Information for Health Care Providers

Collection and transport of Specimens for Influenza H5N1 Testing

• All testing should be performed using appropriate infection control precautions.
• No specimens will be accepted at the Washington State Public Health Laboratories (PHL) without the notification and approval of your local health department.
• For Thurston and Mason Counties, contact Dr. Diana T. Yu at 360-867-2501.

Oropharyngeal swab specimen collection*

1. All testing should be performed using appropriate infection control precautions
2. Place the swab immediately into a sterile vial containing 2 mL of viral transport media. Break off or bend the end of the applicator shaft to close the vial tightly.
3. Label the vial with the patient’s name, specimen source and date obtained.

Nasopharyngeal swab specimen collection*

1. Use only sterile Dacron or rayon swabs with wire shafts. Insert the swab into the nostril parallel to the palate until resistance is met by contact with the nasopharynx.  Leave the swab in for a few seconds. If possible, do the other nostril with the same swab. 
2. Place the swab immediately into sterile vials containing 2 mL of viral transport media. Break off or bend the end of the applicator shaft to close the vial tightly.
3. Label the vial with the patient’s name, specimen source and date obtained.

Nasopharyngeal aspirate specimen collection*

1. Have the patient sit with head tilted slightly backward.
2.  Instill 1-1.5 mL of nonbacteriostatic saline into one nostril.
3. Flush a plastic catheter with 2-3 mL of nonbacteriostatic saline.
4.  Insert the catheter into the nostril parallel to the palate until resistance is met by contact with the nasopharynx.  Aspirate the nasopharyngeal contents. If possible, repeat with the other nostril.
5. Instill the aspirate into sterile vials, and label the vials with the patient’s name, specimen source and date obtained.

Bronchoalveolar lavage, tracheal aspirate or pleural fluid specimen collection

1. During lavage or aspirate, use a double-tube system.
2. Centrifuge half of the specimen, and fix the cell pellet in formalin. Place the remaining unspun fluid in sterile vials with external caps and internal O-ring seal, then seal tightly with the available cap and secure with adhesive tape.
3. Label each specimen with the patient’s name, specimen source and date obtained.
   
   *Multiple naso- or oropharyngeal specimens can be combined in a single viral medium transport tube.

Blood Specimen Collection

1. Antibody testing requires both acute (<7 days of onset) and convalescent (2-4 weeks after onset) serum specimens.
2. Collect 5-10 cc of whole blood in a serum separator tube. Allow the blood to clot, centrifuge briefly, and collect all the sera in vials with external caps and internal O-ring seals. If no O-ring vials are available, seal the existing cap with adhesive tape.
3. The minimum amount of serum needed for testing is 200 μl.
4. For pediatric patients, a minimum of 1 cc of whole blood is needed. Ideally, collect 1 cc in a serum separator and 1 cc in an EDTA tube. If only 1 cc can be collected, collect in a serum separator.
5. Label each specimen with the patient’s name and date obtained.

Storage:  All respiratory and blood specimens should be refrigerated at 4°C until ready for transport.  Transport on ice packs.

Each specimen must be accompanied by a completed PHL Viral Examination Form which includes:

• Patient Name
• Specimen collection date
• Date of symptom onset
• Source of specimen
• Test requested
• Submitter name, mailing address

Packaging: Pack and label specimens as Diagnostic Specimens or Clinical Specimens.  Pack and label viral isolates as Infectious Substances, UN 2814.  Pack and ship according to United States Department of Transportation and United States Postal Service regulations. Specimens that leak in transit or do not have appropriate identification of the patient on the tube will be rejected.  Specimens without collection date, submitter name and address or requested test will be delayed for reporting until the missing information is received.

Transport: Every attempt should be made to transport specimens to the PHL on ice packs within 24 hours of collection.