Rubella Antibodies, IgG and IgM

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Rubella Antibodies, IgG and IgM

Synonym/acronym: German measles serology.

Common use

To assess for antibodies related to rubella immunity or for presence of rubella infection.

Specimen

Serum (1 mL) collected in a gold-, red-, or red/gray-top tube. Place separated serum into a standard transport tube within 2 hr of collection.

Normal findings

(Method: Chemiluminescent immunoassay)
IgMInterpretationIgGInterpretation
Negative0.9 index or lessNo significant level of detectable antibodyLess than 8 U/mLNo significant level of detectable antibody; indicative of nonimmunity
Indeterminate0.91–1.09 indexEquivocal results; retest in 10–14 d8–12 U/mLEquivocal results; retest in 10–14 d
Positive1.1 index or greaterAntibody detected; indicative of recent immunization, current or recent infectionGreater than 12 U/mLAntibody detected; indicative of immunization, current or past infection

Description

Rubella, commonly known as German measles, is a communicable viral disease transmitted by contact with respiratory secretions and aerosolized droplets of the secretions. The incubation period is 14 to 21 days. This disease produces a pink, macular rash that disappears in 2 to 3 days. Rubella infection induces immunoglobulin (Ig) G and IgM antibody production. This test can determine current infection or immunity from past infection. Rubella serology is part of the TORCH (toxoplasmosis, other [congenital syphilis and viruses], rubella, cytomegalovirus, and herpes simplex type 2) panel routinely performed on pregnant women. Fetal infection during the first trimester can affect all organs in the developing fetus and cause spontaneous abortion, fetal demise, or congenital defects. Up to 90% of infants born to mothers infected during the first trimester will develop a pattern of birth defects called congenital rubella syndrome (CRS). The rate of CRS decreases when infection occurs later in the gestational period. Ideally, the immune status of women of childbearing age should be ascertained before pregnancy, when vaccination can be administered to provide lifelong immunity. The presence of IgM antibodies indicates acute infection. The presence of IgG antibodies indicates current or past infection. Susceptibility to rubella is indicated by a negative reaction. Many laboratories use a qualitative assay that detects the presence of both IgM and IgG rubella antibodies. IgM- and IgG-specific enzyme immunoassays are also available to help distinguish acute infection from immune status. Either the rubella-combined or IgG-specific assay should be used in routine prenatal testing of maternal serum.

This procedure is contraindicated for

    N/A

Indications

  • Assist in the diagnosis of rubella infection
  • Determine presence of rubella antibodies
  • Determine susceptibility to rubella, particularly in pregnant women
  • Perform as part of routine prenatal serological testing

Potential diagnosis

Positive findings in:

  • Rubella infection (past or present)

Critical findings

  • A nonimmune status in pregnant patients may present significant health consequences for the developing fetus if the mother is exposed to an infected individual.

  • Note and immediately report to the health-care provider (HCP) pre-gnant patients with rubella non-immune status.

  • It is essential that a critical finding be communicated immediately to the requesting HCP. A listing of these findings varies among facilities.

  • Timely notification of a critical finding for lab or diagnostic studies is a role expectation of the professional nurse. Notification processes will vary among facilities. Upon receipt of the critical value the information should be read back to the caller to verify accuracy. Most policies require immediate notification of the primary HCP, Hospitalist, or on-call HCP. Reported information includes the patient’s name, unique identifiers, critical value, name of the person giving the report, and name of the person receiving the report. Documentation of notification should be made in the medical record with the name of the HCP notified, time and date of notification, and any orders received. Any delay in a timely report of a critical finding may require completion of a notification form with review by Risk Management.

Interfering factors

    N/A

Nursing Implications and Procedure

Potential nursing problems

ProblemSigns & SymptomsInterventions
Knowledge (Related to new condition or diagnosis; lack of familiarity with or understanding of disease and treatment)Lack of interest or questions; multiple questions; anxiety in relation to disease process and managementTeach the patient or parents that this is a disease that is accompanied by a rash and fever that will last for 2 to 3 days; explain to the patient and parents that the disease can be spread to others through coughing and sneezing of the infected person; explain that MMR vaccination is recommended
Infection (Related to exposure to viral organism from an infected individual)Fever and rash lasting 2 to 3 days; runny nose; headache; malaiseExplain that those infected can expose others to the virus from 1 week before the rash is present up to 2 weeks after the rash is gone; administer prescribed acetaminophen for headache and fever; discuss the fetal risk associated with infection during pregnancy (miscarriage, stillbirth); teach good hygiene
Grief (Related to loss of potential child; loss secondary to rubella viral infection)Crying; report of grief; expression of emotional shock; psychological distress; disturbed sleep; loss of appetite; detachment; withdrawal; anger; blame; despairMonitor for manifestation of grief (crying, loud grief vocalization); assess for the stage of grief; assess for the effectiveness of coping strategies; consider the cultural norm for grief expression; encourage sharing feelings; recommend grief support group; recommend psychosocial counseling as appropriate; administer prescribed medication to offset the emotional impact of grief (as appropriate); recognize the need to relive the loss

Pretest

  • Positively identify the patient using at least two unique identifiers before providing care, treatment, or services.
  • Patient Teaching: Inform the patient this test can indicate rubella infection or immunity.
  • Obtain a history of the patient’s complaints, including a list of known allergens, especially allergies or sensitivities to latex.
  • Obtain a history of exposure to rubella.
  • Obtain a history of the patient’s immune and reproductive systems, symptoms, and results of previously performed laboratory tests and diagnostic and surgical procedures.
  • Obtain a list of the patient’s current medications, including herbs, nutritional supplements, and nutraceuticals (see Effects of Natural Products on Laboratory Values online at DavisPlus).
  • Review the procedure with the patient. Inform the patient that several tests may be necessary to confirm diagnosis. Any individual positive result should be repeated in 7 to 14 days to monitor a change in detectable level of antibody. Inform the patient that specimen collection takes approximately 5 to 10 min. Address concerns about pain and explain that there may be some discomfort during the venipuncture.
  • Sensitivity to social and cultural issues, as well as concern for modesty, is important in providing psychological support before, during, and after the procedure.
  • Note that there are no food, fluid, or medication restrictions unless by medical direction.

Intratest

  • Potential complications: N/A
  • Avoid the use of equipment containing latex if the patient has a history of allergic reaction to latex.
  • Instruct the patient to cooperate fully and to follow directions. Direct the patient to breathe normally and to avoid unnecessary movement.
  • Observe standard precautions, and follow the general guidelines in Patient Preparation and Specimen Collection. Positively identify the patient, and label the appropriate specimen container with the corresponding patient demographics, initials of the person collecting the specimen, date, and time of collection. Perform a venipuncture.
  • Remove the needle and apply direct pressure with dry gauze to stop bleeding. Observe/assess venipuncture site for bleeding or hematoma formation and secure gauze with adhesive bandage.
  • Promptly transport the specimen to the laboratory for processing and analysis.

Post-Test

  • Inform the patient that a report of the results will be made available to the requesting HCP, who will discuss the results with the patient.
  • Vaccination Considerations: Record the date of the last menstrual period and determine the possibility of pregnancy prior to administration of rubella vaccine to female rubella-nonimmune patients. Instruct patient not to become pregnant for 1 mo after being vaccinated with the rubella vaccine to protect any fetus from contracting the disease and having serious birth defects. Instruct the patient on birth control methods to prevent pregnancy, if appropriate. Delay rubella vaccination in pregnancy until after childbirth, and give immediately prior to discharge from the hospital.
  • Recognize anxiety related to test results, and provide emotional support if results are positive and the patient is pregnant. Encourage the family to seek counseling if concerned with pregnancy termination. Provide teaching and information regarding the clinical implications of the test results, as appropriate. Decisions regarding elective abortion should take place in the presence of both parents. Provide a nonjudgmental, nonthreatening atmosphere for discussing the risks and difficulties of delivering and raising a developmentally challenged infant as well as for exploring other options (e.g., termination of pregnancy or adoption). Educate the patient regarding access to counseling services, as appropriate.
  • Depending on the results of this procedure, additional testing may be performed to evaluate or monitor progression of the disease process and determine the need for a change in therapy. Evaluate test results in relation to the patient’s symptoms and other tests performed.
  • Patient Education

    • Reinforce information given by the patient’s HCP regarding further testing, treatment, or referral to another HCP.
    • Instruct the patient in isolation precautions during time of communicability or contagion.
    • Emphasize the need to return to have a convalescent blood sample taken in 7 to 14 days.
    • Provide information regarding vaccine-preventable diseases where indicated (e.g., rubella).
    • Provide contact information, if desired, for the Centers for Disease Control and Prevention (www.cdc.gov/vaccines/vpd-vac).
    • Answer any questions or address any concerns voiced by the patient or family.
  • Expected Patient Outcomes

    • Knowledge
    • States understanding about the stages of grief that may be experienced with a loss.
    • Accurately describes the dose and frequency of acetaminophen to treat fever and headache.
    • Skills
    • Demonstrates proficient hand washing—both family and patient
    • Accurately describes precautions that should be taken to prevent the exposure of others to the infecting pathogen
    • Attitude
    • Complies with the recommendation to provide a secondary blood sample up to 14 days after diagnosis
    • Agrees to seek grief counseling to assist in coping with the loss of a potential child

Related Monographs

  • Related tests include culture viral, CMV, rubeola, Toxoplasma, and varicella antibody.
  • Refer to the Immune and Reproductive systems tables at the end of the book for related tests by body system.