Investigation of measles IgM-seropositive cases of febrile rash illnesses in the absence of documented measles virus transmission, State of Sao Paulo, Brazil, 2000-2004

Introduction: To review measles IgM-positive cases of febrile rash illnesses in the state of Sao Paulo, Brazil, over the five-year period following interruption of measles virus transmission. Methods: We reviewed 463 measles IgM-positive cases of febrile rash illness in the state of Sao Paulo, from 2000 to 2004. Individuals vaccinated against measles <= 56 days prior to specimen collection were considered to be exposed to the vaccine. Serum from the acute and convalescent phases was tested for evidence of measles, rubella, parvovirus B19 and human herpes virus-6 infection. In the absence of seroconversion to measles immunoglobulin-G, measles IgM-positive cases were considered false positives in individuals with evidence of other viral infections. Results: Among the 463 individuals with febrile rash illness who tested positive for measles IgM antibodies during the period, 297 (64%) were classified as exposed to the vaccine. Among the 166 cases that were not exposed to the vaccine, 109 (66%) were considered false positives based on the absence of seroconversion, among which 21 (13%) had evidence of rubella virus infection, 49 (30%) parvovirus B19 and 28 (17%) human herpes virus-6 infection. Conclusions: Following the interruption of measles virus transmission, thorough investigation of measles IgM-positive cases is required, especially among cases not exposed to the vaccine. Laboratory testing for etiologies of febrile rash illness aids interpretation of these cases.