Other Specimen Collection and Shipping

TYPE OF TEST: Detection of Clostridium botulinum toxin associated with food samples will be referred to CDC in Atlanta.

SPECIMEN REQUIREMENTS: 15 ml serum, 10-20 gm feces, and suspect food leftovers if available. Notify WPHL of the suspected botulism case immediately. Collection and submission protocol is available on the Microbiology Collection Protocols web page on this web site. A CDC 50:34 form must accompany the specimen. Ship by overnight delivery on cold packs, not dry ice. Ship directly from the submitter to STAT (Attn: Botulism Lab)

SHIPPING REQUIREMENTS: Centers for Disease Control & Prevention 1600 Clifton Road NE,  Atlanta, GA 30329

DAYS TEST PERFORMED: The samples will be processed with immediate urgency due to the nature of the toxin.

RESULTS AVAILABLE: Upon completion of testing, CDC will notify WPHL of results.

REPORTING & INTERPRETATION: Antitoxin is available through CDC Epidemiology and will be sent if there is a confirmed case of adult botulism. BabyBIG is a product licensed to treat type A & B infant botulism cases and is only available through the California Department of Public Health, Infant Botulism Treatment and Prevention Program (IBTPP). Clinicians with a suspect case should contact IBTPP at 510.231.7600.

ADDITIONAL COMMENTS: Wyoming Department of Health – 888-996-9104 (24/7 hotline)

TYPE OF TEST: Reference cultures of isolates will be accepted for identification.

SPECIMEN REQUIREMENTS: Throat or nasopharyngeal swab submitted in Amies, Stuarts, or similar transport medium.

SHIPPING REQUIREMENTS: Ship according to regulations for diagnostic specimens. Complete and enclose WPHL test request form.

DAYS TEST PERFORMED: Monday – Friday

RESULTS AVAILABLE: Upon completion of identification, usually within 5 days.

REPORTING & INTERPRETATION: Isolates will be identified and reported by genus and species.

TYPE OF TEST: MALDI-TOF.

SPECIMEN REQUIREMENTS: Submit isolate on Amies Transport Media or other appropriate tubed media. Growth should be apparent before shipment. A pure culture is required.

SHIPPING REQUIREMENTS: Ship in a manner to assure survival of isolate. Ship according to regulations for infectious substances. Complete and enclose WPHL test request form.

DAYS TEST PERFORMED: Monday – Friday

RESULTS AVAILABLE: Upon completion of identification.

REPORTING & INTERPRETATION: Identification of submitted isolate will be confirmed at WPHL. Report will include genus, species, and serotype. Serotyping is available for types A and B.

ADDITIONAL COMMENTS: Organisms that require further typing, or are requested, will be sent to CDC Atlanta for further characterization.

TYPE OF TEST: Isolates are identified using MALDI-TOF.

SPECIMEN REQUIREMENTS: Specimens for culture should be submitted on Chocolate Agar or MTM (modified Thayer-Martin) agar plates after 18-24 hours of incubation in 5% CO2 at 35-37° C. Samples being shipped in the mail, or courier, should be packed accordingly, taking into account for weather conditions, and time of year.

SHIPPING REQUIREMENTS: Specimens that are being submitted on plates, or tubed media, should be shipped to prevent them from being broken in the mail or courier service, and shipped as diagnostic specimens. Complete and enclose WPHL test request form. Please indicate the site of collection on the test request form. i.e., vaginal, urethral, phayrngeal, etc.

DAYS TEST PERFORMED: Monday – Friday

RESULTS AVAILABLE: Upon completion of test. 

REPORTING & INTERPRETATION: All cultures will be reported by genus and species. On occasion genus will only be reported. 

TYPE OF TEST: MALDI-TOF & Serotyping. 

SPECIMEN REQUIREMENTS: Submit suspected colonies on modified Thayer-Martin, chocolate agar, or similar media. Growth should be apparent before shipment. A pure isolated culture is required.

SHIPPING REQUIREMENTS: Ship in a manner to assure survival of isolate. Ship according to regulations for infectious substances. Complete and enclose WPHL test request form.

DAYS TEST PERFORMED: Monday – Friday

RESULTS AVAILABLE: Upon completion of identification.

REPORTING & INTERPRETATION: Upon completion of identification, usually within 5 days.

ADDITIONAL COMMENTS: Serotyping is performed on all confirmed N. meningitidis isolates.

The CDC’s Antimicrobial Resistance Laboratory Networks (ARLN) has requested State Public Health Laboratories to collect, confirm and characterize carbapenem resistant Enterobacteriales (CRE), Pseudomonas aeruginosa (CRPA), and Acinetobacter baumannii (CRAB) isolates. These activities will help to identify isolates that produce a carbapenemase and classify the kind of carbapenemase resistance present. The goal is to rapidly detect these organisms, inform local responses to prevent their spread, and protect the public health. ARLN Information

TYPE OF TEST:  Carbapenem resistance confirmation is a combination of tests that include: species identification of organisms using MALDI-TOF technology, antimicrobial tests (Etest) that detect carbapenem resistance, and carbapenemase production (mCIM). If a carbapenemase is detected a multiplex molecular panel is performed to identify the most common resistant genes.

SPECIMEN REQUIREMENTS:  Acceptable specimens are carbapenem resistant pure isolates that have been previously tested at the clinical lab level. Targeted isolates accepted are:  Acinetobacter baumannii., Enterobacter sp., E. coli, Klebsiella aerogenes, Klebsiella oxytoca, and Klebsiella pneumonia that are resistant to imipenem, meropenem, doripenem, or ertapenem by standard susceptibility testing methods (i.e., minimum inhibitory concentration of ≥4 ug/mL doripenem, imipenem or meropenem, or ≥2 for ertapenem). Pseudomonas aeruginosa (non-mucoid only) isolates that are resistant to imipenem, meropenem or doripenem at ≥8 MIC.  All specimens submitted must be submitted with the results of the antimicrobials tested.

SHIPPING REQUIREMENTS:  Ship according to regulations for infectious substances. Complete and enclose test request form and the antibiotic sensitivity results.

DAYS TEST PERFORMED: Monday – Friday

RESULTS AVAILABLE: Upon completion of test.

REPORTING & INTERPRETATION:  All results will be reported with an interpretation of Susceptible, Resistant or Intermediate. MICs are not reported. In the event of detection of carbapenemase resistance, results will be phoned to the submitter. All antimicrobial MIC break points are determined by the current edition of the CLSI M100: Performance Standards for Antimicrobial Susceptibility Testing.

ADDITIONAL COMMENTS: Please call if testing of other non-targeted organisms is requested.

CDC’s AR Lab Network Fact Sheet

CRE Fact Sheet

 Candida auris is a multidrug resistant yeast that has been found in multiple countries, including the United States. C. auris can cause invasive infections, be passed from person to person, and persist in the environment. Its severity, communicability and drug resistance makes correctly identifying C. auris crucial to treating patients and preventing infections. This is challenging because traditional phenotypic methods frequently misidentify C. auris. It is often misidentified as Candida haemulonii. C. auris is a reportable disease in the state of Wyoming. For more information: Candida auris.

TYPE OF TEST:  Identification by MALDI-TOF.

SPECIMEN REQUIREMENTS: Submit all confirmed or suspected Candida auris isolates. Pure isolates of Candida sp., other than C. albicans from any specimen source, especially invasive sites are acceptable. Submit yeast isolates from any specimen source when unable to identify species after identification is attempted.

SHIPPING REQUIREMENTS:  Ship according to regulations for infectious substances. Complete and enclose test request form.

DAYS TEST PERFORMED: Monday – Friday

RESULTS AVAILABLE: Upon completion of test.

REPORTING & INTERPRETATION: All results will be reported to the submitter and Wyoming state epidemiologist HAI coordinator.

ADDITIONAL COMMENTS:  All isolates submitted for testing will be forwarded to the Antimicrobial Resistance Laboratory Networks (ARLN) Regional Laboratory.

Candida Fact Sheet

INFLUENZA TESTING

Influenza-like Illness (ILI) Case Definition

A fever greater than or equal to 100.0° F or 37.8° C

– This can include an oral temperature or equivalent

AND

A cough and/or sore throat

– In the absence of a known cause other than influenza

Influenza Sentinel Surveillance Program

The Wyoming Influenza Sentinel Surveillance Program is a partnership between local clinicians, the Wyoming Department of Health (WDH) and the Centers for Disease Control and Prevention (CDC) to conduct surveillance ILI. This program is an important part of our surveillance efforts to track both ILI and influenza. The sentinel provider program involves two major components, which are described below.

Weekly Influenza-Like Illness (ILI) Reporting: Consists of recording and reporting summary data each week to CDC via the internet. The summary data includes the total number of patient visits for any reason and number of patient visits for ILI by age group. Reports are submitted each week, even when no ILI activity is observed.

Laboratory Surveillance: Consists of collecting specimens from patients with ILI; the specimens are sent to the Wyoming Public Health Laboratory (WPHL) for influenza testing.

Laboratory Surveillance

Prior to the start of each influenza season, the WPHL will send influenza kits to the network of influenza sentinel surveillance providers. Each year, sentinel providers from all over the state use the influenza kits to submit specimens to the WPHL for influenza testing. Influenza kits contain the following: Laboratory Requisition Form, Laboratory Protocols and Influenza Virus Collection Kits.

Laboratory Submission Recommendations

Influenza Sentinel Surveillance Providers may submit specimens on all ILI cases or on a sample of ILI case. However, the WPHL and Infectious Disease Epidemiology Section offer the following laboratory submission recommendations:

1. Submit specimens from patients that meet the ILI case definition.

– Submitted specimen should meet the ILI case definition. However, it is permissible to submit specimens on cases that do not meet the ILI case definition.

2. Submit specimens weekly to the Wyoming Public Health Laboratory for specialized testing.

– If it is difficult to submit specimen on cases that meet the ILI case definition, the providers can use their discretion when deciding which samples to submit for testing.

3. Submit specimens on patients with severe disease.

– Specimens should be submitted on all hospitalized ILI cases.

Laboratory Requisition Form

Laboratory Protocol

TYPE OF TEST: PCR

SPECIMEN REQUIREMENTS: Nasopharyngeal specimen using a polyester swab on flexible wire

SHIPPING REQUIREMENTS: Ship according to regulations for diagnostic specimens. Complete and enclose test request form.

DAYS TEST PERFORMED: Daily, Monday through Friday.

RESULTS AVAILABLE: Upon completion of identification.

REPORTING & INTERPRETATION: Positive results are called to the submitter. A negative result does not preclude the possibility of infection.

ADDITIONAL COMMENTS: 

NOROVIRUS

Norovirus also referred to as the “stomach flu”, “24hr flu”, or simply “food poisoning”. It is the most common cause of gastroenteritis in the US. The virus is very contagious and is usually transmitted through contaminated food, person to person contact with infected individuals, and contaminated surfaces. After a short incubation period people exposed to the virus usually become violently ill. Symptoms include nausea, vomiting, diarrhea, fever, chills, and body aches. These symptoms subside rather quickly, usually within 1-3 days. Dehydration is the biggest concern with infected individuals therefore plenty of fluids should be taken in until the nausea and diarrhea subside

Norovirus WPHL is a CaliciNet Laboratory.

TYPE OF TEST: Norovirus testing by real time PCR

SPECIMEN REQUIREMENTS: Acceptable specimens include stool and vomitus (by special request).

SHIPPING REQUIREMENTS: Specimens must be sent in ETM (Enteric Transport Media). Raw stools will not be accepted. Specimen should be shipped with a cold pack. Complete and enclose test request form. Ship according to regulations for infectious substances.

DAYS TEST PERFORMED: Daily, Monday through Friday.

RESULTS AVAILABLE: Upon completion of testing, usually 24-48 hrs after sample is received.

REPORTING & INTERPRETATION: Samples testing postive for Group I or Group II Norovirus RNA will be phoned to submitter and a hard copy mailed. Negative results are not phoned; submitter will receive a hard copy by mail. Interpretation will include “Positive GI Norovirus”, “Positive GII Norovirus”, “Negative”, or “Indeterminate”. Indeterminate results indicate the sample tested could not be determined as being positive or negative.

ADDITIONAL COMMENTS: Testing for suspected larger outbreaks of Norovirus in the community should be coordinated through the Epidemiology Department. If a large outbreak is suspected, please contact our Epidemiology staff at 307-777-7953.

Respiratory SARS-CoV-2 Panel

The Respiratory SARS-CoV-2 Panel offers detection of 24 respiratory illness targets on one test platform. The targets for this panel are as follows:

• Influenza A
• Influenza A H1
• Influenza A H1N1 pdm09
• Influenza A H3
• Influenza B
• Respiratory Syncytial Virus A + B
• Parainfluenza Virus 1
• Parainfluenza Virus 2
• Parainfluenza Virus 3
• Parainfluenza Virus 4
• Human Metapneumovirus A + B
• Rhinovirus/Enterovirus
• Adenovirus
• Mycoplasma pneumoniae
• Bordetella pertussis
• Chlamydophila pneumoniae
• Coronavirus 229E
• Coronavirus OC43
• Coronavirus NL63
• Coronavirus HKU1
• SARS-CoV-2

TYPE OF TEST: This test uses electrochemical detection of amplified PCR products to detect multiple respiratory illness targets.

SPECIMEN REQUIREMENTS: Collect a nasopharyngeal swab according to standard protocol and place in at least 500 µl of viral transport media. Samples should be stored cold or frozen.

SHIPPING REQUIREMENTS:    If you will ship within 3 days of collection, store the specimen at 4°C and ship in an insulated cooler with cold packs.  If you will ship > 3 days following collection, store specimens at <-15°C and ship in an insulated cooler with ice packs. Complete and enclose test request form. Ship according to regulations for infectious substances.

DAYS TEST PERFORMED: Testing is performed upon receipt of sample.

RESULTS AVAILABLE: Upon completion of testing, usually 24 hrs. after sample is received.

REPORTING & INTERPRETATION: Molecular detection of respiratory targets on this platform are more sensitive than Direct Fluorescence and culturing techniques, providing for improved patient care. The results are reported out as either Detected or Not Detected for each target on the panel.

ADDITIONAL COMMENTS: 

WEST NILE VIRUS

The Wyoming Public Health Laboratory uses RT-PCR and ELISA protocols for testing for West Nile Virus. Both methods look for the presence of antibody to WNV in serum and cerebral spinal fluid (CSF).

Ideal Timing of Specimen Collection

Timing is critical in collection of both CSF and Serum for WNV Testing. False negative test results are possible when specimens are collected too early.

• CSF specimens for IgM should be collected prior to 8 days post onset of illness.
• Acute serum specimens should be collected no earlier than 8 days post onset of illness.
• Convalescent specimens should be collected 2-3 weeks after collection of Acute serum.

Clinical Criteria

• Fever ³ 38°C (100.0° C) for 7-10 days.
• Neurological manifestations, including: altered mental status, altered level of consciousness, agitation, lethargy, change in personality, headache, and/or neck pain.
• CSF pleocytosis with predominant lymphocytes and/or elevated protein.
• With or without muscle weakness, (especially flaccid paralysis) confirmed by neurological exam or by EMG).

TYPE OF TEST: PCR or ELISA

SPECIMEN REQUIREMENTS: CSF specimens for IgM should be collected prior to 8 days post onset of illness. Acute serum specimens should be collected no earlier than 8 days post onset of illness. Convalescent specimens should be collected 2-3 weeks after collection of acute serum.

SHIPPING REQUIREMENTS: Daily, Monday through Friday.

DAYS TEST PERFORMED: Daily, Monday through Friday.

RESULTS AVAILABLE: Upon completion of identification

REPORTING & INTERPRETATION: Positive results are called to the submitter.

ADDITIONAL COMMENTS: 

West Nile Virus Submission Protocol

West Nile Virus Testing Guidelines

NUCLEIC ACID AMPLIFICATION TEST (NAAT) M. tuberculosis complex (MTBc)

What is TB NAAT?

Detecting M. tuberculosis (MTB) complex with traditional laboratory culture methods takes 1 to 8 weeks. Nucleic Acid Amplification Test for TB is a molecular test that can detect MTB genetic material from specimens within 1 to 2 days of specimen collection. The test is intended for use with respiratory specimens from patients showing signs and symptoms of active pulmonary TB. The WPHL has access to NAAT testing for Tuberculosis. WPHL also has access to molecular testing for rifampin resistance, a marker of multi-drug resistant TB (MDR-TB).

Who is at risk?

Populations most likely to be at risk for TB infection in the region may include:

· Foreign born

· American Indian

· People 65 or older

· Homeless

· People with alcohol problems

Who should be tested?

It is important to identify patients at risk for tuberculosis and who are good candidates for rapid NAA testing. The test is intended for use with respiratory specimens from patients showing signs and symptoms of active pulmonay TB. The NAAT should not be used for patients who have taken TB medications in the last twelve months or who have taken TB medications for more than 7 days. NAA tests can detect nucleic acids from dead as well as live organisms. Therefore the test can remain positive for long periods in patients who are taking anti-TB medications or who have completed TB treatment.

The following questions can help determine if a NAAT is required:

· Is the patient hospitalized and in airborne isolation?

· Does the patient have a chest X-ray suggestive of TB infection?

· Does the patient have a positive TB skin test (TST) or IGRA?

· Is the patient linked to a known case of TB?

· Does the patient have at least two of the following signs and symptoms?

Persistent Cough

Purulent/Bloody sputum

Shortness of Breath

Chest Pain

Fatigue/Malaise

Unexplained Weight Loss

Night Sweats

Fever/Chills

· If the patient has been diagnosed with pneumonia, has he/she been treated, but is not improving?

How do you order a NAAT?

Healthcare providers should collect and send sputums or respiratory specimens to rule out TB in the same manner as culture and smear specimens are currently submitted to WPHL (send 3 sputum collected at least 8 hours apart). WPHL will test the first sputum collected with NAAT. If the first sputum is smear negative and NAAT negative, but either one or both of the remaining sputums are smear positive, WPHL will also test this specimen. WPHL will not test any other specimens with NAAT unless there is a special request. All 3 sputums will also have smears and and cultures performed. Please request on the WPHL test request form that a NAAT is to be performed. Additionally, submit with the specimen a Supplemental NAAT form by clicking on this link.

What do the results mean?

NAATs should always be interpreted withing the context of the patient’s signs and symptoms, and should always be performed in conjunction with AFB smear and culture.

Quantiferon (TB) Testing (QFT)

TYPE OF TEST: The Quantiferon-TB Gold Plus test (QFT) is an interferon-gamma release assay (IGRA) which measures in vitro responses to peptide antigens simulating mycobacterial proteins, a component of cell-mediated immune reactivity to M. tuberculosis.  It is used as an aid for detecting Mycobacterium tuberculosis infection. However, it DOES NOT distinguish between active and latent TB infection. QFT Plus is an updated method which includes two separate TB Antigen tubes.

SPECIMEN REQUIREMENTS: 

QFT testing requires drawing four tubes:  

1. One Gray top -Nil tube
2. One Green top – TB Antigen tube 1
3. One Yellow top – TB antigen tube 2
4. One Purple top – Mitogen control tube

Specimens must be incubated within 16 hours of the draw.  Incubation should be for 16-24 hours at 37°C. Then tubes may be centrifuged for 20 minutes at 3500 RPM, extending the time frame for receipt at WPHL to 7-10 days. Non-centrifuged specimens must be received at WPHL within three days after incubation. Do not ship specimens on Fridays.

Non-incubated specimens must be delivered to WPHL within 16 hours of the draw. Samples are accepted Monday through Thursday. Contact the WPHL for further instructions.

For further clarification refer to the QFT Collection Protocol in the Microbiology Collection section on this web site.

SHIPPING REQUIREMENTS: 

Tubes should be held and transported at room temperature. Do not refrigerate or place on ice. Samples must be submitted with a completed QFT Requisition form, including the date, time drawn, incubation period, and incubator temperature.

 Place tubes in a biohazard bag, with a completed QFT request form in the outside pocket. Package tubes in the mailers provided by WPHL or a comparable approved shipping container. Ship as a diagnostic specimen following postal or carrier shipping regulations.

DAYS TEST PERFORMED: Testing is based on volume, no less than once a week.

RESULTS AVAILABLE: Results are faxed or mailed, per facility preference. The Lab Web Portal (LWP) keeps test requests and reports updated in real time, and is available to find results for up to two years upon completion.

REPORTING & INTERPRETATION: 

Results are reported with the TB 1 & TB 2 values, along with the final result interpretation as follows:

TB 1 Ag-Nil RESULT: ______; TB 2 Ag-Nil RESULT: ______

Interpretation: NEGATIVE – <0.35 (M. tuberculosis infection NOT likely); POSITIVE –  > 0.35 (M. tuberculosis infection likely); INDETERMINATE – indicates an uncertain likelihood of M. tuberculosis infection OR incorrect specimen handling/incubation. Repeat testing recommended in 6 weeks.

Positive results are called to the submitter.  All results of Quantiferon-TB Gold Plus testing should be interpreted in the context of patient’s likelihood of prior tuberculosis exposure.

ADDITIONAL COMMENTS: QFT tubes fill very slowly. Allow tubes to stay on needle for 2-3 seconds after the tube appears to have filled completely. Required fill is within the width of the black line on the side of the tube.

PulseNet

As a member of PulseNet, a national network of public health and food regulatory laboratories, the EID lab performs characterization on foodborne and waterborne bacterial isolates. With this data, Wyoming Department of Health and CDC-Atlanta Epidemiologists can detect and track foodborne and waterborne disease outbreaks, determine possible exposures, and trace the source of the pathogen. 

NGS is used by the WPHL to evaluate bacterial isolates suspected of being part of an outbreak or cluster of disease in the state or in a facility. Isolates submitted to WPHL as part of the Reportable Disease program will be tested. Any sequences generated from NGS are then entered into PulseNet’s national database that contains DNA sequences and analysis of similar strains recovered from across the nation.

PulseNet NGS is available for:

• Campylobacter species
• Escherichia and Shigella species
• Salmonella species
• Listeria species
• Vibrio species
• Yersinia species other than pestis 

NGS is also useful in nosocomial outbreak situations to determine if isolates from different patients are related.

Contact Taylor Fearing, Chayse Rowley, or Jim Mildenberger for specimen collection and shipping instructions. 

Taylor Fearing (NGS Section Supervisor)  307-777-7809

taylor.fearing@wyo.gov 

Chayse Rowley ( NGS Section Scientist)  307-777-8987

chayse.rowley@wyo.gov

Jim Mildenberger (Molecular Supervisor)  307-777-7425

jim.mildenberger@wyo.gov 

SARS-CoV-2

WPHL also uses NGS to characterize the genomes of SARS-CoV-2 from SARS-CoV-2 clinical specimens. NGS allows for the identification and tracking of new and emerging SARS-CoV-2 variants. Currently, sequencing of SARS-CoV-2 genomes is only performed for surveillance purposes, and lineage identification is not reported back to submitters.

More information on SARS-CoV-2 variants can be found on the CDC SARS-CoV-2 Variant Classifications and Definitions page.  The CDC’s COVID Data Tracker also is a source for information on variant proportions within the US.

Contact Taylor Fearing, Chayse Rowley, or Jim Mildenberger for specimen collection and shipping instructions. 

Taylor Fearing (NGS Section Supervisor)  307-777-7809

taylor.fearing@wyo.gov 

Chayse Rowley ( NGS Section Scientist)  307-777-8987

chayse.rowley@wyo.gov

Jim Mildenberger (Molecular Supervisor)  307-777-7425

jim.mildenberger@wyo.gov 

HIV Ag/Ab Combo

TYPE OF TEST: The GS HIV Combo Ag/Ab EIA is an enzyme immunoassay kit for the simultaneous qualitative detection of Human Immuno-deficiency Virus (HIV) p24 antigen and antibodies to HIV Type 1 (HIV-1 Groups M and O) and HIV Type 2 (HIV-2) in human serum or plasma.

SPECIMEN REQUIREMENTS: Serum or plasma. Two (2) tubes of at least 2 ml each.

SHIPPING REQUIREMENTS: The specimens must be received at the laboratory within 2 days if shipped at room temperature, or within 7 days if shipped at 2-8°C (include cold pack). Specimens that exceed the shipment guidelines will be rejected for testing. Place specimen(s) in biohazard bag, with requisition form in the outside pocket. Package in mailers, provided by WPHL or comparable approved shipping container. Ship as a diagnostic specimen; following all postal or carrier shipping regulations. Refer to HIV Combo Ag/Ab Collection Protocol under Microbiology on this web page.

DAYS TEST PERFORMED: Testing is preformed based on volume, no less than once a week.

RESULTS AVAILABLE: Results are faxed or mailed, per facility preference. The Lab Web Portal (LWP) keeps test requests and reports updated in real time, and is available to find results for up to two years upon completion.

REPORTING & INTERPRETATION: HIV Combo Ag/Ab EIA results are reported as NONREACTIVE, REACTIVE or INCONCLUSIVE.  NONREACTIVE results do not preclude the possibility of exposure to HIV or early infection. REACTIVE indicates the presence of HIV-1 and/or HIV-2 antibodies.

REACTIVE EIAs are repeated in duplicate. If the specimen is repeatedly reactive, the specimen is reflexed to Geenius™ HIV 1/2 Supplemental Assay which detects and differentiates between HIV-1 and HIV-2 antibodies. REACTIVE results are called to the submitter.

ADDITIONAL COMMENTS:  INCONCLUSIVE is reported when the HIV Combo Ag/Ab EIA is repeatedly reactive followed by a nonreactive Geenius™ HIV 1/2 Supplemental Assay. INCONCLUSIVE specimens are sent for further HIV RNA testing to identify a possible early or acute HIV infection.

Syphilis

TYPE OF TEST: ASI RPR (rapid plasma reagin) Card Test for Syphilis is a qualitative and semi quantitative nontreponemal flocculation test for the detection of reagin antibodies associated with Syphilis.

SPECIMEN REQUIREMENTS: Serum or plasma. Submit 7.0 ml of whole blood or 2 ml of serum. Serum is preferable; however, if you cannot separate the serum, send the specimen within 24 hours.

SHIPPING REQUIREMENTS: Place specimen(s) in biohazard bag, with requisition form in the outside pocket. Package in mailers, provided by WPHL or comparable approved shipping container. Ship as a diagnostic specimen; following all postal or carrier shipping regulations. Refer to Hepatitis, Serology and Syphilis Collection Protocol under Microbiology on this web page.

DAYS TEST PERFORMED: Monday and Thursday.

RESULTS AVAILABLE: Results are faxed or mailed, per facility preference. The Lab Web Portal (LWP) keeps test requests and reports updated in real time, and is available to find results for up to two years upon completion.

REPORTING & INTERPRETATION: Syphilis results are reported as NONREACTIVE or REACTIVE. NONREACTIVE results indicate no detectable levels of antibody.  However, nonreactive results do not preclude the possibility of exposure to Syphilis or early infection. REACTIVE results indicate antibodies are present. Samples that are found to be REACTIVE are repeated and titered.  Due to the possibility of biological false positives all REACTIVE card tests are sent for supplemental fluorescent treponemal antibody absorption testing (FTA-ABS). FTA-ABS is a specific treponemal assay for the detection of Treponema pallidum. A REACTIVE or REACTIVE MINIMAL FTA-ABS indicates a true Syphilis positive. REACTIVE or REACTIVE MINIMAL results are called to the submitter.

ADDITIONAL COMMENTS: Excessively hemolyzed specimens will be rejected.

Hepatitis Markers

TYPE OF TEST: EIA for the presence of Hepatitis markers.

SPECIMEN REQUIREMENTS: Serum or plasma. Submit 7.0 ml of whole blood or 2 ml of serum. Serum is preferable; however, if you cannot separate the serum, send the specimen within 24 hours.

SHIPPING REQUIREMENTS: Place specimen(s) in biohazard bag, with requisition form in the outside pocket. Package in mailers, provided by WPHL or comparable approved shipping container. Ship as a diagnostic specimen; following all postal or carrier shipping regulations. Refer to Hepatitis, Serology and Syphilis Collection Protocol under Microbiology on this web page.

DAYS TEST PERFORMED: Tuesday and Thursday.

RESULTS AVAILABLE: Results are faxed or mailed, per facility preference. The Lab Web Portal (LWP) keeps test requests and reports updated in real time, and is available to find results for up to two years upon completion.

REPORTING & INTERPRETATION:

Hepatitis B – Three tests are available to determine the Hepatitis B status:

Hepatitis B surface antibody (HBsAb): This test should be requested to detect Hepatitis B antibody.

Results are reported as:

• REACTIVE indicates the presence of antibody as a result of a previous Hepatitis B infection or vaccination series and the patient is  considered immune.
• BORDERLINE indicates borderline status and interpretation should be based on other clinical information or subsequent testing.
• NONREACTIVE indicates non-detectable or absent levels of antibody. If the patient is known to have been vaccinated against Hepatitis B, their antibody levels may be present but non-detectable. Results are qualitative and are not reported as quantitative titers.

Hepatitis B surface antigen (HBsAg): This test should be requested to detect surface antigen and determine if the patient has an acute or chronic Hepatitis B infection and/or is potentially infectious.

Results are reported as:

• REACTIVE indicates the presence of Hepatitis B surface antigen from an acute or chronic infection.
• NONREACTIVE indicates the absence of surface antigen. This marker should be ordered in conjunction with HBc-lgM to differentiate the infection status.

Hepatitis B Core IgM (HBc-lgM): This test should be requested to detect Core IgM antibody and determine if the patient has an acute Hepatitis B infection and/or is potentially infectious.

Results are reported as:

• REACTIVE indicates the presence of Core IgM antibody from an acute infection and the patient should be considered infectious.
• NONREACTIVE indicates the absence of Core IgM antibody. This marker should be ordered in conjunction with HBsAg to help determine infection status.

Hepatitis C (HCV): This test should be requested to detect Hepatitis C antibody.

Results are reported as:

• REACTIVE indicates the presence of antibody as a result of Hepatitis C infection. However, this screening test will not differentiate between acute, chronic, or resolved/past infections. Patient may or may not be infectious if the screening test is positive. Further HCV RNA testing is recommended.
• NONREACTIVE indicates no detectable antibodies present.

ADDITIONAL COMMENTS: Excessively hemolyzed specimens will be rejected.

Vector-borne Diseases

Colorado Tick Fever

TYPE OF TEST: PCR positive reflexes to ELISA.

SPECIMEN REQUIREMENTS: Paired sera are preferred, but a single sample can be tested.

SHIPPING REQUIREMENTS: Ship according to regulations for infectious substances. Complete and enclose WPHL test request form. Additionally, CDC 50.34 form must accompany the sample. Please see the Forms web page.

DAYS TEST PERFORMED: Daily, Monday – Friday.

RESULTS AVAILABLE: Upon completion.

REPORTING & INTERPRETATION:

ADDITIONAL COMMENTS: This test is outsourced to CDC – Fort Collins.

Lyme Disease

TYPE OF TEST: ELISA.

SPECIMEN REQUIREMENTS: Paired sera are preferred, but a single sample can be tested.

SHIPPING REQUIREMENTS: Ship according to regulations for infectious substances. Complete and enclose WPHL test request form. Additionally, CDC 50.34 form must accompany the sample. Please see the Forms web page.

DAYS TEST PERFORMED: Daily, Monday – Friday.

RESULTS AVAILABLE: Upon completion.

REPORTING & INTERPRETATION:

ADDITIONAL COMMENTS: This test is outsourced to CDC – Fort Collins.

Rocky Mountain Spotted Fever

TYPE OF TEST: PCR positive reflexes to indirect fluorescent antibody (IFA).

SPECIMEN REQUIREMENTS: Paired sera are preferred, but a single sample can be tested.

SHIPPING REQUIREMENTS: Ship according to regulations for infectious substances. Complete and enclose WPHL test request form. Additionally, CDC 50.34 form must accompany the sample. Please see the Forms web page.

DAYS TEST PERFORMED: Daily, Monday – Friday.

RESULTS AVAILABLE: Upon completion.

REPORTING & INTERPRETATION:

ADDITIONAL COMMENTS: This test is outsourced to CDC – Fort Collins.

Hantavirus Testing

TYPE OF TEST: ELISA, IgG and IgM

SPECIMEN REQUIREMENTS: minimum of 1 ml serum should be collected at the time the patient is admitted. A convalescent specimen should be collected 21 days after the first specimen.

SHIPPING REQUIREMENTS: Ship according to regulations for infectious substances. Complete and enclose WPHL test request form. Ship as soon as possible after collection.

DAYS TEST PERFORMED: Daily, Monday – Friday.

RESULTS AVAILABLE: Upon completion.

REPORTING & INTERPRETATION: This procedure is a CDC product and is not FDA approved for diagnostic testing. These results are subject to some interpretation. If the patient had an illness compatible with Hanta-associated respiratory illness and the specimen was drawn three or more weeks from onset of illness, a positive IgM is reasonable evidence that the illness was associated with a Hantavirus infection. A negative IgM response in a single specimen may not rule out the possibility of infection, as the specimen may have been collected too soon. A significant rise in IgG antibodies between acute and convalescent specimens is also suggestive of a recent infection. A positive IgG response in the absence of an IgM response may be indicative of a past infection. Results will be noted as “positive”, “negative”, or “equivocal”, with a laboratory interpretation.

ADDITIONAL COMMENTS: This test is outsourced to Montana PHL.