Notifications of measlesBMJ 1994; 308 doi: https://doi.org/10.1136/bmj.308.6942.1511b (Published 04 June 1994) Cite this as: BMJ 1994;308:1511
EDITOR, - David W G Brown and colleagues' finding that only 17% of sporadic cases of measles were confirmed serologically is not surprising.1 From February to July 1993 we carried out a survey to determine whether notifications of measles in Tameside Metropolitan Borough were based on reasonable clinical suspicion. We defined a notification as reasonable if the patient had had fever; a rash over the face and body lasting at least three days; and one of cough, coryza, and sore eyes.2 For notified cases we interviewed the parents and asked about symptoms and signs; vaccination history; history of measles; and whether, before becoming ill, the patient had been in contact with someone known to have measles. Vaccination history was also checked against child health computer records.
The parents in 35 of 42 cases were available for interview. None gave a history of contact with someone with measles. Only 10 patients fulfilled the criteria, of whom two were under 1 year old and four had been immunised against measles. Of the remaining four patients, three were young men aged between 20 and 22. Ten patients had not had a fever, and 18 had not had a rash of appropriate distribution or duration. Nine were under 1 year old, the youngest being 6 weeks old.
The criteria used in this study were fairly non-specific and would have resulted in the notification of many illnesses other than measles. This makes the notification system impracticable for detecting outbreaks or monitoring vaccination programmes. In addition, many parents in this study expressed anxiety at the diagnosis of measles, particularly in young babies, so care should be taken to ensure that the diagnosis is correct.
Measles is now relatively rare in Britain, and some general practitioners seem to be uncertain of the clinical signs and symptoms. We look forward to the widespread availability of salivary testing and to the day when laboratory confirmation of the diagnosis before notification becomes routine.