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Inicio Enfermedades Infecciosas y Microbiología Clínica (English Edition) Reply to “Implementation of molecular techniques for diagnosis of mumps”
Journal Information
Vol. 37. Issue 1.
Pages 67-68 (January 2019)
Vol. 37. Issue 1.
Pages 67-68 (January 2019)
Letter to the Editor
DOI: 10.1016/j.eimce.2018.05.008
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Reply to “Implementation of molecular techniques for diagnosis of mumps”
Respuesta a «Implementación de técnicas moleculares para el diagnóstico de parotiditis epidémica»
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Juan Carlos Sanza,b,
Corresponding author
juan.sanz@salud.madrid.org

Corresponding author.
, Aurora Fernández-Garcíab,c, Juan Emilio Echevarríab,c, Fernando de Oryb,c
a Laboratorio Regional de Salud Pública de la Comunidad de Madrid, Madrid, Spain
b Programa de Prevención, Vigilancia y control de las Enfermedades Transmisibles (PREVICET), Consorcio de Investigación Biomédica de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
c Laboratorio Nacional de Referencia de Parotiditis, Centro Nacional de Microbiología (CNM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
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Dear Editor,

We were pleased to find that the results provided by Navalpotro Rodríguez et al.1 coincide with our data which were published recently in the EIMC journal.2 In their study, more than two-thirds of IgM-negative mumps cases—which obtained positive results with a Real-Time Polymerase Chain Reaction (RT-PCR)—showed elevated specific IgG levels (understood to be above the measurement limit of the chemiluminescence technique employed).1 Unlike what happens with the other components of the MMR vaccine, in those that have international units of IgG (mIU/ml for measles and IU/ml for rubella), which enable the comparison of serological results from different studies,3 in the case of mumps there is no standard serum that can be referred to in international units.4 Moreover, the quantitation of IgG is expressed in terms of titres or arbitrary units relating to the techniques used.1,2 Furthermore, the difficulties regarding the standardisation of quantitation methods for IgG in mumps4 may hinder the comparison of data provided by different laboratories.5 The fact that approximately a quarter of the cases which are negative with RT-PCR will also present a high degree of positivity, can perhaps be partly explained by the trend in the results obtained by laboratory tests for the diagnosis of mumps. RT-PCR techniques prove more sensitive in the early phases, following the onset of symptoms6,7 but may come back negative as the infection advances. Thus, a negative RT-PCR result (in the late stages) does not definitively rule out infection. IgM detection improves from the second week, but lacks sensitivity in the vaccinated population.6,7 Identifying elevated levels of specific IgG may increase this sensitivity. However, raised IgG levels may of course not prove too specific. The current Spanish vaccination schedule involves administering two doses of the MMR vaccine at 12 months and 3–4 years of age. Between 2007 and 2016, vaccination coverage in older children was sustained at 95% with the first dose and 90% with the second dose.8 In our field, the levels of seroprevalence against mumps in young adults are approaching 90%.9 However, despite this, mumps continues to appear in a cyclic presentation in Spain.10 The emergence of periodic epidemic waves may lead to a “booster” effect in vaccinated individuals which prompts a raise in specific antibody levels after coming into contact with circulating wild-type viruses. We wholeheartedly agree with the authors that the implementation of RT-PCR on saliva samples is currently the best method for confirming mumps cases in our field. Serology may continue to be of interest in unvaccinated groups, in the conduct of epidemiological studies and in special circumstances where it was not possible to obtain samples in the early phases of the disease.

References
[1]
D. Navalpotro Rodríguez, M. Torrecillas Muelas, M.M. Melero García, C. Gimeno Cardona.
Implementación de técnicas moleculares para el diagnóstico de parotiditis epidémica.
Enferm Infecc Microbiol Clin, (2018),
[2]
J.C. Sanz, B. Ramos, A. Fernández, L. García-Comas, J.E. Echevarría, F. de Ory.
Diagnóstico serológico de parotiditis epidémica: valor de la titulación de IgG específica.
Enferm Infecc Microbiol Clin, 36 (2018), pp. 172-174
[3]
L. García-Comas, J.C. Sanz Moreno, M. Ordobás Gavín, D. Barranco Ordóñez, J. García Gutiérrez, B. Ramos Blázquez, et al.
Seroprevalence of measles and rubella virus antibodies in the population of the Community of Madrid, 2008–2009.
J Infect Public Health, 8 (2015), pp. 432-440
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A. Tischer, N. Andrews, G. Kafatos, A. Nardone, G. Berbers, I. Davidkin, et al.
Standardization of measles, mumps and rubella assays to enable comparisons of seroprevalence data across 21 European countries and Australia.
Epidemiol Infect, 135 (2007), pp. 787-797
[5]
G. Kafatos, N. Andrews, K.J. McConway, C. Anastassopoulou, C. Barbara, F. de Ory, et al.
Estimating seroprevalence of vaccine-preventable infections: is it worth standardizing the serological outcomes to adjust for different assays and laboratories?.
Epidemiol Infect, 143 (2015), pp. 2269-2278
[6]
A. Mankertz, U. Beutel, F.J. Schmidt, S. Borgmann, J.J. Wenzel, P. Ziegler, et al.
Laboratory-based investigation of suspected mumps cases submitted to the German National Reference Centre for Measles, Mumps, and Rubella, 2008 to 2013.
Int J Med Microbiol, 305 (2015), pp. 619-626
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L.N. Patel, R.J. Arciuolo, J. Fu, F.R. Giancotti, J.R. Zucker, J.L. Rakeman, et al.
Mumps outbreak among a highly vaccinated university community—New York City, January–April 2014.
Clin Infect Dis, 64 (2017), pp. 408-412
[8]
Coberturas de vacunación. Datos estadísticos. Ministerio de Sanidad, Servicios Sociales e Igualdad. Gobierno de España. Available at: http://www.msssi.gob.es/profesionales/saludPublica/prevPromocion/vacunaciones/coberturas.htm [accessed 29.05.18].
[9]
A. González-Escalada, L. García-García, P. Viguera-Ester, P. Marín-García, J. García, A. Gil-de-Miguel, et al.
Seroprevalence of antibodies against measles, rubella, mumps, varicella-zoster, and B. pertussis in young adults of Madrid, Spain.
Hum Vaccin Immunother, 9 (2013), pp. 1918-1925
[10]
N. López-Perea, J. Masa-Calles, M.V. Torres de Mier, A. Fernández-García, J.E. Echevarría, F. de Ory, et al.
Shift within age-groups of mumps incidence, hospitalizations and severe complications in a highly vaccinated population, Spain, 1998–2014.
Vaccine, 35 (2017), pp. 4339-4345

Please cite this article as: Sanz JC, Fernández-García A, Echevarría JE, de Ory F. Respuesta a «Implementación de técnicas moleculares para el diagnóstico de parotiditis epidémica». Enferm Infecc Microbiol Clin. 2019;37:67–68.

Copyright © 2018. Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica
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