MEASLES ELIMINATION PLAN - Belgium April 2004
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MEASLES ELIMINATION PLAN
Belgium
April 2004TABLE OF CONTENTS
1. INTRODUCTION 5
2. BACKGROUND 6
Incidence of measles 6
National immunization policy 7
Vaccination coverage 8
Seroprevalence study 8
Measles surveillance system 8
3. ACTION PLAN 10
General goal 11
Specific goals 11
Activities 11
1) Immunization 11
2) Measles surveillance 12
3) Advocacy 14
Budget 14
APPENDIX
Information booklet ‘Surveillance de maladies rares chez l’enfant en Belgique’ 154
1. INTRODUCTION
With nearly one million deaths attributed to measles yearly, measles remains a major
cause of vaccine-preventable illness and death worldwide.
The European Regional Office of WHO has targeted measles for elimination from the
region by the year 2010.
The overall objectives of the strategic plan for the elimination of measles and
congenital rubella infection in the European Region, adopted in 1998 by the WHO for
2010 are:
- to interrupt the indigenous transmission of measles 1 ; and
- to prevent congenital rubella infection(< 1 case of CRS per 100.000 live
births).
Six key strategies are recommended for meeting these objectives:
1) achieving and sustaining very high coverage with two doses of measles
vaccine through high-quality routine immunization services;
2) providing a second opportunity for measles immunization through
supplemental immunization activities to populations susceptible to measles,
consistent with national targets for measles control;
3) using the opportunity provided by supplemental measles immunization
activities to target populations susceptible to rubella where appropriate;
4) ensuring protection to women of childbearing age by providing high coverage
with one dose of rubella vaccine;
5) strengthening surveillance systems by vigorous case investigation and
laboratory confirmation; and
6) improving the availability of high-quality, valued information for health
professionals and the public on the benefits and risks associated with
immunization against measles and rubella
A Committee for the Elimination of Measles in Belgium was set up in January 2003.
Members of the committee are representatives from the Ministry of Public Health,
representatives from the three regions of Belgium (the Flemish community, the
French speaking community and the region of Brussels), representatives from
associations of paediatricians and general practitioners, virologists and
epidemiologists.
The Belgian government approved the composition of the committee in April 2003.
The role of the committee is to elaborate a national action plan and follow-up
implementation of activities.
Strategies for the control of CRS might not be implemented in the first period.
1
The situation in which sustained virus transmission cannot occur and secondary spread from
importation of disease will end naturally without intervention.2. BACKGROUND
Incidence of measles
In 1979-1980 and from 1982 up to 2000, measles surveillance occurred through a
sentinel network of about 150 General Practitioners (GP’s) representative of the total
group of Belgian GP’s and covering 1.5% of the Belgian population.
Cases of measles were only clinically diagnosed. Incidence figures obtained by the
sentinel system are underestimates of the true incidence, but are useful as an indicator
of the trends over the years.
As illustrated in table 1 and figure 1, the reported incidence of measles in Belgium
decreased from 998 per 100 000 in 1982 to 6 per 100 000 in 1999.
Table 1: Incidence of measles infection per 100.000 population in Belgium
Incidence 95% CI
1995 105 89 - 120
1996 71 57 - 93
1997 38 28 - 49
1998 16 10 - 24
1999 6 3 - 11
Over the years, differences in incidence rates have been observed between the
Flemish and the French community (Figure 1).
Figure 1: Incidence of measles infection per 100.000 population in the Flemish
and French community (1982-1999)
1400
Incidence per 100.000 population
1200
1000
800
Flemish community
600 French community
400
200
0
1982 1984 1986 1988 1990 1992 1994 1996 1998
As expected following widespread use of measles vaccine, the average age at
infection with measles increases (Figure 2).
6Figure 2: Age distribution of measles cases in Belgium (1982-1999)
50
45
40
35 < 1year
1-4 years
30
5-9 years
25
10-14 years
20
15-19 years
15 > 19 years
10
5
0
1982-1984 1985-1987 1988-1990 1991-1993 1994-1996 1997-1999
With the incidence of measles decreasing to low levels (only 8 cases were reported by
the sentinel system in 1999), the sentinel network of GP’S was considered
inappropriate to assure further surveillance and surveillance of measles stopped in
2000.
No data are available for the years 2000-2002.
Surveillance of measles was reintroduced in October 2002 through a network of
paediatricians and GP’s (see further).
In 2003, 24 cases of measles (mainly clinical diagnosis) were notified by the
surveillance system, while 18 other cases have been identified through school health
services or laboratories.
In June 2003, a cluster of measles cases was reported in a school in Brussels. Through
the surveillance network, two additional schools with measles cases were identified in
the neighbourhood. In total 16 cases of measles were notified, aged between 6 and 10
years old. Two cases (12.5%) were laboratory confirmed. The index case of the
outbreak is likely to be an unvaccinated child who had spent Easter holidays in Italy.
National immunization policy
Measles vaccine is included in the routine childhood immunization in Belgium, but is
not mandatory.
Measles vaccines became available on the Belgian market in 1975. Mass vaccination
against measles started in 1985 with the combined measles-mumps-rubella vaccine
(MMR), administered at the age of 15 months. From 1994 on, it was recommended to
routinely administer a second dose of MMR at the age of 10-12 years.
In 2002, the National Health Council recommended to administer the MMR vaccine
at the age of 12 months. Vaccination status should be checked at school for children
aged 5-6 years, and completed if necessary.
7Vaccination coverage
The most recent data available on measles vaccine coverage are those from the 1999,
2000 and 2003 random cluster sampling surveys conducted in the three regions, as
represented in Table 2.
In 2004, the Flemish Community will carry out a cluster vaccine coverage survey in
18-24 months old and in 12 years old children.
Table 2: Immunization coverage in 18-24 months old children, Belgium, 1999 - 2003
Measles Wallonia Flanders Brussels-Capital Region
vaccine
(MMR) 1999 (n=835) 2003 (n=767) 1999 (n=1005) 2000 (n=564)
% 95 % CI % 95 % CI % 95 % CI % 95 % CI
1st dose 82,4 79,8 – 85,0 82,5 79,7 – 85,4 83,4 80,3 – 86,5 74,5 70,1 - 78,9
Routine first-dose coverage rates in the three regions are below the 95% coverage
goal for measles elimination. Furthermore, when looking to figures from Wallonia,
the coverage rates seem to have stabilized around 80 - 85% since 1999.
Reliable coverage data for the second dose of MMR are currently not available.
The latest change in vaccination schedule, recommending earlier administration of the
first dose of MMR, jointly with vaccination against Meningococcus C (routinely
implemented since 2001), is expected to improve first-dose coverage.
Seroprevalence study
Belgium participates in the European Sero-Epidemiology Network 2 project (ESEN
2). The overall aim of this project is to co-ordinate and harmonise the serological
surveillance of immunity to several vaccine preventable diseases, including measles.
As part of the Belgian participation in the project, a serum bank (3378 sera)
representative for the Belgian population between 1 and 65 years old was established
between November 2001 and March 2003. Results for measles serology will be
available later in 2004.
Measles surveillance system
Measles is not a notifiable disease in Belgium, except within the framework of
notification of infectious diseases in schools to health inspectors of the communities.
Following the success of the British Paediatric Surveillance Unit (BPSU) for
surveillance of rare paediatric diseases, the same methodology has been adopted to set
up a surveillance system in Belgium, using a monthly reporting system of several rare
paediatric conditions, including measles and rubella. Surveillance officially started in
October 2002.
The surveillance is carried out by paediatricians of Belgium and, to start with, general
practitioners (GP’s) from the region of Brussels. Possible extension to other GP’s willbe considered in future. A total of 2130 medical doctors (1150 paediatricians and 980
GP’s) are registered in these two categories and have been contacted to participate in
the surveillance network.
All of them received a booklet with information on the surveillance system and on the
importance to participate (appendices 1 and 2). Medical doctors report on a voluntary
base, through an Internet website or by returning a form by mail in the first week of
each month. Zero-reporting is requested.
Globally 38% of doctors are willing to participate, but actual monthly participation
fluctuates around 28 %.
Doctors reporting a case of measles receive a questionnaire to collect epidemiological
data (appendices 1 and 2).
Case-based surveillance data is transferred to the European surveillance of vaccine
preventable diseases network Euvac.Net based at the Statens Serum Institut,
Copenhagen, Denmark. The network involves surveillance institutions in the 15
European Union countries plus Iceland, Norway, Switzerland and Malta and
collaborates with the WHO.
Measles surveillance data is collected and analysed for the purpose of describing the
epidemiology of measles in participating countries.
According to the case definitions for communicable diseases listed in Decision No
2119/98/EC from the European Commission, the following case definition is applied
to measles:
Clinical description
Clinical picture compatible with measles, i.e. a generalised rash lasting >3 days and a
temperature >38.0 C and one or more of the following: cough, coryza, Koplik’s spots,
conjunctivitis.
Case classification2
Possible: A case diagnosed by a physician as measles
Probable: A clinically compatible case (see above)
Confirmed: A case that is laboratory confirmed or a clinically compatible case
with an epidemiological link. A laboratory-confirmed case does not
need to meet the clinical case definition.
2
A probable case of measles in this classification corresponds to a clinically confirmed case in WHO
classification.
9Flow chart
3
IgM negative Discard
Adequate
specimen
IgM positive
Confirmed
Suspected
measles case Epidemiological link
to lab confirmed
case
No adequate No epidemiological Probable
specimen link to lab confirmed measles case
case
No clinical data Possible
available measles case
3. ACTION PLAN
According to WHO, countries can be classified into one of three stages of control of
measles.
Stage I: limited measles control
Countries with vaccine coverage consistently less than 90% with at least one dose
have had an accumulation of susceptible cohorts in the population over time. Measles
epidemics continue to occur, with inter-epidemic periods of ≤ 5 years, often in
younger age groups with more serious outcomes.
Stage II: measles control
Countries with verified measles vaccine coverage sustained at a high level (90–95%)
with at least one dose of measles vaccine continue to have measles epidemics, but
with an inter-epidemic period of > 5 years, often primarily affecting older age groups.
Stage III: approaching measles elimination
Countries with measles vaccine coverage sustained at a very high level (>95%
nationally; >90% in all districts) with two opportunities for measles vaccination, and
who have addressed older susceptible age cohorts. There is evidence that
transmission of indigenous measles has been interrupted.
With the routine first-dose vaccine coverage consistently less than 90%, Belgium is
still in stage I of limited measles control.
3
While IgM ELISA tests are more sensitive between days 4 and 28 after the onset of rash, a single
serum sample obtained at the first contact with the health care system within 28 days after onset is
considered adequate for measles surveillance
10In line with WHO recommendations made in the strategic plan for the elimination of
measles in the European Region, the following goals are proposed:
General goal:
- To interrupt the indigenous transmission of measles in Belgium by the year
2010.
Specific goals:
- Improve routine vaccination coverage levels to at least 95% in the three
regions of Belgium.
- Achieve coverage above 95% with a routine second dose of measles vaccine.
- Establish a sensitive surveillance system for vaccine coverage and for
suspected measles cases with laboratory confirmation.
In order for these goals to be attained, a national plan of action is to be implemented
and political commitment and resources will be required.
Activities will specifically aim to improve the current epidemiological surveillance
system and reinforce the role of the laboratory in measles surveillance.
Activities
1) Immunization
1.1. Implementation of immunization
For successful measles control, immunization of 95 % of susceptible individuals with
a two-dose schedule is required.
Since routine first-dose coverage rates in the three regions are below this coverage
goal, further improvements in routine vaccine coverage are needed.
The need of supplementary mass campaigns will be evaluated depending on results of
vaccine coverage surveys (carried out by the French community in 2003 and planned
in 2004 by the Flemish community) and results of the seroprevalence study carried
out in 2003.
The National Health Council plays an important role in the coordination of activities
in both communities.
1.2. Follow-up of immunization
A reliable system of monitoring vaccine coverage is needed.
First dose vaccine coverage surveys will be carried out on a regular base and
synchronised in the three Regions of Belgium, using the same methodology for the
three Regions.
Following recommendations of the National Health Council, information on the
vaccination status of children aged 5-6 years will be collected at school level.
Second dose coverage rates will be studied in future. The Flemish community plans
to routinely collect data on vaccination status of all students from 2004 onwards,
through school health centres (Centra voor Leerlingenbegeleiding).
11Implementation and follow-up of immunization are the responsibility of the
communities. Each community is expected to plan activities on a yearly base and
report every 6 months to the Committee for the Elimination of Measles in Belgium.
1.3. Assessment of susceptible population
To prevent the occurrence of outbreaks, it is critical to monitor the accumulation of
susceptible individuals.
Disease notification often under-estimate the incidence of a disease, especially when a
proportion of cases is atypical or misdiagnosed. Serosurveillance therefore
complements disease surveillance.
The data from serosurveillance are also an essential contribution to mathematical
modelling, which can predict the potential for cases in the future, and thus when and
in which age groups intervention is required to prevent an outbreak.
Vaccine coverage studies and the seroprevalence study will allow evaluation of age
specific susceptibility to measles. Strategies will be determined to reduce
susceptibility to2.3. Performance indicators
In line with WHO recommendations, following performance indicators will be
monitored on a regular basis:
- Validated national coverage for first-dose measles vaccine by age 18-24
months
- Coverage with second-dose measles vaccine
- Incidence rate reported by month, year, location and immunization status
- Completeness and timeliness of monthly surveillance reports
- Completeness and timeliness of outbreak investigations
- Percentage of outbreaks with laboratory confirmation
- Percentage of reported cases with core data (age and immunization status).
2.4. Diagnostic confirmation of measles surveillance
In stage I of the elimination process, laboratory confirmation is recommended for as
many suspected measles cases as possible.
Testing for measles by detection of IgM class virus-specific antibodies can be done in
private laboratories. Data should be reported to the national laboratory or through the
surveillance network of measles cases.
When an outbreak is suspected it is recommended that specimens are collected from
at least one case, and preferably more (5 if at least 5 cases are identified) from each
chain of transmission and sent to the national laboratory. Blood specimens should be
collected for the purpose of confirmation and urine, nasopharyngeal or blood (on
EDTA, if early in clinical evolution) specimens for viral isolation or nucleic acid
detection and genetic sequencing. Instructions on collection and shipping of
specimens to the national laboratory have been sent to all laboratories in Belgium.
Molecular characterization of virus isolates is useful to determine epidemiological
links between cases and the geographic origin of imported viruses.
Moving further towards elimination, laboratory confirmation of all suspected measles
cases by the national laboratory and virus isolation or nucleic acid detection from all
chains of measles transmission will be required to determine interruption of
indigenous transmission of measles and evaluate the impact of elimination activities.
2.5. National laboratory
The national laboratory for measles is the Virology branch of the Institute of Public
Health in Brussels.
In stage I of the elimination process, the laboratory will be responsible for confirming
a suspected outbreak of measles using serological assays and for sending specimens
of measles virus for genotyping to the WHO regional reference laboratory in
Luxembourg.
The national laboratory also participates in international surveys such as the ESEN 2
project (European Sero-Epidemiology Network 2) and the ELSM project (Enhanced
Laboratory Surveillance for Measles) and is working on the validation of saliva-
technology for detection of measles antibodies (IgM and IgG).
Before the end of 2004, Nucleic Acid Techniques will be developed.
132.6. Reinforcement of international collaboration
Close collaboration with the Euvac.Net and WHO will be assured by the Institute of
Public Health.
3) Advocacy
Advocacy strategies are needed to encourage political and public support. Efforts are
underway to improve awareness among the communities of their responsibility in the
elimination of measles. All advocacy activities to health professionals and to the
general public should be coordinated with the communities.
General practionners, paediatricians and doctors in schools and kindergartens will be
informed on the strategy to eliminate measles in Belgium and on the importance of
measles surveillance in this strategy. Informational materials on clinical signs of
measles are needed to provide to health professionals.
Budget
The committee would like to insist that some of the planned activities will require
additional funding.
The different communities in Belgium are responsible for financing implementation
and follow-up of vaccination. Funding for advocacy will have to be discussed with the
communities and the Federal Government.
The Committee for the Elimination of Measles will specifically seek funding for
measles surveillance and administrative costs of the Committee.
The national laboratory at the I.P.H. should also be financed with specific funding.
Thus three activities should seek specific financing, which should be evaluated
separately:
1. Follow-up of vaccinations and advocacy;
2. Measles surveillance and Committee;
3. National laboratory, as proposed in WHO guidelines.
14Appendix: Information booklet
Surveillance de maladies rares
chez l’enfant en Belgique
1. Introduction
Dans le cadre de l’éradication de maladies rares, entre autres chez l’enfant, un
système de surveillance s’impose.
La surveillance consiste en un enregistrement volontaire de maladies, par lequel des
données épidémiologiques collectées et analysées de façon continue et systématique
sont ensuite transmises aux instances concernées.
Un système de surveillance efficace doit pouvoir identifier rapidement tous les cas de
maladies rares, assurer un suivi, prendre des mesures pour éviter la propagation de la
maladie (dans le cas d’une maladie infectieuse), et rapporter régulièrement aux
médecins impliqués afin de les informer des fruits de leur collaboration.
Les données épidémiologiques obtenues peuvent être utiles pour la recherche
scientifique et l’élaboration de plans d’actions.
Depuis 1986, 10 pays ont mis en place un système de surveillance de maladies rares
chez l’enfant, l’Angleterre étant le pionnier avec la création du BPSU (British
Paediatric Surveillance Unit) en 1986, suivi notamment par les Pays-Bas en 1990 et le
NSCK (Nederlands Signalerings Centrum Kindergeneeskunde), ainsi que le Canada
en 1996 avec le CPSP (Canadian Paediatric Surveillance Program).
Au niveau mondial, ces systèmes de surveillance se sont regroupés en juin 2000 pour
créer un réseau international, le INoPSU (International Network of Paediatric
Surveillance Units).
Sur base de l’expérience acquise au cours de toutes ces années par les différents
systèmes, la Belgique souhaite également démarrer la surveillance de quelques
maladies rares, telles que la rougeole et la Paralysie Flasque Aiguë (PFA) dans le
cadre de l’éradication de la poliomyélite.
Afin de pouvoir identifier tous les cas d’une maladie rare, la participation de tous les
médecins qui posent le diagnostic de la maladie est requise.
Pour lancer le système en Belgique, on se limitera à la surveillance de 4 maladies, par
tous les pédiatres belges et les médecins généralistes de la Région de Bruxelles.
Par la suite, la surveillance pourra être étendue à d’autres pathologies et s’adresser à
un groupe de médecins plus large.
2. Maladies retenues pour la surveillance
Dans beaucoup de pays, la sélection des maladies surveillées se fait sur base de
propositions et demandes des pédiatres, en fonction de l’intérêt de la surveillance pour
la recherche.Pour démarrer le système en Belgique, 4 maladies rares ont été retenues : la PFA, la
rougeole, les oreillons et la rubéole.
La surveillance de la PFA est un des piliers du programme mondial de l’OMS
(Organisation Mondiale de la Santé) pour l’éradication de la poliomyélite.
Bien que l’Europe ait été déclarée exempte de polio en juin 2002, le risque
d’importation du virus sauvage est réel, et il est donc important de démarrer la
surveillance des cas de PFA.
L’OMS vise également l’élimination de la rougeole en Europe pour l’année 2007.
Des données précises sur le nombre de cas de rougeole en Belgique sont inexistantes
et la surveillance de la rougeole, avec confirmation en laboratoire de tous les cas
suspects, doit donc être mise en place rapidement.
Etant donné que la rubéole et les oreillons sont également prévenus par le vaccin
contre la rougeole (MMR / Priorix), il semble pertinent de les retenir pour la
surveillance. Celle-ci nous permettra ainsi d’évaluer l’impact de la vaccination par
MMR en Belgique.
3. Méthode
La signalisation des cas commencera début novembre 2002, avec un premier
rapportage pour le mois d’octobre.
Une phase pilote de 6 mois est prévue pour évaluer la faisabilité de la méthodologie et
la fonctionnalité des questionnaires proposés. Si la surveillance de maladies rares
semble faisable en Belgique, un engagement continu des médecins sera sollicité.
Nous vous demandons de signaler mensuellement les nouveaux cas des maladies rares
retenues, diagnostiquées au cours du mois écoulé.
La signalisation est la plus simple et rapide par internet. Si vous préférez cette voie de
rapportage, veuillez le signaler au moyen du questionnaire ci-joint, afin que nous
puissions vous envoyer un code d’accès.
Pour les personnes n’ayant pas d’accès à internet, une carte de signalisation sera
envoyée à la fin de chaque mois.
Lorsque aucun cas d’une des maladies retenues a été vu, il suffit de cocher la case
« Rien à signaler ».
Le médecin signalant un cas recevra un questionnaire à remplir afin de pouvoir
assurer un suivi épidémiologique. Toutes les données seront traitées de façon
confidentielle et anonyme. Une investigation approfondie, avec par exemple un
contact entre l’épidémiologiste et le patient, nécessitera l’accord du médecin et du
patient ou de sa famille.
Un rapport semestriel analysera les résultats de la surveillance, et sera envoyé à tous
les participants.
La surveillance sera coordonnée par l’Institut Scientifique de la Santé Publique (ISP).
Personne de contact : Tinne Lernout tél : 02/642 57 47
ISP fax : 02/642 54 10
Service d’Epidémiologie tinne.lernout@iph.fgov.be
Rue J. Wytsman 16
1050 Bruxelles
1617
ROUGEOLE
Introduction
L’objectif d’éradiquer la rougeole doit être atteint en 2010 et une surveillance de la
rougeole avec confirmation sérologique de tous les cas suspects se révèle donc
indispensable.
Le but de la surveillance est triple :
1. Récolter des données sur la source d’infection lors d’une signalisation d’un
nouveau cas de rougeole et prendre les mesures nécessaires pour limiter la
propagation de la maladie
2. Evaluer les progrès obtenus dans le processus d’éradication de la rougeole en
Belgique
3. Démontrer que le faible taux d’incidence de la rougeole en Belgique est
attribuable à l’absence réelle du virus, et non à une signalisation incomplète ou
inadéquate.
Définition de cas
Tableau clinique d’une éruption cutanée généralisée durant plus de trois jours et une
température supérieure à 38.0 °C et un ou plusieurs des symptômes suivants : toux,
rhinite, taches de Koplik, conjonctivite.
(Source : Décision de la Commission Européenne du 19/03/2002 établissant des
définitions de cas pour la déclaration des maladies transmissibles).
Classification des cas :
- Cas possible : cas pour lequel un médecin a posé un diagnostic de rougeole
- Cas probable : cas compatible avec la description clinique
- Cas confirmé : cas confirmé en laboratoire ou cas compatible avec la
description clinique et ayant un lien épidémiologique
(exposé à un cas confirmé ou ayant eu la même exposition)
Instructions
Si vous avez vu un nouveau cas probable de rougeole au cours du mois écoulé,
veuillez remplir les données requises (initiales et date de naissance du patient) sur la
fiche de signalisation.
Il s’agit de tous les cas que vous avez rencontrés en tant que clinicien, même les cas
pour lesquels vous avez donné un avis extérieur, mais qui ne sont pas directement vos
patients.
Tous les cas suspects doivent être confirmés au laboratoire par sérologie, de
préférence entre le 4e et 28e jour suivant l’apparition de l’éruption cutanée.
S’il s’agit de plusieurs cas confirmés, il serait utile de compléter les examens par une
culture virologique et une analyse génétique dans le but de différencier un virus
indigène d’un virus importé.
Après la signalisation d’un cas, vous recevrez un questionnaire afin de recueillir les
données épidémiologiques utiles.Questionnaire
Rougeole
Informations cliniques et épidémiologiques du cas
Veuillez compléter ce formulaire et le transmettre par courrier, fax ou e-mail à l’ISP :
Pedisurv, ISP, Epidémiologie, rue J Wytsman 14, 1050 Bruxelles
ou tinne.lernout@iph.fgov.be ou 02/642.54.10
Date de la déclaration (jour/mois/année) : ____/____/____
Nom du médecin déclarant : _____________________________________
1. Identification du patient
Initiales (nom/prénom) : __ / __
Date de naissance (jour/mois/année) : __ / __ / __
Sexe : masculin féminin
Code postal :
2. Statut vaccinal
Est-ce que le patient est vacciné contre la rougeole ? Oui Non Inconnu
Si non, pourquoi pas? ……………………………………………………………
Si oui, combien de doses a-t-il reçu ? ___
Date du dernier vaccin ? __ / __ / __
Est-ce que la carte de vaccination est disponible ? Oui Non Inconnu
3. Données cliniques
Date d’apparition des premiers symptômes : __ / __ / __
Résumé des symptômes
Eruption cutanée :
Date d’apparition : __ / __ / __ Durée : ___
Aspect : maculopapulaire
vésiculaire
autre : ………………………...
Fièvre ? Oui Non Inconnu Date d’apparition : __ / __ / __
Toux ? Oui Non Inconnu
Rhinite ? Oui Non Inconnu
Conjonctivite ? Oui Non Inconnu
Taches de Koplik Oui Non InconnuComplications ?(précisez)……………………………………………………………………
…………………………………………………………………………………………………
Hospitalisation ? Oui Non Durée : ___
Décès ? Oui Non
Date du décès : __ / __ / __ Cause du décès :
………………………………………
4. Examens complémentaires
A-t-on fait un examen sérologique à la Oui Non Inconnu
recherche d’AC contre la rougeole ?
Si oui, à quelle date a-t-on fait le prélèvement et quel est le résultat ?
Date du 1e échantillon : __ / __ / __ Date du 2e échantillon : __ / __ / __
Résultat : Titre IgG : ……… Résultat : Titre IgG : ……..
(ou AC totaux) (ou AC totaux)
Titre IgM : ……… Titre IgM : ……..
Inconnu Inconnu
A-t-on fait une culture virologique ? Oui Non Inconnu
Si oui, quel type d’échantillon a-t-on prélevé, à quelle date et quel est le résultat ?
Type d’échantillon : …………………………………………………………………..
Date : __ / __ / __
Résultat : Négatif
Positif
Inconnu
5. Sources possibles de l’infection
Y a-t-il eu contact avec un cas probable de Oui Non Inconnu
7 à 23 jours avant l’apparition de l’éruption ?
Si oui, avec qui ?……………………………… Où ………………………………
Y a-t-il eu d’autres cas de rougeole signalés Oui Non Inconnu
dans la région ?
Est-ce que le patient a résidé à l’étranger 7 à 23 Oui Non Inconnu
avant l’apparition de l’éruption ?
Si oui, où ? …………………………………
20Est-ce que le patient travaille dans le secteur du Oui Non Inconnu
ou a des contacts internationaux fréquents ?
Y a-t-il un lien épidémiologique avec un cas importé Oui Non Inconnu
de rougeole ?
Si oui, avec qui ? ……………………………. Où ? ……………………………
6. Classification finale
Diagnostic final : ………………………….
Date : __ / __ / __
Diagnostic clinique
Confirmation au laboratoire
Lien épidémiologique
Virus importé ? Oui Non Inconnu
Pays d’importation : ………………………………
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