Eskiocak Muzaffer, Ekuklu Galip, Doğaner E, Yilmaz Neziha, Saltik Ahmet
Trakya Universitesi Tip Fakültesi, Halk Sağliği Anabilim Dali, Edirne.
Mikrobiyol Bul. 2008 Jan;42(1):143-8.
Measles is still a leading cause of death among young children, despite the availability of a safe and effective vaccine for the past 40 years. EURO Region of World Health Organisation including Turkey has targeted elimination of measles by the year 2010. It is concluded that there must be a sensitive surveillance system to investigate all suspicious measles cases, and diagnosis should be based on both standardized case definition and laboratory confirmation. Standardized case definition based notification has started in 2005 in Turkey. This study was carried out to determine the sensitivity and specificity of clinical measles diagnosis by physicians and families during a measles epidemic affecting 597 cases in Edirne province in 1997. Blood samples and data were collected by trained teams consisting of one physician and one nurse. Thirty clusters sampling method was used for sampling and 210 blood samples were taken from the children. The sera were then sent to Refik Saydam Hygiene Institute, Ankara, for the detection of measles specific IgG and IgM antibodies. Positive results for IgM were considered as acute measles during epidemics, and positive results for IgG were considered as acquired immunity due to vaccination or passed infection. Of 210 children, 19 were found to have recent infection (IgM+, IgG-), 101 were found immune (IgM-, IgG+), 67 were found in convalescence phase after infection (IgM+, IgG+), and 23 were found susceptible (IgM-, IgG-) to measles. The overall IgM seropositivity was detected as 40.9% in the study group. Only half of confirmed cases (43/86) were diagnosed as measles clinically by the physicians. The sensitivity, specificity, positive and negative predictive values (PPV and NPV, respectively) of clinical diagnosis by physicians were estimated as 33%, 89%, 67% and 86%, respectively. Validity measures for measles diagnosis by the families were as follows; 8% sensitivity, 96% specificity, 6% PPV and 60% NPV. It is concluded that, all required measures should be taken for the availability of laboratory confirmation of all suspicious measles cases and field investigation via structured case investigation forms, is necessary for the success of measles surveillance system in our country.
尽管在过去40年里已有安全有效的疫苗，但麻疹仍是幼儿死亡的主要原因。世界卫生组织欧洲区域（包括土耳其）的目标是到2010年消除麻疹。得出的结论是，必须有一个敏感的监测系统来调查所有可疑麻疹病例，诊断应基于标准化病例定义和实验室确诊。基于标准化病例定义的通报于2005年在土耳其开始。本研究旨在确定1997年在埃迪尔内省发生的一起影响597例病例的麻疹疫情期间，医生和家庭对临床麻疹诊断的敏感性和特异性。由一名医生和一名护士组成的训练有素的团队收集血样和数据。采用三十群抽样法进行抽样，从儿童中采集了210份血样。然后将血清送往安卡拉的雷菲克·赛伊丹卫生研究所，以检测麻疹特异性IgG和IgM抗体。在疫情期间，IgM阳性结果被视为急性麻疹，IgG阳性结果被视为因接种疫苗或既往感染而获得的免疫力。在210名儿童中，发现19名近期感染（IgM阳性，IgG阴性），101名有免疫力（IgM阴性，IgG阳性），67名处于感染后的恢复期（IgM阳性，IgG阳性），23名对麻疹易感（IgM阴性，IgG阴性）。研究组总体IgM血清阳性率检测为40.9%。只有一半的确诊病例（43/86）被医生临床诊断为麻疹。医生临床诊断的敏感性、特异性、阳性预测值和阴性预测值（分别为PPV和NPV）估计分别为33%、89%、67%和86%。家庭对麻疹诊断的有效性指标如下：敏感性8%，特异性96%，PPV 6%，NPV 60%。得出的结论是，应采取一切必要措施以实现对所有可疑麻疹病例的实验室确诊，并且通过结构化病例调查表进行现场调查，对于我国麻疹监测系统的成功至关重要。
