Role of oral-fluid based measles diagnostic methods for measles global elimination

Table 2 Application of oral-fluid methods under different countries settings

Applications of oral-fluid methods	Setting for country/district
	Low /Med uptake routine	High uptake routine	Campaign
Population survey	Methods: community surveys of IgG across wide age range. Including hard-to-reach groups, informal settlements. Purpose: immunity profiles. Identifies susceptibility gaps and age range for campaigns. Implications: increase in coverage, need for and age range for campaigns	As previous	As previous plus. Methods: Post-campaign surveys of IgG and perhaps IgM. Purpose: IgG-Identify immunity levels post-campaign. Susceptibility in target age group and outside target group. IgM-indicator of impact, i.e., proportion responding to vaccine. Implications: Age-range for future campaigns; locate problems of vaccine efficacy
Vaccine surveys	Methods: Vaccine clinic samples pre- and post-vaccination. IgM and/or IgG testing. Purpose: Assess efficacy of routine vaccination. Implications: Identify cause of low efficacy.	As previous	As previous plus. Methods: IgG survey of individuals attending vaccine clinics. Purpose: Identify proportion able to respond to vaccine. Implications: Assess potential effectiveness, and suggest alternative method for delivery eg hard-to-reach groups.
Diagnosis	Not indicated while measles incidence remains high	Method: IgM testing on demand. Purpose: Confirmation of clinical diagnosis	As previous
Case surveillance: serological and genetic	Not indicated while measles transmission remains high	Method: System of reporting and oral fluid sampling from sporadic cases and outbreaks. IgM and Genotyping Purpose: Verify cases, and monitor distribution of virus and endemicity Implications: Need for additional control measures	As previous

IgG: Immunoglobulin G; IgM: Immunoglobulin M.