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The importance of molecular testing to confirm measles, mumps and rubella in immunised individuals

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To the Editor: Despite high vaccination coverage, Australians remain at risk of measles, mumps and rubella, either while travelling to endemic countries or from domestic exposure to imported cases. Those most at risk include incompletely vaccinated adults and children whose parents choose not to have them vaccinated. Additionally, immunity generated by vaccination (rather than natural infection) may be less protective, especially if only one vaccine dose is received.1,2

When measles, mumps and rubella were commonly encountered, their clinical features were well recognised, but far fewer cases are now seen, diminishing clinical acumen and the positive predictive value of a clinical diagnosis. Further, the relative proportion of cases in previously vaccinated individuals has increased, making the clinical diagnosis more difficult as these cases may present atypically.1,3

With this clinical uncertainty, laboratory confirmation assumes greater importance.4 However, the IgM response can take several days to appear and can be attenuated or completely absent in post-vaccination infection,1,2 necessitating molecular…