Negative impact of clinical misdiagnosis of measles on health workers' confidence in measles vaccine.
We conducted a survey to determine the accuracy of the clinical diagnosis of measles in Zimbabwe. Between December 1996 and February 1997, we collected blood samples and clinical and demographic information from a sample of 105 children with a clinical diagnosis of measles. A clinical case of measles was defined as a person with a history of fever, rash for three or more days, and either cough, coryza, or conjunctivitis. A laboratory-confirmed case of measles or rubella had IgM antibodies against measles virus or rubella virus respectively. A total of 91% of children met the clinical case definition. Among those who met the clinical case definition for measles, 72% were IgM-positive for measles virus only, 23% were IgM-positive for rubella virus only, 3% were IgM-positive for both measles and rubella viruses, and 2% were IgM-negative for both viruses. This study demonstrates the importance of considering selective laboratory confirmation of measles in periods of high disease incidence when the effectiveness of the vaccine is questioned.
Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
R F
RF
Helfand
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T
Chibi
R
R
Biellik
A
A
Shearley
W J
WJ
Bellini
D000293:Adolescent; D000914:Antibodies, Viral / Q000097:blood; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D002648:Child; D002675:Child, Preschool; D019411:Clinical Laboratory Techniques / Q000592:standards; D003906:Developing Countries; D003951:Diagnostic Errors / Q000706:statistics & numerical data*; D006801:Humans; D007124:Immunoenzyme Techniques / Q000592:standards; D007070:Immunoglobulin A / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D015994:Incidence; D007223:Infant; D008457:Measles / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D008458:Measles Vaccine / Q000592:standards*; D008459:Measles virus / Q000276:immunology; D009341:Negativism; D010808:Physical Examination / Q000592:standards; D012409:Rubella / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D012412:Rubella virus / Q000276:immunology; D012423:Rural Health / Q000706:statistics & numerical data; D012680:Sensitivity and Specificity; D014611:Vaccination / Q000592:standards* / Q000706:statistics & numerical data; D015030:Zimbabwe / Q000453:epidemiology
D000914:Antibodies, Viral; D007070:Immunoglobulin A; D007075:Immunoglobulin M; D008458:Measles Vaccine