Test Catalog

Test Id : MMRV

Measles, Mumps, Rubella, and Varicella (MMRV) Immune Status Profile, Serum

Useful For
Suggests clinical disorders or settings where the test may be helpful

Determining immune status of individuals to measles, mumps, rubella, and varicella-zoster viruses (VZV)

 

Documentation of previous infection with measles, mumps, rubella, or VZV in an individual without a previous record of immunization to these viruses

Profile Information
A profile is a group of laboratory tests that are ordered and performed together under a single Mayo Test ID. Profile information lists the test performed, inclusive of the test fee, when a profile is ordered and includes reporting names and individual availability.

Test Id Reporting Name Available Separately Always Performed
ROPG Measles (Rubeola) Ab, IgG, S Yes Yes
MPPG Mumps Ab, IgG, S Yes Yes
RBPG Rubella Ab, IgG, S Yes Yes
VZPG Varicella-Zoster Ab, IgG, S Yes Yes

Method Name
A short description of the method used to perform the test

Multiplex Flow Immunoassay (MFI)

NY State Available
Indicates the status of NY State approval and if the test is orderable for NY State clients.

Yes

Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test

MMRV Immune Status Profile, S

Aliases
Lists additional common names for a test, as an aid in searching

Immunity Panel

Measles (Rubeola) Ab, IgG, Serum

Mumps Ab, IgG, Serum

Rubella Ab, IgG, Serum

Varicella-Zoster Ab, IgG, Serum

Specimen Type
Describes the specimen type validated for testing

Serum

Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing

Container/Tube:

Preferred: Serum gel

Acceptable: Red top

Specimen Volume: 1 mL

Forms

If not ordering electronically, complete, print, and send Infectious Disease Serology Test Request (T916) with the specimen.

Specimen Minimum Volume
Defines the amount of sample necessary to provide a clinically relevant result as determined by the Testing Laboratory

0.4 mL

Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected

Gross hemolysis Reject
Gross lipemia Reject
Gross icterus Reject
Heat-inactivated specimen Reject

Specimen Stability Information
Provides a description of the temperatures required to transport a specimen to the performing laboratory, alternate acceptable temperatures are also included

Specimen Type Temperature Time Special Container
Serum Refrigerated (preferred) 14 days
Frozen 14 days

Useful For
Suggests clinical disorders or settings where the test may be helpful

Determining immune status of individuals to measles, mumps, rubella, and varicella-zoster viruses (VZV)

 

Documentation of previous infection with measles, mumps, rubella, or VZV in an individual without a previous record of immunization to these viruses

Clinical Information
Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

The measles virus is a member of the Paramyxoviridae family of viruses, which include parainfluenza virus serotypes 1-4, mumps, respiratory syncytial virus (RSV), and metapneumovirus. The measles virus is among the most highly contagious infectious diseases among unvaccinated individuals and is transmitted through direct contact with aerosolized droplets or other respiratory secretions from infected individuals. Measles has an incubation period of approximately 8 to 12 days, which is followed by a prodromal phase of high fever, cough, coryza, conjunctivitis, and malaise. Koplik spots may also be apparent on the buccal mucosa and can last for 12 to 72 hours.(1) Following this phase, a maculopapular, erythematous rash develops beginning behind the ears and on the forehead and spreading centrifugally to involve the trunk and extremities.

 

Immunocompromised individuals, pregnant women, and those with nutritional deficiencies are particularly at risk for serious complications following measles infection, which include pneumonia and central nervous system (CNS) involvement.(1)

 

Following implementation of the national measles vaccination program in 1963, the incidence of measles infection has fallen to fewer than 0.5 cases per 1,000,000 individuals and the virus is no longer considered endemic in the United States. Measles outbreaks continue to occur in the United States due to exposure of nonimmune individuals or those with waning immunity to infected travelers. The measles outbreak in 2011 throughout Western Europe emphasizes the persistence of the virus in the worldwide population and the continued need for national vaccination programs.(2)

 

The diagnosis of measles infection is often based on clinical presentation alone. Screening for IgG-class antibodies to measles virus will aid in identifying nonimmune individuals.

 

Mumps:

The mumps virus is a member of the Paramyxoviridae family of viruses, which include parainfluenza virus serotypes 1-4, measles, RSV, and metapneumovirus. Mumps is highly infectious among unvaccinated individuals and is typically transmitted through inhalation of infected respiratory droplets or secretions. Following an approximately 2-week incubation period, symptom onset is typically acute with a prodrome of low-grade fever, headache, and malaise.(3,4) Painful enlargement of the salivary glands, the hallmark of mumps, occurs in approximately 60% to 70% of infections and in 95% of patients with symptoms. Testicular pain (orchitis) occurs in approximately 15% to 30% of postpubertal men and abdominal pain (oophoritis) is found in 5% of postpubertal women.(3) Other complications include mumps-associated pancreatitis (<5% of cases) and CNS disease (meningitis <10% and encephalitis <1%).

 

Widespread routine immunization of infants with attenuated mumps virus has dramatically decreased the number of reported mumps cases in the United States. However, outbreaks continue to occur, indicating persistence of the virus in the general population.

 

Laboratory diagnosis of mumps is typically accomplished by detection of IgM- and IgG-class antibodies to the mumps virus. However, due to the widespread mumps vaccination program, in clinically suspected cases of acute mumps infection, serologic testing should be supplemented with virus isolation in culture or detection of viral nucleic acid by polymerase chain reaction (PCR) in throat, saliva, or urine specimens.

 

Rubella:

Rubella (German or 3-day measles) is a member of the Togavirus family and humans remain the only natural host for this virus. Transmission is typically through inhalation of infectious aerosolized respiratory droplets and the incubation period following exposure can range from 12 to 23 days.(5) Infection is generally mild and self-limited, and is characterized by a maculopapular rash beginning on the face and spreading to the trunk and extremities, fever, malaise, and lymphadenopathy.(6)

 

Primary in utero rubella infections can lead to severe sequelae for the fetus, particularly if infection occurs within the first 4 months of gestation. Congenital rubella syndrome is often associated with hearing loss and cardiovascular and ocular defects.(7)

 

The United States 2-dose measles, mumps, and rubella (MMR) vaccination program, which calls for vaccination of all children, leads to seroconversion in 95% of children following the first dose.(5) A total of 4 cases of rubella were reported to the Centers of Disease Control and Prevention in 2011 without any cases of congenital rubella syndrome.(8) Due to the success of the national vaccination program, rubella is no longer considered endemic in the United States (www.cdc.gov/rubella). Immunity may, however, wane with age as approximately 80% to 90% of adults will show serologic evidence of immunity to rubella.

 

Varicella-Zoster Virus:

Varicella-Zoster virus (VZV), a herpes virus, causes 2 distinct exanthematous (rash-associated) diseases: chickenpox (varicella) and shingles (herpes zoster). Chickenpox is a highly contagious, though typically benign disease, usually contracted during childhood. Chickenpox is characterized by a dermal vesiculopustular rash that develops in successive crops approximately 10 to 21 days following exposure.(9) Although primary infection with VZV results in immunity and protection from subsequent infection, VZV remains latent within sensory dorsal root ganglia and upon reactivation, manifests as herpes zoster or shingles. During reactivation, the virus migrates along neural pathways to the skin, producing a unilateral rash, usually limited to a single dermatome. Shingles is an extremely painful condition typically occurring in older, nonimmune adults or those with waning immunity to VZV and in patients with impaired cellular immunity.

 

Individuals at risk for severe complications following primary VZV infection include pregnant women, in whom the virus may spread through the placenta to the fetus, causing congenital disease in the infant. Additionally, immunosuppressed patients are at risk for developing severe VZV-related complications, which include cutaneous disseminated disease and visceral organ involvement.

 

Serologic screening for IgG-class antibodies to VZV aids in identifying nonimmune individuals.

Reference Values
Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.

Measles, Mumps and Varicella

Vaccinated: Positive (> or =1.1 AI)

Unvaccinated: Negative (< or =0.8 AI)

Reference values apply to all ages

 

Rubella

Vaccinated: Positive (> or =1.0 AI)

Unvaccinated: Negative (< or =0.7 AI)

Reference values apply to all ages

Interpretation
Provides information to assist in interpretation of the test results

Positive measles, mumps, varicella-zoster viruses (VZV): Antibody Index (AI) value > or =1.1

Positive rubella: AI Value > or =1.0

 

The reported AI value is for reference only. This is a qualitative test and the numeric value of the AI is not indicative of the amount of antibody present. AI values above the manufacturer recommended cutoff for this assay indicate that specific antibodies were detected, suggesting prior exposure or vaccination.

 

The presence of detectable IgG-class antibodies to these viruses indicates prior exposure through infection or immunization. Individuals testing positive for IgG-class antibodies to measles, mumps, rubella, or VZV are considered immune.

 

Equivocal measles, mumps, VZV: AI value 0.9-1.0

Equivocal rubella: AI value 0.8-0.9

 

Submit an additional sample for testing in 10 to 14 days to demonstrate IgG seroconversion if recently vaccinated or if otherwise clinically indicated.

 

Negative measles, mumps, VZV: AI value < or =0.8

Negative rubella: AI value < or =0.7

 

The absence of detectable IgG-class antibodies to measles, mumps, rubella, or VZV suggests no prior exposure to these viruses or the lack of a specific immune response to immunization.

Cautions
Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

IgG-class antibodies to measles, mumps, rubella, or varicella-zoster virus may be present in serum specimens from individuals who have received blood products within the past several months but have not been immunized or experienced past infection with this virus.

 

Specimens drawn early during the acute phase of infection or shortly (1-2 weeks) following vaccination may be negative for IgG-class antibodies.

Supportive Data

To evaluate the accuracy of the BioPlex MMRV assay, 500 prospective serum samples submitted to the laboratory for routine measles, mumps, rubella, and varicella (MMRV) testing by enzyme immunoassay (EIA) were also analyzed by the BioPlex assay within a 24-hour period. Routine testing for measles and varicella-zoster IgG was performed by Diamedix EIA, while routine analysis of mumps and rubella IgG was completed using the SeraQuest EIA assays. Samples that had discordant results after initial testing were repeated by both assays during the same freeze/thaw cycle. Further discrepancies were evaluated by a third method. Samples showing discordant results for measles and varicella IgG were tested using SeraQuest EIAs, while discrepant samples for mumps and rubella IgG were tested by enzyme-linked fluorescent immunoassay (ELFA) (VIDAS). Results are summarized in the tables below:

 

1. Measles IgG

 

Diamedix measles IgG EIA

BioPlex measles IgG

 

Positive

Negative

Equivocal

Positive

420

1(a)

0

Negative

10(b)

27

17

Equivocal

14

0

11

(a) This sample tested negative by the SeraQuest Measles IgG EIA

(b) All 10 samples tested positive by the SeraQuest Measles IgG EIA

Sensitivity: 94.6% (420/444); 95% Confidence Intervals (95% CI): 92.1% to 96.4%

Specificity: 96.4% (27/28); 95% CI: 80.8% to 100.0%

Overall Percent Agreement: 91.6% (458/500); 95% CI: 88.8% to 93.8%

 

2. Mumps IgG

 

SeraQuest mumps IgG EIA

BioPlex mumps IgG

 

Positive

Negative

Equivocal

Positive

412

4(a)

8

Negative

3(b)

48

3

Equivocal

5

6

11

(a) All 4 of these samples tested positive by VIDAS Mumps IgG ELFA

(b) One of these 3 samples tested negative by the VIDAS Mumps IgG ELFA

Sensitivity: 98.1% (412/420); 95% Confidence Intervals (CI): 96.2% to 99.1%

Specificity: 82.8% (48/58); 95% CI: 70.9% to 90.6%

Overall Percent Agreement: 94.2% (471/500); 95% CI: 91.8% to 96.0%

 

3. Rubella IgG

 

SeraQuest rubella IgG EIA

BioPlex rubella IgG

 

Positive

Negative

Equivocal

Positive

446

0

0

Negative

7(a)

23

4

Equivocal

17

0

3

(a) 6/7 samples tested as equivocal by the VIDAS Rubella IgG ELFA

Sensitivity: 94% (446/470); 95% Confidence Interval (95% CI): 92.5% to 96.6%

Specificity: 100% (23/23); 95% CI: 83.1% to 100%

Overall Percent Agreement: 94.4% (472/500); 95% CI: 92.0% to 96.1%

 

4. Varicella-Zoster IgG

 

Diamedix VZV IgG EIA

BioPlex VZV IgG

 

Positive

Negative

Equivocal

Positive

436

0

0

Negative

18(a)

22

4

Equivocal

19

0

1

(a) All 18 samples tested positive by the SeraQuest VZV IgG EIA

Sensitivity: 92.2% (436/473); 95% Confidence Interval (95% CI): 89.4% to 94.3%

Specificity: 100.0 (22/22); 95% CI: 82.5% to 100.0%

Overall Percent Agreement: 91.8% (459/500); 95% CI: 89.0% to 93.9%

Clinical Reference
Recommendations for in-depth reading of a clinical nature

1. Perry RT, Halsey NA: The clinical significance of measles-a review. J Infect Diseases. 2004;189(Supp 1):S4-S16

2. Centers for Disease Control and Prevention (CDC): Increased transmission and outbreaks of measles-European Region, 2011. MMWR Morb Mortal Wkly Rep. 2011;60(47):1605-1610

3. Hviid A, Rubin S, Muhlemann K: Mumps. Lancet. 2008 Mar;371(9616):932-944

4. Hodinka RL, Moshal KL: Childhood infections. In: Storch GA, ed. Essentials of Diagnostic Virology. Churchill Livingstone; 2000; 168-178

5. American Academy of Pediatrics. Rubella. In: Pickering LK, ed. Red Book. Report of the Committee on Infectious Diseases. 2012

6. Best JM: Rubella. Semin Fetal Neonatal Med. 2007;12(3):182

7. Duszak RS: Congenital rubella syndrome-major review. Optometry. 2009;80(1):36

8. Notifiable diseases and mortality tables. MMWR Morb Mortal Wkly Rep. 2012;61(34):466-479

9. Yankowitz J, Grose C: Congenital infections. In: Storch GA, ed. Essentials of Diagnostic Virology. Churchill Livingstone; 2000; 187-201

Method Description
Describes how the test is performed and provides a method-specific reference

The BioPlex 2200 MMRV IgG kit uses multiplex flow immunoassay technology, which allows for the detection and identification of many different antibodies in a single tube. Four different populations of dyed beads are coated with antigens to identify the presence of IgG-class antibodies associated with measles, mumps, rubella, and varicella-zoster. The patient sample, sample diluent, and bead set reagent are mixed together in a reaction vessel and the mixture is incubated at 37 degrees C. After a wash cycle, anti-human IgG antibody conjugated to phycoerythrin (PE) is added to the dyed beads, and this mixture is incubated at 37 degrees C. Excess conjugate is removed during a wash cycle, and the beads are resuspended in wash buffer. The bead mixture next passes through the detector, and the identity of the beads is determined by the fluorescence of the dyes. The amount of antibody captured by the antigen on the bead is determined by the fluorescence of the attached PE. Raw data is calculated in relative fluorescence intensity (RFI).

 

Three additional dyed beads, an internal standard bead, a serum verification bead, and a reagent blank bead are present in each reaction mixture to verify detector response, the addition of serum to the reaction vessel and the absence of significant non-specific binding in serum.(Package insert: BioPlex 2200 System MMRV IgG. Bio-Rad Laboratories; 11/30/2018)

PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information

No

Day(s) Performed
Outlines the days the test is performed. This field reflects the day that the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time before the test is performed. Some tests are listed as continuously performed, which means that assays are performed multiple times during the day.

Monday through Saturday

Report Available
The interval of time (receipt of sample at Mayo Clinic Laboratories to results available) taking into account standard setup days and weekends. The first day is the time that it typically takes for a result to be available. The last day is the time it might take, accounting for any necessary repeated testing.

Same day/1 day

Performing Laboratory Location
Indicates the location of the laboratory that performs the test

Rochester

Fees
Several factors determine the fee charged to perform a test. Contact your U.S. or International Regional Manager for information about establishing a fee schedule or to learn more about resources to optimize test selection.

  • Authorized users can sign in to Test Prices for detailed fee information.
  • Clients without access to Test Prices can contact Customer Service 24 hours a day, seven days a week.
  • Prospective clients should contact their Regional Manager. For assistance, contact Customer Service.

Test Classification
Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR) product.

This test has been cleared, approved, or is exempt by the US Food and Drug Administration and is used per manufacturer's instructions. Performance characteristics were verified by Mayo Clinic in a manner consistent with CLIA requirements.

CPT Code Information
Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Clinic Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.

CPT codes are provided by the performing laboratory.

86735-Mumps virus antibody, IgG

86762-Rubella antibodies, IgG

86765-Measles (rubeola) antibodies, IgG

86787-Varicella-Zoster antibody, IgG

LOINC® Information
Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the order and results codes of this test. LOINC values are provided by the performing laboratory.

Test Id Test Order Name Order LOINC Value
MMRV MMRV Immune Status Profile, S In Process
Result Id Test Result Name Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
VZG Varicella-Zoster Ab, IgG, S 15410-4
DEXG4 Varicella IgG Antibody Index 5403-1
RBG Rubella Ab, IgG, S 40667-8
DEXG2 Rubella IgG Antibody Index 5334-8
DEXG5 Mumps IgG Antibody Index 25418-5
MUMG Mumps Ab, IgG, S 6476-6
ROG Measles (Rubeola) Ab, IgG, S 35275-7
DEXG3 Measles IgG Antibody Index 5244-9

Test Setup Resources

Setup Files
Test setup information contains test file definition details to support order and result interfacing between Mayo Clinic Laboratories and your Laboratory Information System.

Excel | Pdf

Sample Reports
Normal and Abnormal sample reports are provided as references for report appearance.

Normal Reports | Abnormal Reports

SI Sample Reports
International System (SI) of Unit reports are provided for a limited number of tests. These reports are intended for international account use and are only available through MayoLINK accounts that have been defined to receive them.

SI Normal Reports | SI Abnormal Reports