Investigation of measles IgM-seropositive cases of febrile rash illnesses in the absence of documented measles virus transmission, State of São Paulo, Brazil, 2000-2004

Ciccone, Flavia Helena; Carvalhanas, Telma Regina Marques Pinto; Afonso, Ana Maria Sardinha; Flannery, Brendan; Waldman, Eliseu Alves

doi:10.1590/s0037-86822010000300004

Cited by 14 publications

(11 citation statements)

References 20 publications

(22 reference statements)

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“…Others have described the occurrence of false-positive measles and rubella IgM test results, including a case report of a patient who was diagnosed with parvovirus infection after initially testing positive for measles IgM [ 34 ], as well as reports of false-positive IgM results that were resolved with additional IgG testing [ 35 , 36 ]. However, to our knowledge ours is the first study that used confirmed cases of measles and rubella investigated by public health authorities as the gold standard to calculate IgM test performance.…”

Section: Discussionmentioning

confidence: 99%

The utility of measles and rubella IgM serology in an elimination setting, Ontario, Canada, 2009–2014

et al. 2017

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In Canada, measles was eliminated in 1998 and rubella in 2000. Effective measles and rubella surveillance is vital in elimination settings, hinging on reliable laboratory methods. However, low-prevalence settings affect the predictive value of laboratory tests. We conducted an analysis to determine the performance of measles and rubella IgM testing in a jurisdiction where both infections are eliminated.21,299 test results were extracted from the Public Health Ontario Laboratories database and 1,239 reports were extracted from the Ontario Integrated Public Health Information System (iPHIS) from 2008 and 2010 for measles and rubella, respectively, to 2014. Deterministic linkage resulted in 658 linked measles records (2009–2014) and 189 linked rubella records (2010–2014). Sixty-six iPHIS measles entries were classified as confirmed cases, of which 53 linked to laboratory data. Five iPHIS rubella entries were classified as confirmed, all linked to IgM results. The positive predictive value was 17.4% for measles and 3.6% for rubella. Sensitivity was 79.2% for measles and 100.0% for rubella. Specificity was 65.7% for measles and 25.8% for rubella.Our study confirms that a positive IgM alone does not confirm a measles case in elimination settings. This has important implications for countries that are working towards measles and rubella elimination.

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Section: Discussionmentioning

confidence: 99%

The utility of measles and rubella IgM serology in an elimination setting, Ontario, Canada, 2009–2014

et al. 2017

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“…Their results are different from ours. Our younger children had more coryza, Koplik's spot, and other complications, albeit fewer instances of cough, conjunctivitis, and hyperpigmentation, as showed in the Table 3. A study by Ciccone et al with 463 participants found the clinical features of measles patients as follows: fever (85%), rash (97%), cough (46%), coryza (48%), and conjunctivitis (17%) [57]. In the study by Chan et al 165 subjects were recruited, with the following proportions of clinical features: fever (100%), rash (100%), cough (96.4%), coryza (98.25%), conjunctivitis (58.2%), and Koplik's spot (75.2%) [56].…”

Section: Discussionmentioning

confidence: 99%

An evaluation of the clinical features of measles virus infection for diagnosis in children within a limited resources setting

et al. 2020

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Background: Measles is a recurrent health problem in both advanced and developed countries. The World Health Organization (WHO) recommends anti-measles immunoglobulin M (Ig M) as the standard method of detecting the virus; however, many areas still present the inability to perform a serology test of anti-measles IgM. Therefore, a typical clinical feature is necessary to establish the diagnosis of measles. The objective of this study was to evaluate hyperpigmented rash and other clinical features as the diagnostic tools with respect to measles, especially in an outbreak setting. Methods: In this observational diagnostic study, the inclusion criteria were as follows: between 6 and 144 months of age, fever, maculopapular rash for 3 days or more, accompanied by a cough, or coryza, or conjunctivitis. Those with a prior history of measles vaccination (1-6 weeks) were excluded, in addition to those with histories of corticosteroid for 2 weeks or more and immunocompromised conditions. The samples were taken from Dr. Soetomo General Academic Hospital in Surabaya, Indonesia. We evaluated the sensitivity, specificity, the positive predictive value, and the negative predictive value of such clinical features. Hyperpigmented rash was validated using Kappa and Mc Nemar tests. Anti-measles Ig M was considered as the gold standard. Results: This study gathered 82 participants. The clinical manifestations of all subjects included fever, cough, coryza, conjunctivitis, Koplik spots, and maculopapular rash (which turns into hyperpigmented rash along the course of the illness). Most maculopapular rashes turn out to be hyperpigmented (89%). Sensitivity, specificity, positive predictive value, and negative predictive values of the combination of fever, maculopapular rash, and hyperpigmented rash were found to be at 90.7, 28.6, 93.2, and 22.2%, respectively. The Mc Nemar and Kappa tests showed p values of 0.774 and 0.119, respectively. Conclusion: The combination of fever, maculopapular rash, and hyperpigmented rash can be used as a screening tool regarding measles infection in an outbreak setting, which can then be confirmed by anti-measles Ig M. Cough, coryza, and Koplik's spot can be added to this combination, albeit with a slight reduction of sensitivity value.

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“…As countries move from rubella control to elimination, the implementation of vaccination has directed a significant decrease in rubella incidence, resulting in a reduction in the positive predictive value of IgM assay [Medici et al, , Ciccone et al, , Wandinger et al, ]. This reduction has led to a significant risk of false‐positive results [Best ].…”

Section: Discussionmentioning

confidence: 99%

“…There are few articles to differentiate the etiology of rash in rubella‐like illnesses [Davidkin et al, , Davidkin et al, , Ciccone et al, ]. However, limited studies have been conducted on clarifying the source of IgM positivity in these cases.…”

Section: Discussionmentioning

confidence: 99%

The etiology of Rubella IgM positivity in patients with rubella‐like illness in Iran from 2011 to 2013

Khorrami

Mokhtari‐Azad

Yavarian

et al. 2015

Journal of Medical Virology

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Rubella is a mild self-limiting contagious viral disease caused by the rubella virus (RV). Although symptoms are often mild, the concern is centralized around the possible effect on a fetus growth and development in case of primary infection during early months of pregnancy. Recently acquired rubella is commonly confirmed by RV-specific IgM antibody detection in the serum. However, rubella primary infection is not always the only cause of IgM positivity. Other possible causes of rubella IgM positivity may include IgM persistence following vaccination or naturally acquired infection or even re-infection. Moreover, nonspecific IgM reactivity can cause false-positive results. There are few articles to differentiate the aetiology of rash in rubella-like illnesses. However, limited studies have been conducted on clarifying the source of IgM positivity in these cases. This article reports the study of 10,896 clinical cases demonstrating rubella-like illness between 2011 and 2013 in Iran. The rate of IgM positivity among these cases was 0.52% (57 cases). As predicted based on the high coverage of vaccination in Iran fewer than 16% of cases with ELISA IgM positive result, were due to current rubella primary infections. The greater part of the positive IgM reactions occurred in cross reactivity with other viruses (31.6%) or in prolonged IgM response post vaccination (24.6%). This research confirmed that the positive result of rubella IgM assay in vaccinated individuals is mainly caused by prolonged IgM production, rubella re-infection, and false positivity due to infection with other viruses, rather than the rubella primary infection itself.

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Investigation of measles IgM-seropositive cases of febrile rash illnesses in the absence of documented measles virus transmission, State of São Paulo, Brazil, 2000-2004

Cited by 14 publications

References 20 publications

The utility of measles and rubella IgM serology in an elimination setting, Ontario, Canada, 2009–2014

The utility of measles and rubella IgM serology in an elimination setting, Ontario, Canada, 2009–2014

An evaluation of the clinical features of measles virus infection for diagnosis in children within a limited resources setting

The etiology of Rubella IgM positivity in patients with rubella‐like illness in Iran from 2011 to 2013

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