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In this study, we have described the clinical characteristics of vaccine-modified measles  to assess the performance of an expanded case definition in a school outbreak that occurred in 2010. The  sensitivity, specificity, and the positive and negative predictive values were evaluated. Among 74 cases of  vaccine-modified measles, 47 (64%) met the original case definition. Fever and rash were observed in 73%  (54/74); fever was the most common (96%, 71/74) presenting symptom, and rash was noted in 77% (57/74) of  the cases. The original case definition showed an overall sensitivity of 63.5% and a specificity of 100.0%.  The expanded case definition combining fever and rash showed a higher sensitivity (72.9%) but a lower  specificity (88.2%) than the original. The presence of fever and one or more of cough, coryza, or  conjunctivitis scored the highest sensitivity among the combinations of signs and symptoms (77.0%), but  scored the lowest specificity (52.9%). The expanded case definition was sensitive in identifying suspected  cases of vaccine-modified measles. We suggest using this expanded definition for outbreak investigation in  a closed community, and consider further discussions on expanding the case definition of measles for  routine surveillance in South Korea.

Evaluation of an Expanded Case Definition for Vaccine-Modified Measles in a School Outbreak in South Korea in 2010