Manual on Collection, Storage, and Transport of Specimens for TB Testing
Producing reliable test results does not rely solely on the right performance of the step-by-step procedures of the test itself. It all starts in the acceptance of correct, adequate and quality specimens brought to the laboratory. Hence, the National Tuberculosis Reference Laboratory (NTRL) has developed this manual to provide a guide on the proper collection, storage and transport of both pulmonary and extra-pulmonary specimens for tuberculosis (TB) testing.
The primary users of this manual are the physicians, nurses and other health care personnel at the different collection sites who personally face patients consulting at their respective health care facilities. The staff responsible in collecting the patient’s specimens should ensure the sufficiency and quality of the specimens to be submitted to the mycobacteriology laboratory. With the use of this manual, they will be able to learn the recommended collection procedures, as well as the storage and transport conditions that should be followed for each type of specimen.
Laboratory Guidelines for Measles Testing
The primary function of the laboratory in measles surveillance is confirming suspect measles cases, either through serology, molecular detection of the virus or virus isolation. The testing of serum specimen for the presence of antimeasles IgM antibodies remains the gold standard for laboratory confirmation of suspect cases occurring both sporadically, in clusters or during outbreaks. Other means of confirmation includes testing of Dried Blood Spot (DBS) for presence of anti-measles IgM antibodies and/or culture and isolation of measles virus from suspect or clinically confirmed measles cases.
In countries with measles elimination goal and implementing case-based surveillance, the recommendation is to collect either serum or DBS specimen within the first 28 days of rash onset from all suspect measles cases. The collection of Nasopharyngeal/Oropharyngeal (NP/OP) swab specimens for viral isolation must be within the first 7 days of rash onset. Viral isolation provides evidence of elimination of indigenous measles virus, including outbreak source and transmission pathways.
Download the full Laboratory Guidelines for Measles Testing here.
Interim Guidelines for Specimen Collection and Processing from Persons Under Investigation and EVD Suspected Cases
Ebolavirus disease (EVD) is a zoonotic viral hemorrhagic fever and one of the most virulent viral diseases known to humankind. The current EVD outbreaks in affected countries in West Africa have a case fatality rate of 45%-60%. The virus is transmitted to people from through contact with infected wild animals and spreads within the human population through person-to-person transmission. Direct contact with infected persons or their body fluids/secretions is considered the principal mode of transmission. A person becomes contagious once he/she begins to experience symptoms. The incubation period ranges from 2 days-21 days.
Handling and processing clinical samples from persons with suspected or confirmed EVD following routine biosafety precautions in diagnostic laboratories poses no greater risk than samples with bloodborne viruses such as hepatitis B, hepatitis C, and HIV. Percutaneous inoculation injury (i.e.,“needlestick injury”) is the most significant route of infect ion when working with samples that may contain Ebola virus. While there is currently no evidence of any aerosol transmission risk from Ebola infected patients, exposure of mucous membranes to splashes of infectious material, and inhalation of infectious aerosols are still considered potential modes of acquiring EVD.
Download the full Interim Guidelines for Specimen Collection, Packaging, and Transport of Suspected EVD Cases for Confirmatory Testing here
Guidelines for Specimen Collection and Laboratory Testing for Case Finding and Investigation of Human Infection Caused by Novel Respiratory Pathogens
In the recent years, several novel respiratory pathogens (NRPs) have emerged and posed global public health threats with their potential to cause outbreaks or pandemics of severe acute respiratory infections:
- Avian Influenza A (H5N1) Virus. Since the occurrence of large epizootics of the avian Influenza A (H5N1) virus in Southeast Asia in 2004 and 2005, the virus continued to spread among avian populations geographically. In the past year, the World Health Organization (WHO) reported sporadic human cases of H5N1 in Cambodia, Vietnam, Indonesia, Egypt and Bangladesh. Recent sporadic human cases in Egypt, Bangladesh, Cambodia, Vietnam and China indicate that appearance of other cases are expected and will likely occur in the future.
- Middle East Respiratory Syndrome Coronavirus (MERS-CoV). On September 2012, the United Kingdom Health Protection Agency (UK HPA) informed the WHO of a novel Coronavirus from a patient with acute respiratory syndrome, with travel history to Saudi Arabia and Qatar. The virus is similar to an earlier (July 2012) isolate from a fatal case in Saudi Arabia. To date, WHO reports of laboratory-confirmed cases originating in the following countries: Jordan, Qatar, Saudi Arabia, and the United Arab Emirates. Furthermore, WHO encourages “all Member States to continue their surveillance for severe acute respiratory infections and to carefully review any unusual patterns”.
- Avian Influenza A (H7N2) Virus. WHO has been reporting cases of human infection with Avian Influenza A H7N9 viruses, with the source of infection and the mode of transmission currently unknown. As of 29 May 2013, WHO has been informed of a total of 132 laboratory-confirmed cases, including 37 deaths. It is expected that there will be further cases of human infection until the source of infection has been identified and controlled.
You may also view the procedures for the general management of MERS-CoV cases and the Laboratory Request Form for confirmatory testing here.
Guidelines for Laboratory Confirmation of Suspected Hand, Foot, And Mouth Disease (HFMD) Cases
Laboratory confirmation of Hand, Foot, and Mouth Disease (HFMD) is essential to determine the causative agent as it may assist in the clinical management of the disease by preventing further complications. Likewise, identification of the specific agent during outbreaks of HFMD is vital in the prediction of its severity and may provide support in initiating appropriate response. The genus Enterovirus belongs to the family Picornaviridae, which were previously composed of 4 species: Polioviruses, Coxsackie A viruses (CA), Coxsackie B viruses (CB), and Echoviruses. However, recent developments created a new classification of Enteroviruses species into Human Enterovirus Group A, B, C, and D. The Human Enterovirus Group A specie, is the most common cause of HFMD. The serotype Enterovirus 71 (EV-71) has been known to cause severe complications of HFMD particularly neurological manifestations and deaths.
Download the full Guidelines for Laboratory Confirmation of Suspected Hand, Foot, And Mouth Disease (HFMD) Cases and the Laboratory Request Form here.
* Private Hospital/Institutions may refer samples for diagnosis test for EV71 (HFMD) for a charge of PHP6,000.00/sample
Guidelines on Collection and Transport of Specimens for Suspected Cases of Leptospirosis
Leptospirosis is an acute bacterial infection caused by organism belonging to the genus Leptospira. They are zoonotic organisms often affecting animals but can be transmitted directly or indirectly from animals to humans. Leptospirosis is a biphasic disease. The first phase, acute phase or phase of leptospiremia occurs from the start of the disease and may last for 4-7 days. During this phase leptospires multiply in the blood and spread to different organs. Recovery rate of leptospires from blood or other tissues or body fluids is usually high during this stage. It is also during the acute phase wherein seroconversion starts but may only be detectable after 4-7 days after onset of illness. The second phase, convalescent phase, immune phase or leptospirurea phase occurs 3-5 days after the acute phase and may last up to 30 days after the onset of illness. During this phase leptospires are being excreted in the urine and may only persist in the blood at very low concentration. During the convalescent phase seroconversion reaches its peak and antibodies are at their highest detectable level after which they slowly decline and may last for years at very low levels.
Download the full Guidelines on Collection and Transport of Specimens for Suspected Cases of Leptospirosis and Laboratory Request Form here.