Innovation and new Technologies for measles eradication. Dr. David Brown Virus Reference Department HPA Microbiology services Global Measles and Rubella Management Meeting 15 th March 2011. Overview. Current status of measles control Range of research needs already identified
Innovation and new Technologies for measles eradication
Dr. David Brown
Virus Reference Department
HPA Microbiology services
Global Measles and Rubella Management Meeting
15th March 2011
IgM assays and RT-PCR for confirmation of acute infections
IgG assays to guide vaccination, serosurveys
IgG avidity to confirm primary infections
RT-PCR/sequencing for Molecular epidemiology
Track epidemiological pathways
Surveillance of virus diversity
Investigation of potential adverse events
Ideal features of PoCT
Group A Strep
Principle of the IgM capture near patient test
Direction of reagent flow
Oral fluid IgM
Cotton linter paper wick
Conjugate release pad
Plastic backing card
Anti-NP gold conjugate
Serum measles IgM PoCT protocol
Step1 Step 2 Step 3 Step 4 Step 5
Add 5µl antigen to reaction tube.
Mix diluted serum and antigen.
Insert test strip.
Incubate room temp.
Sensitivity : 90.8% (95% CI 81.9 – 96.2)
Specificity : 93.6% (95% CI 86.6 – 97.6)
Measles IgM PoCT: 10 Sera (# 69 – 78, incubation: 10 minutes)
EIA results - - - - - + + + + + + +T/N ratios: 0.16 0.13 0.24 0.22 0.12 4.06 1.54 1.68 2.93 1.03 PC PC PoCT results - - - - - + + + + + +/- +/-
EIA results - + - - - + + + - + T/N ratios:0.25 19.25 0.18 0.17 0.21 2.66 3.65 1.33 0.13 5.65PoCT results - + - - - + + + - +
Manual for the laboratory diagnosis of measles and rubella virus infection
WHO – EPI, WHO/IVB/07.01: 2nd edition 2007
Amplification methods now available to generate 100,000 clones from single reaction, either multiple or single samples.
Requires high-throughput bioinformatics
Cost: £100 – 1000, further reductions in price likely
Turnaround Times >7days
From 454 life sciences website
Measles virus diversity along the length of the genome. Gene coding regions are shown in red.
Measles PoCT evaluated for IgM and Virus detection/genotyping on serum and OF samples. IgM PoCT has appropriate sens/spec for field use. RT- PCR on OF extracted strips sensitive and stable (4 weeks at 22C)
Further evaluation of PoCT with WHO AFRO gave similar results using 100 sera and OF collected in Zimbabwe surveillance programme.
. PoCTs have potential to make a significant contribution to Measles surveillance
Challenges-how to make widely available? ( is there a market? what cost)
Acknowledgement: Lennesha Warender, Dhan Samuel
Americas, Europe, E. Mediterranean, W. Pacific, Africa have elimination goals
90% reduction in deaths
by 2010 (vs. 2000)
2010 SEAR RC
Endorsed WHA 2015 targets
Target date for elimination TBD