Testing for H1N1

Testing for H1N1
Updated October 27, 2009

• Rapid influenza testing is being discouraged due to the inaccuracy of the test (40-70% sensitivity and at least a 7% false positive rate).  Rapid influenza testing kits are not validated for H1N1, so those sensitivities may even be lower.  A negative rapid flu test result does not rule out H1N1.
• H1N1 confirmatory testing can only be ordered on hospitalized patients.  For suspected outpatients, DFA and culture are recommended (although results will not be available until the patient has likely recovered)

Criteria for novel H1N1 influenza testing at the Georgia Public Health Laboratory:

The Georgia Department of Community Health, Division of Public Health’s (DPH) current surveillance goals are to monitor for changes in the severity of H1N1 infections and to identify risk factors for severe illness. To accomplish these goals, they are conducting focused surveillance by continuing traditional surveillance methods (visit http://health.state.ga.us/epi/flu/ for a detailed explanation of influenza surveillance in Georgia) and instituting the following new H1N1 2009 surveillance testing strategies for the 2009-2010 influenza season:

1. Providers who participate in the ILINet sentinel influenza program outside of the metropolitan Atlanta area may submit up to 3 specimens a week for influenza testing (including H1N1 2009) to the GPHL.
2. The Emerging Infections Program (visit http://www.cdc.gov/ncpdcid/deiss/about_eip.html for more information) is collecting specimens on patients who are hospitalized with ILI in the 27 EIP hospitals in metro Atlanta for submission to the GPHL.
3. Any provider may submit specimens from patients with influenza-like illness (ILI)* who are hospitalized in the ICU only.

Laboratory testing for novel H1N1 influenza at the Georgia Public Health Laboratory is used primarily for public health surveillance, not for primary diagnosis of individual patients.
Patients must meet the above criteria to be tested for H1N1 influenza through the Georgia Public Health Laboratory. Clinicians may also choose RT-PCR testing through a commercial reference laboratory.

*Note: Influenza-like illness (ILI) is defined as an illness with fever (≥ 100° F) AND cough and/or sore throat (in the absence of a known cause other than influenza).

Clinicians MUST contact an epidemiologist at their district office or the Georgia Division of Public Health Acute Disease Epidemiology Section (404-657-2588) to obtain approval to submit specimens for testing, the appropriate submission form, and to coordinate specimen shipping.  After business hours, specimens can be collected and held in the refrigerator at 4ºC until Public Health can be consulted.  SAMPLES SUBMITTED DIRECTLY TO THE PUBLIC HEALTH LABORATORY WITHOUT APPROPRIATE PUBLIC HEALTH SCREENING AND THE APPROPRIATE SUBMISSION FORM MAY NOT BE TESTED.

Protocol for Testing:

1. Approval for testing must be obtained from a district epidemiologist before to submission of a clinical specimen from any patient.
1. Call the “district epidemiologist” who represents the district where the patient lives, for approval.
2. If you do not know the district where the patient lives, see http://health.state.ga.us/regional/index.asp or call the Georgia Division of Public Health (404-657-2588).
3. Carroll County is in District 4 at 706-845-4035
4. Haralson County is in District 1-1 at 706-295-6656
2. A form must be completed by the physician/clinician and sent to the lab to accompany the specimen.
1. On the Molecular Biology form, only the Patient Information section needs to be completed.  This form may be obtained here.

Specimen Collection:

A viral transport media (VTM) kit needs to be obtained from the laboratory.  Viral transport media kits typically contain 2 swabs.  Collect both a nasal swab plus an oropharyngeal (throat) swab, if possible.

• For the throat swab, swab both tonsils and posterior oropharnyx.
• For the nasal swab, swab both nostrils with the same swab.  Insert swab into nostril parallel to the palate & leave in place for a few seconds.  Then, slowly withdraw with a rotating motion.
• For patients who are intubated, an endotracheal aspirate should also be collected.
• Any sample should be labeled with the patient’s name and date of birth.
• Specimens should be placed into sterile viral transport media (VTM), double bagged, and immediately placed on ice or cold packs or at 4°C (refrigerator) for transport to the laboratory.  Please send with the completed Screening Form and the Molecular Biology form.

Storing and Shipping Specimens (for laboratory staff):

• Respiratory specimens can be kept at 4°C for up to 1 week.
• Please package samples for Category B shipping to the Georgia Public Health Laboratory:
• Wrap the primary specimen tube(s) in bubble wrap or some other cushioning material and secure with tape. 
• Place the specimens in a plastic bag with a biohazard symbol, place an absorbent sheet in the bag and expel the air before sealing the bag.
• Place the sealed bag in a second sealable, water resistant bag (e.g. a tyvek envelope), expel the air and seal the bag.
• Place the cool pack in the bottom of a Styrofoam container, put specimen, along with the appropriate submission form, in the shipper along with a list of the contents.
• Place the styrofoam shipping container in an outer cardboard box, seal the box and be sure the following markings/labels are placed on the box:
  • A) Triangular 3373 label;
  • B) Category B Biological Substance label;
  • C) Complete shipper’s address, including the name and telephone number of a contact person who can be contacted in case the package is damaged;
  • D) Georgia Public Health Laboratory address:
    • Georgia Public Health Laboratory, 1749 Clairmont Road, Decatur, GA 30033