Sampling Guidelines

DEPARTMENT OF LABORATORY MEDICINE & PATHOLOGY
SECTION OF VIROLOGY AND MOLECULAR BIOLOGY

GUIDELINES ON COLLECTION AND TRANSPORT OF SPECIMENS FROM
PATIENTS WITH SUSPECTED SWINE INFLUENZA A (H1N1) VIRUS INFECTION

1. General Guidelines:

a. Collect upper respiratory tract specimen as soon as possible after onset of illness.
b. In a suspected case, collect 3 specimens as explained below and in the algorithm (i.e. document number 1); one for rapid antigen detection and the other two for PCR.
c. Use swab in kit (for rapid antigen detection), and swabs provided by Virology Lab (for PCR). Do not use Bacteriological swabs. These have cotton tips and wooden shafts which are unsuitable for viruses.
d. Use the Immunology/Serology request form. You must provide clinical information; indicate clearly the request is for detection of influenza virus.
e. Specimens must be adequately labelled.
f. Stamp and sign the request form, and provide contact information (bleep or mobile number).

Samples for Rapid Antigen Detection:

a. Preferred specimen: Nasopharyngeal swab or nasopharyngeal aspirate. Collect nasopharyngeal swab using the swab labelled “Pur Wraps Sterile Foam Tipped Applicator” provided in the kit.
b. If a nasopharyngeal swab cannot be collected, take a nasal swab with nasal secretions (from anterior turbinate area).
c. Place swab in the empty sterile tube provided. You will need to break the shaft for the swab to fit into the tube. Close the tube tightly to avoid leakage.
d. Rapid influenza virus antigen detection test will be done at initial point of care, i.e. HMC Accident and Emergency Lab, Paediatric Emergency Clinic Labs, Airport Clinic and other ports of entry.

Samples for PCR

a. Preferred specimen: Nasopharyngeal swab or nasopharyngeal aspirate. Collect two nasopharyngeal swab specimens using the swab which is provided together with Viral Transport Medium (VTM) from Virology Lab, HMC.
b. If a nasopharyngeal swab cannot be collected, take a nasal swab with nasal secretions (from anterior turbinate area) using the swab as in step “a” above.
c. Place each swab specimen in the tube containing viral transport medium (VTM), which is provided together with swab. Break the swab shaft at the red line for it to fit into the tube. Close the tube tightly to avoid leakage.

Transport and Storage of Specimens:

a. After collection, send the specimen for PCR (i.e. the 2 swabs in VTM, or the 2 nasopharyngeal aspirates) at +4C immediately to Specimen Reception in the Department of Laboratory Medicine & Pathology located in HGH.
b. If the sample cannot be sent immediately to the lab, put it in the fridge (+4C). Arrange for transport to Virology Lab, HMC as soon as possible.


DEPARTMENT OF LABORATORY MEDICINE & PATHOLOGY
SECTION OF VIROLOGY AND MOLECULAR BIOLOGY

GUIDELINES FOR INFLUENZA TESTING IN VIROLOGY LAB

1. Requests for influenza testing on specimens which have been collected from patients with suspected swine flu, but have not been tested by the rapid antigen test elsewhere, should treated as STAT specimens. Test them by the Rapid influenza A and B kit. If negative for both influenza A and B, test for adenovirus and RSV.
2. When the multiplex PCR assay for respiratory viruses becomes available, one of the specimens in Viral Transport Medium, or nasopharyngeal aspirate, will be tested for influenza A and B as STAT specimen.
3. A log of all requests, results and shipped specimens will be kept by the Virology Laboratory.

For any enquiries or further guidance, contact:
Dr Said Al Dhahry, phone 5828293, Bleep 4345678
or Dr Naema Al Molawi, phone 5570058, bleep 4346368