Pandemic Influenza Plan - Questar III

Section 2: Surveillance and Laboratory Testing
sample load that the laboratory is experiencing. If strain identification based on
sequence analysis is required, the result will be available approximately one week
after the sub-type has been determined.
o Under some circumstances, the original diagnostic sample may be tested using a
rapid antigen detection assay.
o Assays based on the real-time PCR technology are also available to detect the
presence of specific respiratory viruses including adenovirus, enterovirus,
respiratory syncytial virus and human metapneumovirus. These assays will be
used as appropriate, and as time permits, for epidemiological purposes.
Additionally, once the presence of avian influenza virus has been ruled out,
culture will be performed to detect the presence of other respiratory viruses.
o Additionally, if there is evidence of the circulation of influenza viruses that are
resistant to the currently available anti-viral agents, the sequence of the NA and
matrix genes can be monitored for the presence of resistance mutations.
• Method and timing of specimen collection
o Respiratory specimens should be collected within 72 hours of symptom onset and
transported quickly to the Wadsworth Center on ice packs at 4°C. If transport is
not possible within 48 hours, sample should be frozen at -70°C and transported on
dry ice. Do not freeze at -20°C.
o Use only Dacron or rayon swabs with a plastic or wire shaft. Do not use calcium
alginate or wooden-shafted swabs.
o All specimens must be clearly labeled with the patient identifier, type of
specimen, and date and time of collection.
o Acceptable respiratory specimens for patients who do not have a history of travel
to an area where the H5N1 avian influenza virus is endemic and are not suspected
to be infected with a novel influenza virus include:
• Nasopharyngeal aspirate: Requires source of suction (syringe, vacuum
pump, or wall suction), specimen trap with two outlets, and catheter (no. 6 to
14 depending on size of patient). Without applying suction, insert catheter
through nose into posterior nasopharynx (approximately the distance from tip
of the nose to the external opening of the ear when measured in a straight
line). Apply gentle suction, leaving catheter in place for a few seconds, then
withdraw slowly. Suction contents of a vial of viral transport medium or nonbacteriostatic
saline through catheter tubing to assist in moving material from
tubing into trap and to add viral transport media to specimen. Transfer
specimen to a sterile screw cap tube for transport to laboratory.
February 7, 2006 2-15