Measles diagnostic criteria
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alejandro Lemor, M.D. [2]
Overview
A measles case is confirmed in a person with febrile rash illness and laboratory confirmation or a direct epidemiologic link to a confirmed case.
Case Definitions
- Clinical case definition is considered any person with fever, and maculopapular rash and cough, coryza or conjunctivitis.[1]
- A laboratory-confirmed case meets the clinical case definition and is laboratory-confirmed or linked epidemiologically to a laboratory-confirmed case.[1]
- Laboratory-confirmed is defined as at least 4 fold increase in antibody titer, or isolation of measles virus or presence of measles-specific IgM antibodies.[1]
- Epidemiological linkage is defined as direct contact with another laboratory-confirmed measles case in which rash onset occurred 7-18 days before the present case.[1]
- Cases are considered imported if exposure to measles virus occurred outside the United States 7–21 days before rash onset and rash occurred within 21 days of entry into the United States, with no known exposure to measles in the United States during that period.
Case confirmation flow chart Adapted from WHO Guidelines For Epidemic Preparedness And Response To Measles Outbreaks[1]
| Suspected measles case | |||||||||||||||||||||||||||||||||||
| Adequate blood specimen† | Non adequate blood specimen† | ||||||||||||||||||||||||||||||||||
| IgM Negative | IgM Positive | Epidemiologic link to laboratory confirmed case | No epidemiologic link to laboratory confirmed case | ||||||||||||||||||||||||||||||||
| Discard | Laboratory confirmed | Clinically confirmed | |||||||||||||||||||||||||||||||||
A suspected measles case that has been completely investigated, including the collection of an adequate blood specimen, and lacks serological evidence of measles virus infection can be classified as discarded. | A case that meets the clinical case definition and that is laboratory-confirmed or linked epidemiologically to a laboratory-confirmed case. | A suspected measles case that, for any reason, is not completely investigated is considered to be clinically confirmed | |||||||||||||||||||||||||||||||||
† Adequate blood sample is considered a single serum obtained at the first contact with the health care system, regardless of which day following the rash onset.