yrs |
1,466 (11) |
1,944 (10) |
960 (12) |
295 (9) |
291 (13) |
| ≥15 yrs |
589 (5) |
1,153 (6) |
1,391 (17) |
435 (14) |
321 (14) |
| Unknown or missing |
NA |
NA |
NA |
NA |
NA |
|
MCV doses received by patients with laboratory-confirmed and epidemiologically linked measles
| |||||
| ≥2 |
1,619 (12) |
3,467 (18) |
1,319 (16) |
700 (22) |
876 (38) |
| 1 |
1,926 (15) |
1,923 (10) |
995 (12) |
406 (13) |
321 (14) |
| 0 |
6,073 (47) |
7,978 (41) |
3,311 (41) |
1,019 (32) |
382 (17) |
| Unknown |
3,438 (26) |
5,897 (31) |
2,495 (31) |
1,076 (34) |
732 (32) |
|
Rubella
| |||||
|
All cases, no.
|
3,097
|
2,381
|
3,487
|
1,397
|
1,681
|
| Laboratory-confirmed** |
888 (29) |
1,032 (43) |
2,088 (60) |
1,293 (93) |
1,636 (97) |
| Epidemiologically linked†† |
2,209 (71) |
1,349 (57) |
1,399 (40) |
104 (7) |
45 (3) |
| Incidence¶ |
2.3 |
1.8 |
2.5 |
1.0 |
1.2 |
| Rubella genotypes, no. |
2B (9) |
2B (9) |
2B (19) |
2B (6) |
NA |
|
Age group of patients with laboratory-confirmed and epidemiologically linked rubella
| |||||
| <9 mos |
115 (4) |
92 (4) |
169 (5) |
109 (8) |
82 (5) |
| 9 mos–4 yrs |
742 (24) |
629 (26) |
1,277 (37) |
665 (48) |
977 (58) |
| 5–9 yrs |
1,198 (39) |
874 (37) |
1,098 (32) |
330 (24) |
283 (17) |
| 10–14 yrs |
652 (21) |
457 (19) |
513 (15) |
164 (12) |
151 (9) |
| ≥15 yrs |
390 (13) |
328 (14) |
430 (12) |
129 (9) |
188 (11) |
| Unknown or missing |
NA |
1 (0) |
NA |
NA |
NA |
|
RCV doses received by patients with laboratory-confirmed and epidemiologically linked rubella
| |||||
| ≥2 |
64 (2) |
108 (5) |
187 (5) |
157 (11) |
345 (21) |
| 1 |
74 (2) |
52 (2) |
489 (14) |
342 (24) |
464 (28) |
| 0 |
1,801 (58) |
1,323 (56) |
1,882 (54) |
608 (44) |
524 (31) |
| Unknown |
1,158 (37) |
898 (38) |
929 (27) |
290 (21) |
348 (21) |
|
Surveillance and program implementation
| |||||
|
States with case-based or fever and rash surveillance
| |||||
| Case-based surveillance§§ |
6 (17) |
17 (47) |
29 (81) |
32 (89) |
0 (0) |
| Fever and rash surveillance¶¶ |
0 (—) |
4 (11) |
4 (11) |
4 (11) |
36 (100) |
|
WHO-accredited measles and rubella laboratories, no.
|
13 |
17 |
21 |
20 |
27 |
|
States completing measles-rubella SIA
|
10 (28) |
26 (72) |
34 (94) |
34 (94) |
34 (94) |
|
Surveillance performance indicators
| |||||
| No. of discarded NMNR cases*** |
3,581 |
7,196 |
14,514 |
11,039 |
25,654 |
| No. of discarded NMNR cases per 100,000, national level (target ≥2) |
0.3 |
0.5 |
1.1 |
0.8 |
1.8 |
| Districts with NMNR discard rate ≥2 |
20 (3) |
20 (3) |
107 (15) |
84 (11) |
321 (42) |
| % of suspected cases adequately investigated††† ≤48 hours after notification (target ≥80) |
83 |
89 |
87 |
89 |
92 |
| % of suspected cases with adequate specimens§§§ tested for measles and rubella in a proficient laboratory¶¶¶ (target ≥80) |
100 |
100 |
100 |
100 |
99 |
| % of samples tested ≤4 days after specimen receipt in laboratory (target ≥80)**** |
89 |
39 |
85 |
84 |
94 |
| % of results received by program ≤4 days after specimen receipt (target ≥80)†††† |
67 |
22 |
47 |
53 |
72 |
| % of weekly surveillance units reporting to national level on time (target ≥80) | 92 | 92 | 94 | 94 | 93 |
Abbreviations: IgM = immunoglobulin M; MCV = measles-containing vaccine; NA = not applicable; NMNR = nonmeasles, nonrubella; RCV = rubella-containing vaccine; SIA = supplementary immunization activity; WHO = World Health Organization.
* Defined as a case that meets the suspected case definition and is laboratory-confirmed (serologically or virologically) as measles.
† As a part of an outbreak investigation, additional suspected cases captured by online-listing forms but without specimens collected are epidemiologically linked if they are part of a laboratory-confirmed measles outbreak.
§ Defined as a suspected case for which no adequate laboratory specimen could be collected and is not epidemiologically linked to a laboratory-confirmed case of measles or rubella and not epidemiologically linked to another laboratory-confirmed communicable disease.
¶ Cases per 1 million population.
** Defined as a case that meets the suspected case definition and is laboratory-confirmed (serologically or virologically) as rubella.
†† As a part of an outbreak investigation, additional suspected cases captured by online-listing forms but without specimens collected are epidemiologically linked if they are part of a laboratory-confirmed rubella outbreak.
§§ A case-based surveillance suspected case is defined as illness in any person with fever and maculopapular (nonvesicular) rash and any one of cough, coryza (runny nose), or conjunctivitis (red eyes); or in any person in whom a clinician or health worker suspects measles infection.
¶¶ A fever and rash surveillance suspected case is defined as illness in any person with fever and maculopapular (nonvesicular) rash or in any person in whom a clinician or health worker suspects measles or rubella infection.
*** Suspected cases that have been investigated and discarded as nonmeasles and nonrubella by 1) laboratory result negative for measles and rubella through serum sample testing in a proficient laboratory and 2) no epidemiological linkage to another confirmed measles or rubella case.
††† Suspected cases investigated ≤48 hours after notification.
§§§ Serum specimen collected ≤28 days (for serology) and throat swab/urine samples collected ≤7 days (for virology) after rash onset.
¶¶¶ A WHO-accredited laboratory that has an established quality assurance program or one with oversight by a WHO-accredited laboratory.
**** Samples tested for measles and rubella IgM ≤4 days after samples received in laboratory.
†††† Laboratory results for measles and rubella IgM received by program ≤4 days after sample receipt by laboratory.