9.6.4 Fever with Rash Measles was eliminated from Jamaica in 1995 (last case in 1991) after years of intense effort through immunizations and surveillance. In 1998, Jamaica’s Ministry of Health embarked on a similar programme to eliminate rubella. At that time, surveillance for these two febrile rash diseases were integrated into fever with rash surveillance. Jamaica remains on high alert for imported cases and so surveillance is ongoing. Surveillance Case Definition and Classification Suspected Case Any person presenting with, or giving a history of a body temperature > 38oC (101.0oF) rectally or >38.6oC (101.5oF) axillary AND a generalized rash. Cases with fever and rash, for whom there is no obvious diagnosis or focus of infection, should be reported. Case Reclassification Suspected cases are re-classified as confirmed or discarded based on laboratory investigations for measles and rubella. For cases lost to follow up, a review of the medical records by a physician should be done to classify the case. The following scheme is used in the PAHO region for case classification.
Fever with Rash
Adequate Specimen
Measles/Rubella IgM positive
Confirm*
Measles/Rubella IgM negative
Discard Clinically confirmed Measles
Inadequate Specimen
Case dead, or lost to follow-up.
Figure 9.6.4.1: Scheme used in the PAHO region for case classification.
Expert Review
Discard
* If a case has documentation of immunization with MMR 2 to 4 weeks prior to specimen collection, then discard as per advice from the CARPHA laboratory.
Reporting Procedure •
Class I notifiable disease
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