Immunization Status

Indications for Testing

  • It may be necessary to assess immunization efficacy to
    • Determine exposure to previous infectious agents
    • Determine immunization status
      • Prior to employment
      • Prior to school admission
      • Prior to care facility or assisted living residence
      • Prior to further immunization
    • Identify latent infection prior to course of treatment

CDC Immunization Schedules

  • Recommended adult immunization schedules (CDC, 2016) – approved by the Advisory Committee on Immunization Practices (ACIP), the American Academy of Family Physicians (AAFP), the American College of Physicians (ACP), the American College of Obstetricians and Gynecologists (ACOG), and the American College of Nurse-Midwives (ACNM)
  • Birth-18 years and “catch up” immunization schedules (CDC, 2016) – approved by ACIP, the American Academy of Pediatrics (AAP), AAFP, and ACOG

NOTE: There is NO laboratory test available that can establish IMMUNITY to the diseases included in this topic; the laboratory tests discussed here can only provide EVIDENCE of vaccination

  • Bordetella pertussis
  • Hepatitis A Virus
  • Hepatitis B Virus
  • Measles Virus
  • Mumps Virus
  • Rubella Virus
  • Varicella-zoster virus
  • Lab Tests
  • References

Bordetella pertussis

Bordetella pertussis Laboratory Testing – Immunization Status Assessment

Tests

Indications for Use

Bordetella pertussis Antibody, IgG by Immunoblot 2004327

  • May be used as evidence of vaccination or past infection
  • Test does not determine immunity to B. pertussis

Bordetella pertussis Antibody, IgG by ELISA with Reflex to Immunoblot 2001768

  • May be used as evidence of vaccination or past infection
  • Test does not determine immunity to B. pertussis

Source: https://www.cdc.gov/pertussis/clinical/diagnostic-testing/diagnosis-confirmation.html

CDC resources

  • Bordetella pertussis case definition and classification (CDC, 2014)
    • Clinical criteria
      • In the absence of a more likely diagnosis, a cough lasting ≥2 weeks with at least one of the following signs or symptoms
        • Paroxysms of cough
        • Inspiratory whoop
        • Posttussive vomiting
        • Apnea (with or without cyanosis) – for infants aged <1 year only
    • Laboratory criteria
      • One or both
        • Isolation of B. pertussis from a clinical specimen
        • Positive PCR test for B. pertussis
  • Pertussis – information for clinicians (CDC, 2015)
  • Pregnancy and pertussis  (CDC, 2015)
  • Grandparents can help protect against whooping cough with Tdap vaccine (CDC, 2015)

Hepatitis A Virus

Hepatitis A Virus Laboratory Testing – Immunization Status Assessment

Tests

Indications for Use

Hepatitis A Virus Antibodies (Total) 0020591

  • May be used as evidence of vaccination or past infection
  • IgG does not appear until convalescent phase but remains detectable for life
  • Test does not determine immunity to HAV

Source: https://www.cdc.gov/vaccines/pubs/pinkbook/downloads/hepa.pdf

CDC resources

  • Hepatitis A case definition and classification (CDC, 2012)
    • Clinical description
      • Acute illness with discrete onset of any sign or symptom consistent with acute viral hepatitis
        • Fever
        • Headache
        • Malaise
        • Anorexia
        • Nausea
        • Vomiting
        • Diarrhea
        • Abdominal pain
      • AND either
        • Jaundice
        • Elevated serum alanine aminotransferase (ALT) or aspartate aminotransferase (AST) levels
    • Laboratory criteria
      • IgM antibody to hepatitis A virus (anti-HAV) positive
    • Case classification
      • Confirmed
        • A case that meets the clinical case definition and is laboratory confirmed OR
        • A case that meets the clinical case definition and occurs in a person who has an epidemiologic link with a person who has laboratory-confirmed hepatitis A (ie, household or sexual contact with an infected person during the 15-50 days before the onset of symptoms
  • Hepatitis A virus information for clinicians (CDC, 2015)
  • Hepatitis A virus guidelines and recommendations (CDC, 2015)

Hepatitis B Virus

Hepatitis B Virus Laboratory Testing – Immunization Status Assessment

Tests

Indications for Use

Hepatitis B Virus Surface Antibody 0020090

  • May be used as evidence of vaccination or past infection
  • Monitor post-liver transplant therapy with hepatitis B immunoglobulin in HBV-positive patients

Source: https://www.cdc.gov/hepatitis/hbv/hbvfaq.htm#general

CDC resources

  • Hepatitis B, acute case definition and classification (CDC, 2012)
    • Clinical description
      • Acute illness with discrete onset of any sign or symptom consistent with acute viral hepatitis
        • Fever
        • Headache
        • Malaise
        • Anorexia
        • Nausea
        • Vomiting
        • Diarrhea
        • Abdominal pain
      • AND either
        • Jaundice
        • Elevated serum alanine aminotransferase (ALT) levels >100 IU/L
    • Laboratory criteria
      • HbsAG positive AND
      • IgM antibody to hepatitis B core antigen (IgM anti-HBc) positive (if done)
    • Case classification
      • Confirmed
        • A case that meets the clinical case definition, AND
        • Is laboratory confirmed, AND
        • Is not known to have chronic hepatitis B  
  • Hepatitis B serology testing information (CDC, 2016)
  • Hepatitis B virus – major guidelines (CDC, 2015)

Measles Virus

Measles Virus Laboratory Testing – Immunization Status Assessment

Tests

Indications for Use

Measles (Rubeola) Antibody, IgG 0050380

  • May be used to detect evidence of vaccination or past infection
  • Test does not determine immunity to measles

Source: https://www.cdc.gov/vaccines/pubs/surv-manual/chpt07-measles.html

CDC resources

  • Measles/rubeola case definition and classification (CDC, 2013)
    • Clinical description
      • Acute illness characterized by
        • Generalized, maculopapular rash lasting ≥3 days, AND
        • Temperature ≥101°F or 38.3°C, AND
        • Cough, coryza, or conjunctivitis
  • Vaccine-preventable diseases – measles (CDC, 2014)

Mumps virus

Mumps Virus Laboratory Testing – Immunization Status Assessment

Tests

Indications for Use

Mumps Virus Antibody, IgG 0050390

  • May be used to detect evidence of vaccination or past infection
  • Test does not determine immunity to mumps

Source: https://www.cdc.gov/mumps/lab/qa-lab-test-infect.html

CDC resources

Rubella virus

Rubella Virus Laboratory Testing – Immunization Status Assessment

Tests

Indications for Use

Rubella Antibody, IgG 0050771

  • Determine immune status of females prior to pregnancy or for vaccination status
  • Test does not determine immunity to rubella

Source: https://www.cdc.gov/rubella/lab/serology.html

CDC resources

Varicella-zoster virus (VZV)

Varicella-zoster Virus Laboratory Testing – Immunization Status Assessment

Tests

Indications for Use

Varicella-Zoster Virus Antibody, IgG 0050167

  • Provide evidence of vaccination or past infection
  • Test does not determine immunity to varicella-zoster virus

Source: https://www.cdc.gov/chickenpox/hcp/lab-tests.html

CDC resources

  • Varicella/chickenpox case definition and classification (CDC, 2010)
    • Clinical description
      • Illness with acute onset of diffuse (generalized) maculo-papulovesicular rash without other apparent cause
    • Laboratory criteria
      • Isolation of varicella virus from clinical specimen, OR
      • Varicella antigen detected by DFA, OR
      • Varicella-specific nucleic acid detected by PCR, OR
      • Significant rise in serum anti-varicella IgG antibody level by any standard serologic assay 
  • Interpreting VZV laboratory tests (CDC, 2016)
  • Assessing immunity to VZV (CDC, 2016)
  • Clinical overview of VZV (CDC, 2016)

Bordetella pertussis Antibody, IgG by Immunoblot 2004327
Method: Qualitative Immunoblot

Bordetella pertussis Antibody, IgG by ELISA with Reflex to Immunoblot 2001768
Method: Semi-Quantitative Enzyme-Linked Immunosorbent Assay/Qualitative Immunoblot

Hepatitis A Virus Antibodies (Total) 0020591
Method: Qualitative Chemiluminescent Immunoassay

Hepatitis B Virus Surface Antibody 0020090
Method: Quantitative Chemiluminescent Immunoassay

Measles (Rubeola) Antibody, IgG 0050380
Method: Semi-Quantitative Chemiluminescent Immunoassay

Mumps Virus Antibody, IgG 0050390
Method: Semi-Quantitative Chemiluminescent Immunoassay

Rubella Antibody, IgG 0050771
Method: Semi-quantitative Chemiluminescent Immunoassay

Varicella-Zoster Virus Antibody, IgG 0050167
Method: Semi-Quantitative Chemiluminescent Immunoassay

Guidelines 

2015 Sexually Transmitted Diseases Treatment Guidelines . Special Populations. Centers for Disease Control and Prevention . Atlanta, GA [Last updated: Jul 2015; Accessed: Dec 2016]

Centers for Disease Control and Prevention (CDC). Recommendations from an ad hoc Meeting of the WHO Measles and Rubella Laboratory Network (LabNet) on use of alternative diagnostic samples for measles and rubella surveillance. MMWR Morb Mortal Wkly Rep. 2008; 57(24): 657-60. PubMed

Centers for Disease Control and Prevention. Pertussis. Hamborsky J, Kroger A, Wolfe S. Epidemiology and Prevention of Vaccine-Preventable Diseases, 13th. Washington D.C: Public Health Foundation, 2016.

Lok AS, McMahon BJ. Chronic hepatitis B: update 2009. Hepatology. 2009; 50(3): 661-2. PubMed

McHugh JA, Cullison S, Apuzzio J, Block JM, Cohen C, Leong SL, London T, McNellis RJ, Neubauer RL, Perrillo R, Squires R, Tarrant D, McMahon BJ. Chronic hepatitis B infection: a workshop consensus statement and algorithm. J Fam Pract. 2011; 60(9): E1-8. PubMed

Papatheodoridis GV, Manolakopoulos S. EASL clinical practice guidelines on the management of chronic hepatitis B: the need for liver biopsy. J Hepatol. 2009; 51(1): 226-7. PubMed

Sorrell MF, Belongia EA, Costa J, Gareen IF, Grem JL, Inadomi JM, Kern ER, McHugh JA, Petersen GM, Rein MF, Strader DB, Trotter HT. National Institutes of Health consensus development conference statement: management of hepatitis B. Hepatology. 2009; 49(5 Suppl): S4-S12. PubMed

U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC). Adult Immunization Schedule. Center for Disease Control and Prevention. [Last updated: Feb 2017; Accessed: Sep 2017]

U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Epidemiology and Prevention of Vaccine-Preventable Diseases - Hepatitis A. Centers for Disease Control and Prevention. Atlanta, GA [Last updated: May 2015; Accessed: Aug 2017]

U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Prevention of Hepatitis A Through Active or Passive Immunization - Recommendations of the Advisory Committee on Immunization Practices (ACIP). Centers for Disease Control and Prevention: Morbidity and Mortality Weekly Report. Atlanta, GA [Published: May 2006; Accessed: Aug 2017]

U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Recommended Immunization Schedules for Children and Adolescents Aged 18 Years or Younger. United States, 2016. Centers for Disease Control and Prevention. Atlanta, GA [Last Updated: Jan 2017; Accessed: Sep 2017]

U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines, 2015. June 5, 2015, 64(RR3);1-137. Centers for Disease Control and Prevention. Atlanta, GA [Last updated: Jun 2015; Accessed: Aug 2017]

U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Update: Prevention of Hepatitis A After Exposure to Hepatitis A Virus and in International Travelers. Updated Recommendations of the Advisory Committee on Immunization Practices (ACIP). Centers for Disease Control and Prevention: Morbidity and Mortality Weekly Report. Atlanta, GA [Published: Oct 2007; Accessed: Aug 2017]

U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Updated Recommendations from the Advisory Committee on Immunization Practices (ACIP) for Use of Hepatitis A Vaccine in Close Contacts of Newly Arriving International Adoptees. Centers for Disease Control and Prevention: Morbidity and Mortality Weekly Report. Atlanta, GA [Published: Sep 2009; Accessed: Aug 2017]

U.S. Preventive Services Task Force. Screening for hepatitis B virus infection in pregnancy: U.S. Preventive Services Task Force reaffirmation recommendation statement. Ann Intern Med. 2009; 150(12): 869-73, W154. PubMed

Weinbaum CM, Williams I, Mast EE, Wang SA, Finelli L, Wasley A, Neitzel SM, Ward JW, Centers for Disease Control and Prevention (CDC). Recommendations for identification and public health management of persons with chronic hepatitis B virus infection. MMWR Recomm Rep. 2008; 57(RR-8): 1-20. PubMed

Last Update: August 2017