Measles: Analysis of risk assessment across London
PHE ePoster Library. Allen M. Apr 10, 2019; 259599
Matilda Allen
Matilda Allen
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Abstract
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Abstract During 2018/19, the three London health protection teams (HPTs) contributed to a study of the effectiveness of their measles risk assessment.On notification to the HPT, measles notifications are assessed as to their likelihood of being a case using the pan-London Standard Operating Procedure's risk assessment - which is based on vaccination status, epidemiological links, and symptoms. Public health actions are carried out on the basis of this initial classification. Relevant details are gathered and entered into an IT system called 'HPZone'.Methodology: Data from a 'baseline' period of low notifications, and an 'outbreak' period, (including information on clinical, epidemiological and demographic features of potential cases, and the results of local risk assessment) were compared to confirmatory results from the national reference laboratory, to determine which cases were risk assessed correctly.Sensitivity, specificity, positive and negative predictive value were calculated. Where relevant, the actual performance of the HPT was compared to the risk assessment tool if strictly applied.

Results:

Initial results suggest that there were clear differences in the performance of the risk assessment in different time periods and between different HPTs. In particular, NPV and sensitivity were lower in the outbreak period, whereas PPV was higher. Combined data across London also provided further details on the likely features of cases - including age, vaccination status, and links to confirmed cases.Implications:This study informs how best to prevent transmission and manage measles in London. Local practice could be adapted, based on the performance of risk assessment tools.Additionally, as the UK strives to maintain the 'elimination' of measles despite increasing rates across Europe and recent outbreaks in London, an up-to-date analysis of how best to risk assess cases, and the features that increase the likelihood of 'true' measles, could help to strengthen the performance of public health organisations. Funding No external funding.
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