title: Case based measles surveillance in Pune: evidence to guide current and future measles control and elimination efforts in India.
abstract: BACKGROUND
  According to WHO estimates, 35% of global measles deaths in 2011 occurred in India. In 2013, India committed to a goal of measles elimination by 2020. Laboratory supported case based measles surveillance is an essential component of measles elimination strategies. Results from a case-based measles surveillance system in Pune district (November 2009 through December 2011) are reported here with wider implications for measles elimination efforts in India.
  
  
  METHODS
  Standard protocols were followed for case identification, investigation and classification. Suspected measles cases were confirmed through serology (IgM) or epidemiological linkage or clinical presentation. Data regarding age, sex, vaccination status were collected and annualized incidence rates for measles and rubella cases calculated.
  
  
  RESULTS
  Of the 1011 suspected measles cases reported to the surveillance system, 76% were confirmed measles, 6% were confirmed rubella, and 17% were non-measles, non-rubella cases. Of the confirmed measles cases, 95% were less than 15 years of age. Annual measles incidence rate was more than 250 per million persons and nearly half were associated with outbreaks. Thirty-nine per cent of the confirmed measles cases were vaccinated with one dose of measles vaccine (MCV1).
  
  
  CONCLUSIONS
  Surveillance demonstrated high measles incidence and frequent outbreaks in Pune where MCV1 coverage in infants was above 90%. Results indicate that even high coverage with a single dose of measles vaccine was insufficient to provide population protection and prevent measles outbreaks. An effective measles and rubella surveillance system provides essential information to plan, implement and evaluate measles immunization strategies and monitor progress towards measles elimination.
authors.affiliation: National Polio Surveillance Project, India Country Office, World Health Organization, New Delhi, India; Vaccine Delivery, Bill & Melinda Gates Foundation, New Delhi, India.
authors.forename: Anindya Sekhar
authors.initials: AS
authors.lastname: Bose
authors.affiliation: National Polio Surveillance Project, India Country Office, World Health Organization, New Delhi, India; Polio Operations & Research, World Health Organization, Geneva, Switzerland.
authors.forename: Hamid
authors.initials: H
authors.lastname: Jafari
authors.affiliation: National Polio Surveillance Project, India Country Office, World Health Organization, New Delhi, India; GAVI, The Vaccine Alliance, Geneva, Switzerland.
authors.forename: Stephen
authors.initials: S
authors.lastname: Sosler
authors.affiliation: National Polio Surveillance Project, India Country Office, World Health Organization, New Delhi, India.
authors.forename: Arvinder Pal Singh
authors.initials: AP
authors.lastname: Narula
authors.affiliation: Department of Health and Family Welfare, Govt. of Maharashtra, Pune, Maharashtra, India.
authors.forename: V M
authors.initials: VM
authors.lastname: Kulkarni
authors.affiliation: Immunization & Vaccine Development, South-East Asia Regional Office, World Health Organization, New Delhi, India.
authors.forename: Nalini
authors.initials: N
authors.lastname: Ramamurty
authors.affiliation: Immunization & Vaccine Development, South-East Asia Regional Office, World Health Organization, New Delhi, India.
authors.forename: John
authors.initials: J
authors.lastname: Oommen
authors.affiliation: National institute of Virology, Indian Council of Medical Research, Pune, Maharashtra, India.
authors.forename: Ramesh S
authors.initials: RS
authors.lastname: Jadi
authors.affiliation: National Polio Surveillance Project, India Country Office, World Health Organization, New Delhi, India.
authors.forename: R V
authors.initials: RV
authors.lastname: Banpel
authors.affiliation: Immunization Vaccines and Biologicals, World Health Organization, Geneva, Switzerland.
authors.forename: Ana Maria
authors.initials: AM
authors.lastname: Henao-Restrepo
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D005260:Female; D062306:Geography, Medical; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008457:Measles / Q000453:epidemiology* / Q000517:prevention & control; D008458:Measles Vaccine; D009026:Mortality; D011159:Population Surveillance; D012621:Seasons; D012737:Sex Factors; D055815:Young Adult
chemical_list: D008458:Measles Vaccine