MMWR Morb Mortal Wkly Rep. 2008 Jun 20;57(24):657-60.
Laboratory confirmation of measles and rubella is an important component of disease surveillance in all settings. Because the use of clinical diagnosis for surveillance is unreliable, case-based laboratory confirmation of disease is critically important in settings with measles or rubella elimination goals. The World Health Organization (WHO) Measles and Rubella Laboratory Network (LabNet) was established in 2000 to provide a standardized testing and reporting structure and a comprehensive, external quality-assurance program. LabNet currently consists of 679 laboratories serving 166 countries. However, measles and rubella surveillance remains incomplete in certain areas because of difficulties with the collection and transport of serum specimens. Recently, LabNet evaluated two alternative sampling approaches to serum samples, the use of dried blood spots (DBS) and oral fluid (OF) samples. Both of these approaches have potential to be useful tools for measles and rubella control programs. In June 2007, WHO convened an ad hoc meeting in Geneva, Switzerland, to review available data and provide recommendations on use of DBS and OF samples for measles and rubella diagnostics. Attendees included LabNet staff members and scientists who had been conducting studies to evaluate use of these alternative diagnostic samples. The attendees concluded that 1) although serum-based diagnostics remain the "gold standard," the use of these two alternative sampling techniques would not adversely affect routine measles and rubella surveillance and might enhance surveillance; 2) regions in the elimination phase that already have established serum-based testing for rash illness surveillance would not likely benefit from converting to DBS or OF sampling methods, except in special circumstances; and 3) DBS or OF sampling are viable options for measles and rubella surveillance in all regions, especially where patients might resist venipuncture for blood collection, or where special challenges exist with transport or refrigeration of diagnostic samples.
麻疹和风疹的实验室确诊是所有环境下疾病监测的重要组成部分。由于将临床诊断用于监测并不可靠，因此在以消除麻疹或风疹为目标的环境中，基于病例的疾病实验室确诊至关重要。世界卫生组织（WHO）的麻疹和风疹实验室网络（LabNet）于2000年成立，旨在提供标准化的检测和报告结构以及全面的外部质量保证计划。LabNet目前由服务于166个国家的679个实验室组成。然而，由于血清标本采集和运输存在困难，某些地区的麻疹和风疹监测仍然不完整。最近，LabNet评估了两种血清样本的替代采样方法，即使用干血斑（DBS）和口腔液（OF）样本。这两种方法都有可能成为麻疹和风疹控制计划的有用工具。2007年6月，WHO在瑞士日内瓦召开了一次特别会议，以审查现有数据并就使用DBS和OF样本进行麻疹和风疹诊断提供建议。与会者包括LabNet工作人员以及一直在进行研究以评估这些替代诊断样本使用情况的科学家。与会者得出的结论是：1）尽管基于血清的诊断仍然是“金标准”，但使用这两种替代采样技术不会对常规麻疹和风疹监测产生不利影响，反而可能会加强监测；2）处于消除阶段且已经建立了基于血清的皮疹疾病监测检测方法的地区，除特殊情况外，不太可能从转换为DBS或OF采样方法中受益；3）DBS或OF采样是所有地区麻疹和风疹监测的可行选择，特别是在患者可能抗拒静脉穿刺采血，或诊断样本运输或冷藏存在特殊挑战的地方。
