COUNTY OF ERIE
GALE R. BURSTEIN, MD, MPH, FAAP DEPARTMENT OF HEALTH
COMMISSIONER OF HEALTH
HEALTH ADVISORY # 338 February 16, 2016
Zika Virus Testing and Specimen Collection Update
Please distribute to Healthcare Providers, Infection Control Department, Emergency Department, Infectious Disease Department, OB/GYN, Family Medicine, Pediatrics, Director of Nursing, Medical Director, Laboratory Service, Pharmacy, and all patient care areas.
- This advisory describes the process for Zika virus testing that all healthcare providers and facilities in Erie County should follow when caring for patients.
- Preauthorization of testing by the Local Health Department (LHD) where the patient resides is required. Erie County residents can be reported to the Erie County Department of Health (ECDOH) at (716) 858-7697, Monday thru Friday, 8:00am to 4:00pm.
- Testing through New York State Department of Health (NYSDOH) Wadsworth Center is available for:
- Pregnant women who traveled to an area with active Zika virus transmission while pregnant.
- Non-pregnant women and men who develop (or developed) compatible symptoms during or within 4 weeks of travel to an area with active Zika virus transmission.
- All persons who traveled to an area with active Zika virus transmission who present with Guillain-Barré syndrome.
- There is no cost for laboratory testing at the NYSDOH Wadsworth Center.
- Hospitals and providers must report suspected cases of Zika virus to the LHD where the patient resides.
INFORMATION FOR HEALTHCARE PROVIDERS AND FACILITIES
Below are the steps that must be taken for Zika virus testing:
1. Healthcare provider identifies a patient presenting for care who meets the following criteria:
- Pregnant woman who traveled to an area with active Zika virus transmission while pregnant (see http://www.cdc.gov/zika/geo/index.html) OR
- Non-pregnant woman or man who develops (or developed) compatible symptoms during or within 4 weeks of travel to an area with active Zika virus transmission OR
- A person who traveled to an area with active Zika virus transmission and who presents with Guillain-Barré syndrome.
2. The provider must contact the LHD where the patient resides for preauthorization of Zika virus testing. Erie County residents can be reported to the ECDOH at (716) 858-7697, Monday thru Friday, 8:00am to 4:00pm.
- The patient should be available to the provider during this call.
- The ECDOH staff will complete the Zika virus testing questionnaire with the provider and/or patient which generates a Registration ticket that will be faxed to the provider’s office to be given to the patient.
- The ECDOH staff will fax the laboratory Infectious Disease Requisition (IDR) form to the provider to be completed and given to the patient.
- The ECDOH will provide a list of specimen collection sites to the provider or patient. The list of collection sites in Erie County is available at: http://www2.erie.gov/health/index.php?q=zika-specimen-collection-sites
3. If testing is approved by the ECDOH, the healthcare provider must provide the patient with a written order/prescription for Zika virus testing that specifies serum and urine for polymerase chain reaction (PCR) and serum for serology.
- Patients must present at the testing site with:
- a written order prescription from a NYS licensed healthcare provider clearly indicating the name, complete address and date of birth of the patient AND
- the Registration ticket AND
- the IDR form
4. The Wadsworth Center will perform molecular tests which detect the presence of the virus, as well as both screening and confirmatory tests for antibodies against Zika and other related viruses. PCR will be performed on specimens that were collected either within one month of the onset of symptoms or within six weeks of travel. PCR results are reported in the evening of the same weekday on which the specimen is received. Testing is not performed on the weekends. Specimens collected between the day of the patient’s return from travel and 9 months of return will be accepted for serology. Screening serology testing takes up to 7 days to complete from date of specimen receipt. Some patients will need confirmatory testing by plaque reduction neutralization testing (PRNT) to rule out the possibility of cross reactivity due to other related viruses such as dengue. PRNT takes an additional 10-14 days because it is dependent on the length of time it takes for virus to grow in culture. For some patients, a second serum specimen may be needed at least three weeks after the first specimen was collected to quantify the rise in antibodies.
5. Results of Zika virus testing will be made available to the ordering provider through the submitting laboratory and/or the LHD where the patient resides. Providers can access public health consultation for assistance with interpretation of results by calling the NYSDOH Zika Information Line at: 1-888-364-4723 between 9AM and 6PM weekdays.
INFORMATION FOR SPECIMEN COLLECTION SITES
1. Specimen Collection
- Serum: Collect at least six milliliters (ml) of blood in a serum tube (red top, serum separator tube, tiger top, speckle top, gold top). These tubes contain clot activator, so that serum can be readily obtained. Do NOT use blood tubes that contain anti-coagulants such as green top, yellow top or purple top. Centrifuge the blood tube, transfer the serum to a separate labeled tube (at least 3 ml serum required) and discard the clot. Seal the serum tubes with parafilm.
- Urine: Collect urine in a sterile cup with a minimum volume of 3 ml and a maximum volume of 20 ml. Close the lid tightly and seal with parafilm. Specimens that leak will not be tested.
- Label the specimens: Failure to properly label a specimen will result in rejection and the specimen will not be tested. Specimens must be labeled with:
- Patient’s First and Last Names
- Patient’s Date of Birth
- Date and Time of Collection
- All information on the specimen label must exactly match the information on Wadsworth’s (IDR) form, including the spelling of the patient’s first and last names.
2. Specimen Handling: It is best that blood specimens be centrifuged, separated and frozen immediately. Specimens that are not directly centrifuged should be immediately refrigerated and must be centrifuged and the serum frozen within six hours. Specimens must be on cold packs when transported from the refrigerator to the freezer during this 6 hour time period. Both the urine and serum need to be frozen at -70 to -80 degrees Celsius. Freezing preserves the integrity of the RNA in the samples.
3. Specimen Transport for Non-NYC residents: Wadsworth’s IDR form, which is available at http://www.wadsworth.org/sites/default/files/WebDoc/1065760803/infectious_diseases_requisition_DOH_4463.pdf must be completed in full and accompany each specimen being submitted on a non-NYC resident.
If present, symptoms should be clearly noted on the IDR.
- Follow shipping regulations for UN 3373 Biological Substance, Category B and UN 1875, Class 9 for dry ice.
- Specimens must be shipped on dry ice to the Wadsworth Center, David Axelrod Institute, 120 New Scotland Avenue, Albany, NY 12208. Label the outside of the package with storage conditions (-70 to -80C).
Providers are required to report suspected cases of Zika virus and all other arboviral diseases to the local health department where the patient resides. Erie County residents can be reported to the ECDOH at (716) 858-7697, Monday thru Friday, 8:00am to 4:00pm.
- General information about Zika virus and disease: http://www.cdc.gov/zika/
- Zika virus information for clinicians: http://www.cdc.gov/zika/hc-providers/index.html
- Zika virus and pregnant women: http://www.cdc.gov/zika/pregnancy/index.html
- Travel notices related to Zika virus: http://wwwnc.cdc.gov/travel/notices
- Information about Zika virus for travelers and travel health providers: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/zika
Health Category Definitions:
Health Alert FLASH: conveys the highest level of importance due to a large-scale, catastrophic public health emergency; warrants immediate action or attention
Health Alert Priority: conveys the highest level of importance; warrants immediate action or attention to a health problem or situation
Health Advisory: provides important information for a specific incident or situation; may not require immediate action
Health Update: provides updated information regarding an incident or situation; no immediate action necessary
You can sign up to receive Health Alerts & Advisories at www.erie.gov/health/index.php?q=node/59. The ECDOH Health Alert & Advisory System is an e-mail notification system designed to alert community partners about important health related information.
The Erie County Department of Health does not provide medical advice. The information provided on the Erie County Department of Health website is not an attempt to practice medicine and is not intended as a substitute for professional medical advice, diagnosis, or treatment. It is for informational purposes only. Always seek the advice of your personal physician or other qualified health provider with any questions you may have regarding a medical condition or issue. Never disregard professional medical advice ordelay in seeking it because of the content found on the Erie County Department of Health website or this correspondence.