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 ~  Abstract
 ~  Introduction
 ~  Materials and Me...
 ~  Results
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Year : 2009  |  Volume : 27  |  Issue : 4  |  Page : 351-353

Oral fluid, a substitute for serum to monitor measles IgG antibody?

1 Department of Paediatrics, B J Medical College and Sassoon General Hospitals, Pune, India
2 Measles Group, National Institute of Virology, Pune, India

Date of Submission27-Jan-2009
Date of Acceptance11-Apr-2009
Date of Web Publication4-Sep-2009

Correspondence Address:
A Goyal
Department of Paediatrics, B J Medical College and Sassoon General Hospitals, Pune
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0255-0857.55457

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 ~ Abstract 

We have analyzed the suitability and potential of Oral Fluid (OF) to substitute serum in estimating measles IgG antibodies, during community surveys, by comparing the Optical Density (OD) of measles IgG antibodies in OF and serum of 100 apparently asymptomatic children. IgG antibody status was determined using commercially available - Measles IgG Capture ELISA. Sensitivity 89.5%, specificity 90.6% Concordance of 89%, coefficient of correlation r is equal to 0.97 (Karl Pearson's) and rho is equal to 0.86 (Spearman's), was found between OD value of OF and serum. The study emphasizes the potential of OF to surrogate serum in estimating Measles IgG antibody among children. The OF collection is advantageous over blood as it is painless. It is suitable for non-technical staff, easy to transport and less bio-hazardous.

Keywords: Measles IgG antibody, Optical density, Oral fluid

How to cite this article:
Goyal A, Shaikh N J, Kinikar A A, Wairagkar N S. Oral fluid, a substitute for serum to monitor measles IgG antibody?. Indian J Med Microbiol 2009;27:351-3

How to cite this URL:
Goyal A, Shaikh N J, Kinikar A A, Wairagkar N S. Oral fluid, a substitute for serum to monitor measles IgG antibody?. Indian J Med Microbiol [serial online] 2009 [cited 2020 Nov 28];27:351-3. Available from:

 ~ Introduction Top

Measles is a highly infectious endemic disease causing extensive morbidity and mortality in the developing countries. Its elimination and control programs stress the need for monitoring immunization status, post-vaccination sero-conversion, rate of transmission, individual and population susceptibility. [1],[2],[3] Oral fluid (OF); the fluid containing gingivo-crevicular exudates and the oral mucosal transudate is a serum derived fluid present in the gingivo-crevicular sulcus. Measles IgM antibody was detected in OF in United Kingdom in 1991-93. [4] Measles IgM and IgA have been used for disease diagnosis and IgG antibody in prevalence surveys. [5],[6],[7],[8] Sensitivity, specificity and concordance of 98,73,95%; 90.4,77.8,80.2%; 97,87%,, have been reported between OF and serum for Measles IgG antibody in previous studies [7],[9],[10] respectively. The age-wise estimation, more so, for infants and under-five has not been done extensively. During community surveys, children and parents prefer collection of painless non-invasive OF over blood. OF is more suitable for non-technical staff and is free from risk to exposure to blood borne pathogens. Being easy to store and transport, OF is clinically and epidemiologically better. We therefore analyzed the potential of OF to replace serum to monitor measles IgG antibody by comparing the OD of antibody in OF and serum detected using the commercially available ELISA kit.

In a pilot study, conducted in August-Sept 2005, a correlation of 90% between OD values of newly delivered infant's OF and cord serum was observed. Therefore, this study was undertaken with an aim to study the concordance of OF and serum values in a larger age group of (seven months to 12 years) asymptomatic children.

 ~ Materials and Methods Top

The study was conducted at an out-patient department (OPD), Department of Paediatrics, of a tertiary care health centre, Sassoon General Hospitals and BJ Medical College, Pune India; in collaboration with Reference Measles Laboratory at National Institute of Virology, Pune, India, on apparently asymptomatic children visiting OPD for age certificate, along with ill siblings or as convalescent follow-up. Any probable history of measles vaccination, infection, contact and clinical features, for the child, were elicited from guardians. Details of child's age, education, religion, occupation, diet, dental hygiene and the family's socio-demographic profile were noted. Written informed consent was taken from the respective parents/guardians of all participants. The Institutional Ethics Committee approved the study.

The OF was collected and transported using "Oracol" (Saliva Collection System - Malvern Medical Developments Limited, Barbourne, Worcester, UK) and extracted from the sponge using extracting fluid. The blood was withdrawn (two to three cc) from children by veni-puncture using needle-syringe or butterfly needles and collected in BD Vacutainer SST TM II Advance. It was allowed to clot and serum was separated by centrifugation at 2000rpm for 30-60 secs. Both samples were stored at minus 70 0 C until assayed. The IgG antibody status was determined using commercially available - Measles IgG Capture ELISA (Measles IgG Capture EIA, an enzyme immunoassay, for the detection of human IgG antibodies to measles virus in human oral fluid and serum/plasma sample; Micro immune Limited, Brentford, Middlesex, United Kingdom). It's antibody status was interpreted from the OD value; the cut-off values to identify measles positivity were calculated separately for each run, according to manufacturer's instructions. Positive -greater than 1.25x the mean OD of three negative controls [ODnc]; negative - less than 1.1x ODnc and equivocal - 1.1 to 1.25x ODnc. A test of significance and coefficient of correlation (r-Karl Pearson's and rho-Spearman's) was calculated using SPSS Statistical Software. Factors thought to affect antibody levels, namely, age, gender, immunization history, history of past infection were analyzed.

 ~ Results Top

The 100 (mean age four years, range seven months to 12 years) enrolled subjects showed male dominance. (66:34). Six subjects gave positive history of measles infection in the past (three males and three females). All of them were above one year. History of Measles vaccination coverage was 90.5% (67/74 of children over nine months). The OF and serum OD value pairs were labeled concordant(C) if the interpretation for both the OF and serum was the same i.e. the pairs are either positive - positive; negative-negative or equivocal-equivocal; else they were labeled discordant (D). Concordance of 89% between OF and serum was observed. Measles-specific IgG antibodies in paired OF and serum samples are presented in [Table 1]. As inferred from the table, IgG antibodies were detected in 55% in OF and 57% in serum. Further, considering serum as gold standard and equivocal results as negative, the sensitivity and specificity is 89.5 and 90.6 respectively. Concordance was uninfluenced by positive history of measles infection in the past, as paired samples of all the six infected subjects were concordant (positive concordance). There was no statistical significance between history of vaccination and concordance (Yates corrected = 0.14 and p value = 0.746) or gender and concordance (Chi-square = 0.36 and p value = 0.55). Out of 67 vaccinated subjects, 59 are concordant (39 positive, 17 negative, three equivocal), and eight are discordant. Coefficient of Correlation (r-Karl Pearson's and rho-Spearman's) between OD values of paired OF and serum samples were r is equal to 0.97 and rho is equal to 0.86. Gender and past history of measles infection/vaccination are not statistically significant to change coefficient of correlations. The OD values for OF and serum were symmetrically distributed along the straight line on the scatter plot indicating high correlation [Figure 1].

 ~ Discussion Top

Gingival sulcus is flooded with gingivo-crevicular exudates and the oral mucosal transudate owing to its rich blood supply. These fluids constitute the OF and contains antibodies proportionate to levels circulating in blood for majority of normal individuals. This is supported by our finding of sensitivity 89.5%, specificity 90.6%, concordance of 89% between OD values of OF and serum pairs; with coefficient of correlation between OD values of OF and serum pairs being r is equal to 0.97 and rho is equal to 0.86 respectively. We can thus extrapolate value of serum measles IgG from OF values. This significant finding should be confirmed in a larger multi-centric study. The possible cause of discordance like sensitivity of the kit, hypersecretory status of oral mucosa, cross reactivity during test should also be further evaluated.

The results are important for measles community surveys requiring high community participation. The OF is easy to collect, store and transport ensuring community acceptability. It is non-invasive and free from danger of blood borne pathogens associated with serum. It has, therefore, no ethical issues involved because of its non-invasive nature and is more suitable for non-technical staff at home, rural and field settings. Hence, it becomes the sample of choice for the masses supported by the fact that gender and history of past infection or immunization does not have any statistical bearing on correlation between OF and serum.

At present, the cost of oral swab is the limiting factor in cost-benefit analysis. Despite the psychological and physical trauma associated with needle prick, especially for infants and under-five in blood collection outweighs the cost of the OF collection device; with government support and indigenous manufacturing, even the cost can be markedly reduced.

 ~ Acknowledgment Top

We are grateful to ICMR for Aayush Goyal's Short Term Student fellowship. We would also like to place on record our gratitude to the Head of Department, Department of Pediatrics and Dean of BJMC & SGH and Director, NIV, for their esteemed guidance and support for the research work.

 ~ References Top

1.Cutts FT, Brown DWG. The contribution of field tests to measles surveillance and control: A review of available methods. Reviews in Medical Virology 1995;5:35-40.  Back to cited text no. 1    
2.Gay N, Ramsay M, Cohen B, Hesketh L, Morgan-Capner P, Brown D, et al . The epidemiology of measles in England and Wales since the 1994 vaccination campaign. Commun Dis Rep CDR Rev 1997;7: R17-21.  Back to cited text no. 2    
3.Cutts FT, Henao-Restrepo A, Olivé JM. Measles elimination: Progress and challenges. Vaccine 1999;17:S47-52.  Back to cited text no. 3    
4.Brown DW, Ramsay ME, Richards AF, Miller E. Salivary diagnosis of measles: A study of notified cases in the United Kingdom, 1991-3. BMJ 1994;308:1015-7. Comment in: BMJ 1994 Jun 4; 308(6942): 1511.   Back to cited text no. 4    
5.NJ Shaikh, V Ganeshan - Measles antibody levels in cord sera and infants (1-9 months age group): Correlation with maternal titres. Indian Journal of Virology 1997;13;91-5.  Back to cited text no. 5    
6.Perry KR, Brown DW, Parry JV, Panday S, Pipkin C, Richards A. Detection of measles, mumps, and rubella antibodies in saliva using antibody capture radioimmunoassay. J Med Virol 1993;40:235-40.  Back to cited text no. 6    
7.Nokes DJ, Enquselassie F, Nigatu W, Vyse AJ, Cohen BJ, Brown DW, et al . Has oral fluid the potential to replace serum for the evaluation of population immunity levels? A study of measles, rubella and hepatitis B in rural Ethiopia. Bull World Health Organ 2001;79:588-95.  Back to cited text no. 7    
8.Nigatu W, Nokes DJ, Enquselassie F, Brown DW, Cohen BJ, Vyse AJ, et al . Detection of measles specific IgG in oral fluid using an FITC/anti-FITC IgG capture enzyme linked immunosorbent assay (GACELISA). J Virol Methods 1999 Dec; 83(1-2): 135-44.  Back to cited text no. 8    
9.Vainio K, Samdal HH, Anestad G, Wedege E, Skutlaberg DH, Bransdal KT, Mundal R, Aaberge IS. Detection of measles- and mumps-specific IgG antibodies in paired serum and oral fluid samples from Norwegian conscripts. Eur J Clin Microbiol Infect Dis. 2008 Jun;27(6):461-5. Epub 2008 Feb 22  Back to cited text no. 9    
10.Kremer JR, Muller CP. Evaluation of Commercial Assay Detecting Specific Immunoglobulin G in Oral Fluid for Determining Measles Immunity in Vaccinees. Clin Diagn Lab Immunol. 2005 May;12(5):668-70.  Back to cited text no. 10    


  [Figure 1]

  [Table 1]

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