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Difficulties in clinical diagnosis of measles: proposal for modified clinical case definition
Author(s) -
Ferson Mark J,
Young Lorraine C,
Robertson Peter W,
Whybin L Ross
Publication year - 1995
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/j.1326-5377.1995.tb124630.x
Subject(s) - measles , medicine , rash , rubella , epidemiology , serology , pediatrics , measles virus , clinical diagnosis , complement fixation test , public health , immunology , vaccination , pathology , antibody
Objective To examine the accuracy of clinical diagnosis of measles and to develop an improved measles clinical case definition. Design Case survey. Setting Eastern Sydney, December 1990 to August 1993. Subjects All cases of measles notified to the Eastern Sydney Public Health Unit without or before serological confirmation. Outcome measures Demographic and clinical details, measles‐ and rubella‐specific IgM and measles complement fixation titres in acute and convalescent (when available) sera and epidemiological links with confirmed measles cases. Results Of 49 subjects reported and with complete follow‐up, 24 w'ere confirmed with measles, four with rubella and 21 had no definite diagnosis. Clinical diagnosis of measles had a false positive rate of 51%. Subjects with confirmed measles were significantly more likely to have a cough (23/24) than those with no definite diagnosis (15/21; P=0.03) and to be febrile on the day of rash onset (23/24 versus 10/21; P= 0.001). The Centers for Disease Control definition had a sensitivity of 92% but specificity of only 24%. A modified case definition of rash, cough and fever present at onset of rash had equal sensitivity but greater specificity (57%). Conclusions As measles is no longer common in Australia, clinical diagnosis is unreliable. When a public health response is needed, cases should be confirmed by serological tests or, if not available, we propose use of our modified clinical case definition.