Jamaican measles surveillance system.

PIP: In 1991, the Ministry of Health and technical consultants from PAHO evaluated the measles surveillance system in Jamaica. This system consisted of the notification system, the sentinel sites system, active hospital surveillance, laboratory reporting, and special surveys. The team concentrated their efforts on the system's ability to detect and investigate suspected cases of measles. The team visited sentinel sites including health centers, hospitals, or a physician in all 13 parishes. 44 sites operated at the time. It spoke with medical Officers and Senior Public Health Nurses and evaluated written records. The notification system had recently classified measles as a Class I disease to encourage a rapid public health response and to secure investigation records. The major weakness of the notification system was case investigation. In 1991, health workers investigated only 6 (3%) of 208 suspected cases within 48 hours and eventually investigated only 76 (36.5%). 23 cases were confirmed as measles. Serology tests revealed that most suspected cases were actually rubella. This indicated a need to include serological testing for confirmation. The team found that the notification system underreported cases. Each sentinel site was required to collect each week a count of the number of cases of measles and other conditions to monitor trends. 87% reported the counts weekly. The sites consistently reported measles bas ed on clinical suspicion. Public health staff visited hospitals weekly to review cases of target disease including measles. They visited at least 1 hospital regularly in each parish. Hospital records did not contain consistent measles data. For example, only 10 of 13 visit reports included patient's name, age, sex, and address and only 7 included outcome. Detailed information was only available on 13 of the 208 suspected cases so the team was only able to evaluate them.^ieng