State measles review may 2010

Dr.Nilanjan MitraSub-Regional Team Leader

- WBWHO-NPSP

Status of Measles

Surveillance

Measles Surveillance-India

States Measles Immunization coverage (%)

Fully Immunized

(%)

Year of introducti

on of measles

surveillance

Andhra Pradesh 88.6 67.1 2006Karnataka 85.2 76.7 2006Kerala 87.9 79.5 2007Tamil Nadu 97.6 83.2 2006West Bengal 82.8 75.8 2007Gujarat * 65.7 45.2 2007Rajasthan 67.5 48.8 2009

Source: DLHS-3 (2007-08); Gujarat – NFHS-3 (2005-2006)

2007

16478 cases

2008

Clinical measles cases through routine weekly reporting

* data as on 15th Feb, 2010

24258 cases

Clinical measles cases through routine weekly reporting

2009


2046 cases

2010*

32921 cases

More clinical measles

cases are pouring over the

years

Measles Seasonal Trend (6 states) -2008-09

0

1000

2000

3000

4000

5000

6000

7000

8000Jan-08

Feb-08

Mar-08

Apr-08

May-08

Jun-08

Jul-08

Aug-08

Sep-08

Oct-08

Nov-08

Dec-08

Jan-09

Feb-09

Mar-09

Apr-09

May-09

Jun-09

Jul-09

Aug-09

Sep-09

Oct-09

Nov-09

Dec-09

AP GUJ KAR

KER TN WB

IND

Source: Routine weekly reports – cases of clinical

measles

Among 6 states -

WB dictates

the seasonali

ty

Reported Measles Cases (5138) & Deaths (25) - J uly,07 - Dec 07

409

474

902

139194 197 197

34

449

52

370

162137

304

523

1497286

288

0

100

200

300

400

500

600

700

800

900

1000

DJ

L

JP

G

KB

R

UD

J

DD

J

ML

D

MB

D

ND

A

BD

N

BB

M

BK

R

PR

L

MN

P

TM

L

NP

G

SP

G

HR

A

HG

L

KO

L

9

2

2

3 41

1

1

1

1

Death

Source – Routine weekly reports

Reported Measles Cases 2008-12156

649703

172

802

364

817

1664

1207

265190

802

384

1024

569

1068

239

565

95

577

0

200

400

600

800

1000

1200

1400

1600

1800

DJ

L

JP

G

KB

R

UD

J

DD

J

ML

D

MB

D

ND

A

BD

N

BB

M

BK

R

PR

L

MN

P

TM

L

NP

G

SP

G

HR

A

HG

L

KO

L

Deaths = 37

13 5

2

1

22

1

1

1 6

1

11


Reported Measles Cases 2009-21052

1018

693

1979

464552

1107

722

20192132

545

983

290

1914

1289

998

2354

742

604647

0

250

500

750

1000

1250

1500

1750

2000

2250

2500

DJ

L

JP

G

KB

R

UD

J

DD

J

ML

D

MB

D

ND

A

BD

N

BB

M

BK

R

PR

L

MN

P

TM

L

NP

G

SP

G

HR

A

HG

L

KO

L

Deaths =48

4

9 36

2

2

2

1

3

2

14

2

7

Popln. density /

sq.km

WB – 903

KOL – 24718

HRA – 2913

BBM – 663

BDN - 982


Measles immunizati

on coverage –

61% (DLHS-3)

Serologically confirmed measles, rubella and mixed outbreaks India

(Andhra Pradesh, Gujarat, Karnataka, Kerala, Rajasthan, Tamil Nadu and West Bengal)

151 outbreaksMeasles outbreaks

confirmed

Rubella outbreaks confirmed

Mixed outbreaks confirmed

1113639

615238

2008 2009*

186 outbreaks


decreased

increased

Summary of OBI – 6 States – 2007 - 2009

States Year

No. of suspect

ed outbrea

ks

No. of serologic

ally investigat

ed outbreaks

%

No. of cases

Identified in measles outbreaks

No. of cases

Identified in rubella outbreaks

Deaths in serologically

confirmed measles

outbreaks

AP2007 54 54 100 678 0 4

2008 46 32 70 490 382 1

2009 44 32 73 1017 81 0

GUJ2007 19 16 84 1044 0 3

2008 47 25 53 2092 0 4

2009 27 11 41 334 220 1

KAR2007 337 52 15 2357 132 7

2008 115 51 44 1755 938 4

2009 77 27 35 768 631 1

2007 76 9 12 314 153 2

2008 66 19 29 382 249 0

2009 55 15 27 128 218 1

2007 101 32 32 1034 87 0

2008 32 13 41 384 0 0

2009 29 5 17 266 105 1

2007 238 23 10 1704 0 19

2008 429 59 14 1967 1286 14

2009 577 67 12 951 3008 3

DISTRICT

Total No. of

Suspected Outbreaks

Decision 1 & 2

% of Decision

1 & 2

Decision 3

% of Decision

3

Decision 4

% of Decision

4

24-PARGANAS NORTH 46 28 60.9 7 15.2 11 23.9

24-PARGANAS SOUTH 72 49 68.1 13 18.1 10 13.9

BANKURA 40 33 82.5 5 12.5 2 5.0

BARDHAMAN 27 25 92.6 1 3.7 1 3.7

BIRBHUM 35 17 48.6 16 45.7 2 5.7

COOCH BEHAR 13 12 92.3 0 0.0 1 7.7

HOOGHLY 27 25 92.6 0 0.0 2 7.4

HOWRA 13 11 84.6 1 7.7 1 7.7

KOLKATA 7 3 42.9 0 0.0 4 57.1

MALDA 48 42 87.5 1 2.1 5 10.4

MURSHIDABAD 21 11 52.4 0 0.0 10 47.6

NADIA 18 14 77.8 0 0.0 4 22.2

PASCHIM MEDINIPUR 25 24 96.0 0 0.0 1 4.0

PURBA MEDINIPUR 41 30 73.2 2 4.9 9 22.0

PURULIA 31 28 90.3 0 0.0 3 9.7

UTTAR DINAJ PUR 64 58 90.6 3 4.7 3 4.7

DARJ EELING 0 0 0.0 0 0.0 0 0.0

J ALPAIGURI 0 0 0.0 0 0.0 0 0.0

DAKSHIN DINAJ PUR 0 0 0.0 0 0.0 0 0.0

TOTAL 528 410 77.7 49 9.3 69 13.11 - No house-to-house investigation; no clustering of cases; 2 - No house-to-house investigation; low case count;3 - No house-to-house investigation; other; 4 - House-to-house investigation to proceed

Decisions on Suspected Outbreaks - District wise -2009

Results of OBI – 6 States – 2007 - 2009

State YearTotal no.

of outbreaks investigat

ed

SEROLOGICALLY CONFIRMED OUTBREAKS

Measles

% Rubella

% Mixed % Negative

%

AP2007 54 47 87.

10 0 7 12.

9

2008 32 14 43.6

6 18.8

6 18.8

6 18.8

2009 32 17 53.1

4 12.5

2 6.2 9 28.1

GUJ2007 16 15 93.

80 0 1 6.2

2008 25 24 96.0

0 1 4.0 0

2009 11 7 63.6

2 18.2

2 18.2

0

KAR2007 52 42 80.

82 3.8 3 5.8 5 9.6

2008 51 29 56.8

11 21.6

6 11.8

5 9.8

2009 27 14 51.8

6 22.2

6 22.2

1 3.8

KER2007 9 6 66.

73 33.

30 0

2008 19 9 47.4

4 21.0

6 31.6

0

2009 15 6 40.0

6 40.0

2 13.3

1 6.7

2007 32 29 90.7

1 3.1 1 3.1 1 3.1

2008 13 8 61.5

0 5 38.5

0

2009 5 3 60.0

2 40.0

0 0

2007 23 19 82.7

0 3 13.0

1 4.3

2008 59 27 45.8

15 25.4

15 25.4

2 3.4

2009 69 10 14.5

33 47.8

26 37.7

0

Measles Outbreak – 2007 (from1st July – Dec 07)

Confirmed Measles Outbreak - 19

Measles & Rubella Outbreak - 3

Outbreak – neither Measles nor Rubella - 1

Kalimpong II (2)

Dhupguri

Kharibari-Phansidewa Jalpaigu

ri

Rajganj

Karandighi

Ratua I & Harishchandrap

ur II

Farakka

SagardighiMurarai

II

Katwa I

Andal-PandebswarRaghunathp

ur II

KulpiNandigram II (2) – 1 mixed & 1 measles Ramnagar

II

Canning I

Goalpokhar II

Total outbreaks

investigated - 23

Raghunathganj II

Baruipur

Mathurapur

II

Measles Outbreak – 2008

Confirmed Measles Outbreak (27)

Measles & Rubella Outbreak (15)

Outbreak – neither Measles nor Rubella (2)

Total outbreaks

investigated - 59

Confirmed Rubella Outbreak (15)

Result Pending (0)

Data as on 08.04.09

Nakashipara (2) – 1

Mixed & 1 measles

Patashpur -I (2)

1 Rubella + 1 Mixed

Jalpaiguri (2)1 Rubella +1 Measles

Basirhat – I (2)

1 Mixed +1 Rubella

Raiganj (3)

2 Measles + 1 Mixed

Arambagh (2) - 1 Negative +

1 Measles

Swarupnagar (2)1 Mixed+1

Rubella

Basirhat – M (2)

1Measles+ 1Mixed

? ?? KOLKATA

Measles Outbreak – 2009

Total outbreaks

investigated - 71

Data as on 22.02.2010

Confirmed Measles Outbreak – (10)

Measles & Rubella Outbreak – (26)

Confirmed Rubella Outbreak (33)

Neither Measles nor Rubella (0)

Result Pending (2)

Kaliganj (2) -

1 Rubella + 1Mixed

Goalpokhar-II(2)

Egra – II (2) -

1 Rubella + 1Pending

?

?

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

23

59

69

62 6359

12

17 18

7579 77

0

10

20

30

40

50

60

70

80

No.of OBIs Notification-Onsetof 1st case

OBI - Notification OBI - Onset of 1stcase

2007 2008 2009

Vaccination status of measles cases – serologically confirmed measles outbreaks,

India, 2009

OBI (23) - Cases by vaccination status, 2007

Vaccinated Not Vaccinated Unknown

N=783

West Bengal<1 Years of age 1-4 Years of age

5-9 Years of age

10-14 Years of age >15 Years of age

N=200 N=788

N=153 N=89

N=644

Cases from serologically confirmed measles outbreaks

OBI (59) - Cases by vaccination status, 2008


N=783


5-9 Years of age


N=397 N=1203

N=734 N=485

N=1588


OBI (67) - Cases by vaccination status, 2009*


N=783


5-9 Years of age


N=425 N=1681

N=1131 N=821

N=2178


1-4 years 5-9 yearsAll age groups

HABRA-II 100 63.8 51HASNABAD 33.6 69.7 41.7MINAKHAN 72.7 38.5 33BADURIA 28.6 30 20TAKI-M 16.7 11.5 9.9BARASAT-I 80.0 66.7 44.4HABRA-I 100.0 83.3 50.0NORTH BARRACKPORE-M 35.7 33.3 26.5BASIRHAT-II 92.9 75.0 37.8AMDANGA 24.2 8.9 13.8GAIGHATA 80.0 85.7 65.3KULPI 10.0 6.7 5.0MAGRAHAT-II 30.4 19.0 16.7KAKDWIP 58.8 29.4 28.1DIAMOND HARBOUR-I 25.9 26.3 18.8MANDIRBAZAR 6.9 0.0 3.6DIAMOND HARBOUR-II 50.0 33.3 35.1BASANTI 61.5 38.2 31.7NAMKHANA 60.0 33.3 24.6JAYNAGAR-II 2.3 3.4 2.4PATHAR PRATIMA 0.0 0.0 0.0BANKURA-I 80.0 86.7 60.7SONAMUKHI 92.9 69.0 62.9

BARDHAMAN KULTI -M 17.1 4.5 66.0MURARAI-I 28.6 4.8 12.6NANOOR 89.5 71.1 58.9

COOCH BEHAR COOCH BEHAR-I 50.0 62.5 50.0UTTARPARA KOTRUNG-M 66.7 40.0 30.8HOOGHLY CHINSURAH-M 68.6 37.3 41.8

HOWRAH ULUBERIA M 14.8 15.4 14.1BOROUGH-9 27.3 0.0 7.8BOROUGH-14 72.7 50.0 42.6

KOLKATA

DISTRICT Blocks% Vaccinated

HOOGHLY

24-PARGANAS NORTH

24-PARGANAS SOUTH

BANKURA

BIRBHUM

2009

1-4 years 5-9 yearsAll age groups

ENGLISH BAZAR 34.6 26.4 22.1HARISHCHANDRAPUR-II 66.7 31.3 27.7KALIACHAK-II 71.2 69.8 55.9CHANCHAL-II 43.5 0.0 16.4CHANCHAL-I 76.5 64.0 45.6KANDI 62.5 23.7 24.5BURWAN 100.0 87.5 64.3SUTI-II 27.6 27.3 22.5LALGOLA 38.9 4.0 21.2BERHAMPORE 30.8 16.7 16.9RAGHUNATHGANJ-I 61.9 46.9 38.3BHARATPUR-II 60.0 50.0 43.6BHARATPUR-I 25.0 35.7 22.9BELDANGA-II 20.0 15.4 12.8RANINGAR-I 9.1 9.4 7.9NABADWIP 94.1 87.9 61.4KRISHNAGAR-I 85.7 60.0 46.0KALIGANJ 78.6 68.0 47.8KALIGANJ 40.0 47.1 25.0

PASCHIM MEDINIPUR SABONG 73.7 18.2 22.5TAMLUK-M 85.7 15.8 22.5HALDIA-M 29.6 8.6 15.9CONTAI-I 71.9 47.6 33.3CHANDIPUR 58.3 33.9 28.7NANDIGRAM-II 58.8 33.9 26.0EGRA-II 75.9 61.6 44.9CONTAI-M 16.1 4.8 6.8KOLAGHAT 79.2 69.4 53.6KOLAGHAT 100.0 72.0 56.5SANTURI 97.3 91.7 93.8JHALDA-II 34.9 10.0 19.8KASHIPUR 100.0 66.7 37.5GOALPOKHAR I 4.0 8.7 5.0GOALPOKHAR II (Kanki PHC) 6.8 0.0 3.9GOALPOKHAR II (Kanki PHC) 2.9 0.0 1.4

DISTRICT Blocks% Vaccinated

PURBA MEDINIPUR

PURULIA

UTTAR DINAJPUR

MALDA

MURSHIDABAD

NADIA

2009

Total cases- 1060 Total cases- 431

Total cases- 266

Andhra Pradesh Gujarat

Tamil Nadu

Total cases- 236

Kerala

Total cases- 3228

West Bengal

Total cases- 1238

Karnataka

Measles cases by age, 2009*


% % %

% % %

Total cases- 146

Rajasthan%


Age distribution of cases in serologically confirmed measles outbreaks in 2008

'5 - 9, 789, 41%

'10 -14, 262, 13%

=> 15 , 73, 4%'0 - 1, 186, 9%

'1- 4, 648, 33%

Total cases- 1967

Age distribution of cases in serologically confirmed measles outbreaks in 2009*

'5 - 9, 359, 36%

'10 -14, 93, 9%

=> 15 , 49, 5%

'0 - 1, 88, 9%

'1- 4, 402, 41%

Total cases- 991

77% Measles cases in 1-10 yrs

age group

SILENT AREAS and AREAS with < 10 cases of Clinical Measles Weekly Reporting of Measles Surveillance -

2008 - WB

SILENT AREAS and

AREAS reported < 10 cases of Clinical measles

in 2009 - WB

Source: Routine weekly Reports -data up to 53

wks

District Silent Areas Areas with < 10 cases District Silent Areas Areas with < 10 casesDARJ ILING-PULBAZAR RAINA-II RAINA-IKALIMPONG-M GALSI-II AUSGRAM-I

MATHABHANGA-M TUFANGANJ -II KATWA-II AUSGRAM-IIMEKLIGANJ -M SITALKUCHI DURGAPUR-FARIDPUR BHATARHALDIBARI-M TUFANGANJ -M RANIGANJ KALNA-IMAL-M J ALPAIGURI-M SALANPUR KALNA-II

ALIPURDUAR-M BARABANI MANTESWARSILIGURI-MC DURGAPUR-MC PURBASTHALI-IMAL KALNA-MUNI. MANGOLKOTEDHUPGURI DAINHAT-M KANKSAKUMARGRAM MEMARI-M ASANSOL-MC

Uttar Dinajpur RANIGANJ -M KATWA-MMaldah OLD MALDA-M GUSKARA-M

BELDANGA-M J ANGIPUR-M J AMURIA-MLALBAGH-M J ALANGI RAMPURHAT-II SURI-I

DOMKAL NALHATI-I KHOYRASOLBIRNAGAR-M RANAGHAT-M MAYURESWAR-II MOHAMMAD BAZAR

KALYANI-M SURI-II SAINTHIATEHATTA I RAJ NAGAR SURI-Muni.RANAGHAT-II ILLAMBAZARGAYESHPUR-M RAMPURHAT-MCAL_BR4 NALHATI-MCAL_BR5 SAINTHIA-MCAL_BR8 DUBRAJ PUR-MCAL_BR10 BOLPUR-MCAL_BR11 BANKURA-M INDPURCAL_BR12 BISHNUPUR-M KHATRACAL_BR15 SIMLAPAL RAIPUR

KANCHRAPARA-M BONGAON SARENGA HALISHAHAR-M KHARDAH-M SONAMUKHI-MGARULIA-M TITAGARH-M J OYPURBARRACKPUR-M DUM DUM SOUTH-M J OYPURKAMARHATI-M ASHOKENAGAR-M AMTA IIDUM DUM NORTH-M BONGAON-M UDAYNARAYANPURDUM DUM-M BADURIA-M BALLY MNEW BARRACKPUR-M RAJ ARHAT-MHABRA-M SALT LAKE-M PURULIA-II ARSHAGOBARDANGA-M J HALDA-M BALARAMPURBKP CANT. BOARD HURABINPUR-II BINPUR-I J HALDA-IGARBETA-III DANTAN-II J OYPURKHARAGPUR-M DASPUR-II MANBAZAR-IISANKRAIL DEBRA RAGHUNATHPUR-I

GARBETA-II RAGHUNATHPUR-IIGOPIBALLABPUR-II RAGHUNATHPUR-MJ AMBONIJ HARGRAM TARAKESHWAR-M SERAMPUR-UTTARPARAKHARAGPUR-II BAIDYABATI-M KHANAKUL-IMEDINIPUR-M KONNAGAR-M CHANDANNAGAR-MCMOHONPUR CHAMPDANI-MNARAYANGARH BHADRESWAR-MSALBONI RISHRA-MJ HARGRAM -M ARAMBAGH-M

DIAMOND HARBOUR (M) BARUIPUR (M) Purba Medinipur EGRA-MBUDGE-BUDGE (M) KULTALIMAHESTALA (M) GOSABARAJ PUR SONARPUR (M) BISHNUPUR IIJ AYNAGAR MAZILPUR (M) SAGARPUJ ALI (M)CANNING II

Hooghly

South 24 Parganas

Murshidabad

Bardhaman

Purulia

Birbhum

Bankura

Howrah

List of SILENT Areas and Areas with less than 10 Clinical Measles Cases 2009 - West Bengal - data upto 53 wks

Darjeeling

Coochbehar

J alpaiguri

Nadia

Kolkata

North 24 Parganas

Paschim Medinipur

Urban Rural Total Urban Rural Total Urban Rural Total

Darjeeling 0 0 0 1 1 2 2 4 10 14 0.0 14.3 14.3

Jalpaiguri 1 0 1 3 3 6 7 5 13 18 5.6 33.3 38.9

Coochbehar 3 0 3 1 2 3 6 6 12 18 16.7 16.7 33.3

Uttar Dinajpur 0 0 0 0 0 0 0 3 9 12 0.0 0.0 0.0

Dakshin Dinajpur 0 0 0 0 0 0 0 2 8 10 0.0 0.0 0.0

Maldah 1 0 1 0 0 0 1 2 15 17 5.9 0.0 5.9

Murshidabad 2 0 2 1 1 2 4 7 26 33 6.1 6.1 12.1

Nadia 1 0 1 3 2 5 6 9 17 26 3.8 19.2 23.1

Barddhaman 7 7 14 2 10 12 26 11 29 40 35.0 30.0 65.0

Birbhum 6 5 11 1 4 5 16 6 19 25 44.0 20.0 64.0

Bankura 2 1 3 1 5 6 9 3 22 25 12.0 24.0 36.0

Purulia 1 1 2 1 8 9 11 3 20 23 8.7 39.1 47.8

West Midnapore 1 3 4 1 12 13 17 4 29 33 12.1 39.4 51.5

East Midnapore 0 0 0 0 1 1 1 4 25 29 0.0 3.4 3.4

24 Parganas (North) 10 1 11 8 1 9 20 28 22 50 22.0 18.0 40.0

24 Parganas (South) 6 1 7 1 4 5 12 7 29 36 19.4 13.9 33.3

Howrah 0 0 0 1 2 3 3 3 14 17 0.0 17.6 17.6

Hooghly 3 0 3 5 2 7 10 12 18 30 10.0 23.3 33.3

Kolkata 0 0 0 7 0 7 7 15 0 15 0.0 46.7 46.7

TOTAL 44 19 63 37 58 95 158 134 337 471 13.4 20.2 33.5

List of SILENT Areas and areas reported less than 10 Clinical Measles cases in 2009

District

Silent areas Areas with < 10 cases

TOTAL

Planning units(PU) % Silent areas of total PU

% Areas with < 10

of total PU

% Total areas of total PU

51% Urban areas under-represented

23% Rural areas under-represented

AFP/Measles surveillance workshops conducted in 2009

0

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RecommendationsMore sensitization workshop Reporting from Medical Colleges Merging with IDSP reports Activation of ERT Serious desk review Supervised preliminary investigation Ensure promptness in notification of clinical

measles and quick decision for OBI OBI should be monitored by district Follow-up corrective immunization action

State measles review may 2010

Health & Medicine

Transcript of State measles review may 2010