Altered hemolysis in single radial hemolysis from a single serum sample as an indicator of recent primary rubella virus infection

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Abstract
The quality of hemolysis in the single radial hemolysis (SRH) test was observed to be altered in a small proportion (5.7%) of Sera (N = 9628) studied for rubella antibodies. Three different types of altered hemolysis were identified. Two of these types, the “soft margin” (SM) or the “soft zone” (SZ), occurred singly or in combination in 97% of paired sera (N = 321) taken 3–30 days after primary rubella infection (diagnostic seroconversion). For comparison, diagnostic inercases of rubella antibodies (N = 77), including both primary and reinfections, contained these types of altered hemolysis in 80% of the cases. Of the remaining 20% of the samples (N = 15) rubella antibodies of IgM class were looked for in seven cases but not found. After primary rubella, SZ was always present in the first serum sample and disappeared rapidly within 20 days while SM persisted longer. The predictive value of the different types of hemolysis was estimated from 96 primary sera, which had altered hemolysis. In this material, SZ was followed by a diagnostic increase of antibodies in 87% of the cases; the prognostic value of the SM was significant but lower. These data show that the appearance of SM or SZ in a single serum sample is a useful marker of recent primary rubella. On the other hand, a normal hemolysis in SRH can be used to exclude recent primary rubella, but not reinfection, with a high degree of probability.