The NHSQL undertakes diagnostic testing for the four quarantinable viral haemorrhagic fevers (VHF) in a physical containment level 4 (PC4) facility. VIDRL can also undertake other testing for any of the human quarantinable diseases if requested. Information on the laboratory testing of samples from persons with a suspected VHF is provided below.
Telephone contact with the VIDRL on-call medical officer is essential before any specimen referral.
The VIDRL on-call microbiologist can be contacted on mobile 0438 599 437. In case of difficulty back-up is provided by the VIDRL on-call laboratory manager (0438 599 439), and the Royal Melbourne Hospital Switchboard (03 9342 7000) if all else fails.
- Detection of haemorrhagic fever viruses (Ebola, Marburg, Lassa, Crimean-Congo, Rift Valley Fever) by nucleic acid.
- Acute serum or plasma
- Throat Swab
- +/- Urine
- Haemorrhagic fever virus serology (Ebola, Marburg, Lasa, Crimean-Congo, Rift Valle Fever viruses).*
- Acute serum
- Convalescent serum
* NB: Serology is only an adjunct to direct detection of VHF viruses.
Specimen Collection and transport
When a patient with suspected quarantinable viral haemorrhagic fever is identified, the NHSQL should be notified through the relevant State or Territory Chief Quarantine Officer. However, direct contact with the medical microbiologist on-call at VIDRL is essential to arrange receipt of specimens and for advice regarding specimen collection, safe packaging and transport.
The essential specimens to be submitted for virus detection are a sample of venous blood, and a throat swab. If post mortem specimens are available, serum, liver, spleen and kidney tissues are desirable.
The following procedures should be followed:
- Venous blood samples must be collected with extreme care to avoid self-inoculation. Ten millilitres of clotted blood should be placed in a sealed plastic container. Needles should not be recapped, bent, broken, removed from disposable syringes or otherwise handled. Blood-taking equipment should be placed into a puncture-proof approved sharps container. When full the container should be placed in a plastic bag, sealed and the outside wiped over with 0.5% hypochlorite, marked with the nature of the contents, and then autoclaved or incinerated.
- Midstream urine specimens should be collected by clean catch. Five millilitres of urine should be placed into a sterile, leak-proof, plastic screw-cap container.
- Throat swabs should be placed in plastic screw-cap containers in 1 ml of sterile, viral transport medium (Minimum Essential Medium plus 2% foetal calf serum, penicillin 100 units/ml, streptomycin 100 ug/ml, neomycin 40 ug/ml and amphotericin B 20 ug/ml; available from VIDRL on request) or equivalent transport medium. A dry swab is preferable if no VTM is available.
- The outside of each specimen container should be swabbed with disinfectant (5000 ppm available chlorine) and a label should be attached bearing the patient’s name, hospital identification, the date of collection and the nature of the suspected infection. The specimens should be double bagged in secure, airtight and watertight bags, which have been similarly labelled. Bags containing specimens should be sponged with disinfectant before they are removed from the patient’s room.
- Samples should be classified as infectious substances affecting humans (Haemorrhagic fever viruses) and packaged and handled as required by International Air Transport Instruction (IATA) instruction 602.
In general, the specimens should be packaged as follows:
- Place the specimens for transport in a tightly sealed, watertight container, such as a screw-cap plastic tube or vial, and seal the cap with tape. Make sure plastic containers are resistant to temperatures as low as -800C.
- Wrap the primary container in sufficient absorbent material (eg. tissue) to absorb the entire contents in case the container leaks or breaks.
- Place the wrapped, sealed primary container in a durable, watertight screw-cap mailing tube or metal can. This secondary container should be sealed with tape. Several primary containers may be placed in one secondary container to a maximum of 50ml of specimen material.
- On the outside of the secondary container, attach the specimen labels and other relevant information.
- Place the second container in a secure box or mailing tube addressed to:
Transport for specimen for virus isolation chilled on wet or dry ice as appropriate, depending on the duration of shipping.
A competent door-to-door courier should be used. Since individual commercial and non-commercial carriers or shipping services may apply different regulations for transporting biologic specimens, contact a representative of the chosen carrier beforehand to ensure all necessary formalities are fulfilled.
Notify the on-call VIDRL medical microbiologist of the dispatch of the specimen with flight time and number, courier or airway bill number as appropriate.
If transport is by air, a dangerous goods declaration must be made. Refer to the IATA Dangerous Goods regulations.
Specimen delivery is to the foyer specimen receiving area at the Doherty Institute, accessed from Elizabeth Street where there are two short-term delivery parking spaces. After 5.30pm or on weekends the specimen shipping container should be deposited in the specimen delivery chute located on the Grattan Street frontage, and a VIDRL staff member notified by calling the specimen reception phone number which appears on the chute. If the package is too big call the on call laboratory manager on 0438 599 439.
- National High Security Quarantine Laboratory
Victorian Infectious Diseases Reference Laboratory (VIDRL)
The Doherty Institute
792 Elizabeth Street
Melbourne Vic 3000