Rubella and congenital rubella become urgent notifiable conditions

What is the issue?

Rubella (also known as German measles) is a viral infectious disease that usually causes mild illness. However, infection during pregnancy, particularly early trimester, can result in miscarriage, stillbirth or severe birth defects from congenital rubella syndrome. Rubella is rare in Australia due to high vaccination coverage but imported cases and outbreaks continue to occur internationally.

From 28 October 2026, rubella and congenital rubella will change from being ‘routine’ to ‘urgent’ notifiable conditions in Victoria under the Public Health and Wellbeing Regulations 2019. This means that medical practitioners and pathology services must notify rubella and congenital rubella upon initial diagnosis (suspected or confirmed) to the Department of Health immediately (as soon as practicable and within 24 hours) by calling 1300 651 160 (24/7). Pathology services must also provide written notification within 5 working days.

These changes support timely identification and management of cases and contacts of rubella, particularly contacts in pregnant women.

Who is at risk?

Rubella can spread through respiratory droplets and direct contact with nose and throat secretions from an infected person. Infants with congenital rubella may shed the virus in pharyngeal secretions and urine for a prolonged period after birth.

People at increased risk of infection include:

• People who have not received two doses of rubella-containing vaccine or do not have serological evidence of immunity to rubella.
• Travellers to or from areas where rubella remains endemic or where outbreaks are occurring.
• People who work in healthcare and childcare settings.

Pregnant women who are not immune to rubella and their babies are at increased risk of serious complications from rubella. The risk is greatest when infection occurs early in the pregnancy. Therefore:

• Women who are planning pregnancy should have their rubella immunity checked and be vaccinated against rubella if they are not immune.
• Pregnant women who may have been exposed to rubella should seek urgent clinical assessment, including review of rubella immunity, serological testing and post-exposure prophylaxis where indicated.

Diagnosis

Clinical presentation

Rubella usually causes a mild, self-limiting illness. Clinical features may include:

• low-grade fever
• rash
• headache
• malaise
• coryza
• conjunctivitis
• lymphadenopathy (post-auricular, occipital or posterior cervical)
• arthralgia or arthritis (particularly in adults).

Clinical diagnosis can be challenging as symptoms and signs are not specific and may change over time. Consider differential diagnoses such as measles and human parvovirus, where clinically appropriate.

Laboratory testing

Clinical diagnosis should be confirmed by laboratory testing, which may include:

• nucleic acid amplification testing such as by polymerase chain reaction (PCR) tests on a throat or nasopharyngeal swab or urine specimen
• rubella-specific serology, including IgM and IgG, with paired acute and convalescent sera.

Confirmatory testing is available through the Victorian Infectious Diseases Reference Laboratory. Medical practitioners should seek testing advice from an infectious disease’s specialist and/or Local Public Health Unit, particularly for patients who are pregnant. PCR testing requires approval from Local Public Health Units to avoid costs being passed on to the patient.

Congenital rubella

Congenital rubella infection refers to rubella infection in the foetus or infant. This may present as miscarriage, stillbirth, birth defects or asymptomatic infection. Congenital rubella syndrome is a severe form of congenital rubella infection which can result in hearing impairment, congenital heart defects, cataracts or congenital glaucoma, and pigmentary retinopathy.

Medical practitioners should seek testing and management advice from an infectious disease’s specialist, obstetrician and neonatologist or paediatrician if congenital rubella is suspected or confirmed.

Recommendations

For medical practitioners

• Notify rubella and congenital rubella upon initial diagnosis (suspected or confirmed) to the Department of Health immediately (as soon as practicable and within 24 hours) by calling 1300 651 160 (24/7) and connecting to the appropriate Local Public Health Unit.
• Consider rubella in patients with compatible illness and relevant epidemiological risk factors such as:
  • contact with a person with rubella
  • recent travel to, or contact with travellers from, a country or region where rubella is circulating
  • maternal rubella infection during pregnancy (for suspected congenital rubella).
• Ask about pregnancy status and possible exposure of pregnant contacts.
• Arrange testing and seek advice from an infectious disease’s specialist and/or Local Public Health Unit.
• Advise cases to avoid contact with others, particularly pregnant women, while infectious (or until test results are known for suspected cases).
• Advise cases to not attend school, childcare or work until 7 days after rash onset or until fully recovered, whichever is longer.
• Refer pregnant patients with suspected rubella, or pregnant contacts exposed to rubella, urgently for clinical assessment and management. This may include urgent serological testing and post-exposure prophylaxis for pregnant contacts.

For pathology services

• Notify rubella and congenital rubella to the Department of Health immediately (as soon as practicable and within 24 hours) when the test result indicates the person has or may have rubella by calling 1300 651 160 (24/7) and connecting to the appropriate Local Public Health Unit.
• Provide written notification within 5 working days.