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					Guidance for Laboratory Diagnosis of Swine Flu – North West

This guidance may be updated over the next few days, depending
on the situation.
Specimens should only be collected from patients who meet the case definition for
swine influenza. Up to date algorithms can be found on the HPA website
www.hpa.org.uk

Specimens must be taken by the attending physician or GP.

All suspected cases must be discussed with the local Health Protection Unit1 to
assess whether the case definition is met.

HPU Contact Telephone Numbers

                                     Normal Hours          Out-of-hours

Cheshire & Merseyside HPU            0151 290 8360         0151 264 6922

Cumbria & Lancashire HPU             01257 246 450         01772 716565

Greater Manchester HPU               0161 786 6710         0161 331 6000

The HPU will contact the HPA Regional testing laboratory to confirm that H1N1 testing
has been requested and is appropriate.

If case definition is met:

The testing physician should contact the local Microbiology Laboratory (the laboratory to
which samples are routinely sent) to request swabs and virus transport medium (VTM).

If a GP practice does not hold VTM the local laboratory should send VTM and appropriate
packaging by taxi or courier to the GP (see Appendix 1 for courier details; taxi costs will be
reimbursed by the local HPU).

If VTM is unavailable dry swabs without medium should not be used.

Certain Chlamydia collection kits may however be used as an alternative. The Roche
Chlamydia PCR medium is one that is known to be satisfactory.

Specimen collection – nose and throat swabs

Duplicate sets of samples are required. One nose swab (from the back of the nasal cavity)
and one throat swab should be combined into a single vial of VTM, and these swabs
repeated for a second vial.

The accompanying request form for the Regional HPA Virology Laboratory at Manchester
Royal Infirmary (MRI) should state the name, date of birth and address of the patient, and
ideally NHS number. The sample vials should also be labelled with at least two identifiers.
The request form should also have written in the clinical details section ‘?swine flu ILOG
953010’.


NW Regional Lab: 28 April 2009                                                              1
The samples are to be packaged in accordance with UN3373.

The samples should be sent to the HPA Virology Laboratory at MRI by Courier – see below.

Alternative specimens

Patients with severe illness may have samples other than nose and throat swabs available.
Samples such as sputum, tracheal aspirate, nasopharyngeal aspirate, and bronchoalveolar
lavage material are all acceptable for testing and should be transported as already outlined
(ideally duplicated).

Precautions when collecting samples

The person collecting nose and throat swabs should preferably wear FFP3 masks - this is
mandatory for hospitalised patients - but if these are not available or not fitted for the
individual then a surgical mask should be worn

For collection of samples other than nose and throat swabs from a person who does not
have a cough properly fitted FP3 masks must be worn, together with gloves, plastic apron
and eye protection.

Courier arrangements:

The HPA has arranged contracts with two courier companies to provide this urgent 24/7
specimen transport service in England. The main contractor is TNT Special services
(Sameday) with City Sprint as the back up facility if required (see below).

 From Hospital sites:

    The courier should be arranged according to details in Appendix 1.

 From GP practices:

   The courier should be arranged as follows - HPU to contact the courier company to
   arrange for specimens to be collected from the Practice [and delivered to the HPA
   Virology Laboratory – see Appendix 1. The HPU should also determine from the courier
   company the expected delivery time of the specimen from time of collection and obtain a
   job reference number which may aid tracking if there is a query. The HPU should then
   phone the Laboratory to inform them that the specimens are being submitted and the
   estimated time of arrival.

Handling samples in the laboratory

Respiratory tract specimens from patients suspected of swine influenza should be treated as
Category 3 samples and handled appropriately.

Testing and results

At the HPA/MRI Virology Department samples will be tested urgently for influenza during the
day, with results excluding or confirming influenza A within 6-8 hours. At present samples are
to be batch tested with two to three runs per day. Samples arriving between 3pm and 7pm in
the laboratory would be tested overnight, with results available around 10.00am the following
morning.




NW Regional Lab: 28 April 2009                                                              2
Additional testing for subtyping of positive influenza strains to differentiate H1 strains, and for
additional testing for a range of respiratory viruses in samples negative for influenza will be
undertaken. The laboratory will aim to have these results within 12-24 hours.

If positive for Influenza A virus, the sample will then be sent for confirmation to Centre for
Infections, Colindale, London.

Results (both positive and negative) will be telephoned to the HPU and to the sending
physician.




NW Regional Lab: 28 April 2009                                                                   3
APPENDIX 1

Protocol for the transport of Suspected Cases of human Avian Flu or Swine Flu from
hospital sites to specified regional testing laboratories

1. This protocol comes into effect when a suspected case of human avian flu or swine flu
   has had a full clinical and risk assessment by the originating clinician and the HPA [local
   Health Protection Unit (HPU) or Centre for Infections] and the HPA has confirmed that
   diagnostic testing (H5N1/H1N1) is required.

2.     HPU contacts the HPA Regional testing laboratory to confirm that H5N1 / H1N1
       testing has been requested.

3.     NHS Hospital/Laboratory telephones the HPA Regional testing laboratory and
       confirms the arrangement to send specimen via courier.

4.     NHS Hospital/Laboratory contacts the courier company to arrange for specimen to be
       collected from [specified name, location and contact number] and delivered to:

               From 9.00am – 5.00pm –      Virology Department, Clinical Sciences Building,
                                            Manchester Royal Infirmary, Oxford Road,
                                            Manchester, M13 3WL

               Out-of-hours –       The Patient’s Reception, Accident & Emergency
                                     Department, Manchester Royal Infirmary, Oxford Road,
                                     Manchester, M13 9WL

       NHS Hospital/Laboratory should also determine from the courier company the
       expected delivery time of the specimen from time of collection and obtain a job
       reference number which may aid tracking if there is a query.

       The HPU/Sender should contact the Virology Laboratory on:

           0161 276 8853/7543 – between 9.00am – 5.00pm

           0161 276 1234 – out-of-hours. As for Virologist on call

       The HPA has arranged contracts with two courier companies to provide this urgent
       24/7 specimen transport service in England. The main contractor is TNT Special
       services (Sameday) with City Sprint as the back up facility if required.

       Main Contractor

       TNT Special Services (Sameday)

       24/7 contact telephone number – 0845 1247 365 or 0207 720 7800

       Quoting Account number - 0100288197

       Service Contacts:             Mike Sharp - 0207 720 7800 (extn 2100)
                                     Marc Trathen - 0777 6228441




NW Regional Lab: 28 April 2009                                                              4
       Back up contractor

       City Sprint

       24/7 contact telephone number – 0844 888 4115

       Quoting Account number – M7100

       Service Contacts:             Andrew Turner -       07989 857 816
                                     David Potter -        07989 855 424

       [Note the sending hospital / laboratory will be invoiced for the cost of the specimen
       transport.]

5.     Suspected human avian flu or swine flu specimen packed by NHS
       Hospital/Laboratory according to category B transport regulations. Any queries on this
       should be referred

6.     Courier company [TNT Special Services (Sameday) or City Sprint] collects from
       specified name at specified location within 1 hour of call. [Note for certain locations
       City Sprint may be offering a two hour collection time.] NHS Hospital/Laboratory signs
       for specimen collection.

7.     NHS Hospital/Laboratory contacts the specified name at the HPA Regional testing
       laboratory to confirm the specimen is on its way and to give the expected arrival time.

8.     Courier company delivers to specified name at specified location at the HPA Regional
       testing laboratory. Specified name signs for safe receipt of specimen.

9.     The specified name at the HPA Regional testing laboratory calls the NHS
       Hospital/Laboratory specified name to confirm safe receipt.

10.    Testing procedure commences.




NW Regional Lab: 28 April 2009                                                              5

				
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