Lab Testing for Rubella at the MDH Public Health Laboratory

Though rubella is no longer endemic in the United States, cases are likely to occur as a result of internationally imported or import-linked cases. Continued success in disease reduction is dependent on maintaining awareness of the disease along with improving vaccination rates.

Download PDF version formatted for print:
Lab Testing for Rubella at the MDH Public Health Laboratory (PDF: 53KB/2 pages)

On this page:
Report suspect rubella cases immediately
Clinical features and differential diagnoses

Lab tests offered at MDH-PHL
Preferred specimens: PCR
Specimen collection: PCR
Approved swabs and media
Transporting specimens to MDH

Report suspect rubella cases immediately

If you suspect rubella in a patient:

  • Call MDH at 651-201-5414 or toll-free at 1-877-676-5414
  • Provide clinical details
  • Collect specimens for PCR testing

Health care facilities are required by law to report suspect cases of rubella immediately to MDH. Call while the patient is still in the office to ensure timely reporting and correct specimen collection.

To minimize transmission of rubella in health care settings, follow the same infection prevention guidelines as measles because the two diseases are hard to differentiate in the early stages of illness.

Clinical features and differential diagnoses

Rubella and measles should both be included in the differential diagnosis of patients presenting with an acute generalized rash and fever.

Rubella is characterized by:

  • Acute onset of a maculopapular rash lasting less than three days
  • Fever higher than 99°F (37.2°C)
  • Arthralgia, arthritis, lymphadenopathy, or conjunctivitis

Measles is characterized by:

  • A generalized maculopapular rash lasting
    three days or more
  • Fever of 101°F (38.3°C) or higher
  • Cough, coryza, or conjunctivitis                                                                        

MDH also encourages health care providers to consider other infectious and non-infectious etiologies that may cause generalized rash, including:

  • Coxsackievirus, Echovirus, Epstein-Barr virus, Erythema infectiosum (Fifth Disease), HIV, Kawasaki disease, Roseola infantum, Scarlet fever, Pharyngoconjunctival fever
  • Dengue fever, Rocky Mountain spotted fever
  • Dermatologic manifestations of Viral hemorrhagic fevers (VHFs)
  • Cutaneous manifestations of syphillis
  • Toxic Shock Syndrome
  • Drug reactions (e.g. antibiotics)
  • Contact dermatitis

Lab tests offered at MDH Public Health Laboratory

Rubella Real-Time Polymerase Chain Reaction (RT-PCR, or PCR) is available for rubella case confirmation at the MDH Public Health Laboratory (MDH-PHL). Providers are asked to collect and send PCR specimens to MDH-PHL when rubella is suspected. Serologic testing for rubella is available at MDH-PHL and should only be considered if PCR specimens cannot be obtained. Please contact MDH directly at 651-201-5414 or 877-676-5414 to discuss requirements for serologic testing.

Preferred specimens: PCR

Clinical specimens for PCR should be taken as soon as rubella is suspected. Viral RNA is more likely to be detected when the specimen is collected as soon as possible after rash onset. Ideally, specimens for rubella PCR should be obtained within five days of rash onset (0-9 days at most). Consider the rash onset date as day ‘0.’ For suspect cases of congenital rubella syndrome, please call MDH immediately to discuss additional specimen options.

Please send specimens to the MDH-PHL. The type and number of specimens sent varies for each case based on rash onset and suspicion level.

  • On day 0-5 of rash, collect a throat swab*
  • On day 6-9 of rash, collect a throat swab and a urine specimen**

*If a throat swab cannot be collected, a nasal specimen can be sent instead; however, a throat swab is the preferred specimen for rubella PCR testing. If case is clinically compatible and reports an exposure to rubella or has had recent travel, attempt collection of all three specimens (throat, nasal and urine).
**If date of specimen collection is already more than nine days past rash onset, PCR is less likely to detect viral presence and may give false negative results.

Specimen collection: PCR

Throat swab: Vigorously swab tonsillar areas and posterior nasopharynx with a viral culturette. Use tongue blade to depress tongue to prevent contamination of swab with saliva. Place swab into 2-3 ml of viral transport medium (VTM).

Nasal or nasopharyngeal swab: Use sterile swabs to swab the nasal passage or the nasopharynx with either a viral culture swab or culturette. Place swab into VTM.

Nasal wash: Use a syringe attached to a small plastic tube and 500 µl of VTM. After placing VTM in the nostril, aspirate as much of the material as possible and rinse the tube with the original (500 µl) of VTM.

Urine specimen: Collect 10-40 ml of urine in a STERILE 50 ml centrifuge tube or a urine specimen container. First-morning voided specimens are ideal, but any urine collection is adequate. Have patient void directly into container, collecting from the first part of the urine stream if possible.

Approved swabs and media

Approved

  • VTM
  • M5
  • M4
  • MEM
  • Saline
  • Balanced salt solutions (BSS)
  • Sterile isotonic solutions
  • Phosphate buffered salines (PBS)
  • Stuart’s Liquid Media
  • BBL Culture Swab
  • Culturettes

Not Approved

  • Wood-tipped applicators
  • Calcium-alginate tipped swabs
  • Charcoal swabs
  • Gel swabs
  • Anaerobic media

NOTE: Flocked swabs are preferred for specimen collection. VTM containing ~1% protein (e.g., bovine serum albumin or gelatin) best supports measles virus; however, sterile saline is acceptable.

Transporting specimens to MDH

  • Label all tubes/containers with the following information:
    • Patient name
    • Patient date of birth
    • Date specimen collected
    • Specimen type
  • Include an Infectious Disease Testing and Submission Form for each specimen. Fill out the form as completely as possible and be sure to indicate which test is requested.
  • Specimens should be kept and transported at refrigeration temperature (2-8° C).
  • Before shipping, always consult with an MDH epidemiologist at 651-201-5414 or 877-676-5414.
  • Send to MDH Public Health Laboratory via overnight shipping.
  • For help with packaging and shipping, call MDH-PHL Biological Accessioning at 651-201-4953.
  • Results will be sent via fax to the submitting laboratory.

Send specimens to arrive Monday-Friday before 4:30 p.m. to:
MDH Public Health Laboratory
Attn: Biological Accessioning
601 Robert St. N.
St. Paul, MN 55155-2531

 

Updated Wednesday, February 04, 2015 at 04:53PM