Classification of measles breakthrough cases in an elimination setting using a comprehensive algorithm of laboratory results: why sensitive and specific IgM assays are important

Objective: In 2006, a measles outbreak occurred in Catalonia (Spain), six years after endemic measles was declared eliminated. This study aimed to classify 19 confirmed measles breakthrough cases (BC) using a high-performance avidity assay developed in 2010. Methods: Serum specimens were tested by i...

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Autores principales:	S. Mercader, A. Dominguez, N. Torner, J. Costa, S.B. Sowers, A. Martinez, W.J. Bellini, C.J. Hickman
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	Measles breakthrough case avidity assay vaccine failure elimination case classification Infectious and parasitic diseases RC109-216
Acceso en línea:	https://doaj.org/article/303209ad01414ff7bd3aa3178fef565c
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spelling	oai:doaj.org-article:303209ad01414ff7bd3aa3178fef565c2021-11-30T04:14:06ZClassification of measles breakthrough cases in an elimination setting using a comprehensive algorithm of laboratory results: why sensitive and specific IgM assays are important1201-971210.1016/j.ijid.2021.09.004https://doaj.org/article/303209ad01414ff7bd3aa3178fef565c2021-11-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S1201971221007116https://doaj.org/toc/1201-9712Objective: In 2006, a measles outbreak occurred in Catalonia (Spain), six years after endemic measles was declared eliminated. This study aimed to classify 19 confirmed measles breakthrough cases (BC) using a high-performance avidity assay developed in 2010. Methods: Serum specimens were tested by indirect IgG, indirect IgM, capture IgM enzyme immunoassay, an endpoint-titer IgG avidity assay, and a plaque reduction neutralization assay. Serology and RNA detection results were combined in an algorithm for measles confirmation and classification of breakthrough cases and analyzed with clinical and epidemiological data. Results: Of 19 samples, thirteen (68%) were conclusive with the classification of BCs, and six (32%) had false-positive IgM results on an indirect-format assay; they were classified as rash and fever illness of undetermined etiology. BCs were primary vaccine failures (seven or 54%), secondary vaccine failures (four or 31%), and two (15%) could not be classified. Conclusions: In measles elimination settings, high-performing assays and a comprehensive algorithm of laboratory results (IgG, IgM, and RNA detection), including IgG avidity and PRN results when necessary, can assist in accurate laboratory confirmation and classification of suspected measles cases for surveillance. Highly specific IgM assays are required to minimize the number of false-positive results.S. MercaderA. DominguezN. TornerJ. CostaS.B. SowersA. MartinezW.J. BelliniC.J. HickmanElsevierarticleMeaslesbreakthrough caseavidity assayvaccine failureeliminationcase classificationInfectious and parasitic diseasesRC109-216ENInternational Journal of Infectious Diseases, Vol 112, Iss , Pp 21-24 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Measles breakthrough case avidity assay vaccine failure elimination case classification Infectious and parasitic diseases RC109-216
spellingShingle	Measles breakthrough case avidity assay vaccine failure elimination case classification Infectious and parasitic diseases RC109-216 S. Mercader A. Dominguez N. Torner J. Costa S.B. Sowers A. Martinez W.J. Bellini C.J. Hickman Classification of measles breakthrough cases in an elimination setting using a comprehensive algorithm of laboratory results: why sensitive and specific IgM assays are important
description	Objective: In 2006, a measles outbreak occurred in Catalonia (Spain), six years after endemic measles was declared eliminated. This study aimed to classify 19 confirmed measles breakthrough cases (BC) using a high-performance avidity assay developed in 2010. Methods: Serum specimens were tested by indirect IgG, indirect IgM, capture IgM enzyme immunoassay, an endpoint-titer IgG avidity assay, and a plaque reduction neutralization assay. Serology and RNA detection results were combined in an algorithm for measles confirmation and classification of breakthrough cases and analyzed with clinical and epidemiological data. Results: Of 19 samples, thirteen (68%) were conclusive with the classification of BCs, and six (32%) had false-positive IgM results on an indirect-format assay; they were classified as rash and fever illness of undetermined etiology. BCs were primary vaccine failures (seven or 54%), secondary vaccine failures (four or 31%), and two (15%) could not be classified. Conclusions: In measles elimination settings, high-performing assays and a comprehensive algorithm of laboratory results (IgG, IgM, and RNA detection), including IgG avidity and PRN results when necessary, can assist in accurate laboratory confirmation and classification of suspected measles cases for surveillance. Highly specific IgM assays are required to minimize the number of false-positive results.
format	article
author	S. Mercader A. Dominguez N. Torner J. Costa S.B. Sowers A. Martinez W.J. Bellini C.J. Hickman
author_facet	S. Mercader A. Dominguez N. Torner J. Costa S.B. Sowers A. Martinez W.J. Bellini C.J. Hickman
author_sort	S. Mercader
title	Classification of measles breakthrough cases in an elimination setting using a comprehensive algorithm of laboratory results: why sensitive and specific IgM assays are important
title_short	Classification of measles breakthrough cases in an elimination setting using a comprehensive algorithm of laboratory results: why sensitive and specific IgM assays are important
title_full	Classification of measles breakthrough cases in an elimination setting using a comprehensive algorithm of laboratory results: why sensitive and specific IgM assays are important
title_fullStr	Classification of measles breakthrough cases in an elimination setting using a comprehensive algorithm of laboratory results: why sensitive and specific IgM assays are important
title_full_unstemmed	Classification of measles breakthrough cases in an elimination setting using a comprehensive algorithm of laboratory results: why sensitive and specific IgM assays are important
title_sort	classification of measles breakthrough cases in an elimination setting using a comprehensive algorithm of laboratory results: why sensitive and specific igm assays are important
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/303209ad01414ff7bd3aa3178fef565c
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Classification of measles breakthrough cases in an elimination setting using a comprehensive algorithm of laboratory results: why sensitive and specific IgM assays are important

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