Abstract
The World Health Organization (WHO) Western Pacific Region has established specific measles elimination surveillance indicators. There has been concern in Australia that these indicators may be too stringent and that measles elimination can occur without all surveillance prerequisites being met, in particular the minimum fever and rash clinician-suspected measles reporting rate with subsequent laboratory exclusion of measles. A regional public health unit in northern New South Wales, Australia, prompted local general practitioners to report fever and rash presentations that met the measles case definition or that they considered to be clinical measles. These notifications from July 2006 to June 2008 were reviewed to determine whether measles indicators for monitoring progress towards measles elimination could be achieved in Australia. Results confirmed that the surveillance indicators of ">2 reported suspected measles cases per 100 000 population," "at least 80% of suspected cases adequately investigated within 48 hours" and "greater than 80% of cases had adequate blood samples collected" could be met. Only half the cases had virology that would allow genotyping of measles virus. Special efforts to engage and convince Australian medical doctors about the public health value of reporting clinically suggestive measles cases and collecting confirmatory blood tests resulted in the current WHO Western Pacific Region indicators for progress towards measles elimination being met in a regional area of Australia.
Highlights
Measles continues to occur in Australia with most cases in recent years resulting directly from importation of the virus
We reviewed suspected measles cases reported between July 2006 and June 2008 in a regional area of northern New South Wales to determine whether the Western Pacific Region indicators for monitoring progress towards measles elimination were met at the subnational level and what implications there might be for documenting sustained elimination in Australia
All suspected measles notifications to the local Public Health Unit are routinely recorded in a secure dedicated Microsoft Excel 2007 spread sheet, and information on probable and confirmed cases is entered into the New South Wales (NSW) Notifiable Conditions Information Management System
Summary
Measles continues to occur in Australia with most cases in recent years resulting directly from importation of the virus. Laboratory definitive evidence At least one of the following: 1. Detection of measles virus by nucleic acid testing, OR 3. IgG seroconversion or a significant increase in antibody level or a fourfold or greater rise in titre to measles virus EXCEPT if the case has received a measles-containing vaccine 8 days to 8 weeks before testing, OR 5. Detection of measles virus specific IgM antibody confirmed in an approved reference laboratory EXCEPT if the case has received a measles-containing vaccine 8 days to 8 weeks before testing. Clinical evidence An illness characterized by all of the following: 1. Contact between two people involving a plausible mode of transmission at a time when: a) one of them is likely to be infectious (approximately 5 days before to 4 days after rash onset), AND b) the other has an illness that starts within 7 to 18 (usually 10) days after this contact, AND Epidemiological evidence An epidemiological link is established when there is: 1. Contact between two people involving a plausible mode of transmission at a time when: a) one of them is likely to be infectious (approximately 5 days before to 4 days after rash onset), AND b) the other has an illness that starts within 7 to 18 (usually 10) days after this contact, AND
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