Modified seroneutralization assay for measles virus antibody detection

The challenges and strategies for laboratory diagnosis of measles in an international setting

Serum-based measles-specific IgM EIAs are the recommended laboratory assays for diagnosis of acute measles infections and appear to be sufficient for measles control programs. However, serum samples are not ideal for molecular characterization of measles virus. Although neither laboratory nor field-based diagnostic tests that rival the EIAs have been developed, laboratory surveillance could be improved if specimen collection were simplified. Ideally the collection method should be noninvasive, have no requirement for a cold chain, and/or have no requirement for technically sophisticated equipment. Two alternative specimen collection technologies appear promising and can be used for both diagnostics and for collecting pertinent genotyping information: oral fluid and filter paper collection methods. These methods are compared along with their respective utilities in supporting measles diagnosis and strain surveillance.

Comparison of immunoglobulin G subclass profiles induced by measles virus in vaccinated and naturally infected individuals

A total of 258 human sera positive for measles antibodies were divided into four different groups: group 1 contained 54 sera from children after natural measles infection (immunoglobulin M [IgM] positive, early infection phase), group 2 contained 28 sera from children after measles vaccination (IgM positive, early infection phase), group 3 contained 100 sera from healthy adults (natural long-lasting immunity), and group 4 contained 76 sera from healthy children (postvaccinal long-lasting immunity). In the early phase of infection, the percent distributions of measles virus-specific IgG isotypes were similar between natural and postvaccinal immune responses. IgG1 and IgG4 were the dominant isotypes, with mean levels of detection of 100% (natural infection) and 100% (postvaccinal) for IgG1 and 96% (natural infection) and 92% (postvaccinal) for IgG4. In comparison, the IgG4 geometric mean titer (GMT) in the early phase of natural infection was significantly higher than the IgG4 GMT detected in the postvaccinal immune response (80 versus 13; 95% confidence interval). In the memory phase, IgG2 and IgG3 responses decreased significantly in both natural infection and postvaccinal groups, while IgG1 levels were maintained. In contrast, the IgG4 postvaccinal immune response decreased strongly in the memory phase, whereas IgG4 natural long-lasting immunity remained unchanged (9 versus 86%; P < 0.05). The results obtained suggest that IgG4 isotype could be used in the early phase of infection as a quantitative marker and in long-lasting immunity as a qualitative marker to differentiate between natural and postvaccinal immune responses.

A simplified and standardized neutralization enzyme immunoassay for the quantification of measles neutralizing antibody

A simplified and standardized neutralization enzyme immunoassay (Nt-EIA) was developed to detect measles virus growth in Vero cells and to quantify measles neutralizing antibody. Heat-inactivated sera were diluted serially 4-fold and tested in duplicate. The 50% reduction point (50%RP) of virus growth was calculated using the Reed-Muench formula and the neutralizing antibody titre of test sera was converted into mIU/ml by comparing their 50%RP with that of the international standard serum. The optimal virus input and incubation time were found to be 50-100 plaque forming unit (PFU)/well and 64-72 h, respectively. The simplified Nt-EIA had a good reproducibility with only 3.7-4.2% of duplicate tests having a ratio > 4 in an evaluation of intra assay variation and the coefficients of variance were 2-9% in an evaluation of inter assay variation. In addition, the simplified Nt-EIA had a high sensitivity(98.6%), specificity (100%) and agreement (98.8%) in qualitative comparison with plaque reduction neutralization test (PRNT). In quantitative comparison, the correlation coefficient between Nt-EIA and PRNT was 0.83 without log transformation or 0.77 after log transformation and 90% of 61 positive sera had a ratio < 4 between antibody titre tested by the two methods. The simplified Nt-EIA is thus a suitable alternative to the PRNT for the quantification of measles neutralizing antibody.

Cell-fusion assay for the detection of rubella virus in Vero cells

BACKGROUND AND OBJECTIVES

Rubella virus (RV) produces a subtle and slow-developing cytopathic effect in Vero cells that is difficult to recognize, especially at low multiplicities of infection. In order to facilitate the detection of RV in cell culture, we standardized a low-pH virus-mediated cell-fusion assay.

STUDY DESIGN

The incubation periods, temperatures, pH and multiplicity of infection were established. The specificity of the method was tested by immunofluorescence assay and cell-fusion inhibition by specific sera.

RESULTS

Six days post infection, Vero cells were treated for 5 min with fusion medium. After that, monolayers were incubated with medium at neutral pH for 16 h and then stained. Gigantic cells with multiple nuclei were observed.

CONCLUSIONS

The method allowed the observation of unequivocal images that are easier to recognize than the cytopathic effect caused by RV in the same cell line. At the same time, the method is simple, accessible and shown to be specific to demonstrate the replication of several strains and isolates of RV in Vero cells.

Loss maternally derived measles immunity in Argentinian infants

BACKGROUND

Measles immunization of children at 1 year of age with a single dose of the current vaccine has successfully reduced measles incidence in Argentina. However, the optimal schedule of measles vaccination of young infants would balance the risk of early loss of maternal antibody in the majority of infants with the risk of primary vaccine failure because of passive measles immunity. This study is the first to document a significant association between loss of passive measles antibody and age among infants born in 1995 and 1996 in Córdoba City, Argentina.

METHODS

This is a seroprevalence study of 340 infants to investigate the duration of transplacentally derived measles antibody, assayed by a neutralization test, during the first 8 months of age in Córdoba City, Argentina.

RESULTS

The proportion with detectable neutralizing measles antibodies decreased from 85% at 1 month of age to 8% at 8 months of age. The simple logistic model with age (in weeks) as the only variable showed that the decline in the proportion of infants with a positive antibody titer was sharpest during the second and fifth months of age (6.6 and 6.8% per week during a 4-week period, respectively).

CONCLUSIONS

These findings suggest that 80% of infants are susceptible to measles infection for at least 3 months before routine immunization at 12 months of age.

Immunoglobulin M antibody response to measles virus following natural virus infection, primary vaccination, and reexposure to the virus

Evaluation of the measles virus ELISA kit (Merck) to detect specific IgM as an indicator of primary measles antibody response was carried out. A modification of the manufacturer's cutoff value interpretation was introduced to allow for equivocal results in addition to positive and negative ones. With this modification, the test assayed gave an overall reproducibility of 96.16%. The IgM seropositivity rate for seroneutralization-confirmed measles cases was 100% for naturally infected measles subjects and 90% for primary measles vaccinated subjects. Individuals with positive neutralizing antimeasles antibodies in close contact with a confirmed measles case gave the following measles IgM ELISA results: 54.54% negative, 9.09% positive, and 36.36% equivocal, showing a booster with IgM antibody response on reexposure to the virus. Positive subjects with neutralizing antimeasles antibodies without recent contact with a measles case gave negative IgM results. IgM seropositivity was strongly associated with IgG seroconversion and clinical measles (p < 0.0001). The technique assayed performed adequately for the confirmation of both measles natural infection and primary vaccination and for the differentiation of primary and secondary antibody response, taking into account the modification in the cutoff value interpretation introduced and providing that the serum samples are obtained between days 5 and 30 after onset of rash.

Neutralization enzyme-linked immunosorbent assay for evaluation of immunity to measles virus

A neutralization enzyme-linked immunosorbent (Nt-ELISA) assay for determination of protective immunity to measles virus was developed and evaluated. This procedure uses the same initial steps as performed to determine antibody titers by seroneutralization (Nt) test. However, a reduction in virus infectivity by neutralizing antibody was determined by quantitation of viral antigen using ELISA. The serum dilution that resulted in neutralization of 50% of infectious virus could be determined from the absorbance values. To be able to screen a large number of specimens, the conditions of the Nt-ELISA test were adjusted such that negative sera for measles antibodies and the positive ones were clearly distinguished on the basis of a single dilution (1:4). This test showed similar sensitivity (88.3%) and equal specificity as the Nt test when screening 136 serum samples from normal subjects. The estimation of protective antibody titers by Nt and Nt-ELISA methods was strongly correlated (correlation coefficient = 0.91). Thus, the measles Nt-ELISA test is rapid, reproducible, sensitive, and specific for detection of protective measles antibodies.