ANNEX 5: RECOMMENDED CASE DEFINITIONS

ACUTE BLOODY DIARRHOEA

Acute diarrhoea with visible blood in the stool

To confirm case of epidemic bacillary dysentery:
Isolation of Shigella dysenteriae type 1 from stool

ACUTE WATERY DIARRHOEA

Three or more abnormally loose or fluid stools in the past 24 hours

SUSPECTED CHOLERA

Person aged over 5 years with severe dehydration or death from acute watery diarrhoea
Person aged over 2 years with acute watery diarrhoea in an area where there is a cholera outbreak.

To confirm case:

Isolation of Vibrio cholera O1 or O139 from diarrhoeal stool sample

ACUTE HAEMORRHAGIC FEVER SYNDROME

Acute onset of fever of less than 3 weeks' duration in a severely ill patient and any two of the following:

· haemorrhagic or purpuric rash
· epistaxis
· haematemesis
· haemoptysis
· blood in stools
· other haemorrhagic symptom and no known predisposing host factors for haemorrhagic manifestations

SUSPECTED MALARIA

UNCOMPLICATED MALARIA

Patient with fever or history of fever within the last 48 hours (with or without other symptoms such as nausea, vomiting and diarrhoea, headache, back pain, chills, myalgia) in whom other obvious causes of fever have been excluded

SEVERE MALARIA

Patient with symptoms as for uncomplicated malaria, as well as drowsiness with extreme weakness and associated signs and symptoms related to organ failure such as disorientation, loss of consciousness, convulsions, severe anaemia, jaundice, haemoglobinuria, spontaneous bleeding, pulmonary oedema and shock

To confirm case:

Demonstration of malaria parasites in blood film by examining thick or thin smears, or by rapid diagnostic test kit for Plasmodium falciparum

ACUTE LOWER RESPIRATORY TRACT INFECTIONS OR PNEUMONIA IN CHILDREN

PNEUMONIA
Cough or difficult breathing

and

Breathing 50 or more times per minute for infants aged 2 months to 1 year
Breathing 40 or more times per minute for children aged 1 to 5 years

and

No chest indrawing, stridor or general danger signs.

SEVERE PNEUMONIA
Cough or difficulty breathing

and

Any danger sign or chest indrawing or stridor in a calm child

MEASLES

Any person with fever and maculopapular rash (i.e. non-vesicular) and cough, coryza (i.e. runny nose) or conjunctivitis (i.e. red eyes)

or

Any person in whom a clinical health worker suspects measles infection

To confirm case:

At least a four-fold increase in antibody titre or isolation of measles virus or presence of measles-specific IgM antibodies

SUSPECTED MENINGITIS

Person with sudden onset of fever (> 38.0 °C axillary) and one of the following:

· neck stiffness
· altered consciousness
· other meningeal sign or petechial or purpural rash

In children <1 year meningitis is suspected when fever is accompanied by a bulging fontanelle

To confirm case:

Positive cerebrospinal fluid antigen detection or positive cerebrospinal fluid culture or positive blood culture

SUSPECTED POLIOMYELITIS/ACUTE FLACCID PARALYSIS

Acute flaccid paralysis in a child aged < 15 years, including Guillain Barré syndrome or any paralytic illness in a person of any age when poliomyelitis is suspected

To confirm case:
Laboratory-confirmed wild poliovirus in stool sample

SUSPECTED NEONATAL TETANUS

Any neonatal death between 3 and 28 days of age in which the cause of death is unknown or any neonate reported as having suffered from neonatal tetanus between 3 and 28 days of age and not investigated

Suspected case:
Any neonate with normal ability to suck and cry during the first 2 days of life, and who between 3 and 28 days of age cannot suck normally and becomes stiff or has convulsions (i.e. jerking of the muscles) or both

Hospital-reported cases are considered confirmed

The diagnosis is entirely clinical and does not depend on bacteriological confirmation

SEXUALLY TRANSMITTED DISEASES

GENITAL ULCER SYNDROME
Ulcer on penis or scrotum in men and on labia, vagina or cervix in women with or without inguinal adenopathy

URETHRAL DISCHARGE SYNDROME
Urethral discharge in men with or without dysuria

VAGINAL DISCHARGE SYNDROME
Abnormal vaginal discharge (amount, colour and odour) with or without lower abdominal pain or specific symptoms or specific risk factors

LOWER ABDOMINAL PAIN
Symptoms of lower abdominal pain and pain during sexual relations, with examination showing vaginal discharge, lower abdominal tenderness on palpation or temperature >38 °C.

SUSPECTED PULMONARY TUBERCULOSIS
Any person who presents with symptoms or signs suggestive of pulmonary tuberculosis, in particular cough of long duration. May also have haemoptysis, chest pain, breathlessness, fever/night sweats, tiredness, loss of appetite and significant weight loss.

All TB suspects should have three sputum samples examined by light microscopy, early morning samples are more likely to contain the tuberculosis organism than a sample later in the day.

SMEAR-POSITIVE PULMONARY TUBERCULOSIS (PTB+)
Diagnostic criteria should include at least two sputum smear specimens positive for acid-fast bacilli (AFB)

or

One sputum smear specimen positive for AFB and radiographic abnormalities consistent with active pulmonary tuberculosis

or

One sputum smear specimen positive for AFB and a culture positive for M. tuberculosis

SMEAR-NEGATIVE PULMONARY TUBERCULOSIS (PTB-)
A case of pulmonary tuberculosis that does not meet the above definition for smear-positive tuberculosis. Diagnostic criteria should include at least three sputum smear specimens negative for AFB

and

Radiographic abnormalities consistent with active pulmonary tuberculosis

and

No response to a course of broad spectrum antibiotics

and

Decision by a clinician to treat with a full course of anti-tuberculosis chemotherapy

TYPHOID

Clinical diagnosis is difficult as it may vary from a mild illness with low grade fever and malaise to a severe picture of sustained fever, diarrhoea or constipation, anorexia, severe headache and intestinal perforation may occur. In absence of laboratory confirmation, any case with fever of at least 38° for 3 or more days is considered suspect if the epidemiological context is conducive.

To confirm case: A suspected case with isolation of S. typhi from blood or stool cultures