Rubella (Rubella virus)

Clinical criteria
Any person with sudden onset of generalised maculo-papular rash
AND
At least one of the following five:

- Cervical adenopathy
- Sub-occipital adenopathy
- Post-auricular adenopathy
- Arthralgia
- Arthritis

Laboratory criteria
- Laboratory criteria for case confirmation, at least one of the following three:
- Isolation of rubella virus from a clinical specimen
- Detection of rubella virus nucleic acid in a clinical specimen
- Rubella virus specific antibody response (IgG) in serum or saliva

- Laboratory criteria for probable case
- Rubella virus specific antibody response (IgM)*
Laboratory results need to be interpreted according to the vaccination status

Epidemiological criteria
An epidemiological link by human to human transmission

Case classification
A. Possible case
Any person meeting the clinical criteria
B. Probable case
Any person meeting the clinical criteria and with at least one of the following two:
- An epidemiological link
- Meeting the laboratory criteria for a probable case
C. Confirmed case
Any person not recently vaccinated and meeting the laboratory criteria for case confirmation.
In case of recent vaccination, a person with detection of wild-type rubella virus strain.

Note:
* When rubella in pregnancy is suspected, further confirmation of a positive rubella IgM results is required (e.g. a rubella specific IgG avidity test showing a low avidity). In certain situations, such as confirmed rubella outbreaks detection of rubella virus IgM can be considered confirmatory in non-pregnant cases.

Current as of: 24 January 2019

Rubella (Congenital) (Including congenital rubella syndrome)

Clinical criteria
Congenital rubella infection (CRI)
No clinical criteria can be defined for CRI

Congenital rubella syndrome (CRS)
Any infant <1 year of age or any stillborn with:
- At least two of the conditions listed in (A) OR
- One in category (A) and one in category (B)

Category A
- Cataract(s)
- Congenital glaucoma
- Congenital heart disease
- Loss of hearing
- Pigmentary retinopathy

Category B
- Purpura
- Splenomegaly
- Microcephaly
- Developmental delay
- Meningo-encephalitis
- Radiolucent bone disease
- Jaundice that begins within 24 hours after birth

Laboratory criteria
At least one of the following four:
- Isolation of rubella virus from a clinical specimen
- Detection of Rubella virus nucleic acid
- Rubella virus specific antibody response (IgM)
- Persistence of rubella IgG between 6 and 12 months of age (at least two samples with similar concentration of rubella IgG)

Laboratory results need to be interpreted according to the vaccination status

Epidemiological criteria
Any infant or any stillborn born to a woman with a laboratory confirmed rubella infection during pregnancy by human to human transmission vertical transmission)

Case classification
A. Possible case
NA
B. Probable case
Any stillborn or infant either not tested OR with negative laboratory results with at least one of the following two:
- An epidemiological link AND at least one category ‘A’ CRS clinical criteria
- Meeting the clinical criteria for CRS
C. Confirmed case
Any stillborn meeting the laboratory criteria OR any infant meeting the laboratory criteria
AND
at least one of the following two:
- An epidemiological link
- At least one category ‘A’ CRS clinical criteria

An infant with positive laboratory criteria only without a history of rubella in the mother during the pregnancy and without ‘A’ clinical criteria will therefore not be notified as rubella case.

Current as of: 24 January 2019