The rubella test is a routine blood test performed as part of prenatal care of pregnant women. It is sometimes also used to screen women of childbearing age before the first pregnancy.
The test is given to evaluate whether a woman is immune to rubella (German measles) as a result of childhood exposure or immunization, or whether she may be presently infected with the disease. The question of a current infection is particularly urgent for pregnant women. Although the disease itself is not serious in adults, it can cause miscarriage, stillbirth, or damage to the fetus during the first trimester (three months) of pregnancy. The rubella test is regarded as a more reliable indication of the patient's immune status than her history, because reinfection with rubella is possible even after immunization. The results of the test may influence decisions to terminate a pregnancy.
The rubella test belongs to a category of blood tests called hemagglutination inhibition (HI) tests. Hemagglutination refers to the clumping or clustering of red blood cells caused by a disease antibody, virus, or certain other substances. Inhibition refers to interference with the clumping process. The presence of rubella antibodies inhibits the cell clumping caused by the rubella virus. Thus, the addition of the virus to a sample of the patient's blood allows a doctor to determine the presence and concentration of rubella antibodies and the patient's immunity to the disease.
When a person is infected with the rubella virus, the body produces both immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies to fight the infection. Once IgG exists, it persists for a lifetime, but the special IgM antibody usually wanes over six months. The rubella test can either confirm that a recent infection has occurred (both IgG and IgM are present) or that a patient has immunity to rubella (IgG only is present).
When the test is performed to confirm the diagnosis of rubella in a woman already pregnant, two blood samples are drawn. One is drawn during the acute phase of the illness about three days after the rash breaks out, and the second is drawn during the convalescent phase about three weeks later. The specimens are then tested simultaneously by a single laboratory. Alternatively, a pregnant woman with a rash suspected to be rubella can be tested for IgM antibody. If the test shows that IgM antibody is present, then a recent rubella infection has occurred.
Because there have been cases of children born with rubella syndrome even though the mother's blood test indicated that she was sufficiently immune to rubella, some researchers are presently recommending a second test, known as a synthetic peptide enzyme-linked immunosorbent assay (ELISA). This test screens for the presence of rubella virus neutralizing (RVN) antibodies in the mother's blood.
If the patient has been successfully immunized against rubella or has had the disease, the HI antibody titer (concentration) will be greater than 1:10-1:20. The red blood cells will fail to clump when the rubella virus is added to the blood serum.
In the case of paired testing for pregnant women, a fourfold rise in antibody titer between the first and second blood samples indicates the suspicious rash was caused by rubella. The alternative test for IgM antibody confirms recent rubella infection if IgM is found in the patient's blood.
If the patient has little or no immunity to rubella, her HI antibody titer will be 1:8 or less. Women without immunity should receive immunization against rubella provided that they avoid pregnancy for a period of three months following immunization. Women with disease of the immune system or who are taking corticosteroid medications should receive immune serum globulin rather than rubella vaccine to prevent infection.
Antibody — A protein molecule produced by the immune system that is specific to a virus, such as the rubella virus. The antibody combines with the virus and disables it.
Hemagglutination — The clumping or clustering of red blood cells caused by certain viruses, antibodies, or other substances.
Inhibition — Restraint of or interference with a biological process, such as the clumping of blood cells.
Titer — The concentration of a substance in a given sample of blood or other tissue fluid.
Beers, Mark H., MD, and Robert Berkow, MD., editors. "Childhood Infections: Viral Infections." In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2004.
Andrews, J. I. "Diagnosis of Fetal Infections" Current Opinion in Obstetrics and Gynecology 16 (April 2004): 163-166.
Giessauf, A., T. Letschka, G. Walder, et al. "A Synthetic Peptide ELISA for the Screening of Rubella Virus Neutralizing Antibodies in Order to Ascertain Immunity." Journal of Immunological Methods 287 (April 2004): 1-11.
American Academy of Family Physicians (AAFP). 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237 or (913) 906-6000. http://www.aafp.org.
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