National Reference Laboratory for Measles and Rubella, Department of Infectious Diseases, National Institute of Health, Rome, Italy.
Department of Infectious Diseases, National Institute of Health, Rome, Italy.
Eur J Public Health. 2018 Feb 1;28(1):119-123. doi: 10.1093/eurpub/ckx067.
During recent years, various mumps outbreaks have occurred among populations vaccinated for mumps worldwide. In Italy, improving routine coverage with two doses of measles, mumps and rubella (MMR) vaccine is one of the key strategies to eliminate measles and rubella. To monitor the effect of the vaccination programme on the population, the surveillance of these vaccine-preventable diseases has been implemented. This provided the opportunity to evaluate the accuracy of the clinical diagnosis of those diseases, including mumps. In fact, vaccinated children may develop a variety of diseases caused by a series of different viruses [Epstein-Barr virus (EBV), parainfluenza virus types 1-3, adenoviruses, herpes virus and parvovirus B19] whose symptoms (i.e. swelling of parotid glands) may mimic mumps. For this reason, laboratory diagnosis is essential to confirm clinical suspicion.
The accuracy of clinical diagnosis of mumps was evaluated by differential diagnosis on EBV in Italy, a country at low incidence of mumps. This retrospective study investigated whether the etiology of 131 suspected mumps cases with a negative molecular/serological result for mumps virus, obtained from 2007 to 2016, were due to EBV, in order to establish a diagnosis.
Differential diagnosis revealed a EBV positivity rate of 19.8% and all cases were caused by EBV type 1.
This study confirms the importance of a lab based differential diagnosis that can discriminate between different infectious diseases presenting with symptoms suggestive of mumps and, in particular, emphasize the importance to discriminate between mumps and EBV-related mononucleosis.
近年来，世界各地接种过腮腺炎疫苗的人群中发生了各种腮腺炎暴发。在意大利，提高麻疹、腮腺炎和风疹（MMR）疫苗的常规覆盖率是消除麻疹和风疹的关键策略之一。为了监测疫苗接种计划对人群的影响，对这些可通过疫苗预防的疾病进行了监测。这为评估包括腮腺炎在内的这些疾病的临床诊断的准确性提供了机会。事实上，接种疫苗的儿童可能会患上一系列由不同病毒引起的各种疾病（例如 EBV、副流感病毒 1-3 型、腺病毒、疱疹病毒和细小病毒 B19），其症状（即腮腺肿胀）可能与腮腺炎相似。因此，实验室诊断对于确认临床怀疑至关重要。
通过对意大利 EBV 的鉴别诊断，评估了腮腺炎的临床诊断准确性。在这个发病率较低的国家，这项回顾性研究调查了 2007 年至 2016 年间，131 例分子/血清学检测为腮腺炎病毒阴性的疑似腮腺炎病例的病因是否为 EBV，以建立诊断。
鉴别诊断显示 EBV 阳性率为 19.8%，所有病例均由 EBV 1 型引起。
本研究证实了基于实验室的鉴别诊断的重要性，这种诊断可以区分具有腮腺炎症状的不同传染病，特别是强调区分腮腺炎和 EBV 相关单核细胞增多症的重要性。
