Laboratory diagnosis of rubella: past, present and future

Abstract

Fifty years ago in New South Wales the late Sir Norman Gregg [1] described congenital cataracts in 78 babies, 67 of whose mothers had had clinical rubella in early pregnancy; he concluded that the disease in the mother caused the abnormality in the baby. Gregg [1–3] and Swan [4, 5] and their colleagues reported that deafness, heart disease and microcephaly were also major components of the congenital rubella syndrome. The need to prevent this tragic outcome stimulated intensive work on laboratory diagnosis and vaccine development, leading to the isolation of rubella virus in 1962 and then to methods for antibody detection. These complementary advances established the two traditional pillars of virological diagnosis and opened the way to immunization, with the result that some countries are now on the verge of eliminating a disease which for over 100 years was regarded as no more than a mild and harmless exanthem of childhood.

Unseen blindness, unheard deafness, and unrecorded death and disability: congenital rubella in Kumasi, Ghana

“…Newer laboratory techniques overcome this diagnostic difficulty for surveillance but may not be feasible in lowresource settings. 21,22,32 The estimated prevalence of congenital rubella syndrome can be modeled from agespecific rates of rubella susceptibility. The rubella seroprevalence documented in this study gives an estimate of more than 3000 Ghanaian women infected while pregnant and almost 700 children born with congenital rubella syndrome in 1 year in Ghana, even given the high levels of immunity that we documented.…”

“…For the rubella serosurvey among pregnant women, the Bristol Public Health Laboratory tested for rubella-specific IgG with single radial hemolysis. 32,33 For single radial hemolysis test results of less than 15 IU/mL, the Rubalex latex agglutination test (Abbott Laboratories, Maidenhead, United Kingdom) was used to retest.…”

Evaluation of Eight Anti-Rubella Virus Immunoglobulin G Immunoassays That Report Results in International Units per Milliliter

“…In developed countries, the risk of congenital rubella syndrome has been minimized through vaccination programs (22-24) and by testing pregnant women for evidence of rubella virus immunoglobulin G (IgG) at their first antenatal visit (10, 11). Since the isolation of rubella virus in 1962, rubella testing has developed continuously, with the hemagglutination inhibition (HAI) assay often being considered the reference method (4,15,29).Since the 1980s, rubella virus IgG assays have been calibrated against the same World Health Organization (WHO) international standard rubella virus serum (second standard preparation) and test results have been reported in international units per milliliter (IU/ml). The introduction of quantitative measurement of rubella virus IgG had the potential to increase standardization and facilitate the comparison between the results of different tests.…”

“…In developed countries, the risk of congenital rubella syndrome has been minimized through vaccination programs (22-24) and by testing pregnant women for evidence of rubella virus immunoglobulin G (IgG) at their first antenatal visit (10, 11). Since the isolation of rubella virus in 1962, rubella testing has developed continuously, with the hemagglutination inhibition (HAI) assay often being considered the reference method (4,15,29).…”

Investigation into Low-Level Anti-Rubella Virus IgG Results Reported by Commercial Immunoassays

“…In this study, the results of a hemagglutination inhibition assay (HAI) (15,16) and a rubella immunoblot (IB) assay (17)(18)(19)(20) were used to assign an anti-rubella virus IgG status. Samples with test results less than or equal to 40 IU/ml were collected from collaborating laboratories using each of five different commercial antirubella virus IgG immunoassays (CIAs).…”