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 were 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.
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 were 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.
Authors: R L De Swart; Y Nur; A Abdallah; H Kruining; H S El Mubarak; S A Ibrahim; B Van Den Hoogen; J Groen; A D Osterhaus Journal: J Clin Microbiol Date: 2001-01 Impact factor: 5.948
Authors: H S el Mubarak; M W Van De Bildt; O A Mustafa; H W Vos; M M Mukhtar; J Groen; A M el Hassan; H G Niesters; S A Ibrahim; E E Zijlstra; T F Wild; A D Osterhaus; R L De Swart Journal: J Clin Microbiol Date: 2000-03 Impact factor: 5.948