Regulations Regarding Counter-epidemic Measures of Measles and Rubella

Issued pursuant to
Section 14, Paragraph one,
Clause 5 of the Epidemiologic Safety Law

1. This Regulation prescribes counter-epidemic measures of measles and rubella in order to prevent the spreading risk of measles and rubella in the State territory.

2. A health care practitioner shall organise laboratory examination of a patient for laboratory confirmation of the measles diagnosis in the following cases:

2.1. the health care practitioner has professionally justified suspicion that the patient has measles, or he or she establishes that the patient has a disease with maculopapular rash, increased body temperature and at least one of the following three symptoms - cough, rhinitis or conjunctivitis;

2.2. the health care practitioner has established that the patient has a disease with maculopapular rash, increased body temperature and has had a permanent or transient contact with a person who has had similar symptoms.

3. The health care practitioner shall organise laboratory examination of the patient for laboratory confirmation of the rubella diagnosis in the following cases:

3.1. the health care practitioner has professionally justified suspicion that the patient has rubella, or he or she establishes that the patient has a disease with maculopapular rash and at least one of the following five symptoms - cervical adenopathy, suboccipital adenopathy, posterior auricular adenopathy, arthralgia or arthirtis;

3.2. the health care practitioner has established that the patient has a disease with maculopapular rash, increased body temperature and has had a permanent or transient contact with a person who has had similar symptoms.

4. The health care practitioner shall organise laboratory examination of the patient for laboratory confirmation of the rubella diagnosis, if he or she has professionally justified suspicion that the patient has congenital rubella, including congenital rubella syndrome or he or she establishes that the infant (a child up to 12 months of age) or stillborn child has:

4.1. at least two of the following diseases - cataract, congenital glaucoma, congenital heart disease, hearing loss and pigmentary retinopathy;

4.2. at least one of the diseases referred to in Sub-paragraph 4.1 of this Regulation and one of the following symptoms - purpura, splenomegaly, microcephaly, meningoencephalitis, delayed development, bone atrophy (X-ray permeable), jaundice (that begins within 24 hours following the birth).

5. For laboratory confirmation of the measles and rubella diagnosis at least one sample shall be taken and examination performed in cases referred to in Paragraphs 1 and 2 of this Regulation in accordance with Annex 1 to this Regulation, but in cases referred to in Paragraph 4 of this Regulation - in accordance with Annex 2 to this Regulation.

6. In cases referred to in Paragraph 4 of this Regulation the health care practitioner shall organise collecting and examination of a blood sample for detection of IgG and IgM antibodies specific to rubella virus also in the mother of the child.

7. The clinical information contained in the examination request form regarding the patient shall state the time when the last vaccination against measles and rubella has been performed and the date when the rash occurred.

8. Within 48 hours after receipt of information on the case of measles or rubella or if professionally justified suspicion of measles or rubella has occurred, or if direct or indirect presence of an agent causing measles or rubella has been established in a sample examined in laboratory, the Disease Prevention and Control Centre shall ensure the following counter-epidemic measures:

8.1. perform epidemiologic investigation, including detection of other potential disease cases;

8.2. in collaboration with a primary care physician, collect information regarding other contact persons and, if necessary, organise vaccination against measles and rubella in the focal point of infection or in the administrative territory, region or state affected by the infection, if the risk of measles and rubella outbreak or epidemic exists;

8.3. determine and organise limiting measures in the educational institution, inpatient medical treatment institution or social care institution affected by the infection.

9. After receipt of information regarding the case of measles or rubella in his or her patient or an employee of a medical treatment institution the primary care physician or the head of the medical treatment institution shall organise, as soon as possible, evaluation of the vaccination data of the contact person and vaccination of the following contact persons against measles or rubella (combined vaccine against measles, rubella and epidemic parotitis may be used):

9.1. adults and children who have not suffered from measles and rubella and who have not been vaccinated against measles and rubella or have been vaccinated only partly (have received only one dose);

9.2. persons whose vaccination against measles or rubella is not documentary confirmed.

10. If an outbreak or epidemic of measles or rubella is recorded in the State territory, the primary care physician shall collect information regarding the persons referred to in Sub-paragraphs 9.1 and 9.2 of this Regulation and shall vaccinate them against measles and rubella (combined vaccine against measles, rubella and epidemic parotitis may be used).

11. The Disease Prevention and Control Centre shall take the following epidemiologic monitoring measures of measles and rubella:

11.1. collect and analyse data on detected cases of measles and rubella, including information regarding genotypes of measles and rubella virus;

11.2. at least once a year highlight the issue on prevention, epidemiologic monitoring and counter-epidemic measures for measles and rubella by sending information to medical treatment institutions, including medical laboratories;

11.3. provide information to the World Health Organisation and the European Centre for Disease Prevention and Control regarding epidemiologic monitoring results of measles and rubella in Latvia.

12. This Regulation shall come into force on 1 January 2013.

Prime Minister V. Dombrovskis

Minister for Health I.Circene

Annex 1
Cabinet Regulation No. 752
6 November 2012

Material to be Examined, its Collection Time after Occurrence of Maculopapular Rash and the Indicator to be Determined in the Sample for Laboratory Examination of the Agent Causing Measles and Rubella

Minister for Health I.Circene

Annex 2
Cabinet Regulation No. 752
6 November 2012

Material to be Examined in Case of Congenital Rubella or Congenital Rubella Syndrome, its Collection Time and the Indicator to be Determined in the Sample for Laboratory Examination of the Agent Causing Rubella

Minister for Health I.Circene

Translation © 2014 Valsts valodas centrs (State Language Centre)