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Dimech W. The Standardization and Control of Serology and Nucleic Acid Testing for Infectious Diseases. Clin Microbiol Rev 2021; 34:e0003521. [PMID: 34319148 PMCID: PMC8404693 DOI: 10.1128/cmr.00035-21] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Historically, the detection of antibodies against infectious disease agents was achieved using test systems that utilized biological functions such as neutralization, complement fixation, hemagglutination, or visualization of binding of antibodies to specific antigens, by testing doubling dilutions of the patient sample to determine an endpoint. These test systems have since been replaced by automated platforms, many of which have been integrated into general medical pathology. Methods employed to standardize and control clinical chemistry testing have been applied to these serology tests. However, there is evidence that these methods are not suitable for infectious disease serology. An overriding reason is that, unlike testing for an inert chemical, testing for specific antibodies to infectious disease agents is highly variable; the measurand for each test system varies in choice of antigen, antibody classes/subclasses, modes of detection, and assay kinetics, and individuals' immune responses vary with time after exposure, individual immune-competency, nutrition, treatment, and exposure to variable circulating sero- or genotypes or organism mutations. Therefore, unlike that of inert chemicals, the quantification of antibodies cannot be standardized using traditional methods. However, there is evidence that the quantification of nucleic acid testing, reporting results in international units, has been successful across many viral load tests. Similarly, traditional methods used to control clinical chemistry testing, such as Westgard rules, are not appropriate for serology testing for infectious diseases, mainly due to variability due to frequent reagent lot changes. This review investigates the reasons why standardization and control of infectious diseases should be further investigated and more appropriate guidelines should be implemented.
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Affiliation(s)
- Wayne Dimech
- National Serology Reference Laboratory, Fitzroy, Victoria, Australia
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2
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Colman S, Vernelen K, China B, Van den Bossche D, Cornelissen L, Delforge ML, Reynders M, Berth M, Depypere M, Van Gasse N, Vijgen S, Van Acker J, Boel A, Padalko E. Pitfalls of rubella serology while on the brink of elimination: evaluation of national data, Belgium, 2017. ACTA ACUST UNITED AC 2021; 26. [PMID: 34018485 PMCID: PMC8138961 DOI: 10.2807/1560-7917.es.2021.26.20.2000074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BackgroundIn Belgium, rubella serology is frequently requested in women of childbearing age, despite high vaccination coverage and a near-absence of congenital rubella cases. Different test kits are available and should be standardised by an international standard preparation.AimTo analyse and compare rubella serology practices in Belgian laboratories.MethodsAs part of the mandatory External Quality Assessment programme for rubella serology in Belgium, the national public health institute, Sciensano, sent a voluntary questionnaire concerning anti-rubella IgM/IgG analyses in women aged 15 to 45 years in 2017 to 130 laboratories.ResultsThe questionnaire response rate was 83.8% (109/130). The majority of 169,494 IgG analyses were performed on Roche (55%), Abbott (17%) and Diasorin (13%) analysers. Not all laboratories used the proposed international cut-off of 10 IU/mL. Assumed median seroprevalence ranged from 76.3% with Liaison (Diasorin) to 96.3% with Modular (Roche). Despite very low rubella incidence in Belgium, 93 laboratories performed 85,957 IgM analyses, with 748 positive and 394 grey zone results. The National Reference Centre for Measles, Mumps and Rubella virus and the National Reference Centre for Congenital infections did not confirm any positive rubella cases in 2017.ConclusionThis retrospective analysis shows that rubella serology results may differ considerably according to the assay used. It is therefore important to use the same test when comparing results or performing follow-up testing. The number of anti-rubella IgM analyses was very high. Incorrect use of IgM for screening women of childbearing age can lead to unwarranted anxiety and overuse of confirmation tests.
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Affiliation(s)
- Sofie Colman
- Clinical Laboratory of Microbiology, OLVZ Aalst, Aalst, Belgium
| | - Kris Vernelen
- Quality of Laboratories, Sciensano, Brussels, Belgium
| | - Bernard China
- Quality of Laboratories, Sciensano, Brussels, Belgium
| | - Dorien Van den Bossche
- Institute of Tropical Medicine, Antwerp, Belgium.,Experts Committee EQA Infectious serology, Quality of Laboratories, Sciensano, Brussels, Belgium
| | | | - Marie-Luce Delforge
- University Hospital Erasme, Brussels, Belgium.,Experts Committee EQA Infectious serology, Quality of Laboratories, Sciensano, Brussels, Belgium
| | - Marijke Reynders
- General Hospital Sint-Jan Bruges, Bruges, Belgium.,Experts Committee EQA Infectious serology, Quality of Laboratories, Sciensano, Brussels, Belgium
| | - Mario Berth
- General Hospital AZ Alma, Eeklo, Belgium.,Experts Committee EQA Infectious serology, Quality of Laboratories, Sciensano, Brussels, Belgium
| | - Melissa Depypere
- University Hospital Leuven, Leuven, Belgium.,Experts Committee EQA Infectious serology, Quality of Laboratories, Sciensano, Brussels, Belgium
| | - Natasja Van Gasse
- Hospital Network Antwerp, Antwerp, Belgium.,Experts Committee EQA Infectious serology, Quality of Laboratories, Sciensano, Brussels, Belgium
| | - Sara Vijgen
- General Hospital Jessa, Hasselt, Belgium.,Experts Committee EQA Infectious serology, Quality of Laboratories, Sciensano, Brussels, Belgium
| | - Jos Van Acker
- General Hospital AZ Sint-Lucas, Ghent, Belgium.,Experts Committee EQA Infectious serology, Quality of Laboratories, Sciensano, Brussels, Belgium
| | - An Boel
- Experts Committee EQA Infectious serology, Quality of Laboratories, Sciensano, Brussels, Belgium.,Clinical Laboratory of Microbiology, OLVZ Aalst, Aalst, Belgium
| | - Elizaveta Padalko
- University Hospital Ghent, Ghent, Belgium.,Experts Committee EQA Infectious serology, Quality of Laboratories, Sciensano, Brussels, Belgium
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Schenk J, Abrams S, Theeten H, Van Damme P, Beutels P, Hens N. Immunogenicity and persistence of trivalent measles, mumps, and rubella vaccines: a systematic review and meta-analysis. THE LANCET. INFECTIOUS DISEASES 2021; 21:286-295. [PMID: 32888410 PMCID: PMC9665966 DOI: 10.1016/s1473-3099(20)30442-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 04/23/2020] [Accepted: 04/29/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Despite the universal use of the two-dose trivalent measles-mumps-rubella (MMR) vaccine in the past two decades, outbreaks of these diseases still occur in countries with high vaccine uptake, giving rise to concerns about primary and secondary failure of MMR vaccine components. We aimed to provide seroconversion and waning rate estimates for the measles, mumps, and rubella components of MMR vaccines. METHODS In this systematic review and meta-analysis we searched PubMed (including MEDLINE), Web of Science, and Embase for randomised controlled trials, cohort studies, or longitudinal studies reporting the immunogenicity and persistence of MMR vaccines, published in English from database inception to Dec 31, 2019. Studies were included if they investigated vaccine-induced immunity in healthy individuals who received a trivalent MMR vaccine, including different dosages and timepoints of vaccine administration. Studies featuring coadministration of MMR with other vaccines, maternal immunity to the MMR vaccine, or non-trivalent formulations of the vaccine were excluded. Pooled seroconversion and waning rates were estimated by random-effects meta-analyses. This study is registered with PROSPERO, CRD42019116705. FINDINGS We identified 3615 unique studies, 62 (1·7%) of which were eligible for analysis. Estimated overall seroconversion rates were 96·0% (95% CI 94·5-97·4; I2=91·1%) for measles, 93·3% (91·1-95·2; I2=94·9%) for mumps when excluding the Rubini strain, 91·1% (87·4-94·1; I2=96·6%) for mumps when including the Rubini strain, and 98·3% (97·3-99·2; I2=93·0%) for rubella. Estimated overall annual waning rates were 0·009 (95% CI 0·005-0·016; I2=85·2%) for measles, 0·024 (0·016-0·039; I2=94·7%) for mumps, and 0·012 (0·010-0·014; I2=93·3%) for rubella. INTERPRETATION Our meta-analysis provides estimates of primary and secondary vaccine failure, which are essential to improve the accuracy of mathematical and statistical modelling to understand and predict the occurrence of future measles, mumps, and rubella outbreaks in countries with high vaccine uptake. FUNDING European Research Council.
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Affiliation(s)
- Julie Schenk
- Data Science Institute, I-BioStat, UHasselt, Diepenbeek, Belgium.
| | - Steven Abrams
- Data Science Institute, I-BioStat, UHasselt, Diepenbeek, Belgium; Global Health Institute, Department of Epidemiology and Social Medicine, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Heidi Theeten
- Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Pierre Van Damme
- Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Philippe Beutels
- Centre for Health Economic Research and Modelling Infectious Diseases, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Niel Hens
- Data Science Institute, I-BioStat, UHasselt, Diepenbeek, Belgium; Centre for Health Economic Research and Modelling Infectious Diseases, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
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Positive predictive value of seroconversion or positive rubella IgM in diagnosis of maternal rubella infection: Seven-years review of French National Reference Laboratory for Rubella. J Clin Virol 2020; 134:104708. [PMID: 33316569 DOI: 10.1016/j.jcv.2020.104708] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 11/17/2020] [Accepted: 11/22/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND In France, as in most developed countries, childbearing age women are routinely screened for rubella antibodies to identify and vaccinate susceptible women. Immunity to rubella is usually determined by measuring the rubella virus-specific immunoglobulin G (RV-IgG). In case of seroconversion for RV-IgG and/or positive RVIgM during pregnancy, laboratories usually send serum samples to the French National Reference Laboratory (FNRL) for Rubella in order to perform complementary investigations and confirm or exclude rubella infection during pregnancy. OBJECTIVE Our aim is to report results of these investigations during a seven-year period (2013-2019) and evaluate the positive predictive value (PPV) of RV-IgG seroconversion or positive RV-IgM to diagnose maternal rubella infection in France. STUDY DESIGN Between 2013 and 2019, 5398 serum samples collected from 4104 pregnant women, were addressed to FNRL because of RV-IgG seroconversion (N=899) or positive RV-IgM (N=3205). Additional serological tests were performed, mainly immunoblot (to look for the presence of anti-E1 protective antibody) and RV-IgG avidity (to exclude or confirm primary infection). RESULTS Overall, for 3724/4104 (90.8 %) women, rubella primary-infection during pregnancy was formally excluded and maternal rubella primary-infection was only confirmed in 46/4104 (1.1 %) cases. CONCLUSION Clinicians and biologists should be particularly aware that RV-IgG seroconversion or positive RV-IgM, in the current context of low RV circulation in France are most often not rubella primary infections. PPV of seroconversion to assess maternal rubella primary infection is as low as 0.2 % (95 % CI: 0 %; 0.5 %) and PPV of positive RV-IgM is only of 1.4 % (95 % CI: 0.99 %; 1.81 %).
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Wanlapakorn N, Puenpa J, Thongmee T, Srimuan D, Thatsanathorn T, Vongpunsawad S, Poovorawan Y. Antibodies to measles, mumps, and rubella virus in Thai children after two-dose vaccination at 9 months and 2.5 years: A longitudinal study. Vaccine 2020; 38:4016-4023. [PMID: 32331806 DOI: 10.1016/j.vaccine.2020.04.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/02/2020] [Accepted: 04/04/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Thailand changed the schedule of childhood measles-mumps-rubella (MMR) vaccination in 2014, moving the second dose from the age of 6 years to 2.5 years. There are currently no data on antibody responses to the MMR vaccine since this recommendation. MATERIAL AND METHODS We investigated antibody responses in a cohort of children who received two doses of MMR vaccine at the ages of 9 months and 2.5 years that was originally established to evaluate antibody levels to Bordetella pertussis antigens (ClinicalTrials.gov no. NCT02408926). Infants were born to mothers who previously received tetanus-diphtheria-acellular pertussis vaccine at 27-36 weeks of gestation. Anti-measles, -mumps, and -rubella virus IgG levels were measured at birth (cord blood) and the ages of 2 and 7 months (before the first MMR vaccination); 18 and 24 months (9 and 15 months, respectively, after the first dose); and 36 months (6 months after the second dose) using commercially available enzyme-linked immunosorbent assay kits. RESULTS At 7 months of age, 96.2%, 99.6%, and 98.8% of infants had no protection against measles, mumps, and rubella, respectively. Levels of antibody against all three antigens increased significantly after the first but not the second dose. At 6 months after two-dose vaccination, 97.4%, 84.8%, and 78.7% of children remained seroprotected against measles, mumps, and rubella, respectively. CONCLUSIONS Maternally derived antibodies to measles, mumps, and rubella virus disappeared by the age of 7 months in Thai children. Two-dose MMR vaccination at 9 months and 2.5 years of age induced robust immune responses against these viruses.
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Affiliation(s)
- Nasamon Wanlapakorn
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Division of Academic Affairs, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Jiratchaya Puenpa
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Thanunrat Thongmee
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Donchida Srimuan
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Thaksaporn Thatsanathorn
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Sompong Vongpunsawad
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Yong Poovorawan
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Academy of Science, Royal Society of Thailand, Bangkok, Thailand.
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Kempster SL, Almond N, Dimech W, Grangeot-Keros L, Huzly D, Icenogle J, El Mubarak HS, Mulders MN, Nübling CM. WHO international standard for anti-rubella: learning from its application. THE LANCET. INFECTIOUS DISEASES 2020; 20:e17-e19. [DOI: 10.1016/s1473-3099(19)30274-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 04/30/2019] [Accepted: 05/21/2019] [Indexed: 10/26/2022]
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Hayford K, Mutembo S, Carcelen A, Matakala HK, Munachoonga P, Winter A, Wanyiri JW, Searle K, Mwansa FD, Mwiche A, Phiri C, Book C, Thuma PE, Moss WJ. Measles and rubella serosurvey identifies rubella immunity gap in young adults of childbearing age in Zambia: The added value of nesting a serological survey within a post-campaign coverage evaluation survey. Vaccine 2019; 37:2387-2393. [PMID: 30905529 PMCID: PMC6467544 DOI: 10.1016/j.vaccine.2019.02.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 02/19/2019] [Accepted: 02/20/2019] [Indexed: 11/13/2022]
Abstract
We nested a measles and rubella serological survey in a vaccination coverage survey. Measles and rubella immunity was significantly higher than expected by vaccination. Study revealed immunity gap in young adults and risk of congenital rubella syndrome. Adding serology to a survey leveraged resources and provided complementary information.
Background Serological surveys can potentially complement vaccine coverage surveys, such as post-vaccination campaign coverage evaluation surveys (PCES), by providing direct information on population immunity within and outside the target age range of the mass vaccination campaign. We estimate age-specific population immunity to measles and rubella viruses in Southern Province, Zambia, and assess the value of adding serological data to vaccination coverage estimates by nesting a serological survey within a PCES. Methods Dried blood spots (DBS) from fingerprick blood were collected from all individuals ages nine months or older in households participating in the PCES and tested for measles and rubella virus-specific immunoglobulin G (IgG) by enzyme immunoassay (Siemens Enzygnost, Marburg, Germany). Results Overall seroprevalence was 95.5% (95% CI: 92.8, 97.2) for measles virus-specific IgG and 97.7% (95% CI: 96.0, 98.7) for rubella virus-specific IgG. Rubella seroprevalence was 98.4% (95% CI: 95.9, 99.4) among children eligible for the MR vaccination campaign, significantly higher than the reported measles-rubella (MR) vaccination campaign coverage of 89.8% (p = 0.003), and higher than the 91.3% rubella seroprevalence for adolescents and adults 16–30 years of age (p = 0.049). Conclusion Seroprevalence to measles and rubella viruses in children younger than 16 years of age was significantly higher than expected from vaccination coverage estimates, likely reflecting exposure to wild-type viruses and underreporting of vaccination. The serosurvey revealed rubella immunity gaps among women 16–30 years of age, precisely the age group in which protection from rubella is most important to prevent congenital rubella syndrome. Nesting serological surveys within existing surveys can leverage resources and infrastructure while providing complementary information important to immunization programs.
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Affiliation(s)
- Kyla Hayford
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Simon Mutembo
- Ministry of Health, Government of the Republic of Zambia, Lusaka, Zambia; Department of Epidemiology and Biostatistics, University of Georgia, College of Public Health, Athens, GA, USA
| | - Andrea Carcelen
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Amy Winter
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jane W Wanyiri
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kelly Searle
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Francis D Mwansa
- Ministry of Health, Government of the Republic of Zambia, Lusaka, Zambia
| | - Angels Mwiche
- Ministry of Health, Government of the Republic of Zambia, Lusaka, Zambia
| | - Caroline Phiri
- Ministry of Health, Government of the Republic of Zambia, Lusaka, Zambia
| | | | | | - William J Moss
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Determination of rubella virus-specific humoral and cell-mediated immunity in pregnant women with negative or equivocal rubella-specific IgG in routine screening. J Clin Virol 2019; 112:27-33. [DOI: 10.1016/j.jcv.2019.01.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 01/19/2019] [Accepted: 01/23/2019] [Indexed: 11/21/2022]
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Jo SY, Shin KH, Lee SM, Jeong EY, Lee HJ, Chang CL. Comparison of three immunoassays for determination of immunity to rubella virus in healthcare workers. J Immunol Methods 2018; 463:84-88. [PMID: 30237054 DOI: 10.1016/j.jim.2018.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 09/14/2018] [Accepted: 09/14/2018] [Indexed: 10/28/2022]
Abstract
Rubella virus is a critical infectious pathogen to healthcare workers but is preventable by vaccination. In this study, we used three immunoassays - LIAISON Rubella IgG, ARCHITECT Rubella IgG, and AtheNA Multi-Lyte MMRV IgG - to detect rubella virus IgG and tested 182 serum specimens. The percentage of positives with the three Rubella tests were as follows: LIAISON, 71.9%; ARCHITECT, 83.5%; and AtheNA, 99.5%. The three assays showed an overall agreement rate of 71.9%. The rates of seropositive detection with LIAISON, ARCHITECT, and AtheNA among healthcare workers with and without self-reporting history of past infection or vaccination were 70.7% and 90.9%, 83.6% and 81.8%, and 99.4% and 100%, respectively. The three immunoassays showed a low agreement rate for rubella virus IgG. Therefore, choosing accurate and appropriate IgG assay methods is very important for effective infection control and prevention.
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Affiliation(s)
- Su-Yeon Jo
- Department of Laboratory Medicine, Pusan National University Yangsan Hospital, 20 Geumo-ro, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, Republic of Korea
| | - Kyung-Hwa Shin
- Department of Laboratory Medicine and Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan, Republic of Korea.
| | - Sun Min Lee
- Department of Laboratory Medicine, Pusan National University Yangsan Hospital, 20 Geumo-ro, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, Republic of Korea.
| | - Eun-Young Jeong
- Department of Laboratory Medicine, Pusan National University Yangsan Hospital, 20 Geumo-ro, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, Republic of Korea
| | - Hyun-Ji Lee
- Department of Laboratory Medicine, Pusan National University Yangsan Hospital, 20 Geumo-ro, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, Republic of Korea
| | - Chulhun L Chang
- Department of Laboratory Medicine, Pusan National University Yangsan Hospital, 20 Geumo-ro, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, Republic of Korea.
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Winter AK, Martinez ME, Cutts FT, Moss WJ, Ferrari MJ, McKee A, Lessler J, Hayford K, Wallinga J, Metcalf CJE. Benefits and Challenges in Using Seroprevalence Data to Inform Models for Measles and Rubella Elimination. J Infect Dis 2018; 218:355-364. [PMID: 29562334 PMCID: PMC6049004 DOI: 10.1093/infdis/jiy137] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 03/16/2018] [Indexed: 11/23/2022] Open
Abstract
Background Control efforts for measles and rubella are intensifying globally. It becomes increasingly important to identify and reach remaining susceptible populations as elimination is approached. Methods Serological surveys for measles and rubella can potentially measure susceptibility directly, but their use remains rare. In this study, using simulations, we outline key subtleties in interpretation associated with the dynamic context of age-specific immunity, highlighting how the patterns of immunity predicted from disease surveillance and vaccination coverage data may be misleading. Results High-quality representative serosurveys could provide a more accurate assessment of immunity if challenges of conducting, analyzing, and interpreting them are overcome. We frame the core disease control and elimination questions that could be addressed by improved serological tools, discussing challenges and suggesting approaches to increase the feasibility and sustainability of the tool. Conclusions Accounting for the dynamical context, serosurveys could play a key role in efforts to achieve and sustain elimination.
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Affiliation(s)
- Amy K Winter
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, New Jersey
| | - Micaela E Martinez
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York
| | - Felicity T Cutts
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - William J Moss
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Matt J Ferrari
- Center for Infectious Disease Dynamics, The Pennsylvania State University, State College, Pennsylvania
| | - Amalie McKee
- Center for Infectious Disease Dynamics, The Pennsylvania State University, State College, Pennsylvania
| | - Justin Lessler
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kyla Hayford
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jacco Wallinga
- Netherlands National Institute for Public Health and the Environment, Bilthoven, Netherlands
- Leiden University Medical Center, Leiden, Netherlands
| | - C Jess E Metcalf
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, New Jersey
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Vauloup-Fellous C. Standardization of rubella immunoassays. J Clin Virol 2018; 102:34-38. [DOI: 10.1016/j.jcv.2018.02.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 02/01/2018] [Accepted: 02/09/2018] [Indexed: 10/18/2022]
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Haralambieva IH, Gibson MJ, Kennedy RB, Ovsyannikova IG, Warner ND, Grill DE, Poland GA. Characterization of rubella-specific humoral immunity following two doses of MMR vaccine using proteome microarray technology. PLoS One 2017; 12:e0188149. [PMID: 29145521 PMCID: PMC5690594 DOI: 10.1371/journal.pone.0188149] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 11/01/2017] [Indexed: 11/18/2022] Open
Abstract
Introduction//Background The lack of standardization of the currently used commercial anti-rubella IgG antibody assays leads to frequent misinterpretation of results for samples with low/equivocal antibody concentration. The use of alternative approaches in rubella serology could add new information leading to a fuller understanding of rubella protective immunity and neutralizing antibody response after vaccination. Methods We applied microarray technology to measure antibodies to all rubella virus proteins in 75 high and 75 low rubella virus-specific antibody responders after two MMR vaccine doses. These data were used in multivariate penalized logistic regression modeling of rubella-specific neutralizing antibody response after vaccination. Results We measured antibodies to all rubella virus structural proteins (i.e., the glycoproteins E1 and E2 and the capsid C protein) and to the non-structural protein P150. Antibody levels to each of these proteins were: correlated with the neutralizing antibody titer (p<0.006); demonstrated differences between the high and the low antibody responder groups (p<0.008); and were components of the model associated with/predictive of vaccine-induced rubella virus-specific neutralizing antibody titers (misclassification error = 0.2). Conclusion Our study supports the use of this new technology, as well as the use of antibody profiles/patterns (rather than single antibody measures) as biomarkers of neutralizing antibody response and correlates of protective immunity in rubella virus serology.
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Affiliation(s)
- Iana H. Haralambieva
- Mayo Vaccine Research Group, Mayo Clinic and Foundation, Rochester, MN, United States of America
| | - Michael J. Gibson
- Mayo Vaccine Research Group, Mayo Clinic and Foundation, Rochester, MN, United States of America
| | - Richard B. Kennedy
- Mayo Vaccine Research Group, Mayo Clinic and Foundation, Rochester, MN, United States of America
| | - Inna G. Ovsyannikova
- Mayo Vaccine Research Group, Mayo Clinic and Foundation, Rochester, MN, United States of America
| | - Nathaniel D. Warner
- Division of Biomedical Statistics and Informatics- Department of Health Science Research, Mayo Clinic and Foundation, Rochester, MN, United States of America
| | - Diane E. Grill
- Division of Biomedical Statistics and Informatics- Department of Health Science Research, Mayo Clinic and Foundation, Rochester, MN, United States of America
| | - Gregory A. Poland
- Mayo Vaccine Research Group, Mayo Clinic and Foundation, Rochester, MN, United States of America
- * E-mail:
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Dilemmas and Pitfalls in Rubella Laboratory Diagnostics in Low Prevalence or Elimination Settings. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2016. [DOI: 10.1007/s40506-016-0090-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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14
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Lai FY, Dover DC, Charlton CL. Economic impact of switching rubella IgG methodologies to the prenatal public health program in Alberta. J Clin Virol 2016; 83:43-7. [PMID: 27567094 DOI: 10.1016/j.jcv.2016.08.294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 07/01/2016] [Accepted: 08/12/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Despite widespread use of a universal rubella standard, variability in rubella antibody titre can be observed between assays, particularly at the low end of the linear range. OBJECTIVES Here, we investigate the impact of a methodology change for rubella IgG from the Abbott AXSYM to the Abbott Architect in a comprehensive prenatal screening program in the Canadian province of Alberta. STUDY DESIGN 51,815 specimens (21,399 tested by AxSYM and 30,416 tested by Architect) submitted for routine prenatal screening between January 2006 and December 2012 from women who lived in Alberta after the universal childhood immunization programme for rubella was implemented, and whose immunization records were available, were included in the study. RESULTS Prenatal samples tested by AxSYM for rubella IgG were approximately 30% higher than those reported by Architect. Among individuals who had tests across multiple pregnancies, the change in test platform led to an additional 7% of women who initially tested positive, becoming non-positive (i.e. negative or indeterminate) in their subsequent tests. The tendency of the Architect IgG assay to report lower quantitative values was demonstrated across all birth cohorts and vaccination status, and resulted in an additional 2800 women requiring vaccination between 2010 and 2012 with an estimated cost of $38,500. CONCLUSION The change in rubella IgG screening assay resulted in a significant increase in the number of women who required post partum vaccination and Public Health follow-up.
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Affiliation(s)
- Florence Y Lai
- Surveillance and Assessment, Alberta Ministry of Health, Edmonton, Alberta, Canada
| | - Douglas C Dover
- Surveillance and Assessment, Alberta Ministry of Health, Edmonton, Alberta, Canada
| | - Carmen L Charlton
- Provincial Laboratory for Public Health (ProvLab), Edmonton, Alberta, Canada; Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada.
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Bouthry E, Furione M, Huzly D, Ogee-Nwankwo A, Hao L, Adebayo A, Icenogle J, Sarasini A, Revello MG, Grangeot-Keros L, Vauloup-Fellous C. Assessing Immunity to Rubella Virus: a Plea for Standardization of IgG (Immuno)assays. J Clin Microbiol 2016; 54:1720-1725. [PMID: 27147722 PMCID: PMC4922105 DOI: 10.1128/jcm.00383-16] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 04/11/2016] [Indexed: 12/31/2022] Open
Abstract
Immunity to rubella virus (RV) is commonly determined by measuring specific immunoglobulin G (RV IgG). However, RV IgG results and their interpretation may vary, depending on the immunoassay, even though most commercial immunoassays (CIAs) have been calibrated against an international standard and results are reported in international units per milliliter. A panel of 322 sera collected from pregnant women that tested negative or equivocal for RV IgG in a prior test (routine screening) was selected. This panel was tested with two reference tests, immunoblotting (IB) and neutralization (Nt), and with 8 CIAs widely used in Europe. IB and Nt gave concordant results on 267/322 (82.9%) sera. Of these, 85 (26.4%) sera were negative and 182 (56.5%) sera were positive for both tests. All 85 IB/Nt-negative samples were classified as negative with all CIAs. Of the 182 IB/Nt-positive samples, 25.3 to 61.5% were classified as equivocal and 6 to 64.8% were classified as positive with the CIAs. Wide variations in titers in international units per milliliter were observed. In our series, more than half of the women considered susceptible to RV based on CIA results tested positive for RV antibodies by IB/Nt. Our data suggest that (i) sensitivity of CIAs could be increased by considering equivocal results as positive and (ii) the definition of immunity to RV as the 10-IU/ml usual cutoff as well as the use of quantitative results for clinical decisions may warrant reconsideration. A better standardization of CIAs for RV IgG determination is needed.
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Affiliation(s)
- Elise Bouthry
- AP-HP, Hôpital Paul Brousse, Groupe Hospitalier Universitaire Paris-Sud, Virologie, WHO Rubella NRL, National Reference Laboratory for Maternofetal Rubella Infections, University Paris-Sud, INSERM U1193, Villejuif, France
| | - Milena Furione
- Fondazione IRCCS Policlinico San Matteo, SC Microbiologia e Virologia, Pavia, Italy
| | - Daniela Huzly
- Institute of Virology, University Medical Center Freiburg, Freiburg, Germany
| | - Adaeze Ogee-Nwankwo
- Measles, Mumps, Rubella and Herpesvirus Laboratory Branch, Division of Viral, Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - LiJuan Hao
- Measles, Mumps, Rubella and Herpesvirus Laboratory Branch, Division of Viral, Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Adebola Adebayo
- Measles, Mumps, Rubella and Herpesvirus Laboratory Branch, Division of Viral, Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Joseph Icenogle
- Measles, Mumps, Rubella and Herpesvirus Laboratory Branch, Division of Viral, Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Antonella Sarasini
- Fondazione IRCCS Policlinico San Matteo, SC Microbiologia e Virologia, Pavia, Italy
| | - Maria Grazia Revello
- Fondazione IRCCS Policlinico San Matteo, SC Ostetricia e Ginecologia, Pavia, Italy
| | - Liliane Grangeot-Keros
- AP-HP, Hôpital Paul Brousse, Groupe Hospitalier Universitaire Paris-Sud, Virologie, WHO Rubella NRL, National Reference Laboratory for Maternofetal Rubella Infections, University Paris-Sud, INSERM U1193, Villejuif, France
| | - Christelle Vauloup-Fellous
- AP-HP, Hôpital Paul Brousse, Groupe Hospitalier Universitaire Paris-Sud, Virologie, WHO Rubella NRL, National Reference Laboratory for Maternofetal Rubella Infections, University Paris-Sud, INSERM U1193, Villejuif, France
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16
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Dimech W, Mulders MN. A review of testing used in seroprevalence studies on measles and rubella. Vaccine 2016; 34:4119-4122. [PMID: 27340096 DOI: 10.1016/j.vaccine.2016.06.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 05/15/2016] [Accepted: 06/01/2016] [Indexed: 11/18/2022]
Abstract
Seroprevalence studies are an essential tool to monitor the efficacy of vaccination programmes, to understand population immunity and to identify populations at higher risk of infection. An overarching review of all aspects of seroprevalence studies for measles and rubella published between 1998 and June 2014 was undertaken and the findings reported elsewhere. This paper details the considerable variation in the testing formats identified in the review. Apart from serum/plasma samples, testing of oral fluid, breast milk, dry blood spots and capillary whole blood were reported. Numerous different commercial assays were employed, including microtitre plate assays, automated immunoassays and classical haemagglutination inhibition and neutralisation assays. A total of 29 of the 68 (43%) measles and 14 of the 58 (24%) rubella studies reported qualitative test results. Very little information on the testing environment, including quality assurance mechanisms used, was provided. Due to the large numbers of testing systems, the diversity of sample types used and the difficulties in accurate quantification of antibody levels, the results reported in individual studies were not necessarily comparable. Further efforts to standardise seroprevalence studies may overcome this deficiency.
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Affiliation(s)
- Wayne Dimech
- NRL, 4th Floor Healy Building, 41 Victoria Parade, Fitzroy 3065, Victoria, Australia.
| | - Mick N Mulders
- World Health Organization, Global VPD Laboratory Networks, 20, Avenue Appia, CH-1211 Geneva 27, Switzerland.
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Abstract
The lack of standardization of rubella IgG testing continues to be a problem 20 years since the standard was introduced. The situation is complex and poorly understood. As demonstrated by an article in this issue (E. Bouthry, M. Furione, D. Huzly, A. Ogee-Nwankwo, L. Hao, A. Adebayo, J. Icenogle, A. Sarasini, M. Grazia Revello, L. Grangeot-Keros, and C. Vauloup-Fellous, J Clin Microbiol 54:1720-1725, 2016, http://dx.doi.org/10.1128/JCM.00383-16), the problem remains. The situation is far from being resolved, but at least the process for change has started.
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