Herpes B Virus – Serology and PCR

Testing Indications

Herpes B virus testing is only considered following human exposure to a macaque. Infection with Herpes B virus is extremely rare in humans; however, when it does occur, the infection can result in severe neurologic impairment or fatal encephalomyelitis if the patient is not treated soon after exposure.

Testing for Herpes B virus requires prior approval by the PHO laboratory. Prior to submission - ideally after a physician has seen the patient but before specimens are collected - contact PHO’s laboratory's Customer Service Centre at 416-235-6556/1-877-604-4567 or the After-Hours Emergency Duty Officer at 416-605-3113.

Specimens from patients suspected to have Herpes B virus require shipping under the Emergency Response Assistance Plan (ERAP). Submitters should ensure that a Transportation of Dangerous Goods (TDG) certified individual is available to ship the specimens. The PHO Laboratory will assist in facilitation of the ERAP process during the shipment.

Specimen Collection and Handling

Specimen Requirements

Test Requested Required Requisition(s) Specimen Type Minimum Volume Collection Kit

Herpes B Virus PCR1

Swab of infected area/skin lesion2

1 swab

Sterile container without media. Avoid diluting the sample.

Herpes B Virus PCR1

Biopsy or nerve tissue at necropsy3

3.0 mm

Sterile container. Frozen tissue or formalin fixed acceptable. Clearly indicate if tissue is formalin fixed.

Herpes B Virus PCR1

CSF4

1.5-2 ml

Sterile container 1.5-2 ml

Herpes B Virus IgG Serology1

Whole Blood5

5.0 ml whole blood

Blood, clotted - vacutainer serum separator tubes (SST) or serum (red top)

Submission and Collection Notes

1

Herpes B Virus testing specimens are referred to the Special Pathogens Unit at National Microbiology laboratory. Refer to https://cnphi.canada.ca/gts/laboratory/1021

2

Samples for PCR testing should not be obtained from a wound which occurs at the time of exposure, as the act of collection could push infectious virus more deeply into the wound. Samples for PCR should be collected only if symptoms consistent with B virus disease appear, for example, appearance of blisters at or near the exposure site. Swabs may also be collected from macaque oral mucosa following macaque bite of human.

3

For collection of nerve tissue at necropsy, the right and left trigeminal ganglia and/or the sacral dorsal root ganglia should be submitted.

4

CSF should not be bloody; do not centrifuge.

5

Centrifugation of serum tubes (e.g. SST) is not required and should be avoided. Place specimen in biohazard bag and seal. Specimens should be stored at 2°-8°C following collection and shipped to PHOL on ice packs. Herpes B IgG serology testing of the source macaque may also be considered after discussion with the PHO laboratory (see Related Information at the end of this document for further details).

Limitations

The IgG serology in use at NML cross reacts with herpes simplex virus 1 and 2 (HSV-1, HSV-2) due to structural similarity in the glycoprotein targets of the IgG serology assay. Human IgG antibodies against HBV may be tested, but due to substantial cross-reactivity with HSV-1 and HSV-2, these may not be helpful and/or not tested.

Preparation Prior to Transport

Label the specimen with the patient’s full name, date of collection, and one other unique identifier such as the patient’s date of birth or Health Card Number. Failure to provide this information may result in rejection or testing delay.

Herpes B testing require prior approval by the PHO laboratory. Contact Public Health Ontario Laboratory before collecting and sending the specimens.

Follow institutional and provincial guidelines as well as Transport Canada’s Transportation of Dangerous Goods Regulations (TDGR), including their Shipping Infectious Substance Bulletin for specimen collection, transportation and storage. Specimens should be stored at 2 to 8°C following collection and shipped to PHOL on ice packs. Frozen tissue samples should be shipped on dry ice. Formalin fixed samples may be shipped at room temperature.

Special Instructions

Samples should be shipped out as Category A, UN 2814, and require initiation of ERAP
(Emergency Response Assistance Plan). Contact the PHO Customer Service Centre to request assistance in shipping out these types of samples.

In addition to a PHOL General Test Requisition, a National Microbiology Lab submission form must be submitted.

Samples are sent from the PHO Laboratory to the Special Pathogens Section at the National Microbiology Lab in Winnipeg, for both ELISA and PCR testing.

Requisitions and Kit Ordering

Test Frequency and Turnaround Time (TAT)

TAT to receive results is up to 7 days from receipt of specimens at NML.

Reporting

NML reports are received back at PHO, scanned and reported to the submitter.

Specimens that are positive for Herpes B Virus are reported to the Medical Officer of Health as per the Health Protection and Promotion Act.

Test Methods

Both IgG ELISA and PCR tests can be done at NML.

Molecular tests are available for acute diagnosis. Specimens are tested using a Polymerase Chain Reaction (PCR) to detect Herpes B Virus. PCR positive specimens may also be set up for virus culture at NML.

IgG serology is conducted using an in-house ELISA method at NML.The IgG serology in use at NML cross reacts with herpes simplex virus 1 and 2 (HSV-1, HSV-2) due to structural similarity in the glycoprotein targets of the IgG serology assay.

contact lab

Contact Laboratory Customer Service

Laboratory Services

customerservicecentre@oahpp.ca

Updated 20 July 2020