Download Rubella Case Investigation and Sample Collection Guidelines

Rubella Case Investigation and Sample Collection Guidelines
Rubella, sometimes called German measles or three-day measles, is a contagious disease caused
by a virus. The infection is usually mild with fever and rash.
Symptoms
Rubella usually causes the following symptoms in children:


Rash that starts on the face and spreads to the rest of the body
Low fever (less than 101 degrees)
These symptoms last 2 or 3 days.
Older children and adults may also have swollen glands and symptoms like a cold before the rash
appears. Aching joints occur in many cases, especially among young women.
About half of the people who get rubella do not have symptoms.
Case Definition:
Suspected: Any generalized rash illness of acute onset that does not meet the criteria for
probable or confirmed rubella or any other illness.
Probable: In the absence of a more likely diagnosis, an illness characterized by all of the
following:
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acute onset of generalized maculopapular rash; and
temperature greater than 99.0° F or 37.2° C, if measured; and
arthralgia, arthritis, lymphadenopathy, or conjunctivitis; and
lack of epidemiologic linkage to a laboratory-confirmed case of rubella; and
noncontributory or no serologic or virologic testing.
Confirmed: A case with or without symptoms who has laboratory evidence of rubella infection
confirmed by one or more of the following:
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isolation of rubella virus; or
detection of rubella-virus specific nucleic acid by polymerase chain reaction; or
significant rise between acute-and convalescent-phase titers in serum rubella
immunoglobulin G antibody level by any standard serologic assay; or
positive serologic test for rubella immunoglobulin M (IgM) antibody*,†
OR
An illness characterized by all of the following:
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

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acute onset of generalized maculopapular rash; and
temperature greater than 99.0° F or 37.2° C; and
arthralgia, arthritis, lymphadenopathy, or conjunctivitis; and
epidemiologic linkage to a laboratory-confirmed case of rubella.
Clinical Specimens
Clinical specimens for viral isolation are often helpful to confirm a positive serum result and for
viral surveillance of rubella genotypes.
Blood / Serum Sample for Serology
Specimen type
Collection procedure
Optimum collection
time
Transportation
container
Transport
Blood/serum
Use a plain sterile vial for IgM to rubella and antigen detection by PCR
Collect at first contact. Virus can usually be detected 2-3 days before rash and
up to about 14 days post rash. The optimal timing for virus isolation is day of
rash through day 5 post rash.
Collect at least 3ml of blood in a plain sterile vial
Under cold chain, with ice packs. Should be received at the lab within 48 hours
of collection. If shipment is delayed and facilities are available, the specimens
should be frozen at –700 C and shipped on dry ice. Otherwise, store specimens
in refrigerator (freezing at -200 C reduces viability of virus).
Throat swab (Oropharyngeal swab)
Specimen type
Collection procedure
Optimum collection
time
Transportation
container
Transport
Throat swab (Oropharyngeal swab). This is the preferred sample for rubella
virus.
Use a cotton/dacron swabs to collect the specimen. Swab the posterior pharynx
and tonsillar areas, avoiding the tongue (tongue depressor may be helpful). The
mucosa behind the uvula and between the tonsils should be gently swabbed
with a back-and-forth motion. Keeping swabs moist after collection is most
important .
Collect at first contact. Virus can usually be detected 2-3 days before rash and
up to about 14 days post rash. The optimal timing for virus isolation is day of
rash through day 5 post rash.
Place swab in 3-4 ml Viral Transport Media (VTM). Swabs may be broken off
and shipped with media.
Under cold chain, with ice packs. Should be received at the lab within 48 hours
of collection. If shipment is delayed and facilities are available, the specimens
should be frozen at –700 C and shipped on dry ice. Otherwise, store specimens
in refrigerator (freezing at -200 C reduces viability of virus).
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Nasopharyngeal (NP) swab (optional)
Specimen type
Collection
procedure
Transportation
container
Transport
Nasopharyngeal (NP) swab. An NP swab can be collected in addition to a
throat swab or can serve as an alternative specimen for infants with CRS.
The NP swab can also be pooled with a throat swab or shipped separately.
Use a cotton/dacron swab to collect the specimen. Insert sterile swab into
nasopharynx, rotate and remove. Keeping swabs moist after collection is
most important (see transportation below.)
Place swab in 3-4 ml Viral Transport Media (VTM). Any sterile isotonic
fluid, like phosphate buffered saline (PBS) or common tissue medium like
Eagle’s MEM can be used. Swabs may be broken off and shipped with
media. Alternatively, swirl/agitate the swab in the media for several minutes
before removal. Commercially available kits containing swabs and viral
transport media are acceptable
As above for oropharyngeal specimens
Urine Sample (optional)
Specimen type
Collection procedure
Optimum collection
time
Transportation
container
Volume
Transport
Urine. (Throat or NP specimens have higher rate of rubella virus
recovery than urine.)
Collect clean void, first morning if possible.
As above.
Sterile plastic leak-proof container
Approx. 10ml
Cold, on ice packs.
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