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 General Information: Measles
Genotyping Results United States
Genotyping Results: International
Measles Lab Manual (English)
Measles Lab Manual (Español)
Vero/SLAM cell line
Specimens for Measles Virus Isolation
Genetic Analysis
Guidelines for Naming
Strains or Sequences
Measles Strain Banks
 Genetic Characterization
and Sequencing

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Measles Serology




In areas with a low incidence of measles, the diagnosis of measles by clinical presentation is often complicated because of the sporadic nature of the disease and the widespread occurrence of other rash-causing illnesses. In addition, many measles cases in previously vaccinated or immunosuppressed individuals do not meet the clinical case definition. Therefore, confirmation of measles virus infection must be made using laboratory-based methods.

Antibody detection is the most versatile and commonly used method for measles diagnosis. In acute, uncomplicated measles, a significant rise in measles-specific IgG antibodies between acute- and convalescent-phase serum specimens is generally considered diagnostic. A positive test result for specific IgG antibodies in a single serum specimen indicates past infection with measles virus or measles vaccination, but does not ensure protection from infection or re-infection. Detection of specific IgM antibodies in a single serum specimen collected within the first few days of rash onset can provide a good presumptive diagnosis of current or recent measles virus infection. Therefore, the IgM assay is the test of choice for rapid diagnosis of measles cases.



Blood Collection
Blood for serologic testing is collected by venipuncture or by finger/heel stick into a serum-gel separator tube. Do not freeze the tube before serum has been removed. Centrifuge the tube to separate serum from clot. Aseptically transfer serum to a sterile tube that has an externally threaded cap with an o-ring seal. Fresh, sterile serum can be shipped overnight on wet ice pack or at ambient temperature. Frozen serum is shipped on dry ice for next-day delivery. Hemolyzed and lipemic serum and plasma are noted and tested; usually without apparent interferences.

Arrival, Tracking, Reporting
Serum specimens for measles IgG, IgM, and neutralization testing arrive at CDC through the Data and Specimen Handling Section (DASH) from international, state, and local health departments, occasionally from doctors' offices and from contract health clinics working on special study or vaccine protocols with the National Center for Infectious Diseases or the National Immunization Program and from PAHO and WHO reference laboratories. A completed DASH form (appendix: CDC 50.34 rev 11/92 ) must be submitted for specimens from state health department laboratories (US only). All specimens accepted are by prior approval of Dr. William J. Bellini, Chief of the Measles Virus Section. Specimens are tracked by DASH and results are reported back through DASH to state health departments or directly to the principal investigators, contract clinics, or PAHO and WHO. Raw data of all test results are kept on file. All results are reported through the laboratory director.

Frozen serum is thawed at room temperature 1-2 hours or in refrigerator overnight just prior to testing. Serum may be kept at +4 C for several days to complete retesting before returning to -20 C for long-term storage. As quantities permit, all serum samples tested are kept in long-term storage within the measles laboratory.



To ensure optimal test performance, it is essential that all test procedures be followed exactly as described in the package inserts:

  1. Working dilutions of the assay reagents must be prepared identically each time.

  2. Incubation times and temperatures must be strictly observed.

  3. Test reagents must be handled in the prescribed manner. To minimize freeze-thaws and to avoid contamination, use sterile technique to dispense reagents in small volumes but not volumes less than 50 ul.

  4. Lyophilized reagents, especially diluents, should be reconstituted to volume described and mixed vigorously on a mechanical mixer.

  5. High background signal.

    a. High background signal in scattered plate wells indicates poor washing technique or reagent cross-contamination. Clean washer and repeat test.
    b. High background in all plate wells may indicate improper reagent dilution or contamination of test reagents or diluents. Repeat test with new products.
    c. High background signal in uninfected cell control wells of a particular test specimen suggests unidentified serum antibody reactions with test reagents. The specimen may be retested in serial dilution.

  6. Special care should be taken to match patient identifiers with serum dilution tubes, with location of sera on test plates and with calculated O.D. values.

  7. A record should be kept of each assay as the test is performed. Note the reagents, lot numbers, and expiration dates. Record how dilutions are made and the timing of each step.

  8. A continuous record of all control values should be kept to monitor changes in assay performance over time.



Previous Infection
+ + or - not vaccinated, no
history of measles
1st MMR
+ + or - not vaccinated, no
history of measles
wild-type measles seroconvert*, classic measles
+ + or - Previously vaccinated, primary vaccine failure recent
2nd MMR
- + previously vaccinated,
2nd MMR
IgG level may stay same or boost
+ + previously vaccinated,
wild-type measles may have few or no symptoms**
+ + recently vaccinated exposed to
wild-type measles
cannot distinguish if vaccine or wild-type, evaluate on epidemiologic grounds***
+ or - + distant history of measles wild-type measles may have few or no symptoms**, if clinically compatible may have been misdiagnosed initially

* IgG response depends on timing of specimen collection (4)
** If so, do not consider contagious unless clinical presentation is consistent with measles
*** If IgM negative, helpful to rule out wild-type measles infection


  1. Cremer NE, CK Cossen, G Shell, J Diggs, D Gallo, and NJ Schmidt. (1985) Enzyme immunoassay vs plaque neutralization and other methods for determination of immune status to measles and varicella-zoster viruses and vs complement fixation for serodiagnosis of infections with those viruses. J. Clin. Microbiol. 21:869-873.

  2. Erdman DD, LJ Anderson, DR Adams, JA Stewart, LE Markowitz, and WJ Bellini. (1991) Evaluation of monoclonal antibody-based capture enzyme immunoassays for detection of specific antibodies to measles virus. J. Clin. Microbiol. 29:1466-1471.

  3. Hummel KB, DD Erdman, J Heath, and WJ Bellini. (1992) Baculovirus expression of the nucleoprotein gene of measles virus and utility of the recombinant protein in diagnostic enzyme immunoassays. J. Clin. Microbiol. 30:2874-2880.

  4. Helfand RF, JL Heath, LJ Anderson, EF Maes, D. Guris, and WJ Bellini. (1997) Diagnosis of measles with an IgM capture EIA: The optimal timing of specimen collection after rash onset. J. Infect. Dis. 175:195-199.

  5. Ratnam S, G Tipples, C Head, M Fauvel, M Fearon, and BJ Ward. (2000) Performance of indirect immunoglobulin M (IgM) serology tests and IgM capture assays for laboratory diagnosis of measles. J. Clin. Microbiol. 38:99-10.

Other sources of information for Measles surveillance
item Pan American Health Organization

Central Public Health Laboratory, UK

item Canada: Laboratory Centre for Disease Control
item Chile: Surveillance
item World Health Organization
Measles Initiative
Note: The links in this box lead outside the CDC site. Any links from these sites to nonfederal organizations links do not constitute an endorsement of these organizations or their programs by CDC or the federal government, and none should be inferred. CDC is not responsible for the content of the individual organization Web pages found at these links.

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This page last reviewed July 5, 2001

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