Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
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: 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: 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: 1 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). 2 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. 3