title: A risk stratification approach to assessing for true cases of measles in a highly vaccinated population.
abstract: OBJECTIVE
  In Australia, the notification rate for measles fluctuates greatly between baseline and outbreak periods. We aimed to identify characteristics of notified cases that allow risk stratification in order to improve the efficiency of the public health response in an outbreak setting.
  
  
  METHODS
  Retrospective descriptive case series for all measles notifications made to the Victorian Government Department of Health between 1 August and 30 September 2013.
  
  
  RESULTS
  A total of 151 notifications were included in the analyses, of which 17 (11%) were confirmed as measles. Applying the clinical criteria of the measles case definition or identifying susceptible cases (determined by vaccination status) correctly identified all measles cases. Requiring cases to meet both criteria reduced sensitivity to 88%, but improved the positive predictive value (48% vs 25%) and retained a high negative predictive value (98.33%). Application of a risk stratification approach based on these features would have saved intensive public health follow-up for 79.5% of notifications in this outbreak.
  
  
  CONCLUSIONS
  Immune status and clinical features can reliably be used to predict which notifications are unlikely to become confirmed cases.
  
  
  CONCLUSIONS
  Risk stratification and modification of current surveillance practices may provide for a more efficient public health response, particularly during periods of increased case notification.
authors.affiliation: Communicable Disease Prevention and Control, Victorian Department of Health.|Department of Infectious Diseases, Austin Health, Victoria.
authors.forename: Katherine
authors.initials: K
authors.lastname: Bond
authors.affiliation: Communicable Disease Prevention and Control, Victorian Department of Health.
authors.forename: Veronica
authors.initials: V
authors.lastname: Martin-Gall
authors.affiliation: Communicable Diseases Epidemiology and Surveillance, Victorian Department of Health.
authors.forename: Lucinda
authors.initials: L
authors.lastname: Franklin
authors.affiliation: Communicable Disease Prevention and Control, Victorian Department of Health.
authors.forename: Brett
authors.initials: B
authors.lastname: Sutton
mesh_terms: D000293:Adolescent; D000328:Adult; D001315:Australia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D018563:Disease Notification / Q000379:methods / Q000706:statistics & numerical data; D004196:Disease Outbreaks / Q000517:prevention & control* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008457:Measles / Q000453:epidemiology*; D008458:Measles Vaccine; D011237:Predictive Value of Tests; D011634:Public Health / Q000379:methods*; D012189:Retrospective Studies; D012306:Risk; D014611:Vaccination / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D008458:Measles Vaccine
keywords: Australia; measles; public health