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Assessment of the performance of a definition of a suspected measles case: implications for measles surveillance.

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Title: Assessment of the performance of a definition of a suspected measles case: implications for measles surveillance.
Authors: de Oliveira SA (AUTHOR), Camacho LAB (AUTHOR), Pereira ACM (AUTHOR), Setúbal S (AUTHOR), Nogueira RMR (AUTHOR), Siqueira MM (AUTHOR)
Source: Pan American Journal of Public Health / Revista Panamericana de Salud Pública. Abr2006, Vol. 19 Issue 4, p229-235. 7p.
Abstract (Portuguese): OBJECTIVE: To assess the performance, in Brazil, of the definition of a suspected measles case among patients with rash diseases that has been adopted in Brazil and many other countries. METHODS: From January 1994 to December 2003, patients with acute rash were seen at two large primary health care units and a public general hospital in Niteroi, a city in the metropolitan area of the city of Rio de Janeiro, Brazil. Data from clinical and serologic assessment were used to estimate sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the definition of a suspected measles case that has been adopted in Brazil, as well as other combinations of signs and symptoms; serologic status was taken as the reference. Using enzyme immunoassay, serum samples were tested for immunoglobulin M (IgM) antibodies against measles virus. RESULTS: A total of 1,221 patients with an illness characterized by different combinations of rash with other signs and symptoms were studied. The suspected case definition that has been adopted in Brazil (rash, fever, and at least one of the following: cough, coryza, or conjunctivitis) had an overall sensitivity of 100%, and a specificity of 58.7%. Confirmed measles cases were 2.4 times as likely as were other rash diseases to have that combination of signs/symptoms. The suspected case definition adopted in Brazil had a 6% PPV and 100% NPV. The combination of all five signs and symptoms had the highest specificity, PPV, and likelihood ratio, for both children (< 15 years old) and adults (> or = 15 years). That was achieved at the expense of sensitivity, which dropped to 89%, but the NPV was still very high. CONCLUSIONS: Our results show that the suspected measles case definition adopted in Brazil is extremely sensitive for measles surveillance among patients with rash diseases. However, the high false-positive rates that were found may result in a substantial number of other rash diseases being misclassified as measles, leading to the misdirection of control measures and increases in their cost. [ABSTRACT FROM AUTHOR]
Copyright of Pan American Journal of Public Health / Revista Panamericana de Salud Pública is the property of Pan American Health Organization and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: OBJECTIVE: To assess the performance, in Brazil, of the definition of a suspected measles case among patients with rash diseases that has been adopted in Brazil and many other countries. METHODS: From January 1994 to December 2003, patients with acute rash were seen at two large primary health care units and a public general hospital in Niteroi, a city in the metropolitan area of the city of Rio de Janeiro, Brazil. Data from clinical and serologic assessment were used to estimate sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the definition of a suspected measles case that has been adopted in Brazil, as well as other combinations of signs and symptoms; serologic status was taken as the reference. Using enzyme immunoassay, serum samples were tested for immunoglobulin M (IgM) antibodies against measles virus. RESULTS: A total of 1,221 patients with an illness characterized by different combinations of rash with other signs and symptoms were studied. The suspected case definition that has been adopted in Brazil (rash, fever, and at least one of the following: cough, coryza, or conjunctivitis) had an overall sensitivity of 100%, and a specificity of 58.7%. Confirmed measles cases were 2.4 times as likely as were other rash diseases to have that combination of signs/symptoms. The suspected case definition adopted in Brazil had a 6% PPV and 100% NPV. The combination of all five signs and symptoms had the highest specificity, PPV, and likelihood ratio, for both children (&lt; 15 years old) and adults (&gt; or = 15 years). That was achieved at the expense of sensitivity, which dropped to 89%, but the NPV was still very high. CONCLUSIONS: Our results show that the suspected measles case definition adopted in Brazil is extremely sensitive for measles surveillance among patients with rash diseases. However, the high false-positive rates that were found may result in a substantial number of other rash diseases being misclassified as measles, leading to the misdirection of control measures and increases in their cost. [ABSTRACT FROM AUTHOR]
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  Data: &lt;i&gt;Copyright of Pan American Journal of Public Health / Revista Panamericana de Salud P&#250;blica is the property of Pan American Health Organization and its content may not be copied or emailed to multiple sites without the copyright holder&#39;s express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.&lt;/i&gt; (Copyright applies to all Abstracts.)
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        Value: 10.1590/s1020-49892006000400002
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        Text: Portuguese
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              Text: Abr2006
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