What We Do
Although rubella appears to be a mild illness, it can lead to fetal death or congenital rubella syndrome during pregnancy. It is therefore important for Santé publique France to monitor the epidemiological trends of rubella, promote vaccination against it, and help eliminate the disease.
Epidemiological Surveillance of Rubella
Following the plan to eliminate measles and rubella recommended by the World Health Organization (WHO) Regional Committee for Europe, mandatory reporting (MR) was implemented in late 2018 to monitor the disease in the general population, including maternal-fetal and congenital rubella infections, in order to enable Santé publique France to characterize the residual epidemiology of the disease and guide the national elimination process.
Thus, following the decree published on May 7, 2018, amended by the order of August 22, 2018, rubella was added to the list of notifiable diseases (ND), entailing changes to surveillance procedures effective from the last quarter of 2018.
Until that date, surveillance focused solely on recording cases of rubella infection in pregnant women and cases of congenital rubella in newborns. This surveillance system was established in France in 1976 through the Rénarub network, which included nearly all laboratories performing serological diagnosis of rubella. This Rénarub surveillance system was maintained at least during the first year of the DO’s implementation, until the end of 2019. With the implementation of the DO in late 2018, rubella surveillance in pregnant women is now integrated into surveillance of the general population.
Mandatory reporting
Mandatory reporting involves collecting as comprehensive information as possible regarding all cases of certain diseases known as "notifiable diseases" from laboratory technicians and physicians.
Physicians and laboratory professionals who suspect or diagnose a notifiable disease must report it without delay and by any appropriate means (telephone, fax) to the ARS physician in their area of practice. Reporting enables the early implementation of individual follow-up and collective prevention measures, including contact tracing around the case and treatment of any identified cases.
Notification occurs after the initial report and, in the case of rubella, only after biological confirmation of the diagnosis. Reporting physicians or laboratory professionals notify the ARS physician in their area of practice using a specific form. Notification enables the analysis and monitoring of the disease’s progression within the population to better target local and national prevention efforts.
In the event of a reported case of rubella in a pregnant woman or a newborn, Santé publique France subsequently contacts the reporting physician to gather additional information on the case using a dedicated questionnaire (based on the one used until 2019 for the Rénarub surveillance program, detailed below).
Case reporting criteria
Any person (except pregnant women) who has not been vaccinated against rubella or whose vaccination status is unknown, and who presents with:
A maculopapular rash with or without fever AND at least one of the following symptoms: cervical, suboccipital, or retroauricular lymphadenopathy, or arthralgia or arthritis
AND a positive PCR or IgM test in saliva or serum OR who has been in contact with a confirmed rubella case within 12–23 days before the rash.
Any pregnant woman who has received fewer than 2 doses of the rubella vaccine and who presents with:
a maculopapular rash with or without fever AND a positive IgM test on blood samples
OR seroconversion for rubella, to be confirmed by the National Reference Center (NRC)
Congenital Rubella Syndrome (CRS)
Infant <1 year: sensorineural hearing loss AND/OR ocular abnormalities AND/OR microcephaly AND/OR cardiovascular abnormalities
Newborn ≤28 days: same manifestations AND/OR meningoencephalitis, interstitial pneumonia, hepatitis, hepatosplenomegaly, purpura, growth retardation
AND detection of the virus in urine, pharyngeal secretions, cerebrospinal fluid (CSF), or the lens OR presence of IgM in serum Positive rubella PCR (even in the absence of clinical signs).
There is no recommendation to exclude a rubella case from a community setting; however, information must be provided to staff and individuals frequenting that community (parents in the case of a school or daycare) and any pregnant woman who has been in contact with the case must be advised to consult her doctor. There is also no French recommendation for post-exposure prophylaxis (vaccine and/or immunoglobulins) around a case, particularly in a pregnant woman, or in situations involving clusters of cases (for the record, immunoglobulins do not have marketing authorization for this indication).
However, verifying and updating the vaccination status of the case’s contacts, in accordance with the current vaccination schedule, are useful measures for the subsequent protection of uninfected individuals who have been in contact with the first case, particularly young girls and women of childbearing age, and especially in group settings (Note: the vaccine is contraindicated in pregnant women and immunocompromised individuals).
Notification Form
Informing the public about the reporting of notifiable diseases
A network of partners
This surveillance program relies on several partners:
Regional Health Agencies
Overview and contact information for the ARS: http://www.ars.sante.fr
National Reference Center for Measles, Rubella, and Mumps
The CNR provides expertise to laboratories with rubella diagnostic tests nationwide, offers diagnostic support when needed, and assists in determining the timing of maternal primary infections. It contributes to epidemiological and virological surveillance.
CAEN UNIVERSITY
HOSPITAL VIROLOGY
LABORATORY AVENUE GEORGES CLEMENCEAU
14033 CAEN CEDEX 9
Name of Director: Prof. Astrid VABRET
Tel.: 02 31 27 25 54 (secretariat) - Fax: 02 31 27 25 57
Email: vabret-a@chu-caen.fr; cnr-roug-para@chu-caen.fr
CNR website for measles, rubella, and mumps viruses: http://www.chu-caen.fr/service-129.html
CNR ASSOCIATED LABORATORY AP-HP Paul Brousse
VIROLOGY LABORATORY PAUL-BROUSSE HOSPITAL
12, AVENUE PAUL VAILLANT-COUTURIER
94 804 VILLEJUIF
Name of the head: Dr. Christelle Vauloup-Fellous (maternal-fetal rubella infections)
Tel.: 01 45 59 33 14 - Office: 01 45 59 37 21 - Fax: 01 45 59 37 24
Email: christelle.vauloup@aphp.fr
The Directorate General of Health (Ministry of Health): http://www.sante.gouv.fr/
The surveillance network: Renarub
The Renarub network was established in 1976 by the National Health Laboratory and has been coordinated by Santé publique France since 1993. It remained in operation until 2019, following the implementation of the rubella DO in late 2018.
Objective of Renarub surveillance: to identify, at the national level, maternal rubella infections and congenital infections diagnosed during pregnancy, at birth, or during the first year of life.
The Renarub network brought together, on a voluntary basis, private and hospital clinical laboratories that perform serological testing for rubella infection (particularly testing for anti-rubella IgM) and/or virological testing (PCR) in France.
Biologists were asked by the CNR to report cases in which a sample analyzed in their laboratory met biological criteria suggestive of maternal infection or congenital infection in newborns or fetuses.
Following the CNR’s assessment, cases that could be considered indicative of a recent maternal infection or a congenital infection were reported to Santé publique France via individual case reports. Prior to this transmission, the CNR sent a letter to the clinician (the physician who ordered the test) accompanied by an information letter to the patient to notify her of the collection of data concerning her and the transmission of this data to Santé publique France, subject to her objection to the CNR within one month (CNIL authorization, Decision No. 2013-343 of November 7, 2013).
In a second phase, clinicians (primary care physicians, gynecologists, obstetricians, and pediatricians) were contacted by Santé publique France and provided, via a dedicated questionnaire, demographic, biological, and clinical information about the infected woman and the newborn or fetus.
Participation by laboratory technicians and clinicians was voluntary. The information collected covered the periods of pregnancy, birth, and the first months of life but did not include follow-up of children born to infected mothers.
A rubella prevention initiative
Santé publique France promotes vaccination through various tools (website, promotional campaigns, brochures, etc.). We have created an informational website on the different vaccinations available in France to provide reliable, scientifically validated answers to questions the public and healthcare professionals may have on the subject.
A section dedicated to rubella vaccination is available in two sections—one aimed at the general public and the other at healthcare professionals—to better support them in their practice.
Santé publique France produces informational tools and documents for healthcare professionals and the general public to answer questions regarding vaccination. These documents are available under the TOOLS tab.
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