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Med J Aust. 1995 Oct 2;163(7):364-6.

Difficulties in clinical diagnosis of measles: proposal for modified clinical case definition.

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1
Public Health Unit, Eastern Sydney Area Health Service, NSW.

Abstract

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.

PMID:
7565261
[Indexed for MEDLINE]

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