ARCHIVED - Congenital Rubella Syndrome/Infection

 


Nationally notifiable since 1979

1.0 National Notification

Only confirmed cases of disease should be notified.

2.0 Type of Surveillance

Active, weekly case-by-case notification (including zero-notification) by provincial and territorial ministries of health to the Canadian Measles/ Rubella Surveillance System (CMRSS)

Routine case-by-case notification to the federal level

3.0 Case Classification

3.1 Confirmed case

Congenital Rubell Syndrome (CRS)

Live birth: two clinically compatible manifestations (any combination from Table 1, Columns A and B) with laboratory confirmation of infection:

  • isolation of rubella virus from an appropriate clinical specimen
    OR
  • detection of rubella virus RNA
    OR
  • positive serologic test for IgM antibody in the absence of recent immunization with rubella-containing vaccine
    OR
  • rubella IgG persisting for longer than would be expected (approximately six months after birth) from passive transfer of maternal antibody, or in the absence of recent immunization

Still birth: two clinically compatible manifestations with isolation of rubella virus from an appropriate clinical specimen

3.2 Probable case

In the absence of appropriate laboratory tests, a case that has at least

  • any two clinically compatible manifestations listed in Table 1, column A
    OR
  • one manifestation listed in Table 1, column A, plus one listed in Table 1, column B

NOTE: The following cannot be classified as a case of CRS:

  • rubella antibody titre absent in the infant
    OR
  • rubella antibody titre absent in the mother
    OR
  • rubella antibody titre declining in the infant consistent with the normal decline after birth of passively transferred maternal antibody
Congenital Rubella Infection

Confirmed case

Laboratory confirmation of infection but with no clinically compatible manifestations:

  • isolation of rubella virus from an appropriate clinical specimen
    OR
  • detection of rubella virus RNA
    OR
  • positive serologic test for rubella IgM antibody in the absence of recent immunization with rubella-containing vaccine
    OR
  • rubella IgG persisting for longer than would be expected (approximately six months after birth) from passive transfer of maternal antibody, or in the absence of recent immunization

Table 1. Congenital Rubella Syndrome: Clinically Compatible Manifestations

Column A

Column B

  1. Cataracts or congenital glaucoma (either one or both count as one)
  2. Congenital heart defect
  3. Sensorineural hearing loss
  4. Pigmentary retinopathy
  1. Purpura
  2. Hepatosplenomegaly
  3. Microcephaly
  4. Micro ophthalmia
  5. Mental retardation
  6. Meningoencephalitis
  7. Radiolucent bone disease
  8. Developmental or late onset conditions such as diabetes and progressive panencephalitis and any other conditions possibly caused by rubella virus

4.0 Laboratory Comments

Further strain characterization is indicated for epidemiologic, public health and control purposes.

5.0 Clinical Evidence

See Table 1

6.0 ICD Code(s)

6.1 ICD-10 Code(s)

B06.0
plus G05.1, B06.9
P35.0
Congenital rubella

6.2 ICD-9/ICD-9CM Code(s)

056.01
Encephalomyelitis due to rubella
771.0
Congenital rubella

7.0 Type of International Reporting

Weekly reporting to the Pan American Health Organization, in accordance with the goal of eliminating rubella and congenital rubella syndrome in the Western Hemisphere.

8.0 Comments

Probable case definitions are provided as guidelines to assist with case finding and public health management, and are not for national notification purposes.

Active weekly surveillance began in 2006. All cases are reviewed by the Immunization and Respiratory Infections Division (Public Health Agency of Canada) for classification before being added to the national database.

9.0 References

Pan American Health Organization. Elimination of Rubella and Congenital Rubella Syndrome Field Guide. Scientific and Technical Publication No. 606.

10.0 Previous Case Definitions

Canadian Communicable Disease Surveillance System: disease-specific case definitions and surveillance methods. Can Dis Wkly Rep 1991;17(S3).

Case definitions for diseases under national surveillance. CCDR 2000;26(S3).

Date of Last Revision/Review:

May 2008


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