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913. Incidentally Positive Measles Results with a Commercially Available Multiplex Polymerase Chain Reaction Panel for Exanthems — Tennessee, 2022–2023

BACKGROUND: In January 2023, the Tennessee Department of Health (TDH) received report of a positive measles result from a multiplex polymerase chain reaction (PCR) panel ordered to evaluate a fever and rash in a child. Immediate public health investigation concluded that the positive test was becaus...

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Autores principales: Thomas, Christine, Hartley, Amanda, Newhouse, Caitlin N, Jones, Timothy F, Schaffner, William, Fill, Mary-Margaret A, Dunn, John R
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10677566/
http://dx.doi.org/10.1093/ofid/ofad500.958
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author Thomas, Christine
Hartley, Amanda
Newhouse, Caitlin N
Jones, Timothy F
Schaffner, William
Fill, Mary-Margaret A
Dunn, John R
author_facet Thomas, Christine
Hartley, Amanda
Newhouse, Caitlin N
Jones, Timothy F
Schaffner, William
Fill, Mary-Margaret A
Dunn, John R
author_sort Thomas, Christine
collection PubMed
description BACKGROUND: In January 2023, the Tennessee Department of Health (TDH) received report of a positive measles result from a multiplex polymerase chain reaction (PCR) panel ordered to evaluate a fever and rash in a child. Immediate public health investigation concluded that the positive test was because of recent measles vaccination. Because multiplex PCR tests have not typically included measles, we assessed patient characteristics, provider responses, and measles virus strain when multiplex PCR identified measles to guide public health response in Tennessee. METHODS: We retrospectively identified Tennessee residents who tested positive for measles by 2 multiplex PCR panels, commercially available since 2022, that include 7–9 viruses and Streptococcus pyogenes. We queried the state immunization registry for measles vaccine records for those persons and asked ordering providers about their clinical assessment, test use, and response to the positive result. CDC performed the Measles Vaccine (MeVA) assay (real-time RT-PCR) on available clinical specimens. RESULTS: Of 296 multiplex PCR tests on Tennessee residents, 7 (2.4%) were positive for measles. Median age was 1 year (range: 1–6 years). All 7 received a measles vaccine within 8–15 days before the test. Among 7 providers, 6 did not suspect measles prior to testing. All ordered testing to evaluate a rash, with or without fever, and none were aware of patient exposure to persons with measles. After the positive result, 2 providers contacted TDH for guidance, 4 attributed the result to recent vaccination, and 1 reported not having received the test result. Three patients tested positive for additional viruses in the panel including enteroviruses (n = 2), human herpesvirus type 6 (n = 2), human herpesvirus type 7 (n = 1), and Epstein-Barr virus (n = 1). MeVA testing of 2 specimens identified measles vaccine strain in 1 specimen and an inconclusive result in the other. CONCLUSION: Inclusion of measles in multiplex PCR panels can incidentally identify measles virus in recently vaccinated persons, requiring MeVA testing to confirm vaccine strain. In recently vaccinated persons, medical and public health professionals must carefully consider use and interpretation of measles results in multiplex PCR panels. DISCLOSURES: All Authors: No reported disclosures
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spelling pubmed-106775662023-11-27 913. Incidentally Positive Measles Results with a Commercially Available Multiplex Polymerase Chain Reaction Panel for Exanthems — Tennessee, 2022–2023 Thomas, Christine Hartley, Amanda Newhouse, Caitlin N Jones, Timothy F Schaffner, William Fill, Mary-Margaret A Dunn, John R Open Forum Infect Dis Abstract BACKGROUND: In January 2023, the Tennessee Department of Health (TDH) received report of a positive measles result from a multiplex polymerase chain reaction (PCR) panel ordered to evaluate a fever and rash in a child. Immediate public health investigation concluded that the positive test was because of recent measles vaccination. Because multiplex PCR tests have not typically included measles, we assessed patient characteristics, provider responses, and measles virus strain when multiplex PCR identified measles to guide public health response in Tennessee. METHODS: We retrospectively identified Tennessee residents who tested positive for measles by 2 multiplex PCR panels, commercially available since 2022, that include 7–9 viruses and Streptococcus pyogenes. We queried the state immunization registry for measles vaccine records for those persons and asked ordering providers about their clinical assessment, test use, and response to the positive result. CDC performed the Measles Vaccine (MeVA) assay (real-time RT-PCR) on available clinical specimens. RESULTS: Of 296 multiplex PCR tests on Tennessee residents, 7 (2.4%) were positive for measles. Median age was 1 year (range: 1–6 years). All 7 received a measles vaccine within 8–15 days before the test. Among 7 providers, 6 did not suspect measles prior to testing. All ordered testing to evaluate a rash, with or without fever, and none were aware of patient exposure to persons with measles. After the positive result, 2 providers contacted TDH for guidance, 4 attributed the result to recent vaccination, and 1 reported not having received the test result. Three patients tested positive for additional viruses in the panel including enteroviruses (n = 2), human herpesvirus type 6 (n = 2), human herpesvirus type 7 (n = 1), and Epstein-Barr virus (n = 1). MeVA testing of 2 specimens identified measles vaccine strain in 1 specimen and an inconclusive result in the other. CONCLUSION: Inclusion of measles in multiplex PCR panels can incidentally identify measles virus in recently vaccinated persons, requiring MeVA testing to confirm vaccine strain. In recently vaccinated persons, medical and public health professionals must carefully consider use and interpretation of measles results in multiplex PCR panels. DISCLOSURES: All Authors: No reported disclosures Oxford University Press 2023-11-27 /pmc/articles/PMC10677566/ http://dx.doi.org/10.1093/ofid/ofad500.958 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Abstract
Thomas, Christine
Hartley, Amanda
Newhouse, Caitlin N
Jones, Timothy F
Schaffner, William
Fill, Mary-Margaret A
Dunn, John R
913. Incidentally Positive Measles Results with a Commercially Available Multiplex Polymerase Chain Reaction Panel for Exanthems — Tennessee, 2022–2023
title 913. Incidentally Positive Measles Results with a Commercially Available Multiplex Polymerase Chain Reaction Panel for Exanthems — Tennessee, 2022–2023
title_full 913. Incidentally Positive Measles Results with a Commercially Available Multiplex Polymerase Chain Reaction Panel for Exanthems — Tennessee, 2022–2023
title_fullStr 913. Incidentally Positive Measles Results with a Commercially Available Multiplex Polymerase Chain Reaction Panel for Exanthems — Tennessee, 2022–2023
title_full_unstemmed 913. Incidentally Positive Measles Results with a Commercially Available Multiplex Polymerase Chain Reaction Panel for Exanthems — Tennessee, 2022–2023
title_short 913. Incidentally Positive Measles Results with a Commercially Available Multiplex Polymerase Chain Reaction Panel for Exanthems — Tennessee, 2022–2023
title_sort 913. incidentally positive measles results with a commercially available multiplex polymerase chain reaction panel for exanthems — tennessee, 2022–2023
topic Abstract
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10677566/
http://dx.doi.org/10.1093/ofid/ofad500.958
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