Rabies Laboratory Submission Policy

Links

• Examination of Animal Specimens
• Examination of Human Serum for Rabies Antibody
• Antemortem Diagnosis of Human Rabies

Examination of Animals for Evidence of Rabies Infection

• Submission of a rabies specimen requires prior approval of the local health authority (county health department or district office of the State Health Department). Emergency and after-hour exceptions can be made with the approval of the Rabies Laboratory:

  TELEPHONE 518-869-4527

  AFTER-HOURS 518-527-7369 OR 527-7370.

• Acceptable specimens include:

  a. rabies suspect mammals for which there has been a reported bite, scratch, or other possible saliva or nervous tissue exposure to a human.

  b. all bats encountered in situations where it is possible that human contact that may have occurred would have gone undetected.

  c. rabies suspect mammals with reported bites to (or other "intimate" contact with) a domestic animal.

  d. highly suspect surveillance specimens (no reported contacts), including (i)rabies vector species showing clear signs of rabies infection, from an area without previous confirmed cases; (ii) a mammal not commonly recognized as a rabies vector, but showing clear signs of rabies infection; (iii) a domestic animal that dies or is euthanatized under the care of a veterinarian for which rabies is part of the differential diagnosis of neurologic disorder.

  e. specimens associated with laboratory-approved enhanced surveillance programs associated with wildlife vaccination trials.

• No live animals will be accepted by the laboratory. The intact head only of approved specimens will be accepted. Exceptions include bats, which should be submitted whole, and livestock, for which a cross-section of the brainstem and representative sections of all 3 lobes of the cerebellum, removed by a veterinarian, constitute the specimen.
• Specimens must be properly packaged in a standard rabies shipping container (available at county health department). Specimens must be accompanied by a completed rabies specimen history form (PDF 480K). Submitters should see rabies specimen packing and shipping instructions for details.
  Download a free PDF Reader.
• Rabies diagnosis is performed weekdays from 8:00 a.m. - 4:30 p.m. Specimens received evenings, weekends, or holidays are processed the next regular workday.
• Emergency Examination. An animal that has bitten a human and is highly suspect of rabies infection because of species, behavior, and location of capture, and for which a physician is awaiting the results before initiating post-exposure rabies prophylaxis, will be examined on a weekend or holiday, by prior arrangement with the laboratory. Such specimens must arrive at the rabies laboratory prior to 11:00 a.m. to be tested the same day, and should be accompanied by telephone numbers of the after-hour contact to receive results. Because some bat bites may be more difficult to recognize than those of other rabies vector species, all cases of direct human contact with a bat, when bite or mucous membrane contact cannot be ruled out, should be treated as an emergency.
• During warm months, it is particularly important that specimens being shipped on Fridays or preceding holidays be sent with attention to prompt delivery and proper packaging. If hand delivery cannot be arranged, then accelerated courier service should be requested. If using U.S. Postal Service , request Express Mail. If using a commercial carrier , request Saturday delivery. Do NOT request Next Day Service, as this usually refers to the next normal business day, and will needlessly delay delivery of the specimen. Instruct packers to place one or two extra freezer packs in the standard rabies shipping container.
• Specimens shipped by any courier OTHER than U.S. Postal Service should be re-addressed to:
  Rabies Laboratory
  Griffin Laboratory
  5668 State Farm Rd.
  Slingerlands, NY 12159
• Routine rabies examination results will be sent by FAX to the county or district health office, that shall in turn notify other interested parties. Reports will be available at the local health office during the workday morning following receipt of the specimen at the laboratory. Except for emergencies and late Friday submissions, local offices are asked to refrain from calling the laboratory routinely for examination results. Reports of rabid animals will continue to be immediately reported by telephone to the local health authority.

Examination of Human Serum for Rabies Antibody

• Following Postexposure Prophylaxis or Initial Pre-exposure Immunization. Serologic confirmation of adequate response (0.5 IU or greater) is not routinely necessary. Testing will be performed when:

  a. the patient is suspected to be immunocompromised.

  b. a vaccine is employed which is not licensed for use in the U.S.

  c. terms of administration (schedule, dose, route) are other than those in the manufacturer's recommendation.

• To determine need for booster vaccination in order to maintain pre-exposure immunization status. Testing will be performed at two years or longer after the most recent dose of vaccine. If adequate antibody titer ( 0.5 IU or greater) is demonstrated, testing will be repeated annually until a booster vaccination is required. Note: testing for rabies antibody is not appropriate when a previously immunized individual is exposed to rabies: two 1 ml doses must be administered intramuscularly as soon as possible after the exposure, regardless of current antibody titer. Previously immunized is defined for this purpose as a patient that received pre- or postexposure vaccination with a currently licensed vaccine according to the manufacturer's recommendations, or vaccinated by any other means and at any time had serologically-confirmed adequate response (0.5 I.U. or greater).
• The sample for rabies serology is 3 ml of serum. When testing follows pre- or postexposure vaccination, the sample should be collected 2-4 weeks after administration of the last dose of vaccine.
• Rabies serology samples can be submitted directly to the laboratory. Rabies Serology Kits, which include the necessary form and instructions, can be ordered by calling 518-474-4175 and requesting Kit #DOH 3542. One kit is necessary for each specimen. Note: a fully completed Infectious Diseases Requisition form (PDF 101K) must accompany each specimen, or testing will not be performed.
  Download a free PDF Reader.
• Serology results will be mailed to the submitter identified on the form, normally within two weeks following receipt of the sample.

Antemortem Diagnosis of Human Rabies

• The diagnosis of rabies in human patients with symptoms indicative of rabies infection can be achieved with the following tests:

  a. fluorescent antibody test (FAT) on skin punch biopsy from the nuchal region and on corneal impressions.

  b. in vitro virus isolation from saliva.

  c. virus neutralization assay on serum and cerebrospinal fluid (CSF) for evidence of rabies antibody.

  d. rt-pcr on saliva for rabies viral RNA.

• Prospective submitters should arrange testing with the laboratory Director by telephone. We need 1.0 ml each of serum and CSF. Corneal impressions should be taken by an opthomologist, by rubbing the flat surface of a clean microscope slide on the cornea (the slide should be labeled to identify the surface with the impression). The saliva sample (one ml) can be aspirated into a plastic jar or tube. The punch biopsy of skin should be taken from the back of the neck, full thickness, 0.3 - 0.5 centimeters in diameter, including several hair follicles. All ante-mortem samples should be quickly frozen, stored at -70oC and shipped with dry ice.
• Positive results with virus isolation or FAT, or evidence of rabies antibody in serum and CSF, are indicative of rabies infection. Negative results with these procedures do not rule-out rabies infection, as antemortem tests for antibody and rabies antigen may remain negative well into the clinical period.
• Physicians and pathologists must be reminded that should the patient die and rabies is suspected, fresh (not fixed) brain tissue, including cerebellum and brainstem, should be submitted for FAT and virus isolation.
• All samples should be collected, packaged, and transported under strict isolation and biocontainment practices.