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4 References 1. Berger BE, Omer SB. Could the United States experience rubella outbreaks as a result of vaccine refusal and disease importation? Hum Vaccin 2010; 6(12): Esteghamati A, Gouya MM, Zahraei SM, Dadras MN, Rashidi A, Mahoney F. Progress in measles and rubella elimination in Iran. Pediatr Infect Dis J 2007; 26(12): Usonis V, Anca I, Andre F, Chlibek R, Cizman M, Ivaskeviciene I, et al. Rubella revisited: where are we on the road to disease elimination in Central Europe? Vaccine 2011; 29(49): Vauloup-Fellous C, Grangeot-Keros L. Humoral immune response after primary rubella virus infection and after vaccination. Clin Vaccine Immunol 2007; 14(5): Khorrami SM, Mokhtari-Azad T, Yavarian J, Nasab GS, Naseri M, Jandaghi NZ. The etiology of Rubella positivity in patients with rubella-like illness in Iran from 2011 to J Med Virol 2015; 87(11): Pandolfi E, Chiaradia G, Moncada M, Rava L, Tozzi AE. Prevention of congenital rubella and congenital varicella in Europe. Euro Surveill 2009; 14(9): Hamkar R, Jalilvand S, Abdolbaghi MH, Jelyani KN, Esteghamati A, Hagh-goo A, et al. Distinguishing between primary infection and reinfection with rubella vaccine virus by IgG avidity assay in pregnant women. East Mediterr Health J 2009; 15(1): Best JM. Rubella. Semin Fetal Neonatal Med 2007; 12(3): de Paschale M, Manco MT, Paganini A, Agrappi C, Mirri P, Cucchi G, et al. Rubella antibody screening during pregnancy in an urban area of Northern Italy. Infect Dis Rep 2012; 4(1): e Wandinger KP, Saschenbrecker S, Steinhagen K, Scheper T, Meyer W, Bartelt U, et al. Diagnosis of recent primary rubella virus infections: significance of glycoprotein-based serology, IgG avidity and immunoblot analysis. J Virol Methods 2011; 174(1-2): Hamkar R, Jalilvand S, Mokhtari-Azad T, Nouri JK, Dahi-Far H, Soleimanjahi H, et al. Assessment of enzyme immunoassay and IgG avidity assay for distinguishing between primary and secondary immune response to rubella vaccine. J Virol Methods 2005; 130(1-2): Bottiger B, Jensen IP. Maturation of rubella IgG avidity over time after acute rubella infection. Clin Diagn Virol 1997; 8(2): Thomas HI, Barrett E, Hesketh LM, Wynne A, Morgan-Capner P. Simultaneous reactivity by EIA against more than one virus in measles, parvovirus B19 and rubella infection. J Clin Virol 1999; 14(2): Ang LW, Chua LT, James L, Goh KT. Epidemiological surveillance and control of rubella in Singapore, Ann Acad Med Singapore 2010; 39(2): Dimech W, Panagiotopoulos L, Marler J, Laven N, Leeson S, Dax EM. Evaluation of three immunoassays used for detection of anti-rubella virus immunoglobulin M antibodies. Clin Diagn Lab Immunol 2005; 12(9): Andrus JK, de Quadros CA. Recent advances in immunization. 2 nd ed. Washington, DC: Pan American Health Organization; p

5 Journal of Isfahan Medical School Received: Vol. 33, No. 360, 4 th Week, January 2016 Accepted: Positive Predictive Value of Detection in Diagnosis of Acute Rubella Infection Seyed-Mahmood Seyed-Khorrami MSc 1, Talat Mokhtari-Azad DVM, MPH, PhD 2, Jila Yavarian MD, PhD 3, Nahid Moghadam-Nia 4, Azadeh Shadab 1, Fatemeh Adjaminezhad-Fard 1, Azam Sabouri MSc 5, Fatemeh Saadatmand 1, Nazanin-Zahra Shafiei-Jandaghi PhD 3 Abstract Short Communication Background: Rubella vaccination is essential due to the relationship between the primary infection and congenital abnormalities. Detection of is the most common method of diagnosing acute rubella infection. In Iran, no rubella outbreak has been reported after the global vaccination; although positive rubella cases have been detected. Approaching elimination of a viral infection, its incidence rate and the positive predictive value (PPV) of the diagnostic test would be reduced. Recently, adequate vaccination coverage leads to a reduction in rubella incidence, in such a situation this study estimated the PPV of rubella specific. Methods: Serum samples from cases with fever and rash, during three tandem years were collected from all over the country. To evaluate the PPV of detection in acute rubella infection diagnosis, all the sera were subjected to detection, then all positive cases were evaluated via IgG avidity assay. Findings: The PPV of detection test to detect acute rubella infection was 15.8%. Conclusion: In conclusion, giving the appropriate immunization coverage in the country, the PPV of detecting rubella was low. Therefore, diagnosis of acute rubella infection should not be confirmed only based on positive result. Keywords: Acute rubella infection, detection, Positive predictive value Citation: Seyed-Khorrami SM, Mokhtari-Azad T, Yavarian J, Moghadam-Nia N, Shadab A, Adjaminezhad- Fard F, et al. Positive Predictive Value of Detection in Diagnosis of Acute Rubella Infection. J Isfahan Med Sch 2016; 33(360): Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran 2- Professor, National Laboratory for Measles/Rubella AND Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran 3- Assistant Professor, Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran 4- MSc Student, Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran 5- Department of Vaccine-Preventable Diseases, Center of Diseases Control, Ministry of Health and Medical Education, Tehran, Iran Corresponding Author: Nazanin-Zahra Shafiei-Jandaghi PhD, nz-shafiei@tums.ac.ir 2053