Proof of concept for a novel diagnostic assay for rubella virus (RUB) based on RUB replicons expressing reporter genes was demonstrated. RUB replicons have the structural protein coding region replaced with a reporter gene such as green fluorescent protein or chloramphenicol acetyltransferase. Previously, it was shown that a replicon construct with a specific in-frame deletion in the nonstructural protein coding region (NotI, approximately nucleotides 1500 to 2100 of the genome) failed to replicate and express the reporter gene unless rescued by a coinfecting wild-type helper RUB (W.-P. Tzeng et al., Virology 289:63-73, 2001). In the present study, it was found that rescue of reporter gene expression by NotI replicons occurred when coinfection was done with clinical specimens containing RUB, indicating that this system could be the basis for a diagnostic assay. The assay was sensitive, using laboratory RUB strains and as low a dose as one plaque-forming unit. The assay was specific in that it was positive for RUB strains of both genotypes and was negative for a panel of human viruses. It was also possible to genetically sequence the RUB present in positive clinical specimens detected in the assay for genotypic strain determination.Diagnosis of rubella virus (RUB) infection is essential after potential exposure of a woman in the first trimester of pregnancy (2), is necessary for confirmation of potential cases of congenital rubella syndrome in newborns (12), and is important in the surveillance component of rubella vaccination programs (4,11,20). Interestingly, diagnosis of RUB infection is also an important aspect of surveillance in measles vaccination programs since rubella is the most common nonmeasles rash illness screened during measles surveillance. Serodiagnostic assays for RUB infection are based on the detection of RUBspecific immunoglobulin M (IgM) in serum and saliva; IgM is also diagnostic of congenital RUB infection if present in fetal or newborn serum (1, 2). However, on the day of rash onset, only 50% of patients are IgM positive (1, 2). The percentage increases to 90% by 5 days after rash onset, and detection of RUB-specific IgG commences 3 days after rash onset; however, in light of the benign nature of the disease, it is often difficult to convince patients to return for collection of a second specimen (1, 2). In comparison, 90% of throat swab specimens taken on the day of rash onset are positive for the presence of RUB by virus isolation or reverse transcription-PCR (RT-PCR) assay (1). These techniques have also been used successfully to detect RUB in serum, saliva, nasopharyngeal washes, and urine (RT-PCR has been used to detect RUB genomes in chorionic villi or amniotic fluid in utero specimens [3,14,16,17]). Thus, direct detection of virus is more sensitive than serodiagnosis in diagnosis of RUB infection on the days immediately after presentation of symptoms.Both primary monkey kidney cell cultures or cultures of suitable continuous monkey kidney cell lines have been used to isolate RUB fro...