Tests Performed

• fluorescent antibody test on punch biopsy of skin from the nuchal region
• fluorescent antibody test on corneal impressions
• in vitro virus isolation from saliva
• virus neutralization assay on serum, for evidence of rabies antibody
• virus neutralization assay on cerebrospinal fluid, for evidence of rabies antibody
• RT-PCR for viral RNA and genomic nucleotide sequence analysis on saliva

Negative results with these procedures do not rule-out rabies infection, as ante-mortem tests may remain negative well into the clinical period of rabies infection. Make arrangements for testing with the Rabies Laboratory Director by telephone (518) 485-6464 before sending specimens.

Specimen Collection

Punch biopsy

• From the back of the neck
• Full thickness and 0.3-0.5 centimeter in diameter
• Include a few hair follicles

Corneal impressions

• Obtained by an ophthalmologist
• Firmly rub a flat surface of a clean microscope slide on each cornea (the slide should be labeled to identify the surface with the impression).

Saliva sample

• 1 mL minimum volume
• In plastic sputum jar or tube.

Serum and CSF

• 1 mL minimum volume

Specimen Storage

Quickly freeze all ante-mortem samples and store at -70° C until submission.

Specimen Shipping

Ship all ante-mortem samples on dry ice.

All samples should be collected, packaged and transported under strict isolation and biocontainment practices.Should the patient die, fresh refrigerated or frozen, not fixed brain tissue including one cubic-centimeter piece each of cerebellum and brainstem, should be submitted for immunofluorescence examination and virus isolation.

Required Specimen Submission Information

If you have access to the Health Commerce System (HCS) and the Clinical Laboratory Information Management System (CLIMS), follow steps below:

• Log onto the Health Commerce System (HCS)_[1]
• Select 'CLIMS'
• Select 'Remote Order'
• Click on the tab that indicates the type of sample you would like to submit: human, animal, environmental, etc.
• Fill in the screens, ‘Place the Order’, print form and submit with specimen.

This method provides many advantages over paper submission including specimen tracking, notification when results become available, online access to results and access to testing catalog. Should you encounter difficulty, please access the Reference Guide in the Remote Order application or contact CLIMS_[2].

Note: If you are from a licensed clinical laboratory with a valid PFI number or county or regional health department your HIN/HCS coordinator can grant you access to CLIMS (and create your HCS account if needed). For all other access, the Request for Access to the Wadsworth Center Laboratory Information Management System (CLIMS) form must be completed, signed and faxed to (518) 474-8140 or (518) 473-1326.

If you do not have access to HCS/CLIMS, complete the Infectious Diseases Requisition form_[3], print and send with the specimen. 

For each non-CLEP certified test, complete a Non-permitted Laboratory Test Form_[4].

Instructions for completing the form (with or without access to Health Commerce)

1. Enter the full name of the patient, date of birth and address, include county. 
2. Fill in the submitter’s reference number.
3. Fill in the hospital name and complete address where the report is to be sent. 
4. Provide the full name of physician and phone number and indicate who should be contacted with results.
5. Examination requested is Other -Rabies- Ante Mortem.
6. If known: Exposure to bat or other rabies vector species should be indicated under LAB FINDINGS.  
7. All known CLINICAL HISTORY should be completed.
8. Important information to provide if known would be previous vaccination and /or previous exposure.  
9. Print a copy to include with the specimen during shipping. 

Results

• Results will be phoned to physician
• Electronic copies can be accessed by logging into the Health Commerce System_[5].
• Results will be mailed if submitter has not subscribed to the HCS