Laboratory
AVIAN INFLUENZA

Agent Overview:		Influenza H5N1: Causative agent is an influenza virus. Human cases of 
			influenza A (H5N1) infection have occurred in several Asian and European 
			countries. It is believed that human H5N1 cases result from contact with 
			infected birds or surfaces contaminated with excretions from infected birds. At 
			this time, there is no evidence of efficient person-to-person transmission. PCR 
			testing is available at DPHL and is performed by special request.  DPHL 
			will facilitate culture confirmation of Delaware suspect cases by CDC.

Lab Specimen Submittal:	Authorization by Dr. Jane Getchell, Director DPHL, or Christina Pleasanton 
			Deputy Director DPHL. Specimens for laboratory testing should be submitted to 
			the DPHL only for patients who meet clinical and epidemiologic criteria.  Testing 
			for influenza A (H5N1) is indicated for hospitalized patients with:
	
			a.	radiographically confirmed pneumonia, acute respiratory distress 
		 		syndrome (ARDS), or other severe respiratory illness for which an 
				alternate diagnosis has not been established, AND

			b.	history of travel within 10 days of symptom onset to a country with 
				documented H5N1 avian influenza in poultry and/or humans (for a listing 
				of H5N1-affected countries, see the WHO web site at http://www.who.int/en/ )

			Testing for influenza A (H5N1) should be considered on a case-by-case basis 
			in consultation with public health epidemiologists for hospitalized or ambulatory 
			patients with:

			a.	documented temperature of >38*C (>100.4*F), AND

			b.	one or more of the following: cough, sore throat, shortness of breath, 
				AND

			c.	history of contact with domestic poultry (e.g., visited a poultry farm, 
				household raising poultry, or bird market) or a known or suspected 
				human case of influenza A (H5N1) in an H5N1-affected country within 10 
				days of symptom onset.
	
Type of Specimens	Call the DPH Laboratory (302-223-1520) for information about laboratory 
Necessary for Testing:	testing and to coordinate the submission of specimens for analysis.

			SPECIMEN COLLECTION from hospitalized patients: 
			*Upper Respiratory: nasopharyngeal aspirate, nasopharyngeal and 
			oralpharyngeal swabs.
			*Lower Respiratory: Broncheoalveolar lavage (BAL), tracheal aspirate 
			or pleural tap.
	
Packaging instructions: Clinical specimens must be in unbreakable double containers and outside of
			container decontaminated with bleach (10%).	

Receiving specimens	Authorized specimens are accepted at the back of the building by the loading                   
at DPHL:		dock. Submitter must present ID and have proper forms completed.
 	
Handling of Specimens:	Specimens must be kept at refrigerator temperature (in a cooler, but not frozen) 
			until delivered to the laboratory.

Reporting Results:	
Preliminary:  		A preliminary positive or negative test result is issued upon 
			completion of PCR. PCR may take 4 to 24 hrs. However, all PCR results must 
			be confirmed by culture at CDC.

Contact Information:	Jane Getchell, DrPH, DPHL director, 302-223-1520 (24/7 coverage). 
 
 
 
24/7 Emergency Contact Number:  1-888-295-5156
Revised: 05/2008  Doc. No. 35-05-20/08/05/50