Reporting & Investigation of Rubella

Table of Contents

A. Purpose of surveillance and reporting

  • To identify all cases and susceptible exposed people and to prevent further spread of infection, especially to pregnant women.
  • To ensure appropriate management of exposed pregnant women and their babies.
  • To monitor the effectiveness of outbreak control strategies.
  • To identify cases of congenital rubella infection or syndrome that may occur after a cluster or outbreak of rubella.

B. Laboratory and Healthcare Provider Reporting

Iowa Administrative Code 641-1.3(139)stipulates that the laboratory and the healthcare provider must report. The preferred method of reporting is by utilizing the Iowa Disease Surveillance System (IDSS). However, if IDSS is not available to your facility the reporting number for IDPH Center for Acute Disease Epidemiology (CADE) is (800) 362-2736; fax number (515) 281-5698, mailing address:

Iowa Department of Public Health, CADE
Lucas State Office Building, 5th Floor
321 E. 12th St.
Des Moines, IA 50319-0075

Postage-paid disease reporting forms are available free of charge from the IDPH clearinghouse. Call (319) 398-5133 or visit the website: healthclrhouse.drugfreeinfo.org/cart.php?target=category&category_id=295to request a supply.

What to Report to the Iowa Department of Public Health

  • A case of rash illness accompanied by fever, or
  • A suspect case of rubella (with or without fever), as diagnosed by a healthcare provider; or
  • Positive serologic test for rubella IgM; or
  • Significant rise between acute and convalescent phase titers in serum rubella IgG or total antibody level by any standard serologic assay; or
  • Isolation of rubella virus from a clinical specimen.
  • A suspect or confirmed case of congenital rubella syndrome (CRS) in a child (usually a baby), as diagnosed by a healthcare provider (the CRS case definition appears under “Additional Information” at the end of this chapter).

Laboratory Services Available

1. Serologic Testing for Non-Congenital Rubella

  • Rubella IgM test: False positive rubella IgM results can occur in persons with parvovirus infection, infectious mononucleosis, or rheumatologic disease.  It can be drawn as late as 6 weeks after the onset of the rash. (If serum is collected prior to the third day and tests are negative, a follow-up specimen may be requested.). 
  • Rubella total antibody paired-titer test: Testing for rubella IgM is greatly preferred because it provides an earlier result. However, paired titer tests can be performed. Acute serum (IgM) should be collected 7-10 days after onset of rash. Convalescent serum (IgG) should be collected 14 days later.
  • SHL does not perform rubella testing. IgG and IgM testing may be performed at hospital or reference laboratories.  

C. Local Public Health Agency Roles and Control Measure Responsibilities

  1. Implement control measures before serologic confirmation.  This is especially important in settings involving pregnant women (obstetric-gynecologic and prenatal clinics).
  2. Isolate case during infectious period as defined above.
    • The individual must stay home during infectious period; if hospitalized, the patient must be placed in droplet isolation for seven days after the onset of rash.
    • For congenital rubella, place infant in Contact Precautions during any admission until 1 year old, unless nasopharyngeal and urine cultures are negative for virus after the age of 3 months.
  3. In order to identify those exposed, identify “zones of exposure” such as place of work (including sites which employ individuals from other countries where rubella is prevalent), school, family, child care, etc.
  4. Identify high-risk susceptibles that the index case has had contact with during infectious period.
    • Immunocompromised individuals should be referred to their physicians.
  5. Identify susceptibles.  These are individuals without proof of immunity.
    • Proof of Immunity to Rubella(1)
      • Documentation of rubella vaccination on or after the first birthday, unless pregnant.
      • Serologic proof of immunity.(2)

    • (1) Remember, persons born outside the US (without written proof of immunity) are more likely to be susceptible, especially if they have been in the US for only a short time.

    • (2) Documentation of serologic evidence of immunity is the only acceptable proof of immunity for pregnant women.

    • Physician-diagnosed disease or born before 1957 is not acceptable proof of immunity.

  6. Immunize all susceptibles for whom it is not contraindicated, keeping in mind the following:
    • Rubella containing vaccine will not prevent development of disease after infection.
    • Vaccinating an individual who may be incubating rubella is not harmful.
  7. Child care and school settings:
    • Determine if there are any susceptible:
      • Pregnant teachers, staff, volunteers, student teachers, or students.
      • Immunocompromised individuals.
      • Medical/religious vaccine exemptions anywhere in the classroom or school of the suspected case.
    • These individuals, if medically appropriate, should be encouraged to receive vaccine and may self exclude during the time frames described above.

D. Initial Questions to Ask Healthcare Provider and Patient

In order to assess the likelihood that a suspect case is a true case prior to laboratory testing, IDPH and/or LPHA staff conducting the investigation should ask about:

  • Symptoms
  • Rubella immunization history
  • Country of origin and length of residence in US
  • Recent travel history (location and dates)
  • Whether there were any recent out-of-town visitors location and dates)
  • Whether there was any recent contact with anyone with similar symptoms