Evaluation of the Measles Clinical Case Definition

An accurate system of identifying and classifying suspected measles cases is critical for the measles surveillance system in the United States. To examine the performance of the clinical case definition in predicting laboratory confirmation of suspected cases of measles, we reviewed 4 studies conduc...

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Bibliographic Details
Published in:The Journal of infectious diseases 2004-05, Vol.189 (Supplement-1), p.S153-S159
Main Authors: Katz, Samuel L., Hutchins, Sonja S., Papania, Mark J., Amler, Robert, Maes, Edward F., Grabowsky, Mark, Bromberg, Kenneth, Glasglow, Victoria, Speed, Tamika, Bellini, William, Orenstein, Walter A.
Format: Article
Language:English
Subjects:
Adolescent
Antibodies
Antibodies, Viral - blood
Caribbean Region - epidemiology
Complement Fixation Tests
Diseases
Epidemiology
Exanthema
Fever
Hemagglutination Inhibition Tests
Humans
Immunoenzyme Techniques
Immunoglobulin M - blood
Incidence
Measles
Measles - diagnosis
Measles - epidemiology
Measles virus - immunology
Predictive Value of Tests
Preventive medicine
Sensitivity and Specificity
Serologic tests
Specimens
Suriname - epidemiology
Surveillance
The Critical Role of the Laboratory in Measles Surveillance
United States - epidemiology
Venezuela - epidemiology
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Summary:An accurate system of identifying and classifying suspected measles cases is critical for the measles surveillance system in the United States. To examine the performance of the clinical case definition in predicting laboratory confirmation of suspected cases of measles, we reviewed 4 studies conducted between 1981 and 1994. A clinical case definition was examined that included a generalized maculopapular rash, fever (5 =38.3°C, if measured), and either a cough, coryza, or conjunctivitis. Serological confirmation of measles was done either by hemagglutination inhibition assay, complement fixation assay, or enzyme immunoassays. The positive predictive value of the clinical case definition decreased from 74% to 1% as incidence decreased from 171 cases/100,000 population to 1.3 cases/100,000 population. Sensitivity was high, and for the larger studies with the most precise estimates, sensitivity was 76%–88%. The low positive predictive value of the clinical case definition in settings of low incidence demonstrates that serological confirmation is essential to ensure an accurate diagnosis of measles when measles is rare.
ISSN:0022-1899
1537-6613
DOI:10.1086/379652