The positive duration of varicella zoster immunoglobulin M antibody test in herpes zoster

Herpes zoster is an internal reactivation of varicella zoster virus, and its onset depends on immunity against this virus. We have previously reported that antiviral antibody titers are inversely correlated with patient numbers. In this study, we hypothesized that patients with higher titers may be late visitors to the clinic, whose antibodies were already boosted at presentation because of the time lapse between onset of zoster and measurement of antibodies. We analyzed antibody titers of patients with acute herpes zoster who visited Fukuoka University Hospital from January 2009 to May 2016 (n = 141, 62 males and 79 females). Varicella zoster virus-specific immunoglobulin G, M and complement fixation tests were positive in 93.9%, 12.0% and 64.2% of the patients, respectively. Immunoglobulin G and complement fixation titers were strongly correlated (Spearman's r = 0.8634, P < 0.0001). Patients with high immunoglobulin G and complement fixation titers were immunoglobulin M-negative. Unexpectedly, immunoglobulin G and complement fixation titers showed large inter-subject variation, and were only weakly correlated with onset-measurement time lapse. Patients with consecutive tests tended to show increasing immunoglobulin G and complement fixation titers. Our data suggest that herpes zoster preferentially occurs in patients with low immunoglobulin G and complement fixation titers, and subsequently causes antibody elevation. However, the timing of elevation varies and can be as late as 10 days after zoster. The large variation in antibody titer over the time from onset to testing suggests that some mechanism exists that resists the local breakthrough of virus in the skin, and so delays the onset of blisters.

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“…c). Min et al . reported that the incidence of positive IgM was 37% in acute HZ and showed longitudinal kinetics similar to ours.…”

Section: Discussionsupporting

confidence: 88%

Relationship between serum anti‐varicella zoster virus antibody titer and time from onset of herpes zoster

Ihara

Miyachi

Imafuku

2017

The Journal of Dermatology

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“…21 It has been noted that IgM titer appears 2-5 days after the lesions and reaches to maximum level at 6-10 days and decreases subsequently with lowest levels after 10 weeks. 22 Nevertheless, a positive IgM ELISA result from a person with a generalized rash is usually interpreted as laboratory confirmation of varicella. 21 Although polymerase chain reaction (PCR) testing of skin lesions is more sensitive than IgM serology but due to its readily availability, lower cost and faster test results in cases of no skin lesions, IgM can be a diagnostic test of choice.…”

Section: Discussionmentioning

confidence: 99%

“…There are other laboratory tests available for diagnosis of VZV such as Tzanck smear, virus culture, immunefluroscence methods, serological methods and PCR. 22 All the cases in the outbreak were unvaccinated against varicella zoster as vaccine against chicken pox is not included in National Immunization schedule of India. However Indian Academy of Pediatrics (IAP) recommends administration of this vaccine in children aged 15 months or older.…”

Section: Discussionmentioning

confidence: 99%

Outbreak investigation of viral exanthem in Jharkhand, India: an eye opener for surveillance managers and vaccine policy makers

Pall¹,

Kumar

2018

Int J Community Med Public Health

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Background: Chicken pox outbreaks are frequent in tribal state of Jharkhand but rarely they are reported and investigated. Based on the preliminary information from field about the spurt of fever with rash cases in the inmates of a residential school, an outbreak investigation was undertaken to establish the disease outbreak and take appropriate steps of control and prevention of further transmission.Methods: The outbreak investigation using shoe-leather epidemiology was carried out in the month of March 2016 accordingly the standard steps of investigation in Chakulia block of Jharkhand, India and a fixed number of blood samples were sent to the apex medical institute of Jharkhand for its confirmation by laboratory tests. Concurrently control and preventive steps were taken to check further transmission of the viral exanthem.Results: A total of 79 cases satisfying the case definition occurred in the present outbreak and serum samples were collected from 7 patients for detection of VZV IgM antibodies by ELISA. Out of the total samples tested, five samples showed positive serology for VZV IgM. This confirmed the outbreak of Chickenpox in the KGBV, Chakulia.Conclusions: There is a desperate need of strengthening surveillance mechanism and field workers should be motivated for reporting cases timely so that the transmission of any viral exanthem may be checked at the earliest by application of control measures.

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“…The overall antibody positive rate (43.5%) and antibody GMC (225.4 mU/ ml) were lower than those reported in relevant studies in Beijing city and Shanghai city [ 14 – 16 ]. According to several clinical trial and observational studies in the domestic and foreign literature, relatively low vaccination rates and sero-conversion rates will lead to an increase in varicella outbreaks [ 17 – 19 ]. This study’s findings confirm previous reports that single-dose varicella vaccine is insufficient to provide the population with an immune barrier.…”

Section: Discussionmentioning

confidence: 99%

Analysis of sero-epidemiological characteristics of varicella in healthy children in Jiangsu Province, China

Zhang

Liu

et al. 2018

BMC Infect Dis

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BackgroundIn recent years, outbreaks of varicella have continued to occur, and the coverage rate of varicella vaccine in Jiangsu Province, China, remains unclear. This study aims to analyse the levels of immune antibody against varicella and obtain a comprehensive understanding of the varicella attenuated live vaccine (VarV) coverage rate in children aged 1–9 years in Jiangsu Province.MethodsFrom June to October 2016, a cross-sectional survey was conducted to collect 3631 serum samples from healthy children aged 1–9 years in Jiangsu Province. The immunoglobulin G (IgG) antibody levels of varicella were detected by enzyme-linked immunosorbent assay (ELISA).ResultsThe VarV coverage rate of healthy children was only 43.1% (95% CI: 41.1–44.7%). The seroprevalence after vaccination with a single dose of VarV was only 57.1%, and the overall seropositivity and geometric antibody titre (GMC) were 43.5% and 225.4 mU/ml, respectively. The seropositivity was significantly higher in girls than in boys (χ2 = 18.82, P < 0.001). The difference in seropositivity between the 5–9 age group and 1–4 age group was statistically significant (χ2 = 84.31, P < 0.001). The difference in seropositivity between different regions was statistically significant, with the highest seropositivity in the northern area, 53.7% (χ2 = 35.64, P < 0.001). The seropositivity in the group receiving one dose of VarV was significantly higher than that of the unvaccinated group (χ2 = 205.16, P < 0.001). Linear regression analysis suggested that the GMC of varicella antibodies wanes with the time since vaccination (F = 65.01, P = 0.002).ConclusionThe VarV coverage rate of healthy children in Jiangsu Province was low. Sero-conversion rates were also low after one dose of VarV, and the immune effectiveness of a single dose of VarV was limited. To control the spread of varicella, VarV should be included in the routine immunization program, and strengthened immunization measures for the varicella-susceptible population warrant additional consideration.

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The positive duration of varicella zoster immunoglobulin M antibody test in herpes zoster

Cited by 27 publications

References 19 publications

Relationship between serum anti‐varicella zoster virus antibody titer and time from onset of herpes zoster

Relationship between serum anti‐varicella zoster virus antibody titer and time from onset of herpes zoster

Outbreak investigation of viral exanthem in Jharkhand, India: an eye opener for surveillance managers and vaccine policy makers

Analysis of sero-epidemiological characteristics of varicella in healthy children in Jiangsu Province, China

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