Objective:

To highlight the challenges and necessary improvements in laboratory response to measles outbreaks in the US, particularly in the context of declining vaccination rates.

Approach:

• Vaccination Trends: Describes the decline in national vaccination coverage due to factors such as the COVID-19 pandemic and vaccine skepticism.
• Clinical Risks: Details the acute and long-term complications associated with measles, including immune amnesia and SSPE.
• Laboratory Challenges: Discusses the absence of FDA-cleared assays for measles and the reliance on laboratory-developed tests.
• Testing Plans: Stresses the importance of having a testing plan and communication with public health laboratories.
• Advances in Diagnostics: Highlights recent advances in PCR testing for earlier detection of measles.

Key Findings:

• Vaccination coverage has declined, with some communities below 50% MMR vaccination.
• Measles can lead to serious complications, including immune amnesia and SSPE.
• No FDA-cleared assays for measles exist, relying on laboratory-developed tests.
• PCR testing can detect measles earlier than IgM serology and distinguish between wild-type and vaccine strains.
• Clear communication between clinical and public health laboratories is essential during outbreaks.

Interpretation:

The article underscores the urgent need for improved laboratory capabilities and preparedness in response to measles outbreaks.

Limitations:

• No FDA-approved assays for measles testing.
• Limited capacity for developing and validating tests in many clinical laboratories.

Conclusion:

Laboratories must enhance their testing protocols and communication strategies to effectively manage measles outbreaks.

Sources:

• College of American Pathologists