Ding Y X, Mao N Y, Zhang Y, Gao Z G, Xu W W
Institute for Infectious Diseases Control and Prevention of Tianjin Center for Diseases Control and Prevention, Tianjin 300011, China.
National Institute for Viral Disease Control and Prevention of Chinese Center for Diseases Control and Prevention, Beijing 102206, China.
Zhonghua Yu Fang Yi Xue Za Zhi. 2019 May 6;53(5):508-512. doi: 10.3760/cma.j.issn.0253-9624.2019.05.014.
To study the application of measles specific IgM and IgG antibody detection in classification of primary vaccination failure (PVF) and secondary vaccination failure (SVF). Measles surveillance information system was used to collect measles confirmed cases in Tianjin, 2013-2015, and their blood specimens were collected, totally 284 cases were enrolled. Measles IgM and IgG were detected with enzyme-linked immunosorbent assay (ELISA), and the relative avidity index (RAI) was used to express the result of measles avidity. Measles IgM, IgG and IgM/IgG was analyzed with receiver operating characteristic (ROC) curve, the area under the ROC curve (AUC) as evaluation indicators. In addition, compared with a measles outbreak (26 cases) of a middle school in Tianjin in 2016, for making further verification on the diagnostic value of vaccination failure with IgM, IgG and IgM/IgG. The age of cases ranged was 0-58 years old, the interval median ((25), (75)) of serum collection after rash onset was 2 (1, 4) days. The positive rate of measles IgM and IgG in acute phase specimens were 76.06% (216 cases) and 88.38% (251 cases). According to the ROC curve analysis, the area under the ROC curve (AUC) of IgM, IgG and IgM/IgG were 0.753, 0.891 and 0.952, indicating that IgM/IgG was the best index to distinguish PVF and SVF. The best cut off value for IgM/IgG was 0.06, the sensibility and specificity were 88.75% and 86.63%. When IgM/IgG >1, 96.30% cases were low-avidity (RAI <40%), only 1 case was equivocal response (RAI: 40%-60%). 97.14% cases were high-avidity (RAI >60%) when IgM/IgG <0.01, only 3 cases were equivocal response (RAI 40%-60%). The threshold of IgM/IgG was used to verify the measles outbreak of a middle school in Tianjin, 2016. In the acute phase specimens, 100% (26 cases) of IgM/IgG were <0.06, 84.62% (22 cases) of IgM/IgG were <0.01. The detection of measles IgM and IgG with ELISA, and IgM/IgG is a valuable diagnostic tool to distinguish PVF and SVF.
研究麻疹特异性IgM和IgG抗体检测在原发性疫苗接种失败（PVF）和继发性疫苗接种失败（SVF）分类中的应用。利用麻疹监测信息系统收集2013 - 2015年天津市麻疹确诊病例，并采集其血液标本，共纳入284例。采用酶联免疫吸附测定（ELISA）法检测麻疹IgM和IgG，并使用相对亲和力指数（RAI）表示麻疹亲和力结果。以受试者工作特征（ROC）曲线分析麻疹IgM、IgG和IgM/IgG，以ROC曲线下面积（AUC）作为评价指标。此外，与2016年天津市某中学麻疹暴发（26例）进行比较，以进一步验证IgM、IgG和IgM/IgG对疫苗接种失败的诊断价值。病例年龄范围为0 - 58岁，出疹后血清采集间隔中位数（(25)，(75)）为2（1，4）天。急性期标本中麻疹IgM和IgG阳性率分别为76.06%（216例）和88.38%（251例）。根据ROC曲线分析，IgM、IgG和IgM/IgG的ROC曲线下面积（AUC）分别为0.753、0.891和0.952，表明IgM/IgG是区分PVF和SVF的最佳指标。IgM/IgG的最佳截断值为0.06，灵敏度和特异度分别为88.75%和86.63%。当IgM/IgG >1时，96.30%的病例为低亲和力（RAI <40%），仅1例为不确定反应（RAI：40% - 60%）。当IgM/IgG <0.01时，97.14%的病例为高亲和力（RAI >60%），仅3例为不确定反应（RAI 40% - 60%）。采用IgM/IgG阈值对2016年天津市某中学麻疹暴发进行验证。急性期标本中，100%（26例）的IgM/IgG <0.06，84.62%（22例）的IgM/IgG <0.01。采用ELISA法检测麻疹IgM和IgG，且IgM/IgG是区分PVF和SVF的有价值诊断工具。
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