Appendix 16.1

Instructions for Completing

the Rubella Surveillance Worksheet

General

If the month and year for any date are known but the exact day is unknown, enter a 15 for the day ●

While “unknown” is an option for many questions, please make every effort to obtain the appropriate ●

If information is obtained after the record has been submitted to the Centers for Disease Control and ●

● If copies of the paper form are sent to CDC, either fold back the information above the dotted line 

or cut it off after photocopying and before sending the rest of the information to CDC to preserve 

confidentiality.

Zip Code: Requested (but not required) for vaccine-preventable diseases. Enter a 5-digit zip code.

Birth Date: If known, enter the birth date. If unknown or before the year 1900, leave blank and enter the 

age and age type.

Age and Age Type: If birth date is unknown and age is known, enter age of patient at rash onset in number 

of years, months, weeks, or days as indicated by the age type codes.

Event Date and Event Type: Enter the earliest known date associated with the incidence of the disease. 

The event type describes the date entered in event date. The event types are listed in order of preference.

Outbreak Associated: Enter 1 if the case is outbreak associated and the state does not assign numerical 

values to outbreaks; if the state assigns numerical values to outbreaks, enter the assigned value; if the case

is known to be not associated with an outbreak, enter 0. If unknown, enter 999.

Reported: This field is used in various ways, such as to enter the date reported to the state, a local or other 

health department. Check with the State Epidemiologist to determine what guidelines apply in your state. 

Imported: Indicate where the patient acquired rubella. This is a required field for rubella reports.

Indigenous—In state; any case that cannot be proven to be imported

International—Out of U.S.; international importation from another country; onset of rash is within 

18 days of entering the United States

Out of state—importation from another state; documentation that the person either had face-to-face 

contact with a case of rubella outside the state or was out of the state for the entire period when he or 

she might have become infected (12–23 days before rash onset)

Complications

Death: If patient died from rubella, verification with the physician is recommended.

Other Complications: Please indicate pregnancy complications (spontaneous abortion, fetal death) or 

termination if applicable.

Laboratory

Include laboratory results from specimens taken from the case. Serologic testing and virus detection 

can be used to confirm acute or recent rubella infection. A positive serologic test includes detection of 

rubella-specific IgM result and/or a four-fold rise in rubella-specific IgG antibody titers between acute and 

convalescent phase serum specimens, tested simultaneously. Rubella virus can be detected from nasal, 

throat, urine, blood, and cerebrospinal specimens using real-time RT-PCR, RT-PCR or viral culture.

IgM: Please indicate the date when the specimen was collected and the IgM test result. 
Appendix 16.2

IgG: Please indicate the dates when the acute and convalescent specimens were collected and the result. 

The result is based on the interpretation of results from the paired serum specimens. A four-fold rise in 

antibody titer between acute and convalescent serum specimens, tested at the same time, is considered a 

positive result.

Other Lab Result: Please indicate the test result(s) and type of test(s) used if other types of tests were 

performed, such as real-time RT-PCR, RT-PCR or viral culture. 

Epidemiologic Information

Date First Reported to a Health Department: Date reported is considered the earliest date the case was 

initially reported to a health department, either local, district, or state level health department.

Outbreak Related: An outbreak is defined as 3 or more cases (with at least one laboratory-confirmed case) 

clustered in space and time. 

Source of Exposure for Current Case: A source case must be either a confirmed or probable case and 

have had face-to-face contact with a subsequent case. Exposure must have occurred between 12 to 23 days 

before rash onset in the new case, and between 4 days before rash onset and 7 days after rash in the source 

case. Enter state ID if source was an in-state case (imported entry on core screen = 1), enter country name 

if source was out of USA (imported entry on core screen = 2), enter state name if source was out-of-state 

(imported entry on core screen = 3).

Epi-Linked to Another Confirmed or Probable Case? An epi-linked case is either a source case or 

same-generation case. Epi linkage is characterized by direct face-to-face contact. For same-generation 

cases that are epi-linked, a common exposure is likely.