MEASLES IN LARUT, MATANG AND SELAMA: ANALYSIS AND EVALUATION OF CLINICAL CASE DEFINITIONS FOR 2015-2019
An accurate system of identifying measles cases is critical for the measles surveillance system. The objectives were: 1) To determine the incidence rate of measles in Larut, Matang and Selama district in Perak from 2015 to 2019 2) To evaluate the measles clinical case definition by comparing the performance of the measles clinical case definition in predicting laboratory-confirmed measles case. A cross-sectional analysis was carried out looking at all suspected and laboratory-confirmed measles cases in Larut, Matang and Selama District registered on the online measles surveillance reporting system between 2015 to 2019. The sensitivity, specificity, positive predictive value and negative predictive value of the clinical case definition as confirmed by the laboratory result were calculated. The incidence rate for suspected measles showed an increasing trend from 3.96 per 100,000 population in 2015 to 28.82 per 100,000 population in 2019. For laboratory-confirmed measles cases, the incidence rate showed more variation with an increase to 36.11 per million population in 2017 from 5.67 per million population in 2015. The incidence rate later decreased to 10.99 per million population in 2018 and increased again to 24.47 per million population in 2019. The sensitivity of the clinical case definition in confirming measles was 86.67% (95% CI: 69.28%, 96.24%) , specificity 47.52% (95% CI: 41.56%, 53.52%), positive predictive value 14.95% (95% CI 12.81%, 17.36%) and negative predictive value 97.10% (93.03%, 98.83%). Measles incidence is increasing in trend. The clinical case definition is an effective tool to rule out measles in cases that failed to meet the criteria due to the high negative predictive value of the definition. However, for cases that meet the clinical case definition, laboratory confirmation or epidemiological link to a confirmed case is needed.
Bennett JE, Dolin R, Blaser MJ. Mandell, Douglas, and Bennett's : Principles and Practice of Infectious Diseases. Vol. 1. Elsevier Health Sciences 2014: 200-204.
World Health Organization. Immunization, Vaccines and Biologicals: Measles. January 2020 [cited 2020 February 06]. Available from: https://www.who.int/immunization/diseases/measles/en/
Centers for Disease Control and Prevention. Measles (Rubeola), for Healthcare Professionals. 2018 February 5 [Cited 2020 February 06]; Section: [Clinical Features]. Available from: https://www.cdc.gov/measles/hcp/index.html
Samb B, Aaby P, Whittle H, et al. Decline in Measles Case Fatality Ratio after the Introduction of Measles Immunization in Rural Senegal. American Journal of Epidemiology. 1997;145(1):51-57. doi: 10.1093/oxfordjournals.aje.a009031.
Cairns KL, Nandy R, Grais RF. Challenges in Measuring Measles Case Fatality Ratios in Settings without Vital Registration. Emerging Themes in Epidemiology. 2010;7(1):4.
Okamoto Y, Vricella LA, Moss WJ, et al. Immature CD4+ CD8+ Thymocytes are Preferentially Infected by Measles Virus in Human Thymic Organ Cultures. PloS One. 2012;7(9):e45999. doi.org/10.1371/journal.pone.0045999.
Rosen JB, Arciuolo RJ, Khawja AM, et al. Public Health Consequences of a 2013 Measles Outbreak in New York City. JAMA Pediatrics. 2018;172(9):811-817.
Perry RT, Gacic-Dobo M, Dabbagh A, et al. Progress Toward Regional Measles Elimination—Worldwide, 2000–2013. MMWR Morbidity and Mortality Weekly Report. 2014;63(45):1034.
Cheong AT, Tong SF, Khoo EM. How Useful is a History of Rubella Vaccination for Determination of Disease Susceptibility? A Cross-Sectional Study at a Public Funded Health Clinic in Malaysia. BMC Family Practice. 2013;14(1):19. doi.org/10.1186/1471-2296-14-1.
Saraswathy T, Zahrin HN, Norhashmimi H, et al. Impact of a Measles Elimination Strategy on Measles Incidence in Malaysia. Southeast Asian J Trop Med Public Health. 2009;40(4):742.
Sniadack DH, Mendoza-Aldana J, Jee Y, et al. Progress and Challenges for Measles Elimination by 2012 in the Western Pacific Region. The Journal of Infectious Diseases. 2011;204(suppl_1):S439-S446.
Hagan JE, Kriss JL, Takashima Y, et al. Progress Toward Measles Elimination—Western Pacific Region, 2013–2017. Morbidity and Mortality Weekly Report. 2018;67(17):491.
World Health Organization (Western Pacific Region). Measles-Rubella Bulletin. Manila: WHO. 2019; 13 (1): 1-10.
Abidin ZBZ. Factors Associated With Adherence Towards Different Vaccines OF Childhood Immunization of under Five Children among Mothers Attending Klinik Kesihatan Seremban [Master's Thesis]. Serdang (Selangor): Universiti Putra Malaysia; 2017.
World Health Organization. Eliminating measles and rubella and preventing congenital rubella infection: WHO European Region strategic plan 2005-2010. Denmark: WHO Regional Office Europe; 2005.
Ministry of Health Malaysia. Case Definitions for Infectious Diseases in Malaysia. 3rd Edition. Putrajaya: Disease Control Division; 2017.
Nsubuga F, Ampaire I, Kasasa S, et al. Positive Predictive Value and Effectiveness of Measles Case-Based Surveillance in Uganda, 2012-2015. PLOS ONE. 2017;12(9):e0184549. doi: 10.1371/journal.pone.0184549.
Hutchins SS, Papania MJ, Amler R, et al. Evaluation of the Measles Clinical Case Definition. The Journal of Infectious Diseases. 2004 May 1;189 Suppl 1:S153-9. doi: 10.1086/379652.
Data.gov.my [internet]. Putrajaya: Jabatan Ukur dan Pemetaan Malaysia; [cited 2020 February 06]. Available from http://www.data.gov.my/data/ms_MY/dataset/keluasan-malaysia/resource/f9c7dc6f-dd9d-4ea3-8eb3-f722e75d1de0
Kerajaan Negeri Perak. Basic Data Negeri Perak Darul Ridzuan 2016. Ipoh; Setiausaha Kerajaan Negeri Perak; 2016.
Government of Malaysia. Undang-Undang Malaysia: Akta Pencegahan dan Kawalan Penyakit Berjangkit 1988 (Act 342). Kuala Lumpur, Malaysia; 1988.
Liyanatul Najwa Z, Nadiatul Ima Z, Wan M, et al. The Concept of District Health Management in Malaysia. International Journal of Public Health and Clinical Sciences 2016;3(1):1-16.
Schluter WW, Xiaojun W, Mendoza-Aldana J, et al. Progress toward Measles Elimination—Western Pacific Region, 2009–2012. MMWR Morbidity and Mortality Weekly Report. 2013;62(22):443.
World Health Organization. Public health Laboratories for Alert and Response: a WHO Guidance Document. Manila: WHO Regional Office for the Western Pacific; 2012.
MEDCALC. Easy to use Statistical Software. Version 19.1.7. Ostend (Belgium): MedCalc Software Ltd; 2020.
Bujang MA, Adnan TH. Requirements for Minimum Sample Size for Sensitivity and Specificity Analysis. Journal of Clinical Diagnostic Res. 2016;10(10):YE01-YE06.
Muscat MJT. Who Gets Measles in Europe?. The Journal of Infectious Diseases. 2011;204(suppl_1):S353-S365.
Principi N, Esposito S. Early Vaccination: a Provisional Measure to Prevent Measles in Infants. The Lancet Infectious Diseases. 2019;19(11):1157-1158. doi: 10.1016/s1473-3099(19)30520-1.
European Centre for Disease Prevention and Control. Surveillance Report: measles and Rubella Surveillance 2017. Stockholm: European Centre for Disease Prevention and Control; 2018.
Guerra FM, Crowcroft NS, Friedman L, et al. Waning of Measles Maternal Antibody in Infants in Measles Elimination Settings–A Systematic Literature Review. Vaccine. 2018;36(10):1248-1255.
Hughes SL, Bolotin S, Khan S, et al. The Effect of Time since Measles Vaccination and Age at First Dose on Measles Vaccine Effectiveness–A Systematic Review. Vaccine. 2020; 38 (3):460-469.
Cáceres VM, Strebel PM, Sutter RW. Factors Determining Prevalence of Maternal Antibody to Measles Virus Throughout Infancy: A Review. Clinical Infectious Diseases. 2000;31(1):110-119.
Orenstein WA, Cairns L, Hinman A, et al. Measles and Rubella Global Strategic Plan 2012–2020 Midterm Review Report: Background and Summary. Vaccine. 2018;36:A35-A42.
World Health Organization. Measles vaccines: WHO position paper, April 2017–Recommendations. Vaccine. 2019;37(2):219-222.
Poletti P, Parlamento S, Fayyisaa T, et al. The Hidden Burden of Measles in Ethiopia: How Distance to Hospital Shapes the Disease Mortality Rate. BMC Medicine. 2018;16(1). doi: 10.1186/s12916-018-1171-y.
Figueiras A, Lado E, Fernández S, et al. Influence of Physicians' Attitudes on Under-Notifying Infectious Diseases: A Longitudinal Study. Public Health. 2004;118(7):521-526. doi: 10.1016/j.puhe.2003.12.015.
Mansuri FA, Kalar M. Factors Responsible for Under Reporting of Notifiable Infectious Diseases by General Practitioners: A Veiled Reality. Biomedica. 2014;30(2):126-129.
Bernard H, Werber D, Höhle M. Estimating the Under-Reporting of Norovirus Illness in Germany Utilizing Enhanced Awareness of Diarrhoea During a Large Outbreak of Shiga Toxin-Producing E. coli O104: H4 in 2011–A Time Series Analysis. BMC infectious diseases. 2014;14(1):116.
Akobeng AK. Understanding diagnostic tests: Sensitivity, Specificity and Predictive Values. Acta Paediatrica. 2007;96(3):338-341. doi: 10.1111/j.1651-2227.2006.00180.x.
Romaguera RA, German RR, Klaucke DJP, et al. Evaluating Public Health Surveillance. Principles and Practise of Public Health Surveillance. 2000;2:176-93.
Dabbagh A, Patel MK, Dumolard L, et al. Progress Toward Regional Measles Elimination—Worldwide, 2000–2016. MMWR Morbidity and Mortality Weekly Report. 2017;66(42):1148.
Clemmons NS, Wallace GS, Patel M, et al. Incidence of Measles in the United States, 2001-2015. JAMA. 2017;318(13):1279-1281.
liveira SAD, Camacho LAB, Pereira ACDM, et al. Assessment of the Performance of a Definition of a Suspected Measles Case: Implications for Measles Surveillance. Revista Panamericana de Salud Pública. 2006;19(4):229-235. doi: 10.1590/s1020-49892006000400002.
World Health Organization. Epidemiological Update Measles: Situation Summary. Washington: Pan American Health Organization; 2019.