The Wadsworth Center is a reference laboratory. Use local or commercial laboratory services whenever available.

Call the Order Desk at (518) 474-4175 to order kits to be tested at the Wadsworth Center.

Item	Order Number
Fecal outfit	DOH-1795(L)
Swab outfit with viral transport media	DOH-483
Miscellaneous outfit with empty tube for CSF, blood, urine etc.	DOH-727

History and Specimen Labeling

Placing orders electronically is the preferred method for submitting specimens to Wadsworth Center for infectious disease testing. Submitters need an account on the Health Commerce System (HCS) and permission to access CLIMS (Wadsworth Center’s laboratory information management system). Then follow the general steps below or click here for detailed instructions_[1]:

• Log onto the Health Commerce System (HCS)_[2]
• Select 'CLIMS'
• Select 'Remote Order'
• Click on the button that indicates the type of sample you would like to submit: human, animal, environmental, etc.
• Fill in the screens, ‘Place the Order’, print the shipping manifest 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 the testing catalog. The Online Test Request/Reporting page _[3]contains information about CLIMS and helpful resources including Quick Start Guides. Should you encounter difficulty, please access the Reference Guide in the Remote Order application or contact CLIMS_[4].

Note: If you are from a NYSDOH licensed clinical laboratory with a valid PFI number, a NYSDOH licensed nursing home, or a NYS 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 by the new user and an appropriate HCS Coordinator, 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_[5] as completely as possible. Please fill out one form per specimen submitted. Do not ask for “virus studies”. If the condition is obscure, indicate whether the symptoms are respiratory, gastrointestinal, central nervous system, etc. Provide the date of onset of illness and collection date for the specimen. Each specimen should be labeled with patient name, specimen type, and the date and time collected. Print the completed form and send with the specimen.

For each non-CLEP certified test, complete a Non-permitted Laboratory Test Form_[6].

Specimen Collection

If necessary, the physician may telephone the laboratory to confer with a virologist as to the best types of specimens to be collected and the procedures to be followed. Telephone: (518) 474-4177. Refer to the Test Catalog_[7] for test-specific specimen collection information. 

Respiratory Tract Specimens 

Respiratory specimens should be collected as early as possible in the course of illness. The likelihood of recovering most viruses diminishes markedly >72 hours after symptom onset. Two common types of specimens should be collected: (1) nasopharyngeal/oropharyngeal swabs or (2) nasopharyngeal wash/aspirate. Nasopharyngeal/oropharyngeal swabs are the specimen of choice for respiratory viruses.

Collection of nasopharyngeal/oropharyngeal swabs: Flocked swabs are preferred. Sterile dacron or rayon swabs with plastic or flexible metal handles may also be used. Do NOT use cotton or calcium alginate swabs or swabs with wooden sticks as they may contain substances that inactivate some viruses and inhibit PCR.

• Nasopharyngeal swabs: Insert swab through the nasal cavity and into the posterior nasopharynx. Rub swab against mucosal surface and leave in place for 5 seconds to absorb secretions. Repeat procedure for second nostril. Ship sample immediately. See below for shipping instructions.
• Oropharyngeal swabs: Swab both posterior pharynx and tonsillar areas, avoiding the tongue. Place both NP and OP swabs immediately into labeled sterile tubes containing viral transport medium. Break both applicator sticks off at the score line (flocked swabs) or near the tip, or cut with sterile scissors (metal shaft NP swabs) to permit tightening of the cap. Ship sample immediately. See below for shipping instructions.
• Collection of nasopharyngeal wash/aspirate: Have the patient sit with the head tilted backward. Instill 1.0 - 1.5 ml of nonbacteriostatic saline (pH 7.0) into one nostril. Flush a plastic catheter or tubing with 2.0 - 3.0 ml of saline. Insert the tubing into the nostril parallel to the palate. Aspirate nasopharyngeal secretions. Repeat this procedure with the other nostril. Collect specimens in labeled sterile vials. Ship sample immediately. See below for shipping instructions.
• Broncheolar lavage, tracheal aspirate, pleural tap: If these specimens have been obtained, place in sterile, labeled vials with external caps and internal O-ring seals. If there are no internal O-ring seals, cap securely and seal with parafilm. Ship sample immediately. See below for shipping instructions.
• Buccal swabs: Gently massage the parotid gland area on both sides of the face just in front of and below the ears for 30 seconds. Sweep the swab between the cheek and gum from the upper molar to the lower molar for 10 to 15 seconds, being sure to swab across Stensen’s duct. Repeat the same motion on the opposite side of the mouth using the same swab. Place the swab in a sterile tube containing viral transport medium. Ship sample immediately. See below for shipping instructions.

Vesicles and other skin lesions

It is best to sample fresh, fluid-filled lesions as more viruses are recovered from these lesions than from older crusted vesicles. Use a 26- or 27-guage needle and tuberculin syringe to aspirate liquid from the vesicle. The fluid should then be expressed into the labeled tube of viral transport medium, rinsing and flushing the needle and syringe with viral transport medium. The vesicle can then be unroofed and swabbed vigorously to obtain cells from the base of the lesion. Flocked swabs are preferred, but sterile dacron or rayon swabs with plastic handles can also be used. Do NOT use cotton or calcium alginate swabs or swabs with wooden sticks as they may contain substances that inactivate some viruses and inhibit PCR. The swab should be immediately placed into the labeled sterile tube of viral transport medium. Ship sample immediately. See below for shipping instructions.

Urine

Collect 2.5 to 4.0 ml of clean voided urine in labeled sterile containers with external cap and an internal O-ring seal. If there is no internal O-ring seal, cap securely and seal with parafilm. Urine for virus isolation(e.g. viruria due to measles or mumps) should be collected within three days of onset of symptoms. Ship sample immediately. See below for shipping instructions. 

CSF

Collect spinal fluid for neuropathogenic viruses within seven days of onset of symptoms. Collect in sterile, labeled container. Do NOT put into virus transport medium or any preservatives. Ship 1 to 3 ml. Freeze immediately at -70ºC or below. See below for shipping instructions. 

Stool

Collect a minimum of 4 spoonfuls of stool using the enclosed spoon from the collection kit or 1.0 g/ml of stool as soon as possible after onset of symptoms. (Quantities greater than 1.0 gram or milliliter are preferred. Consult lab if quantities are less than suggested minimum). Place in supplied, sterile, collection kit tube or in another leak-proof, sterile container. Make sure container lids are properly aligned and secured. Specimens may be held at 4ºC or frozen (<0ºC) until shipped. Ship sample immediately. See below for shipping instructions.

Tissue

Tissue obtained by autopsy or biopsy may be submitted to Wadsworth for testing. The type of tissue to be collected depends on the disease. Tissue must be collected as soon as possible after onset of disease or death. Collect in sterile, labeled container. Freeze immediately at -70ºC. Tissue should be fresh frozen NOT formalin-fixed or paraffin-embedded. See below for shipping instructions. Formalin-fixed or paraffin-embedded tissue may be submitted with prior approval for CDC-referral testing ONLY.  See below for shipping instructions.

Blood and serum

Collect 7 to 10 ml of blood into red-top or gold-topped serum separator tube (or equivalent). Allow the blood to clot at room temperature (15-25°C), and do not freeze (<0°C) prior to spinning.Spin samples to separate serum. Dispense to a sterile, labeled tube for shipment.  Ship >2.5 ml. Ship sample immediately. See below for shipping instructions.

Shipping Instructions

Preferred Method: Ship samples frozen (< 0°C) with enough dry ice to last until delivery to Wadsworth Center. Use at least 2 kg (5 lbs) of dry ice.

• Exceptions:
  • requests for CMV, RSV, or VZV virus culture, follow Alternative Method below.
  • formalin-fixed or paraffin-embedded tissues for CDC referral testing ONLY (and with prior approval), samples can be sent following Alternative Method below or at room temperature (15-25°C). 

Alternative Method: If dry ice isn’t available, ship samples overnight with frozen (< 0°C) ice/gel packs. Do not use wet ice. Gel packs must be at least 680 g (24 oz) and frozen to -20°C or colder before use. Samples must arrive the next day.

Packaging: Always use an insulated box with a Styrofoam (or equivalent) insert. Choose a size that allows at least two-thirds of the space to be filled with dry ice or ice packs surrounding the sample.

Timing: Specimens should ONLY be shipped using an overnight courier Sunday – Thursday, excluding days preceding holidays, so that appropriate laboratory personnel can be present to accept and accession specimens Monday - Friday.

It is essential that specimens be sent to the Virology Laboratory at the Wadsworth Center as soon as possible after collection. All original paperwork must be complete and accompany each specimen. It is the shipper’s responsibility to ensure that appropriate shipping materials are used. Please contact your carrier for shipping and packaging information. Please refer to IATA_[8] and NYSDOT_[9] regulations upon shipment.