Chapter 87 : Measles and Rubella Viruses

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Clinical differentiation of fever and rash illnesses caused by measles and rubella viruses has become increasingly difficult. The paucity of measles and rubella cases in the United States and other developed countries has led to a decline in clinical diagnostic acumen among physicians and health care workers. Milder forms of measles have been reported to occur in previously vaccinated individuals, further obscuring diagnosis based on the clinical case definition. As global programs to control and eliminate measles expand, the medical and public health communities have become more dependent on laboratory confirmation of clinical diagnosis. Those countries that have controlled and eliminated measles through a variety of vaccination strategies, are now controlling and eliminating rubella via the incorporation of rubella and measles combined vaccines in their programs, in some cases taking advantage of new funding opportunities for rubella immunization activities. Laboratory diagnostic tests and laboratory surveillance activities for measles and rubella are performed in parallel in many clinical and public health laboratories worldwide. Consequently, this chapter combines the current laboratory diagnostic methods for measles and rubella for convenient review and reference. A summary of laboratory tests for confirmation of measles and rubella, including many of the tests described briefly herein, has been published by the World Health Organization.

Citation: Bellini W, Icenogle J. 2015. Measles and Rubella Viruses, p 1519-1535. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch87
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CPE of measles virus when propagated in Vero/hSLAM cells, a cell line that is transfected with a gene encoding the wild-type virus receptor (CDw150) for measles virus. The cell line naturally expresses the simian form of CD46 on the cell surface. (A) Uninfected monolayer of Vero/hSLAM cells. (B) Measles virus-infected monolayer of Vero/hSLAM cells with apparent syncytium formation and multinucleated giant cells (arrows). doi:10.1128/9781555817381.ch87.f1

Citation: Bellini W, Icenogle J. 2015. Measles and Rubella Viruses, p 1519-1535. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch87
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Image of FIGURE 2

IFA of rubella virus-infected cells using monoclonal antibody to the E2 protein. Vero cells were infected with wild-type rubella virus and 3 days after infection were fixed with cold paraformaldehyde followed by permeabilization with −20°C methanol. Reaction of infected cells with monoclonal antibody to the E2 protein (monoclonal antibody 24–26; Meridian Life Science, Saco, ME) was followed by detection of bound monoclonal antibody with Alexa Fluor 488-conjugated, highly cross-absorbed goat anti-mouse IgG (Molecular Probes Inc., Eugene, OR). Cell nuclei were visualized by staining with propidium iodide. About 25% of the cells which stained with propidium iodide were positive for E2 protein. doi:10.1128/9781555817381.ch87.f2

Citation: Bellini W, Icenogle J. 2015. Measles and Rubella Viruses, p 1519-1535. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch87
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Image of FIGURE 3

Time course of rubella virus-specific IgM and IgG detection by ELISA in sera of rubella patients. Commercial IgM capture ELISA (A) and IgG indirect ELISA (B) were used to detect rubella virus-specific antibodies at the indicated number of days after onset of symptoms (usually rash); antibody index and ISR are the commercial test designations for the ratio of the optical density obtained for the test serum to the optical density obtained for a standard (cutoff) serum. The minimum signal considered positive in each test is indicated by a dashed line. Only results from patients who tested positive for IgM to rubella virus at some time after the onset of symptoms are shown. doi:10.1128/9781555817381.ch87.f3

Citation: Bellini W, Icenogle J. 2015. Measles and Rubella Viruses, p 1519-1535. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch87
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Interpretation of measles ELISA results

Citation: Bellini W, Icenogle J. 2015. Measles and Rubella Viruses, p 1519-1535. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch87
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Timing of biological markers of rubella virus infection

Citation: Bellini W, Icenogle J. 2015. Measles and Rubella Viruses, p 1519-1535. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch87

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