The diagnostic facilities of the Wadsworth Center are designed to provide laboratory services for persons in the state for whom such services are not otherwise available. Please use local or commercial laboratory services whenever available. To order collection kits and infectious disease requisitions, contact the New York State Department of Health's Order Desk at PO Box 509, Albany, NY 12201-0509 (Telephone: (518) 474-4175)
|Swab outfit with viral transport media||DOH-483|
|Miscellaneous outfit with empty tube for CSF, blood, urine etc.||DOH-727|
History and Specimen Labeling
Fill in the Infectious Diseases Requisition Form as completely as possible. Please fill out one form per specimen submitted. Do not ask for “virus studies”. If the condition is obscure, indicate whether the symptoms are respiratory, gastrointestinal, central nervous system, etc. Provide the date of onset of illness and collection date for the specimen. Each specimen should be labeled with patient name, specimen type, and the date and time collected.
If you have access to the Health Commerce System (HCS) and the Clinical Laboratory Information Management System (CLIMS), follow steps below:
- Log onto the Health Commerce System (HCS)
- Select 'CLIMS'
- Select 'Remote Order'
- Click on the tab that indicates the type of sample you would like to submit: human, animal, environmental, etc.
- Fill in the screens, ‘Place the Order’, print form and submit with specimen.
This method provides many advantages over paper submission including specimen tracking, notification when results become available, online access to results, and access to the testing catalog. Should you encounter difficulty, please access the Reference Guide in the Remote Order application or contact CLIMS.
Note: If you are from a licensed clinical laboratory with a valid PFI number or are from a county or regional health department your HIN/HCS coordinator can grant you access to CLIMS (and create your HCS account if needed). For all other access, the Request for Access to the Wadsworth Center Laboratory Information Management System (CLIMS) form must be completed, signed, and faxed to (518) 474-8140 or (518) 473-1326.
Respiratory Tract Specimens
Respiratory specimens should be collected as early as possible in the course of illness. The likelihood of recovering most viruses diminishes markedly >72 hours after symptom onset. Two common types of specimens should be collected: (1) nasopharyngeal/oropharyngeal swabs or (2) nasopharyngeal wash/aspirate. Nasopharyngeal/oropharyngeal swabs are the specimen of choice for respiratory viruses.
Collection of nasopharyngeal/oropharyngeal swabs: Flocked swabs are preferred. Sterile dacron or rayon swabs with plastic or flexible metal handles may also be used. Do NOT use cotton or calcium alginate swabs or swabs with wooden sticks as they may contain substances that inactivate some viruses and inhibit PCR.
- Nasopharyngeal swabs: Insert swab through the nasal cavity and into the posterior nasopharynx. Rub swab against mucosal surface and leave in place for 5 seconds to absorb secretions. Repeat procedure for second nostril.
- Oropharyngeal swabs: Swab both posterior pharynx and tonsillar areas, avoiding the tongue. Place both NP and OP swabs immediately into labeled sterile tubes containing viral transport medium. Break both applicator sticks off at the score line (flocked swabs) or near the tip, or cut with sterile scissors (metal shaft NP swabs) to permit tightening of the cap. Ship sample immediately on cold packs.
- Collection of nasopharyngeal wash/aspirate: Have the patient sit with the head tilted backward. Instill 1.0 - 1.5 ml of nonbacteriostatic saline (pH 7.0) into one nostril. Flush a plastic catheter or tubing with 2.0 - 3.0 ml of saline. Insert the tubing into the nostril parallel to the palate. Aspirate nasopharyngeal secretions. Repeat this procedure with the other nostril. Collect specimens in labeled sterile vials. Ship sample immediately on cold packs.
- Broncheolar lavage, tracheal aspirate, pleural tap: If these specimens have been obtained, place in sterile, labeled vials with external caps and internal O-ring seals. If there are no internal O-ring seals, cap securely and seal with parafilm. Ship sample immediately on cold packs.
Vesicles and other skin lesions
It is best to sample fresh, fluid-filled lesions as more viruses are recovered from these lesions than from older crusted vesicles. Use a 26- or 27-guage needle and tuberculin syringe to aspirate liquid from the vesicle. The fluid should then be expressed into the labeled tube of viral transport medium, rinsing and flushing the needle and syringe with viral transport medium. The vesicle can then be unroofed and swabbed vigorously to obtain cells from the base of the lesion. Flocked swabs are preferred, but sterile dacron or rayon swabs with plastic handles can also be used. Do NOT use cotton or calcium alginate swabs or swabs with wooden sticks as they may contain substances that inactivate some viruses and inhibit PCR. The swab should be immediately placed into the labeled sterile tube of viral transport medium. Ship sample immediately on cold packs.
Collect 5-10ml of clean voided urine in labeled sterile containers with external cap and an internal O-ring seal. If there is no internal O-ring seal, cap securely and seal with parafilm. Urine for virus isolation (e.g. viruria due to measles or mumps) should be collected within three days of onset of symptoms. Ship sample immediately on cold packs. Do not freeze.
Collect spinal fluid for neuropathogenic viruses within seven days of onset of symptoms. Collect in sterile, labeled container. Do NOT put into virus transport medium. Freeze immediately at -70ºC and ship on dry ice.
Collect a minimum of 4 spoonfuls of stool using the enclosed spoon from the collection kit or 1.0 g/ml of stool as soon as possible after onset of symptoms. (Quantities greater than 1.0 gram or milliliter are preferred. Consult lab if quantities are less than suggested minimum). Place in supplied, sterile, collection kit tube or in another leak-proof, sterile container. Make sure container lids are properly aligned and secured. Specimens may be held at 4ºC or frozen until shipped. Ship with cold packs or on dry ice.
Tissue obtained by autopsy or biopsy may be submitted. The type of tissue to be collected depends on the disease. Tissue must be collected as soon as possible after onset of disease or death. Collect in sterile, labeled container. Freeze immediately at -70ºC and then ship on dry ice.
Blood and serum
Collect 7 to 10 ml of blood into a marble-topped tube or a plastic yellow-topped serum separator tube. Spin samples to separate serum. Dispense to a sterile, labeled tube for shipment at room temperature. Alternatively, collect 3 to 5 ml of blood into a labeled lavender-topped tube. Gently mix blood with anticoagulant (not heparin) in tube to prevent clotting. Ship samples at room temperature.
If necessary, the physician may telephone the laboratory to confer with a virologist as to the best types of specimens to be collected and the procedures to be followed. Telephone: (518) 474-4177.
Shipping Samples for Virus Isolation
It is essential that specimens be sent to the Virology Laboratory at the Wadsworth Center as soon as possible after collection. All original paperwork must be complete and accompany each specimen. It is the shipper’s responsibility to ensure that appropriate shipping materials are used. Please contact your carrier for shipping and packaging information. Please refer to IATA and NYSDOT regulations upon shipment.
For refrigeration, use commercially available frozen ice packs. Do not use wet ice. For frozen specimens (culture isolates), use dry ice. All specimens must be shipped "Priority Overnight" and received within 24 hours via chosen carrier. Serum samples may be shipped at room temperature.
Specimens should ONLY be shipped Sunday - Thursday so that appropriate laboratory personnel can be present to accept and accession specimens Monday - Friday.