Dilemmas and Pitfalls in Rubella Laboratory Diagnostics in Low Prevalence or Elimination Settings

Abstract

The changing epidemiology of rubella in populations with either low prevalence levels, or where rubella elimination has been achieved, has challenged laboratory diagnostics. This review will discuss the challenges in identification of acute rubella and outline appropriate confirmatory testing, particularly for cases with low pretest probability. Implementation of pre-analytical screening processes can mitigate follow-up testing required to confirm false positive antibody results, and laboratories should consider not accepting requests for testing that do not have appropriate travel or clinical history. The role of laboratory surveillance will be examined, and challenges in determining protective immunity to rubella infection in light of waning rubella antibody levels in vaccinated populations will be explored. Special populations including prenatal women and the prevention of congenital rubella syndrome will be discussed in the context of low prevalence populations.