Interpretation of rubella serology in pregnancy—pitfalls and problems
BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7356.147 (Published 20 July 2002) Cite this as: BMJ 2002;325:147
- Jennifer M Best, reader in virology (jenny.best@kcl.ac.uk)a,
- Siobhan O'Shea, clinical scientistb,
- Graham Tipples, head of viral exanthematac,
- Nicholas Davies, specialist registrarb,
- Saleh M Al-Khusaiby, head of department of child healthd,
- Amanda Krause, clinical directore,
- Louise M Hesketh, clinical scientistf,
- Li Jin, clinical scientistg,
- Gisela Enders, head of instituteh
- a Guy's, King's and St Thomas's School of Medicine, St Thomas's Hospital, London SE1 7EH
- b Department of Infection, Guy's and St Thomas's Hospital Trust, London SE1 7EH
- c Bureau of Microbiology, Laboratory Center for Disease Control, 1015 Arlington Street, Winnipeg, Canada
- d Royal Hospital, PO Box 1331, Postal Code 111, Sultanate of Oman
- e Department of Human Genetics, South African Institute for Medical Research and University of the Witwatersrand, PO Box 1038, Johannesburg 2000, South Africa
- f Public Health Laboratory, Royal Preston Hospital, Fulwood, Preston PR2 9HG
- g Central Public Health Laboratory, Colindale, London NW9 5HT
- h Institut für Virologie, Infektologie und Epidemiologie, Rosenbergstrasse 85, D-70193 Stuttgart, Germany
- Correspondence to: J M Best
- Accepted 12 February 2002
Rubella acquired in the first 12 weeks of pregnancy is associated with a 90% risk of congenital malformations. Although rare in many industrialised countries, because of the success of vaccination programmes, rubella continues to occur where uptake of the vaccine is low and in many developing countries with no vaccination programme. The World Health Organization has therefore encouraged all countries to assess their rubella status and introduce immunisation and surveillance, if appropriate.1 As the clinical diagnosis of rubella is unreliable, serological tests are needed for a diagnosis, especially when a patient is pregnant or has been in contact with a pregnant woman.2 Diagnosis is usually made by detection of rubella specific IgM. Although commercial assays are available, they vary in format, sensitivity, and specificity.3 Furthermore, rubella specific IgM may be present a year or more after natural infection or vaccination and after asymptomatic reinfection.4–8 False positive results may also be due to cross reacting IgM antibodies or rheumatoid factor.9 Consequently, …