Diagnostic accuracy of commercially available serological tests for the detection of measles and rubella viruses: a systematic review and meta-analysis

Abstract

Measles and rubella serological diagnoses are done by IgM detection. The World Health Organization Global Measles and Rubella Laboratory Network previously endorsed Siemens Enzygnost enzyme-linked immunosorbant assay kits, which have been discontinued. A recommended replacement has not been determined. We aimed to search for suitable replacements by conducting a systematic review and meta-analysis of IgM detection methods that are currently available for measles and rubella. A systematic literature search was performed in Medline, Embase, Global Health, Cochrane Central, and Scopus on March 22 and on 27 September 2023. Studies reporting measles and/or rubella IgM detection with terms around diagnostic accuracy were included. Risk of bias was assessed using QUADAS tools. Meta-DiSc and R were used for statistical analysis. Clinical samples totalling 5,579 from 28 index tests were included in the measles meta-analysis. Sensitivity and specificity of the individual measles studies ranged from 0.50 to 1.00 and 0.53 to 1.00, respectively. Pooled sensitivity and specificity of all measles IgM detection methods were 0.94 (CI: 0.90-0.97) and 0.94 (CI: 0.91-0.97), respectively. Clinical samples totalling 4,983 from 15 index tests were included in the rubella meta-analysis. Sensitivity and specificity of the individual rubella studies ranged from 0.78 to 1.00 and 0.52 to 1.00, respectively. Pooled sensitivity and specificity of all rubella IgM detection methods were 0.97 (CI: 0.93-0.98) and 0.96 (CI: 0.93-0.98), respectively. Although more studies would be ideal, our results may provide valuable information when selecting IgM detection methods for measles and/or rubella.

Keywords: measles IgM; meta-analysis; rubella IgM; systematic review.

Fig 1

PRISMA Flow Diagram for Study Selection. Flowchart illustrating the process for the selection of the included articles for the systematic review and meta-analysis for measles and rubella IgM detection methods.

Fig 2

Measles IgM forest plot showing individual index test sensitivity and specificity. Index tests are grouped by test format (indirect ELISA, capture ELISA, and CLIA). Bars represent 95% confidence intervals and the boxes represent the sensitivity or specificity value. Note: TP, true positive; FN, false negative; TN, true negative; FP, false positive. *Validation data provided by manufacturer.

Fig 3

Rubella IgM forest plot showing individual index test sensitivity and specificity. Index tests are grouped by test format (indirect ELISA, capture ELISA, and CLIA). Bars represent 95% CI, and the boxes represent the sensitivity or specificity value. Note: TP, true positive; FN, false negative; TN, true negative; FP, false positive. *Validation data provided from manufacturer.

Fig 4

(A) Overall percentage of risk of bias and applicability concern using the QUADAS-2 and QUADAS-C tools for measles IgM detection studies. (B) Overall percentage of risk of bias and applicability concern using the QUADAS-2 and QUADAS-C tools for rubella IgM detection studies.