Ramsay M E, Brugha R, Brown D W, Cohen B J, Miller E
Immunisation Division, Communicable Disease Surveillance Centre.
Epidemiol Infect. 1998 Jun;120(3):315-9. doi: 10.1017/s0950268898008838.
Rubella infections, notified by general practitioners on the basis of a clinical diagnosis, were investigated by testing blood and saliva samples for specific IgM. Overall 52 (29%) of 178 cases with appropriately timed blood specimens were confirmed as recent rubella by IgM serology. Only 2 (3%) of 74 cases in children under 5 years were confirmed compared to 50 (48%) of 104 cases in older children and adults. The confirmation rate was lower (6%) in those with documented vaccination history than in those without (42%). The specificity of saliva rubella IgM testing compared to testing corresponding blood samples was 99%. The overall sensitivity of saliva rubella IgM testing was 81%. This rose to 90% if results from inappropriately timed specimens and specimens taking more than 1 week to reach the laboratory were excluded. A corresponding saliva rubella IgG test was 98% sensitive and 100% specific. Of 126 rubella IgM negative cases, 25 (20%) were positive for parvovirus B19 IgM. This study confirmed that rubella surveillance based on clinical reports is not specific. It also demonstrated that saliva samples, if taken 7-42 days after onset of illness and transported rapidly to the laboratory, are a feasible alternative to blood samples for rubella surveillance.
由全科医生根据临床诊断报告的风疹感染病例，通过检测血液和唾液样本中的特异性IgM进行调查。在178例采集了适时血液样本的病例中，共有52例（29%）经IgM血清学确诊为近期风疹感染。5岁以下儿童的74例病例中仅有2例（3%）得到确诊，而年龄较大的儿童和成人的104例病例中有50例（48%）得到确诊。有疫苗接种记录者的确诊率（6%）低于无疫苗接种记录者（42%）。唾液风疹IgM检测与相应血液样本检测相比，特异性为99%。唾液风疹IgM检测的总体敏感性为81%。如果排除采集时间不当的样本以及送检时间超过1周才到达实验室的样本，敏感性可升至90%。相应的唾液风疹IgG检测敏感性为98%，特异性为100%。在126例风疹IgM阴性病例中，25例（20%）细小病毒B19 IgM呈阳性。本研究证实，基于临床报告的风疹监测缺乏特异性。研究还表明，如果在发病后7 - 42天采集唾液样本并迅速送检至实验室，唾液样本可作为风疹监测中血液样本的可行替代方案。
