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Qualitative Variation among Commercial Immunoassays for Detection of Measles-Specific IgG
Donald R Latner1, Sun B Sowers1, Kiana Anthony1
1National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Insights
Accurate measles IgG testing is crucial for assessing immunity. This study found that while most measles IgG tests perform well, some false negatives can occur, potentially impacting public health decisions.
Area of Science:
- Immunology
- Virology
- Diagnostic Test Evaluation
Background:
- Measles virus-specific IgG testing is vital for determining immunity in individuals with unknown vaccination or immune status.
- Inaccurate IgG test results (false negatives or positives) can lead to significant public health consequences, including unnecessary quarantine, revaccination, or failure to identify susceptible individuals.
- Understanding the performance characteristics of commercially available measles IgG tests is essential for reliable diagnostic interpretation.
Purpose of the Study:
- To evaluate and compare the performance of five widely used commercial measles IgG test platforms.
- To assess the accuracy of these platforms against a gold standard method for measles virus neutralizing antibodies.
Main Methods:
- Comparison of five commercial measles IgG test platforms using 223 well-characterized serum samples.
- Quantification of measles virus neutralizing antibodies via *in vitro* plaque reduction neutralization assay (gold standard).
- Analysis of discrepant results, particularly in low-positive ranges, and overall agreement across platforms.
Main Results:
- Good agreement was observed across platforms for measles IgG-negative sera and samples with intermediate to high IgG levels.
- Discrepant results were noted for samples in the low-positive ranges, indicating potential variability in sensitivity.
- Approximately 11% of sera with low levels of neutralizing antibody yielded false-negative measles IgG test results.
Conclusions:
- While most measles IgG tests show good performance, discrepancies exist, especially in low-positive ranges.
- A notable rate of false-negative results (approx. 11%) was observed in samples with low neutralizing antibody levels.
- These findings highlight the need for careful interpretation of measles IgG test results, particularly in borderline cases, to ensure accurate assessment of immunity.
Abstract:
Measurement of measles virus-specific IgG is used to assess presumptive evidence of immunity among immunocompetent individuals with uncertain immune or vaccination status. False-negative test results may lead to unnecessary quarantine and exclusion from activities such as employment, education, and travel or result in unnecessary revaccination. In contrast, false-positive results may fail to identify susceptible individuals and promote spread of disease by those who are exposed and unprotected. To better understand the performance characteristics of tests to detect measles IgG, we compared five widely used, commercially available measles IgG test platforms using a set of 223 well-characterized serum samples. Measles virus neutralizing antibodies were also measured by in vitro plaque reduction neutralization, the gold standard method, and compared to IgG test results. Discrepant results were observed for samples in the low-positive ranges of the most sensitive tests, but there was good agreement across platforms for IgG-negative sera and for samples with intermediate to high levels of IgG. False-negative test results occurred in approximately 11% of sera, which had low levels of neutralizing antibody.
