风疹病毒核酸检测在风疹消除阶段应用的必要性

Necessity of Application of Rubella Virus Nucleic Acid Detection in Rubella Elimination Stage

风疹是由风疹病毒(Rubella virus,RV)引起的一种以发热、出疹为主要表现的急性呼吸道传染病,孕早期感染RV可引起先天性风疹综合征(Congenital rubella syndrome,CRS)。风疹是疫苗可预防性传染病,2008年我国将风疹疫苗纳入国家扩大免疫规划,通过连续10年免疫规划的实施,风疹发病率迅速下降,2014～2017年已接近风疹消除的目标(风疹发病率为0.8/10万～0.12/10万)。加强对风疹可疑病例的报告和实验室鉴别诊断,对隔离传染源、指导疫苗使用以及阻断RV传播具有重要的作用。《麻疹和风疹病毒感染实验室诊断手册》要求在风疹暴发流行阶段,只针对每起暴发采集5～10份血标本,检测风疹IgM是风疹病例确诊的金标准;而在消除风疹和CRS阶段要求对每一例散发疑似病例采集血清标本和鼻咽拭子,分别进行IgM抗体和RV核酸的检测。本文对我国在消除风疹和CRS阶段将RV核酸检测应用于风疹病例早期诊断的必要性进行了阐述。

Rubella is an acute respiratory infection caused by rubella virus(RV),which is characterized by fever and rash.Transplacental infection of fetus during the first trimester of pregnancy results in a group of congenital anomalies called as congenital rubella syndrome(CRS).As a vaccine preventable disease,rubella vaccine was incorporated into the national immunization program in China in 2008.Through the implementation of the 10 ‐ year immunization program,the incidence rate of rubella decreased rapidly.From 2014 to 2017,the incidence rates of rubella were 0.8/100,000~0.12/100,000,which is close to the goal of rubella elimination.Strengthening the reporting of suspected cases of rubella and laboratory differential diagnosis play important roles in isolating the pathogen of infection,guiding the use of vaccines,and blocking the spread of RV.In the epidemic stage of rubella outbreak,5~10 blood samples should be collected for each outbreak.RV‐specific IgM Enzyme‐linked immunosorbent assay(ELISA)is the gold standard for the diagnosis of rubella cases.While in the rubella elimination stage,a sensitive surveillance with laboratory confirmation of each sporadic suspected case is required.Serum samples and nasopharyngeal swabs should be collected from each case,then IgM antibodies and RV nucleic acids are detected,respectively.In this article,we review the necessity and importance of nucleic acid detection to supplement the early laboratory diagnosis of rubella cases in the rubella elimination stage in China.