Evaluation of the measles clinical case definition

Sonja S. Hutchins, Mark J. Papania, Robert Amler, Edward F. Maes, Mark Grabowsky, Kenneth Bromberg, Victoria Glasglow, Tamika Speed, William J. Bellini, Walter A. Orenstein

Research output: Contribution to journalReview articlepeer-review

66 Scopus citations


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 (≥38.3°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/100,000 population to 1.3 cases/100,000 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.

Original languageEnglish
Pages (from-to)S153-S159
JournalJournal of Infectious Diseases
Issue numberSUPPL. 1
StatePublished - 1 May 2004
Externally publishedYes


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