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TESTING DIRECTORY


LABORATORY TESTING SERVICES

This section outlines investigations offered by all the departments of the laboratory. These guidelines are applicable for routine specimen referrals.

Please note - Potential outbreaks are managed on a case by case basis following contact with the Laboratory and Epidemiology divisions for further guidance.

Note:

All specimens referred for serological testing assays should:

  • Have a minimum volume of 1.0 ml.
  • Be maintained at temperatures within the range of 4oC to -20oC.
  • Be contained in appropriate vials that do not exceed the dimensions of 1.5 cm diameter and 4.7 cm in height e.g. Nunc vial. Only vials with external threads should be used.


Specimens submitted under the Expanded Programme on Immunization (EPI)

Please check the EPI field guide or the EPI manager in-country for further information for the following vaccine preventable diseases covered under the EPI elimination or eradication programme

  • Congenital rubella syndrome
  • Measles
  • Poliomyelitis
  • Rubella (German measles)


Matrix of Disease/Etiology Specimen Type/s Diagnostic Method and Turnaround Times

Disease/Aetiologic Agent Comment Specimen Method Turnaround Time (Days)

Campylobacter

Performed at CARPHA for countries without testing capability

Isolate in Cary Blair media;

Stool

Culture and biochemical tests

7

Chlamydia infection

Please contact CARPHA before submission of specimens

(Sent to CARPHA's Reference Laboratory)

Vaginal discharge in transport media

PCR

14 - 21

Chicken pox (varicella)

Please contact CARPHA before submission of specimens

(Sent to CARPHA's Reference Laboratory)

Vesicle swab

Serum

PCR

IgG ELISA

14 - 21

Chikungunya

Performed at CARPHA for outbreaks

Acute serum (collected 1-4 days from onset);

PCR

7

Cholera

Initial laboratory testing in country,

CARPHA: referral for further testing

Isolate in maintenance media

Stool in Cary Blair media

Serotyping

Confirmation

7

Ciguatera poisoning

Please contact carpha for discussion and decision making

-

-

-

Diphtheria

Performed at CARPHA for countries without testing capability

Throat swab in transport media

Culture

Biochemical tests and gram staining

14

Dengue Fever;

Dengue haemorrhagic fever

Dengue shock syndrome

Performed at CARPHA for countries without testing capability

Acute serum (collected 1-4 days from onset);

PCR

7

Convalescent serum (collected 7-15 days from onset)

IgM ELISA

7

E. coli (pathogenic)

Performed at CARPHA for countries without testing capability

Isolate in maintenance media;

Stool in Cary Blair media

EIA assay;

Serotyping;

Confirmation

7

EBV

Not routinely tested

CARPHA to be contacted for discussion and assistance prior to submission of specimens

Serum

IgM ELISA

7

Neisseria Gonococcal Infection

Performed at CARPHA for countries without testing capability

Isolate in BHI with glycerol or on chocolate agar

Culture;

Antimicrobial Resistance (AMR) testing

7 - 14

Influenza and other Respiratory syncytial, Parainfluenza 1 - 4, Metapneumovirus, Adenovirus, Rhinovirus

Performed at CARPHA for countries without testing capability

Nasopharyngeal or oropharyngeal swabs, aspirate or washes;

Broncheoalveolar lavage, tracheal aspirates (collected within 1 -7 days of onset)

PCR

Virus isolation

7
28

Leptospirosis

Performed at CARPHA for countries without testing capability

Serum (collected > 5 days after onset)

IgM ELISA

7

Malaria (indigenous and imported)

Laboratory testing: in-country

CARPHA: to be contacted for discussion if necessary

Thick and thin slides

Microscopy

2

Meningitis infection (due to Neisseria meningitidis)

Performed at CARPHA for countries without testing capability

Isolates to be submitted to CARPHA for further characterization.

Isolate in BHI with glycerol or on chocolate agar

Culture;

Antimicrobial Resistance (AMR) testing;

Serotyping

7 - 14

Meningitis/Pneumonia (due to Streptococcus pneumoniae)

Meningitis/Pneumonia (due to Haemophilus influenzae)

Norovirus

Performed at CARPHA for countries without testing capability

Stool

PCR;

IgM ELISA

7

Opportunistic infections (e.g. cryptosporidium, CMV, toxo, pnuemo,etc)*

Performed at CARPHA for countries without testing capability

Toxoplasma: Serum

IgM ELISA

7

CMV:serum

IgM ELISA

7

Cryptosporidium: Stool

Microscopy: Stool staining

7

Cryptococus neoformans: CSF

Microscopy: India ink staining

7

Pertussis

Performed at CARPHA for countries without testing capability

Nasopharyngeal or throat swab

Culture;

Referred for PCR testing

7

Plague

Sent to CARPHA's Reference Laboratory

Blood;

Biopsy material from bubo

Blood culture;

Microscopy;

Culture;

Antimicrobial Resistance (AMR) testing

14

Rabies (in humans)

CARPHA: to be contacted for discussion if necessary

(Sent to CARPHA's Reference Laboratory)

-

-

-

Rotavirus

Performed for countries without testing capability in outbreak situations. - Please contact CARPHA for discussion

Stool

Antigen ELISA

PCR

7

Salmonellosis

Performed at CARPHA for countries without testing capability

Isolates to be submitted for further characterization

Isolate in maintenance media

Serotyping;

Phage Typing of S. enteritidis

7 - 14

Shigellosis

Serotyping

Serotyping

7

*Tuberculosis (Pulmonary)

Performed at CARPHA for countries without testing capability

Selected specimens sent to CARPHA's Reference Laboratory

Sputum

Identification (PCR)

Drug Sensitivity Testing (PCR)

4

Tuberculosis (Extra-pulmonary)

Please contact CARPHA submission of specimens

-

-

-

Typhoid and paratyphoid fever

Performed at CARPHA for countries without testing capability

Stool, Isolate in maintenance media

Identification

Serotyping

7

Viral Encephalitis/Meningitis

Performed at CARPHA for countries without testing capability

1 -2 mL acute CSF; nasopharyngeal swab in viral transport media, unpreserved stool

PCR (Enterovirus, HSV1 and HSV 2)

7

Viral Hepatitis A, E

Performed at CARPHA for outbreak investigation

Single serum

IgM ELISA

7

Viral Hepatitis B

Performed at CARPHA for countries without testing capability

Single serum

ELISA (surface antigen HBsAg)

7

Yellow fever

CARPHA for testing:

(Sent to CARPHA's Reference Laboratory)

Single serum

Viral Isolation (when BSL3 facility is available

ELISA; PCR

21




Entomology Specimen Referrals

The following table lists information relevant to the collection and testing of specimens for Entomology investigations.

NOTE: All specimens sent to the Entomological unit must be accompanied by the following information:

  • Method of specimen collection
  • Date and time of specimen collection
  • Name of specimen collector
  • Country and location
  • Type of habitat (from which collection was made)

Test Specimen recommended Notes Turnaround time (calendar days)

Insecticide resistance

Aedes aegypti mosquito eggs

On removal from ovitraps, the paper containing eggs should be placed in a container lined with damp paper towels.

After 2-3 days, the paper should be removed from the container and left to air-dry for 1-2 days. Fold paper in two with the side containing the eggs on the inside.

42

Mosquito identification (larval specimen)

Specimen collected and killed in hot but NOT boiling water

Specimen should be sent in vials containing 70% ethanol.

7

Mosquito identification (adult specimen)

Specimen killed with chloroform, ether, carbon dioxide or rapidly frozen in a domestic refrigerator

The specimen should be packaged and sent in a small vial or cardboard box lined with grease-proof paper or paper towels.

7

Virus isolation:

  • Dengue fever

Live adult mosquitoes:

  • Aedes aegypti

Individual vials should contain a pool of 20 adults. These vials should be lined with grease-proof paper and stored in a -700C freezer until ready for shipment.

Overseas laboratories:
The vials must be transported to CARPHA in a container packed with dry ice.

Local Laboratories:
Live adult mosquitoes should be forwarded directly to CARPHA in ice coolers within 24 hours of collection.

28




SUBMISSION OF SPECIMENS TO CARPHA

Specimens must be routed through the relevant National Reference/ Public Health Laboratory or the Ministry of Health.

The following minimum information must accompany each specimen

1. A labelled specimen container with the following information:

  • National Patient ID/Laboratory Number
  • Date of collection
  • Specimen type

2. Completed CARPHA Laboratory Investigation form (Refer to page. 8) or Country’s Laboratory form with similar information



General Information for Transportation of Specimens

Referred specimens must always be prepared, packaged and transported in accordance with current international shipping guidelines and IATA (International Air Transport Association) regulations.

1. Incoming Receipt Notifications (including baggage tags, airway bill number) should be sent to the Laboratory using the following means of communication –

Data Entry and Reporting Unit

	Fax:				1-868-628-9302, 
	Telephone:		1-868-622-4261/2 
	Email:			customerservice@carpha.org

2. All packages must be addressed in the following manner:

	The Director of CARPHA
	The Caribbean Public Health Agency (CARPHA)
	16-18 Jamaica Boulevard
	Federation Park
	PORT of SPAIN
	TRINIDAD, W.I.



SPECIMEN COLLECTION GUIDELINES


PURPOSE

To describe methods for the collection and transport of the following specimens (most commonly submitted specimens are italicised):

A. Blood

  • Venous Blood Samples
  • Serum from Blood
  • Capillary Blood Samples

B. Respiratory Tract Samples

  • Upper Respiratory Tract Specimens
    • Throat Swab
    • Pre-Nasal and Post Nasal Swab
    • Aspirates
  • Lower Respiratory Tract Specimens

C. Cerebrospinal Fluid


D. Faecal Specimens

  • Stool Specimen
  • Rectal Swab from Infants

E. Eye Specimen


F. Samples From For Skin Lesions

  • Vesicular or Vesiculo-Pustular Rash
  • Crusting Stage
  • Aspiration of Abscesses

G. Urine Specimens


H. Post- Mortem Specimens

  • Collection of Tissue Specimens

I. Sputum Specimens for TB Testing


Caribbean Public Health Agency © 2014