# Situation: A 4-year-old child who has never received a measles-containing vaccine develops fever, cough, runny nose, red eyes, and a rash that began at the hairline and spread downward. The public health nurse visits the family at home. Earlier the same day, the nurse also saw a 7-year-old with dengue without warning signs. The measles case has not yet been confirmed by the laboratory. How should the nurse report the two cases under the Philippine Integrated Disease Surveillance and Response (PIDSR) system?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=627228  
> language: ko  
> subject: Nursing Practice I — Community Health Nursing

## 문제

Situation: A 4-year-old child who has never received a measles-containing vaccine develops fever, cough, runny nose, red eyes, and a rash that began at the hairline and spread downward. The public health nurse visits the family at home.

Earlier the same day, the nurse also saw a 7-year-old with dengue without warning signs. The measles case has not yet been confirmed by the laboratory. How should the nurse report the two cases under the Philippine Integrated Disease Surveillance and Response (PIDSR) system?

## 보기

1. Measles once laboratory-confirmed; dengue in the weekly report
2. Measles within 24 hours; dengue in the weekly report **✔ 정답**
3. Both cases within 24 hours, on case investigation forms
4. Both cases in the weekly report of notifiable diseases

**정답: 2**

## 해설

Measles is a Category I, immediately notifiable disease under PIDSR: a suspect case is reported within 24 hours of detection with a case investigation form, without waiting for laboratory confirmation. Dengue is a Category II disease and is reported weekly on case report forms. Each disease follows its own category.

## 심화 해설

PIDSR reporting categories determine both the timeline and the form

The Philippine Integrated Disease Surveillance and Response (PIDSR) system groups notifiable conditions into categories that dictate how quickly a case must be reported and which documentation is used. The key distinction in this scenario is between a disease that requires immediate notification and one that follows routine weekly reporting.

Measles is classified as a Category I disease under PIDSR. This category includes conditions with epidemic potential or those targeted for elimination, and it carries an immediate reporting obligation: a suspect case must be reported within 24 hours of detection using a case investigation form, without waiting for laboratory confirmation. The rationale is that the clinical presentation of fever, cough, coryza, conjunctivitis, and a rash spreading from the hairline downward is sufficiently characteristic to trigger a public health response. Delaying until laboratory results return would undermine outbreak containment, contact tracing, and timely immunization of susceptible contacts. The Key point! A suspect measles case is reportable based on clinical suspicion alone; laboratory confirmation is not a prerequisite for notification.

In contrast, dengue without warning signs is a Category II disease under PIDSR. Category II conditions are reported through the weekly notifiable disease report using case report forms, not case investigation forms. This does not mean dengue is unimportant; rather, the surveillance objective is trend monitoring and seasonal pattern recognition rather than immediate outbreak response for each individual case. The 7-year-old child with dengue without warning signs does not require an urgent 24-hour notification because the clinical presentation does not suggest severe disease or an imminent threat of rapid spread that would demand immediate public health intervention.

The reporting forms also differ. Case investigation forms collect detailed epidemiological and clinical data needed for diseases under elimination or eradication programs, such as measles. Case report forms for weekly reporting capture aggregate or line-listed data sufficient for monitoring disease trends. Using the wrong form or timeline for either disease would misalign the surveillance response with the public health risk it poses.

| Feature | Measles (suspect) | Dengue without warning signs |
| --- | --- | --- |
| PIDSR category | Category I (immediately notifiable) | Category II (weekly notifiable) |
| Reporting timeline | Within 24 hours of detection | Weekly report |
| Required form | Case investigation form | Case report form |
| Laboratory confirmation needed before reporting | No (suspect case is reportable) | Not applicable for weekly reporting |

The integrated surveillance framework described in the IDSR guidelines reinforces this tiered approach: diseases with high epidemic potential or those targeted for elimination require immediate, event-based notification, while endemic diseases with lower immediate transmission risk are captured through routine aggregated reporting. This ensures that limited public health resources are directed toward the conditions most likely to require rapid field investigation and response.

Watch out! Do not assume that all notifiable diseases are reported the same way. The category assigned to each disease under PIDSR determines both the reporting deadline and the documentation required, and these must be applied independently to each case.

## 임상 시나리오

PIDSR Reporting Timeline and FormsCategory I vs Category II notification duties
Under PIDSR, measles is a Category I disease. A suspect case must be reported within 24 hours of detection using a case investigation form, based on clinical suspicion alone without waiting for laboratory confirmation.

Dengue without warning signs is a Category II disease. It is reported through the weekly notifiable disease report using case report forms, not case investigation forms.

CautionDo not delay measles notification pending laboratory results. The characteristic clinical presentation of fever, cough, coryza, conjunctivitis, and a rash spreading from the hairline downward is sufficient to trigger immediate public health action.

## 핵심 개념

- **PIDSR** — Philippine Integrated Disease Surveillance and Response system that categorizes notifiable diseases by reporting urgency and form type.
- **Category I disease** — Conditions with epidemic potential or elimination targets requiring reporting within 24 hours of detection using a case investigation form.
- **Category II disease** — Conditions reported through the weekly notifiable disease report using case report forms.
- **Suspect case** — A case identified by clinical presentation alone, reportable without waiting for laboratory confirmation.
- **Case investigation form** — The documentation used for immediate reporting of Category I diseases under PIDSR.

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