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.
Method Name A short description of the method used to perform the test. Reporting Name Lists a shorter or abbreviated version of the Published Name for a test. Aliases Lists additional common names for a test, as an aid in searching. Specimen Type Describes the specimen type validated for testing.
Specimen Required Defines the optimal specimen required to perform the test and the preferred volume to complete testing. Specimen Minimum Volume Defines the amount of sample necessary to provide a clinically relevant result as determined by the Testing Laboratory. Reject Due To Identifies specimen types and conditions that may cause the specimen to be rejected.
Specimen Stability Information Provides a description of the temperatures required to transport a specimen to the performing laboratory, alternate acceptable temperatures are also included. Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test.
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. IgM Negative Reference values apply to all ages. Interpretation Provides information to assist in interpretation of the test results. Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances. Clinical Reference Recommendations for in-depth reading of a clinical nature. Churchill Livingstone; 2.
Method Description Describes how the test is performed and provides a method-specific reference. Immunoglobulin M: The presence or absence of IgM-class antibody to varicella-zoster virus VZV is determined by an indirect immunofluorescence assay. PDF Report Indicates whether the report includes an additional document with charts, images or other enriched information.
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. 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.
Specimen Retention Time Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded. Performing Laboratory Location Indicates the location of the laboratory that performs the test.
Fees Several factors determine the fee charged to perform a test. Contact your U. 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. Adequate collection of specimens from maculopapular lesions in vaccinated people can be challenging.
However, one study Evaluation of Laboratory Methods for Diagnosis of Varicella pdf icon external icon comparing a variety of specimens from the same patients vaccinated with one dose suggests that maculopapular lesions collected with proper technique can be highly reliable specimen types for detecting VZV.
Other sources such as nasopharyngeal secretions, saliva, blood, urine, bronchial washings, and cerebrospinal fluid are less likely to provide an adequate sample and can often lead to false negative results. Other viral isolation techniques for confirming varicella are direct fluorescent antibody assay DFA and viral culture. However, these techniques are generally not recommended because they are less sensitive than PCR and, in the case of viral culture, will take longer to generate results. IgM serologic testing is considerably less sensitive than PCR testing of skin lesions.
IgM serology can provide evidence for a recent active VZV infection, but cannot discriminate between a primary infection and reinfection or reactivation from latency since specific IgM antibodies are transiently produced on each exposure to VZV. IgM tests are also inherently prone to poor specificity. Paired acute and convalescent sera showing a four-fold rise in IgG antibodies have excellent specificity for varicella, but are not as sensitive as PCR of skin lesions for diagnosing varicella.
People with prior history of vaccination or disease history may have very high baseline titers, and may not achieve a four-fold increase in the convalescent sera. The usefulness of this method for diagnosing varicella is further limited as it requires two office visits.
For both unvaccinated and vaccinated people, PCR is the most reliable method for confirming infection. Examples of possible varicella vaccine-adverse events for which PCR genotyping for VZV can be useful include varicella or a varicella-related complication in a vaccinated person 7 to 42 days after vaccination, herpes zoster in a vaccinated person, and suspected secondary vaccine-strain VZV transmission.
A single serologic IgG test can be used to determine if a person has antibodies to VZV from past varicella disease or who may be candidates for varicella-zoster immune globulin VZIG.
The product available in the U. Specific IgE VZV responses were not observed, indicating that IgE responses to the VZV vaccine are not a universal phenomenon but may represent responses observed only in selected individuals or at specific time points following immunization not captured by our study. This case demonstrates that in a subgroup of people, the Ab response to vaccination with VZV may be low despite normal cell-mediated responses.
Prior literature has reported persistent serologic non-response to VZV immunization in a patient with adequate cellular response [ 13 ]. When VZV Ab levels are low, assays that test cellular responses lymphocyte proliferation assays or commercial assays not available should be used.
The accepted standard for identifying VZV vaccine responses or prior disease exposure is measuring the IgG Ab titer [ 13 ]. These assays are sensitive and can detect Ab to natural infection, but a level of variability exists in detecting Ab levels after vaccination [ 14 ]. These results may indicate that evaluation of positive immune status through detection of IgG VZV antibody responses after vaccination may not be sufficient.
Often, it is important to assess the varicella immunity status of adolescents and adults and vaccinate those who lack evidence of varicella immunity [ 16 ].
If immunity needs to be determined, but the IgG in serum is below the cutoff for immunity, a cellular immune response assay or rechecking IgG following a booster immunization is recommended [ 16 ]. Vaccine-mediated immunity is complicated [ 17 ]. A vaccine stimulates specific Abs; protection depends on the amount of vaccine-induced Ab and the quality of the response antigen-binding avidity [ 17 ].
B cell responses to a vaccine are mediated by T cells, which are important for long-term immunologic memory [ 17 ]. The innate immune system responds to molecules associated with pathogens and host cell damage pathogen-associated molecular patterns [ 18 ]. In addition, cytokines produced by innate cells can activate adaptive immune responses e. Waning of vaccine-induced Ab levels can be expected and has been reported in certain vaccinated adults MMR vaccine [ 19 ].
However, the current findings have confirmed previous observations regarding the relationship between the primary Ab response to the varicella vaccine and protection against varicella disease [ 20 ].
It should also be mentioned that our patient received two doses of MMR vaccine, but had negative responses for measles and rubella. It can be speculated that in our patient, this may be due to suboptimal cell-mediated immune responses against the measles and rubella vaccine or perhaps due to fewer virus-specific T cells. In humans, responses to infectious diseases or vaccines depend on many different cell populations and interactions between different cell populations [ 22 ].
This may indicate stimulation or maintenance of memory B cells. B cells play multiple important roles during the induction of immune responses to vaccines [ 23 ] and also have regulatory functions. They can act as antigen-presenting cells or effector cells which produce Abs, cytokines, and chemokines [ 24 — 26 ]. It could also be that memory B cells and their response to vaccination may be less predictable than previously thought.
Primary non-responders have a T cell deficiency, but secondary vaccine deficiencies as observed in this study are less well understood.
Since the numbers of T cells did not increase in our patient, it could be speculated that a lack of a robust T cell memory response may indicate the underlying pathology of secondary vaccine failure. Understanding the immune mechanisms that underlie the successful generation of immune memory responses after VZV vaccination has remained a challenge and has significant implications for the management of vaccine non-responders.
Further studies are necessary to investigate new strategies to improve vaccine responses. No funding or sponsorship was received for this study or publication of this article.
The article processing charges were funded by the authors. All named authors meet the International Committee of Medical Journal Editors ICMJE criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published. Tamar A. Smith-Norowitz, Tehila A. Saadia, Kevin B. Norowitz, Rauno Joks, Helen G. Durkin, and Stephan Kohlhoff have nothing to disclose.
Enhanced content. National Center for Biotechnology Information , U. Journal List Infect Dis Ther v. Infect Dis Ther. Published online Dec Smith-Norowitz , 1 Tehila A. Saadia , 1 Kevin B. Norowitz , 1 Rauno Joks , 2 Helen G. Durkin , 3 and Stephan Kohlhoff 1. Tehila A. Kevin B. Helen G. Author information Article notes Copyright and License information Disclaimer.
Smith-Norowitz, Email: ude. Corresponding author. Received Oct This article has been cited by other articles in PMC. Associated Data Data Availability Statement All data generated or analyzed during this study are included in this published article.
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