酶联免疫法检测风疹病毒急性感染结果分析

目的探讨酶联免疫法在诊断风疹病毒急性感染中的应用。方法对2100例无偿献血者血浆样本分别检测风疹病毒IgM抗体、IgG抗体,对IgM抗体阳性和IgM抗体阴性且IgG抗体阳性的样本检测其IgG抗体亲合力。结果 2100例样本中,风疹病毒IgM抗体阳性率为0.76%,IgG抗体阳性率为78.67%,447例样本个体风疹病毒IgM抗体和IgG抗体均为阴性。在对IgM抗体阴性且IgG抗体阳性的样本进行IgG抗体亲合力检测时,有19例样本为低亲合力,可判定为原发性感染。在对IgM抗体阳性的样本进行IgG亲合力检测时,样本SZ0259和SZ1490IgM抗体为可疑值,IgG抗体阳性,IgG抗体高亲合力,可能由于IgM抗体常年保持低水平,并非正处于风疹病毒急性感染期。最终确定风疹病毒急性感染的样本为33例,感染率1.57%。结论可同时检测风疹病毒IgM抗体和风疹病毒IgG抗体亲合力来诊断风疹病毒感染,IgM抗体阳性或IgG抗体低亲合力的样本均可判定为风疹病毒急性感染。     

2005—2008年玉溪市发热出疹性疾病病例监测分析

目的通过对玉溪市发热出疹性疾病病例流行病学监测分析,全面掌握玉溪市发热出疹性疾病流行规律,为制定防制措施提供科学依据。方法对玉溪市2005—2008年以来发热出疹性疾病监测情况作描述性流行病学分析。结果 2005—2008年共报告554例疑似麻疹发热出疹性疾病病例,其中实验室检出麻疹IgM抗体阳性305例、确诊率为55.05%;风疹IgM抗体阳性67例、确诊率为11.91%;未检出麻疹IgM和风疹IgM病例182例,占总病例的32.85%。结论玉溪市目前发热出疹性疾病病例以麻疹为主,各年龄段均有病例,发病主要集中在冬春季,同时具有一定数量的风疹病例,以及其他类型的出疹性疾病。     

Rubella-specific IgM reactivity in sera from cases of infectious mononucleosis.

Eight sera from 125 cases of infectious mononucleosis (IM) were reactive for rubella-specific IgM in an M-antibody capture radioimmunoassay. The reactivity of individual sera varied depending upon the source of the rubella antigen used in the assay. One serum gave strongly positive results with some rubella haemagglutinating antigens but negative results with others and may have contained an IgM antibody which was capable of distinguishing between strains of rubella virus. If the diagnosis of rubella is based solely on detection in solid-phase immunoassay of rubella-specific IgM, IM should be excluded.     

IgA antibody response in acute rubella determined by solid-phase radioimmunoassay.

A solid-phase radioimmunoassay (RIA) for detecting rubella virus IgA serum antibodies was developed. Purified rubella virus grown in roller cultures of Vero cells was adsorbed onto polystyrene beads. The coated beads were then incubated with dilutions of serum, and rubella IgA antibodies which attached to the virus antigen on the solid-phase were subsequently detected with 125I-labelled anti-human-alpha antibodies. The specificity of the iodinated anti-human immunoglobulins was confirmed by RIA analysis of fractions obtained by chromatography of an early convalescent serum on an agarose column. A complete separation of IgM, IgA, and IgG was observed. A total of 144 serial serum specimens from 31 adult patients with an acute rubella infection were tested for rubella IgA antibodies, and the results were compared with the RIA IgG and IgM titres reported earlier from the same specimens. The RIA IgA response was detected in each of the 31 patients and the IgA antibodies appeared almost simultaneously with the IgG and IgM antibodies. The maximum titres, which were lower than the IgG and IgM titres, were reached in about 1 week after the onset of rash. In 6 patients out of 31 the IgA antibody response was transient and persisted approximately two months, while in the remaining 25 patients the IgA antibodies persisted throughout the study period of more than 5 months. The results obtained indicate that the presence of rubella IgA antibodies in serum is not an indication for a recent rubella infection.     

麻疹IgM抗体的检测和麻疹误诊分析

对１９８８年以来收集的部分疑似麻疹病例血清，采用麻疹和风疹ｌｇＭ抗体捕捉ＥＭ法进行检测．结果在 １５９４份疑似麻疹病例的血清中，麻疹ＩｇＭ抗体阳性者９１４份，阳性率为 ５７．３％。对 １７２份麻疹ＩｇＭ抗体阴性的血清检测了风疹ＩｇＭ抗体，发现３９份阳性，阳性率２２、７％。说明疑似麻疹的病例中有一部分是风疹病例，从而为科学鉴别麻疹与风疹、及时控制麻疹疫情提供了依据。     

An outbreak of rubella in the Federation of Bosnia and Herzegovina between December 2009 and May 2010 indicates failure to vaccinate during wartime (1992-1995)

A rubella outbreak involving 1900 cases was recorded in the Federation of Bosnia and Herzegovina between mid-December 2009 and the end of May 2010. Sera from 389 suspected rubella cases were examined for the presence of rubella-specific IgM and IgG antibodies. A total of 32 throat swabs from suspected rubella cases were tested by RT-PCR and were used to attempt virus isolation. Most patients (945/1900, 49·73%) had never received rubella vaccination or had an unknown vaccination status (563/1900, 29·63%). About 45% (178/389) of suspected rubella patients were IgM positive. From 13 of the throat swabs a virus isolate and E1 gene sequences attributed to genotype 2B were obtained. The rubella outbreak was due to failure to vaccinate during the war period (1992-1995) and emphasizes the need for additional vaccination opportunities.     

小于胎龄儿围产期相关高危因素分析

目的:探讨与小于胎龄儿出生相关的围产期高危因素。方法:对2008年8月~2010年7月在儿科新生儿病房住院的71例小于胎龄儿进行回顾性调查和统计学分析,研究与小于胎龄儿发生可能有关的各种危险因素。结果:①位于前3位的相关致病因素分别是孕母患妊娠期高血压疾病、患儿风疹病毒IgM阳性以及孕母文化水平较低;②在风疹病毒IgM阳性及阴性两组患儿中,出生体重、头围、重量指数、身长/头围以及先天畸形发生率的差异均无统计学意义;③部分风疹病毒IgG阳性孕妇可再次受到感染,有可能对胎儿造成损害。结论:积极治疗孕母疾病,加强产前保健,减少围产期相关高危因素是降低小于胎龄儿出生的关键。     

Newborn screening for congenital infectious diseases

To estimate the prevalence of congenital toxoplasmosis, Chagas disease, cytomegalovirus, and rubella, blood samples on dried blood spot (DBS) from neonates (day 3-20 of life) were screened for immunoglobulin (Ig) M against Toxoplasma gondii, cytomegalovirus, rubella virus, and IgG against Trypanosoma cruzi by methods used for serum and adapted for use with DBS. Positive samples were further analyzed for IgM and IgG in serum from neonates and mothers. DBS samples from 364,130 neonates were tested for Toxoplasma gondii-specific IgM, and 15,873 neonates were also tested for IgM against cytomegalovirus and rubella virus and for Trypanosoma cruzi-specific IgG. A total of 195 were diagnosed with congenital toxoplasmosis, 16 with cytomegalovirus, and 11 with congenital rubella. One newborn had a confirmed result for Chagas disease, and 21 mothers had positive serum antibodies. These results suggest that infectious diseases should be considered for future inclusion in programs for newborn screening of metabolic diseases in disease-endemic areas.     

Are many women immunized against rubella unnecessarily?

Radial haemolysis (RH) was used to test sera for immunity to rubella from 1317 patients attending a general practice. One hundred and forty-one (10.7%) were treated as susceptible and offered an attenuated virus vaccine (RA 27/3). Pre-immunization sera from 43% of these patients were reactive at low levels in RH (less than 15 international units rubella antibody per ml). Pre- (S1) and post- (S2) immunization sera from 66 vaccinees were studied in detail. Antibody was detected by RH, haemagglutination inhibition (HI) and enzyme-linked immunosorbent assay (ELISA), and the specific IgM response was measured by a solid-phase M-antibody capture radioimmunoassay (MACRIA). The vaccine-induced IgM response was only detected if the S1 serum was non-reactive by all tests for rubella antibody. It was weaker than that seen following wild virus infection. It could be detected reliably for six weeks, and in most cases for nine weeks, after immunization. In contrast, patients with S1 specimens reactive by RH, HI or ELISA never showed an IgM response in the S2 specimen despite "significant'' antibody rises often being present. It was considered that an IgM response to RA 27/3 was the best indicator of pre-immunization susceptibility to rubella. The failure of many vaccinees to make an IgM response implied that a significant proportion were already immune. It is suggested that the threshold for a report of immunity to rubella could be lowered from 15 i.u. antibody per ml and so fewer women immunized without vaccine being withheld from those who need it.     

江西省麻疹实验室网络的建立和运转情况分析

目的　评价江西省麻疹实验室网络在加速控制麻疹阶段中的作用。方法　对江西省 1 999年、2 0 0 1～ 2 0 0 3年麻疹实验室网络监测结果进行了分析 ,共检测了 1 2 0 8份疑似麻疹血清标本。结果　 83 4份麻疹流行区的血清中 ,麻疹IgM抗体阳性 5 1 0份 ,分属 6 1起流行 ;3 74份麻疹IgM抗体阴性血清中 ,风疹IgM抗体阳性 1 97份 ,分属 2 6起风疹流行。麻疹、风疹IgM抗体检出率与病例出疹后采血时间密切相关 ,以出疹后 4～ 1 4d检出率最高( 6 2 . 4 5 %,71. 0 4 %)。麻疹、风疹流行人群中以学龄前儿童、中小学生为主 ,是省内发病的重点人群。江西省 2 0 0 3年采集 3份咽拭子 ,并用B95a细胞首次成功地分离到 2株麻疹野病毒 ,经核酸序列分析鉴定均为H1 基因型。结论　为进一步加强实验室麻疹病毒学与血清学的监测 ,应通过对麻疹实验室网络的职能考核 ,不断提高实验室血清学诊断的工作质量 ,为加速控制麻疹监测提供科学依据     

2006年山东省风疹暴发地区孕妇风疹病毒早期感染状况调查

[目的]了解风疹暴发地区孕妇风疹病毒早期感染状况,为监测与预防先天性风疹综合症（CRS）提供依据。[方法]2006年4月,在山东省5处近期风疹暴发地区采集部分未发生风疹的孕妇血清,检测风疹IgM抗体,并对阳性孕妇所生儿童进行追踪观察。[结果]调查孕妇1030名,风疹IgM抗体阳性5例,阳性率为0．49％;5例孕妇孕周分别为16周、19周、20周、21周和40周,其中2例（孕周16周、20周）流产,3例均顺利生产,跟踪观察1年,儿童未发现出生缺陷。[结论]山东省风疹暴发地区孕妇风疹病毒早期感染率不高。     

河北省80699例已婚女性孕前TORCH检测结果分析

目的:了解TORCH检测在河北省孕前优生健康检查中的意义,降低出生缺陷发生风险。方法:按照《河北省开展免费孕前优生健康检查工作实施方案》要求,采用酶联免疫法测定血清中风疹病毒IgG抗体、巨细胞病毒IgG、IgM抗体和弓形虫IgG、IgM抗体。各试点县(市)每月汇总上报TORCH检查结果,由河北省计划生育科研院专家将汇总表进行统计分析。结果:河北省15个国家项目试点县(市)共有80 699例已婚待孕妇女接受TORCH检查,风疹病毒IgG抗体、巨细胞病毒IgG、IgM抗体及弓形虫IgG、IgM抗体阳性率分别为50.13%、29.84%、3.79%、0.50%和0.20%;所检测的3种病毒抗体阳性率最高和最低比较,具有统计学差异(P<0.001)。结论:TORCH检测在孕前优生健康检查中具有重要意义,应提高待孕夫妇对TORCH检测意义和TORCH感染危害性认识,规范TORCH检测方法,强化实验室质量控制和管理,提高试剂质量。     

Laboratory confirmation of congenital rubella syndrome in South Korea in 2017: A genomic epidemiological investigation

• The WHO Regional Verification Commission certified in 2017 that Korea was the first country in the WHO Western Pacific Region to achieve rubella elimination. A suspected congenital rubella syndrome (CRS) was reported to the Korea Centers for Disease Control and Prevention in August 2017. The mother of a new-born had visited Vietnam during her pregnancy. CRS was confirmed based on the detection of rubella-specific IgM and rubella RNA in the urine and throat swab. Rubella virus isolated from the throat swab was classified as genotype 2B, and a phylogenetic analysis indicated that this genotype had been imported from Vietnam. This is the first report of CRS confirmed using virus isolation in Korea. Laboratory surveillance plays a critical role in the elimination of rubella through the provision of laboratory testing data, and characterisation of circulating strains.

     

Negative impact of clinical misdiagnosis of measles on health workers' confidence in measles vaccine

We conducted a survey to determine the accuracy of the clinical diagnosis of measles in Zimbabwe. Between December 1996 and February 1997, we collected blood samples and clinical and demographic information from a sample of 105 children with a clinical diagnosis of measles. A clinical case of measles was defined as a person with a history of fever, rash for three or more days, and either cough, coryza, or conjunctivitis. A laboratory-confirmed case of measles or rubella had IgM antibodies against measles virus or rubella virus respectively. A total of 91% of children met the clinical case definition. Among those who met the clinical case definition for measles, 72% were IgM-positive for measles virus only, 23% were IgM-positive for rubella virus only, 3% were IgM-positive for both measles and rubella viruses, and 2% were IgM-negative for both viruses. This study demonstrates the importance of considering selective laboratory confirmation of measles in periods of high disease incidence when the effectiveness of the vaccine is questioned.     

山西省介休市风疹筛查及相关知识态度行为调查

目的：检测育龄妇女和儿童风疹的自然感染率,调查育龄妇女对风疹认知、态度、行为,为山西省实施风疹的疫苗干预提供参考依据。方法：采集2008年1月-6月在介休市计划生育妇幼保健中心进行健康检查,未接种过风疹疫苗的育龄妇女和学龄前儿童的血清,进行IgM与IgG抗体检测,对来该中心接受优生知识培训的育龄妇女进行风疹知识、态度、行为调查。结果：育龄妇女IgG阳性率为69．1％,IgM阳性率为0．34％;儿童IgG阳性率为72．3％,IgM阳性率为0．99％。问卷调查显示,受访对象中96．3％认为孕妇感染风疹会对胎儿造成危害,86．2％认为孕妇不能接种疫苗,愿意免费接种风疹疫苗的占76．4％,若感染了风疹会采纳医生建议引产的占86．5％,产前接受过风疹感染相关检查的占1．6％,接种过风疹疫苗的占5．7％。妇女的教育水平、经济收入都会对风疹的认知、态度、行为产生一定的影响。结论：育龄妇女经过宣传教育,对有关风疹的认知、态度上取得了一定的成效,但在行为上还存在不足,应加强行为方面的宣传教育和有针对性的专题培训。     

Outcome of asymptomatic infection with rubella virus during pregnancy.

We have tried to detect prenatal infection in 34 infants whose mothers were re-infected with rubella virus during pregnancy and in six infants whose mothers had primary subclinical rubella during pregnancy. Two methods of assessment were used: first, serum obtained soon after birth was tested for IgM antibody; secondly, serum obtained after the age of 8 months was tested for specific IgG. The 34 women with re-infections had increases in IgG antibody titre but no IgM response. No evidence of prenatal infection was found in 33 of their 34 infants. One infant was found to have IgG antibody at the age of 11 months. This infant was IgM-negative at birth and had a rubelliform rash at the age of 5 1/2 months; it therefore probably contracted post- rather than pre-natal infection. Fetal infection from maternal re-infection during pregnancy is probably rare. The six women with primary subclinical rubella produced both IgG and IgM classes of antibody. Three of their six infants showed serological evidence of intrauterine infection. One, infected when its mother was 8 weeks pregnant, had clinical evidence of congenital rubella. Primary subclinical rubella during pregnancy therefore carries a significant risk of fetal infection. Because of the difference in outcome, great care should be taken to distinguish between primary infection and re-infection when investigating symptomless increases in antibody titre after contact with rubella during pregnancy.     

大连市2010年麻疹风疹疑似病例IgM抗体检测结果分析

目的:通过实验室麻疹、风疹IgM抗体检测结果,了解大连市2010年麻疹、风疹的流行特征,为促进免疫规划工作提供科学依据。方法:采用ELISA对2010年麻疹、风疹疑似病例血清标本进行IgM抗体检测;结果:全年共检测麻疹、风疹IgM抗体69份,麻疹IgM抗体阳性率为28.99%;风疹IgM抗体阳性率为43.48%;发病地区主要集中在流动人口频繁的城乡结合部,麻疹发病以5岁以内儿童为主,风疹以青少年居多;流行季节均主要为春季。结论:加强流动人口管理仍是今后防控的重点,同时继续加强计划免疫管理,开展查漏补种,做好疫情监测,预防暴发。     

Serological response to rubella revaccination in adolescent females

The study's purpose was to utilize ELISA in determining rubella susceptibility in teenagers who are seronegative by HI. Ten previously vaccinated, seronegative adolescent females were revaccinated with RA 27/3 and their IgG and IgM responses measured by ELISA. Before revaccination, all 10 were seronegative for rubella by HI (less than 1:10). However, by ELISA, six showed an IgG and no IgM levels. After reimmunization, three showed a significant IgM response by day 6, indicating primary rubella exposure. The remaining seven females failed to demonstrate an IgM response; however, the failure was consistent with a history of prior rubella vaccination. Peak IgG responses were noted by day 12 in nine of the females. The remaining teenager failed to show an IgG response and was considered a vaccine failure. This study confirms the superiority of ELISA as compared to HI titers in determining rubella susceptibility.     

上海市浦东新区2012年麻疹疑似病例IgM抗体检测结果分析

目的对2012年上海市浦东新区麻疹疑似病例进行IgM抗体检测,分析麻疹流行病学特征,为进一步制订麻疹防治策略提供科学依据。方法应用酶联免疫吸附试验（ELISA）对疑似麻疹病例血清标本同时检测麻疹、风疹IgM抗体。结果 2012年该区共检测麻疹疑似病例241例。检出麻疹IgM抗体阳性111例,阳性率为46.06%;风疹IgM抗体阳性38例,阳性率为15.77%;其中有4例麻疹、风疹IgM抗体均为阳性。麻疹阳性年龄主要分布于20-30岁年龄和8个月-10岁以下年龄,其次是8个月以下婴儿。流行高峰后移至5-9月份。风疹阳性年龄20-30岁组最高,其次为30-40岁组。流行高峰在3-6月份。麻疹、风疹IgM抗体阳性率与血清采集时间有密切关系。出疹4天后采集的血清标本IgM抗体阳性率（麻疹49.75%、风疹18.27%）明显高于3天内（麻疹为29.55%、风疹为4.55%）。麻疹、风疹病例中无免疫史或免疫不详者占88.29%和92.11%。结论建议对重点人群进行麻疹强化免疫,提高免疫接种率,开展查漏补,麻疹初免年龄应适当提早。提高疑似麻疹病例的血清标本采集率。同时也需要加强风疹的监测和预防接种工作,控制风疹疫情的蔓延,并进一步加强麻疹、风疹及其他出疹性疾病的监测。     

某初中1起风疹暴发疫情的流行病学调查

目的 对广西苍梧县某初中发生的1起风疹暴发疫情进行调查分析。 方法 采用描述流行病学方法对某初中风疹暴发疫情的病例个案资料和流行特征进行分析。 结果 2018年4月27日—5月20日,共发生风疹病例51例,均为学生,罹患率为4.08％。实验室检测20名学生的咽拭子和血液标本,其中18份咽拭子风疹病毒核酸阳性,18份风疹IgM抗体阳性。发病学生中仅2名学生接种过麻腮风疫苗,其余学生含风疹成分疫苗接种史空白。 结论 落实学校传染病管理工作,尽早开展含风疹成分疫苗的应急接种,是预防控制风疹暴发的重要措施。