The Clinical Characteristics of Rash and Fever Illnesses and the Sensitivity and Specificity of Different Diagnostic Criteria

In order to study the clinical characteristics of measles and other rash and fever illnesses (RFIs) and find out the sensitivity and specificity of diagnostics diagnostics criteria, so as to carry out measles surveillance well, an investigation of RFIs was launched in 3 counties and 1 district of Xinxiang prefecture in Henan Province from March 1996 to March 1997. Through analyzing the clinical Characteristics of RFIs, we found that measles and rubeds had significant differences in clinical aspects, especially in fever, days of rash, the of rash occur after fever. The classical case definition, WHO criteria, of at least 3 days of generalized rash, history of a fever of 38℃ or more, and "1 of the 3 Cs (cough, coryza and conjunctivitis)" had a sensitivity of 81% and a specificity of 73%. The sensitivity and specificity of Chinese measles clinical diagnostic criteria, at least 3 days of generaled rash starting from face/neck, history of a fever of 38℃ or more, and/or "1 or the 3 Cs",were 78% and 83% respectively. A case definition of rub on the third day or later after fever, history of a fever of 38℃ or more, and "1 of the 3 Cs" yielded a sensitivity of 88% and a specificity of 74%. In measles surveillance, we should consider: (1) taking rash occurring on the third day or later after fever as part of clinical measles case definition, (2) taking rash, fever and "1 of the 3Cs" as suspected measles cases definition, and (3) taking different surveillance strategy to areas with different measles status.

中文摘要 ： 为了探索麻疹和其它发热出疹性疾病的临床特点及其诊断的特异度和敏感度，更好地开展麻疹监测，于1996年3月～1997年3月，在河南省3个县1个区开展了发热出疹性病例的流行病学调查。临床分析发现，麻疹和风疹在发热、出疹天数、出疹时间等症状和体征有明显差异；世界卫生组织（WHO）和我国麻疹临床诊断标准的敏感度和特异度分别为81％、73％和78％、83％；如以“发热≥38℃，发热后第3天或以后出疹，并伴有咳嗽、卡他性鼻炎或结膜炎症状之一者”作为麻疹诊断标准，敏感度和特异度分别为88％和74％．建议：以“发热后第3天或以后出疹（即发热后48小时或以后）”作为麻疹临床诊断指标的一部分；以“发热、出疹并伴有