COMMUNICABLE DISEASE MANUAL POLICIES/PROCEDURES
RUBELLA – CONGENITAL SYNDROME
OBJECTIVE:
Outbreak control primarily to prevent defects in the offspring of women who
acquire the disease during pregnancy.
DESCRIPTION:
Clinical Case Definition: An illness usually manifesting in infancy resulting from
rubella infection in utero and characterized by signs or symptoms from the
following categories:

Cataracts/congenital glaucoma, congenital heart disease (most
commonly patent ductus arteriosus, or peripheral pulmonary artery
stenosis), loss of hearing, pigmentary retinopathy.

Purpura, splenomegaly, jaundice, microcephaly, developmental
delay, meningoencephalitis, radiolucent bone disease.
Clinical Case Description: Presence of any defects or laboratory data
consistent with congenital rubella infection. Infants with congenital rubella
syndrome usually present with more than one sign or symptom consistent with
congenital rubella infection. However, infants may present with a single defect.
Hearing impairment is the most common single defect.
EQUIPMENT:
Rubella Contact Sheet, Microbiology/Virology Test Requisition, Rubella IgM
Antibody Determination and MDSS User Manual (disease specific form will be
found in MDSS.. Also MDCH Web site at www.michigan.gov/cdinfo and
CDC Web site at www.cdc.gov/a-z/a.html.
POLICY:
Legal Responsibility: Michigan's communicable disease rules of Act No. 368 of
the Public Acts of 1978, as amended, being 333.5111 of the Michigan
Compiled Laws. Follow-up time 72 hours post referral and enter into
MDSS within 24 hours of receipt of referral.
PROCEDURE:
A.
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Case Investigation:
1.
Referral received per phone call, laboratory results, or
automatically through MDSS.
2.
Document all case investigation proceedings.
3.
Contact MD and/or client to start process of completing disease
specific form in MDSS on same day as referral received.
Immediately notify the CD Supervisor and Medical Director
for confirmed or suspected cases. Call MDCH at 517-3358165 and Regional Epidemiologist.
Nurse to Fax
Notification of Serious Communicable Disease Form to
MDCH for confirmed or suspected cases.
4.
In the event of death, obtain and send copies of hospital
discharge summary, death certificate and autopsy report to
MDCH VPD Surveillance Coordinator.
B.
C.
Case Classification:
1.
Suspected: A case with some compatible clinical findings, but
not meeting the criteria for a probable case or confirmed case.
2.
Probable: A case that is not laboratory confirmed and that has
any two complications listed in the first bullet under Clinical
Description, or one complication from the first bullet and one
from the second bullet, and lacks evidence of any other etiology.
3.
Confirmed:
confirmed.
4.
Infection Only: A case that demonstrates laboratory evidence of
infection, but without any clinical symptoms or signs.
5.
Comment: In probable cases, either or both of the eye-related
findings (i.e., cataracts and congenital glaucoma) count as a
single complication. In cases classified as infection only, if any
compatible signs or symptoms (e.g., hearing loss) are identified
later, the case is reclassified as confirmed.
6.
See CDC Case Classification - 2010 (attachment 7419-A) for
imported and U.S. acquired case classification included with this
policy.
Lab Criteria for Diagnosis
1.
D.
Congenital rubella in the newborn is laboratory confirmed
by:
a.
Isolation of rubella virus in a positive PCR and from
an appropriate clinical specimen (nasopharyngeal
aspirate, throat swab, urine, or heparinized blood).
Best results come from throat swabs;
b.
Demonstration of rubella-specific immunoglobulin M
(IgM) antibody, or
c.
Infant rubella antibody level that persists at a higher
level and for a longer period than expected from
passive transfer of maternal antibody (i.e., rubella
titer that does not drop at the expected rate of a
twofold dilution per month).
d.
See # 7419C, “Lab Specimens Procedure” and
“Recommended Lab Tests for Confirmation” attached
with this policy.
Control Measures
1.
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A clinically compatible case that is laboratory
Accurate diagnosis and reporting of congenital rubella syndrome
and vaccine complications are extremely important in assessing
the control of rubella. All birth defects in which rubella infection
is etiologically suspected should be thoroughly investigated and
reported to the Centers for Disease Control through the local or
state health departments.
E.
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2.
Patients with congenital rubella in day care should be
considered contagious until they are one year old, unless
nasopharyngeal and urine cultures are negative for rubella.
3.
Mothers should be made aware of the potential hazard of their
infants to susceptible pregnant contacts.
4.
Pregnant women who have been exposed to rubella should be
tested ASAP.
5.
The routine use of immune globulin (IG) for postexposure
prophylaxis of rubella in early pregnancy is not recommended.
Administration of IG should be considered only if termination of
the pregnancy is not an option.
6.
Previously, rubella reimmunization was not recommended.
However, in conjunction with the recently recommended twodose measles immunization schedule, two doses of Rubella
vaccine are now given routinely.
Upon orders of CD Supervisor and/or Medical Director, the
following should be done quickly.
1.
Revaccination should include siblings and persons born in or
after 1957 who do not have proof of receiving one dose of
rubella vaccine on or after first birthday or evidence of Rubella
immunity. They should be immunized with one dose of MMR.
2.
Record search of day care, etc., to determine who has not had
two doses of MMR on or after 12 months of age.
3.
EXCLUDE FROM DAY CARE all children not vaccinated with
two doses of MMR vaccine on or after 12 months of age. May
re-enter day care if proof provided of vaccination. Must have
one month between MMR’s and unvaccinated children may reenter day care after having one MMR. If they are not vaccinated
(per waiver or noncompliance) wait until 14 days after rash onset
date of last reported case.
4.
Health Department to provide clinic for all children who have not
been vaccinated with two doses of Rubella vaccine on or after
12 months of age.
5.
MMR’s should be used in day care centers for those who have
not had one dose of Rubella or vaccinated prior to 12 months of
age.
6.
Mass revaccination of entire community not necessary and too
costly.
7.
F.
Educate contacts and public. A “Question and Answer Rubella
Information Sheet” from the Immunization Action Coalition is
located with the Fact Sheets in this policy.
MDSS Case Report
Complete case investigation using disease specific form in
MDSS.
1.
Notify CD Supervisor that case report is ready for review. PHN
will be notified if corrections are needed prior to closing case in
MDSS.
2.
CD Supervisor reviews case for completeness and closes
MDSS case report.
3.
Copy disease specific form and mail a copy to MDCH at the
following address:
Address:
G.
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Michigan Department of Community Health
Immunization Division
Attn: Immunization Coordinator
201 Townsend Street
P.O. Box 30195
Lansing, MI 48913
Refer to current Red Book, current Control of Communicable
Disease Manual, and VPD Guidelines at
www.michigan.gov/immunize for more specific educational
material.