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Influenza - Respiratory
SPECIMEN REQUIREMENTS
Specimen Type:

​Nasopharyngeal swab, throat swab, bronchoalveolar lavage (BAL), pleural fluid, respiratory tract tissue

Container/Kit:

Virus-Respiratory Collection Kit. Nasopharyngeal aspirates, pleural fluid, respiratory tract tissue or BALs may be submitted in sterile containers.


The recommended respiratory specimen is a nasopharyngeal swab or aspirate.

Collection information:

​To order Collection Kits or other PHOL Supplies complete the Requisition for Containers and Supplies. The form should be faxed to the Public Health Ontario Laboratory at 416-235-5753 or your local PHOL.

Minimum volume required:

​Submit 1 swab or 2.0 ml aspirate

Requisition:

​Complete all fields of the General Test Requisition Form. Ensure the following fields are completed if diagnostic testing is requested: 

  • Patient setting (see test information below)
  • Symptoms
  • Onset date
  • Travel history 
  • Animal exposure; contact PHOL Customer Service if submitting specimens from a patient with respiratory symptoms of onset within 10 days of swine or avian exposure
Limitation:

​None

SPECIMEN HANDLING
Preparation prior to transport:

​Place specimen in biohazard bag and seal. Specimens should be stored at 2-8°C following collection and shipped to PHOL on ice packs.

Special Instructions:

​Follow the instructions found in the Virus-Respiratory Kit Instruction Sheet.

TEST INFORMATION

Public Health Ontario Laboratories (PHOL) utilizes different testing algorithms for influenza and other respiratory viruses during the winter and summer seasons.

The winter algorithm usually takes effect the first Monday of November and remains in effect until the first Sunday of May.

The summer algorithm usually takes effect the first Monday of May and remains in effect until the first Sunday of November.

Exact effective dates may vary due to influenza activity in the community during the transition time periods.


Refer to the table below:

Patient Setting1
Winter
Summer
In-patient ICU/CCU2
Influenza A/B RT PCR (and subtype if flu A is positive).
If flu A or B is positive then no further testing will be performed. If flu A/B is negative, samples will be further tested by Rapid Viral Culture3,4
Rapid Viral Culture3,4
Inpatient ward/Institutions
Influenza A/B RT PCR (and subtype on a selection of flu A-positive specimens).
If flu A or B is positive then no further testing will be performed. If flu A/B is negative, samples will be further tested by Rapid Viral Culture3
Rapid Viral Culture3
Institutional Respiratory Infection Outbreaks
Influenza Rapid Testing up to 4 outbreak samples.
Influenza A/B RT PCR (1 sample from each flu A-positive outbreak will be subtyped).
If flu A or B is positive then no further testing will be performed. If flu A/B is negative, samples will be further tested by Rapid Viral Culture3
Influenza Rapid Testing up to 4 outbreak samples.
Influenza A/B RT PCR (1 sample from each flu A-positive outbreak will be subtyped).
If flu A or B is positive then no further testing will be performed. If flu A/B is negative, samples will be further tested by Rapid Viral Culture3
Emergency Room patients5
Testing not available6
Testing not available6
Ambulatory –  influenza high risk patients5
Testing not available6
Testing not available6
Ambulatory – patients NOT influenza high risk5
Testing not available6
Testing not available6

Table footnotes:
1. Patient setting must be provided to help triaging of specimens. If patient setting is not provided, sample will NOT be tested.
2. ICU - Intensive Care Unit; CCU - critical care units.
3. The Rapid Viral Culture system (R-Mix Too) detects:  adenovirus, influenza A, influenza B, respiratory syncytial virus (RSV), parainfluenza 1, 2 and 3, and human metapneumovirus.
4. CMV PCR for bronchial alveolar lavage (BAL)/bronchial wash/pleural fluid will be done if requested on the requisition.
5. Respiratory swab collection kits will not be supplied for these patient settings.
6. To assist with patient management when respiratory viral testing is not available, healthcare providers are encouraged to refer to PHO’s respiratory surveillance reports for information on respiratory pathogen activity in Ontario.

Refer to the current labstract on respiratory viral testing titled: LAB-SD-121 (Respiratory Viral Testing Algorithm and Enhanced Surveillance - Update) for testing method that will be performed based on patient setting.

 

Testing methods include Influenza A/B PCR, rapid respiratory virus culture (R-Mix TOO) and/or traditional virus culture (mainly for tissue samples). 

ADDITIONAL INFORMATION

​For Outbreaks, contact your local Health Unit.

TESTING FREQUENCY AND TURNAROUND TIME (TAT)

The Influenza testing is performed daily Monday to Saturday.

The TAT for the Direct Rapid Antigen Test for Influenza is within 1 day after receipt.
The TAT for Influenza A/B PCR is up to 2 days after receipt at testing site.
The TAT for rapid respiratory virus culture (R-Mix TOO) is up to 4 days.

Samples tested by virus culture are observed for a minimum of 17 days prior to reporting a negative culture result; samples that are positive can be observed at any point during this period; TAT is up to 18 days.

TAT will vary during the winter months.

REPORTING

​Results are reported to the ordering physician or health care provider as indicated on the requisition.

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


Uncontrolled print copy. Valid only on day of Print: [date]
Page updated on [date/time] 2018-06-19 10:42 AM
© , Ontario Agency for Health Protection and Promotion