title: Evaluation of the measles clinical case definition.
abstract: 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 (>or=38.3 degrees 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/100000 population to 1.3 cases/100000 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.
authors.affiliation: National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. ssh1@cdc.gov.
authors.forename: Sonja S
authors.initials: SS
authors.lastname: Hutchins
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Papania
authors.forename: Robert
authors.initials: R
authors.lastname: Amler
authors.forename: Edward F
authors.initials: EF
authors.lastname: Maes
authors.forename: Mark
authors.initials: M
authors.lastname: Grabowsky
authors.forename: Kenneth
authors.initials: K
authors.lastname: Bromberg
authors.forename: Victoria
authors.initials: V
authors.lastname: Glasglow
authors.forename: Tamika
authors.initials: T
authors.lastname: Speed
authors.forename: William J
authors.initials: WJ
authors.lastname: Bellini
authors.forename: Walter A
authors.initials: WA
authors.lastname: Orenstein
mesh_terms: D000293:Adolescent; D000914:Antibodies, Viral / Q000097:blood*; D017691:Caribbean Region / Q000453:epidemiology; D003168:Complement Fixation Tests; D006385:Hemagglutination Inhibition Tests; D006801:Humans; D007124:Immunoenzyme Techniques; D007075:Immunoglobulin M / Q000097:blood; D015994:Incidence; D008457:Measles / Q000175:diagnosis* / Q000453:epidemiology; D008459:Measles virus / Q000276:immunology*; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D013532:Suriname / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D014687:Venezuela / Q000453:epidemiology
chemical_list: D000914:Antibodies, Viral; D007075:Immunoglobulin M