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To determine if you have sufficient rubella antibodies to protect you from the rubella virus; to verify a past infection or detect a recent infection
Prior to or at the beginning of a pregnancy to verify immunity; when a pregnant woman has symptoms of rubella, such as fever and rash; when a newborn shows signs of abnormal development or birth defects that may be caused by an in utero infection; whenever there is need to verify a recent rubella infection or to verify immunity
A blood sample drawn from a vein in the arm of an adult or blood drawn from a heelprick or from the umbilical cord of a newborn
Rubella is a virus that causes an infection that is usually mild and characterized by fever and rash that last about 2 to 3 days. The Infection is highly contagious but is preventable with a vaccine. A rubella test detects and measures rubella antibodies in the blood that are produced by the body's immune system in response to immunization or an infection by the rubella virus.
Clinical diagnosis of rubella is unreliable; therefore, cases must be laboratory-confirmed. Antibody tests are the most common methods of confirming the diagnosis of rubella.
The rubella virus generally causes a mild infection marked by a fine red rash that appears on the face and neck and then travels to the trunk and limbs before disappearing a few days later. The virus is spread by contact with an infected person through coughing and sneezing. The infection can cause symptoms such as fever, enlarged lymph nodes, runny nose, red eyes, and joint pain. Symptoms may be so minimal, especially in children, that they go unnoticed and people do not know that they have a viral illness. In most people, rubella goes away within a couple of days without any special medical treatment and usually causes no further health issues.
The primary concern with rubella infection is when a pregnant woman contracts it for the first time during the first three months of her pregnancy. The developing baby (fetus) is most vulnerable to the virus at this time. If rubella is passed from a mother to her unborn baby, it can cause miscarriage, stillbirth, or congenital rubella syndrome (CRS), a group of serious birth defects that will permanently affect the child. CRS can cause intellectual and development disabilities, deafness, cloudiness of the lens of the eyes (cataracts), an abnormally small head, liver problems, and heart defects.
Because of the severe consequences for unborn babies, a national campaign was started in 1969 to immunize all children in the United States and to work to eradicate rubella infection, first in the U.S. and then throughout the world. The rubella vaccine is contained in a combination vaccine called MMR, which stands for measles, mumps and rubella. All children should receive two doses of MMR, the first dose at 12-15 months of age and the second dose at 4-6 years of age.
Prior to 1969 and routine vaccinations, rubella infections would emerge as cyclic outbreaks that lasted for several years. According to the Centers for Disease Control and Prevention (CDC), during the 1962-1965 rubella epidemic, 12.5 million cases of rubella occurred in the U.S. and there were 20,000 infants born with CRS. Due to vaccination efforts, these numbers have decreased drastically. The number of reported cases of rubella in the United States has declined dramatically to a median of 11 cases annually in 2005-2011.
The CDC now declares endemic rubella to be eradicated in the U.S., although people traveling from other countries bring it to the U.S. and the incidence continues to be monitored. People should not become complacent with this reduction, however, and the CDC cautions people to continue to have their children vaccinated. Anyone who has not received the vaccination as a child (and a few that have) may still be vulnerable to rubella infection.
Pregnant women and women considering pregnancy continue to be routinely tested for rubella antibodies to ensure that they are immune.
A blood sample is drawn from a vein in the arm of an adult or from a heelprick or the umbilical cord of a newborn.
No test preparation is needed.
The rubella test is used to detect antibodies in the blood that develop in response to a rubella infection or immunization. Rubella testing may be used to:
Rubella is a viral infection that is usually mild and marked by fever and rash that last about 2 to 3 days. The infection usually resolves without treatment. However, if a pregnant woman contracts it for the first time during the first three months of her pregnancy, rubella can cause serious complications in the developing baby (fetus). (For more on this, read the "What is being tested?" section.)
A rubella test may be ordered for a person, pregnant or not, who has symptoms that a health practitioner suspects are due to a rubella infection. It may also be ordered for a newborn who is suspected to have become infected during pregnancy or that presents with congenital birth defects that a health practitioner suspects may be due to a rubella infection.
There are two types of rubella antibodies that lab tests can detect, IgM and IgG:
The IgM rubella test is the standard test for the rapid laboratory diagnosis of rubella. Detection of a rise in IgG rubella in blood samples collected when a person is acutely ill and then as the person begins to recover (convalescent phase) can be used to confirm infection. The antibody tests vary among laboratories and the state health department can provide guidance on available laboratory services and preferred tests.
The IgG rubella test is ordered when a woman is pregnant or is planning on becoming pregnant. It is ordered whenever a check for immunity against rubella is required. IgM and IgG rubella tests may be ordered when a pregnant woman has signs and symptoms that may indicate a rubella infection.
Some signs and symptoms include:
Since many conditions can cause similar symptoms, a health practitioner will need to order the tests in order to confirm the diagnosis.
IgM and IgG tests may be ordered for a newborn when the mother was diagnosed with a rubella infection during pregnancy and/or when a newborn is born with birth defects such as hearing loss, heart defects, or cloudy lens of the eyes (cataracts) that could be due to congenital rubella syndrome (CRS).
Since rubella antibodies take some time to appear after infection, the tests may be repeated after day 5 of illness onset (IgM) and 7-21 days after the first specimen (IgG) to see if the antibody levels have become detectable (when initially absent) and to determine whether the levels are rising or falling over time.
This test may be required of a healthcare worker or a person starting college and is still ordered for women in some states as part of the blood testing required to obtain a marriage license.
Adult or Child
In an adult or child, the absence of IgG rubella antibodies means that the person likely has not been exposed to the rubella virus or been vaccinated and is not protected against it.
The presence of IgG antibodies but not IgM antibodies indicates a history of past exposure to the virus or vaccination and indicates that the person tested should be immune to the rubella virus.
The presence of IgM antibodies, with or without IgG antibodies, in a child or adult indicates a recent infection with the rubella virus.
The presence of IgG antibodies, but not IgM antibodies, in a newborn means that the mother's IgG antibodies have passed to the baby in utero and these antibodies may protect the infant from rubella infection, although they should decrease by four- to eight-fold by three months of age and should disappear by 6 to 12 months of age.
The presence of IgM antibodies in a newborn indicates that the baby was infected during pregnancy because the mother's IgM antibodies do not pass to the baby through the umbilical cord.
The table below summarizes some results that might be seen:
|Adult/Child||Positive||Positive or negative||Recent infection|
|Adult/Child||Positive||Prior infection or vaccination, immune|
|Newborn||Positive||Recent postnatal or congenital infection|
|Newborn||Positive||Mother has passed antibodies to baby during pregnancy; this passive immunity may last for up to 6-12 months.|
|Any age||Negative||Negative||No current or prior infection; not immune; no or low immune response due to weakened immune system|
Because rubella incidence is low, a person may have a false-positive test for IgM rubella antibodies due to infection with other viruses or the test components are cross-reacting with other proteins in the body. To confirm the IgM result, the health practitioner may order an IgG test to establish a baseline level of antibody and may repeat the IgG test again (tested together with the first specimen) in 7-21 days to look for a significant increase in the amount (titer) present, indicating a recent rubella infection.
In addition to antibody tests, the evidence of recent rubella infection is a positive viral culture for rubella or detection of rubella virus by testing for the genetic material (RNA) of the rubella virus in a body fluid sample, such as a throat swab. Because these procedures are complex, time-consuming and expensive, most diagnostic laboratories refer this testing to a reference lab such as the Centers for Disease Control and Prevention (CDC).
The number of cases of rubella and congenital rubella is monitored by the CDC to track the effectiveness of the rubella vaccine and to detect any outbreaks of the disease.
The rubella vaccine is contained in a combination vaccine called MMR, which stands for measles, mumps and rubella. Since all three of these are common viral illnesses, they are contained within one vaccine. Measles is also known as rubeola and is different from Rubella (German Measles). All children should receive two doses of MMR, the first dose at 12-15 months of age and the second dose at 4-6 years of age.
The rubella vaccine should not be given to a pregnant woman, and a woman should avoid getting pregnant for at least one month after getting vaccinated.
The vaccine contains a live virus that has been altered so it promotes an antibody response but does not cause a rubella infection. Some people may have a rash that lasts 2-3 weeks after vaccination and pain in their joints, especially their hands and wrists. Side effects are rarely seen in young children who get the vaccine. People who have suppressed immune systems, such as those with HIV/AIDS and those with cancer who are undergoing chemotherapy, should consult with their healthcare providers before getting a rubella vaccine.
Symptoms are not always noticeable, but if they do appear, the rash usually begins 12-23 days after coming in contact with an infectious person. A person is usually infectious about a week before the rash is visible and for 1-2 weeks afterwards. A newborn who was infected during pregnancy may remain infectious for several months.
Sources Used for Current Review
May 2015 reviewer: Zhen Zhao, PhD, DABCC, Director of General Chemistry, Department of Laboratory Medicine, NIH Clinical Center.
Centers for Disease Control and Prevention. Epidemiology and Prevention of Vaccine-Preventable Diseases. Hamborsky J, Kroger A, Wolfe S, eds. 13th ed. Washington D.C. Public Health Foundation, 2015, Chapter 20, Rubella. Available online at http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/rubella.pdf through http://www.cdc.gov. Accessed May 2015.
CDC Manual for the Surveillance of Vaccine-Preventable Diseases. 5th Edition, 2012. Chapter 14: Rubella.
WHO Manual for the laboratory diagnosis of measles and rubella virus infection. 2nd Edition, 2007.
Simon R Dobson. Congenital rubella syndrome: Clinical features and diagnosis. UpToDate (updated: June 02, 2014).
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