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 4^oC to -20^oC.
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

Blood >>