Isaac Beth M, Zucker Jane R, Giancotti Francesca R, Abernathy Emily, Icenogle Joseph, Rakeman Jennifer L, Rosen Jennifer B
Bureau of Immunization, New York City Department of Health and Mental Hygiene, Queens, New York, USA
Council of State and Territorial Epidemiologists/Centers for Disease Control and Prevention Applied Epidemiology Fellowship, Atlanta, Georgia, USA.
Clin Vaccine Immunol. 2017 Sep 5;24(9). doi: 10.1128/CVI.00102-17. Print 2017 Sep.
The New York City Department of Health and Mental Hygiene (DOHMH) receives clinical and laboratory reports for rubella. Because rubella immunoglobulin M (IgM) assays may produce false-positive results and rubella infections may be asymptomatic, interpretation of positive IgM results can be challenging. Rubella reports received by DOHMH in 2012 to 2013 were reviewed. The rubella IgM testing purpose was determined through case investigation. Results of IgM testing by indirect enzyme-linked immunosorbent assay (ELISA) and capture enzyme immunoassay (EIA) were compared to determine positive predictive value (PPV) and specificity. DOHMH received 199 rubella reports; 2 were true cases. Of all reports, 77.9% were tested for rubella IgM erroneously, 19.6% were tested for diagnostic purposes, 2.0% had unknown test purpose, and 0.5% were not tested. PPV of indirect ELISA was 6% overall, 14% for diagnostic tests, and 0% for tests ordered erroneously. PPV of capture EIA was 29% overall, 50% for diagnostic tests, and 0% for tests ordered erroneously. Overall, specificity was 52% for indirect ELISA and 85% for capture EIA. Limiting rubella IgM testing to patients for whom rubella diagnosis is suspected and using a more specific IgM assay have the potential to reduce false-positive rubella IgM results.
纽约市卫生和精神卫生部门（DOHMH）接收风疹的临床和实验室报告。由于风疹免疫球蛋白M（IgM）检测可能产生假阳性结果，且风疹感染可能无症状，因此对阳性IgM结果的解读可能具有挑战性。对DOHMH在2012年至2013年期间收到的风疹报告进行了审查。通过病例调查确定风疹IgM检测的目的。比较间接酶联免疫吸附测定（ELISA）和捕获酶免疫测定（EIA）的IgM检测结果，以确定阳性预测值（PPV）和特异性。DOHMH收到199份风疹报告；其中2例为确诊病例。在所有报告中，77.9%的风疹IgM检测是错误进行的，19.6%是用于诊断目的，2.0%检测目的不明，0.5%未进行检测。间接ELISA的总体PPV为6%，诊断检测为14%，错误开具的检测为0%。捕获EIA的总体PPV为29%，诊断检测为50%，错误开具的检测为0%。总体而言，间接ELISA的特异性为52%，捕获EIA的特异性为85%。将风疹IgM检测限于疑似风疹诊断的患者，并使用更具特异性的IgM检测方法，有可能减少风疹IgM假阳性结果。
