Viral Hemorrhagic Fevers
Consistent with O. Reg. 671/92 of the French Language Services Act, laboratory testing information on this page is only available in English because it is scientific or technical in nature and is for use only by qualified health care providers and not by members of the public.
IMPORTANT NOTE FOR SHIPPING/TRANSPORTATION:
This is a Risk Group 4 pathogen. In accordance with Transportation of Dangerous Goods Regulations, shipping clinical specimens suspected of Risk Group 4 pathogens require Category A packaging (section 2.36) and an Emergency Response Assistance Plan (ERAP) (section 7.2(1)(g)).
Background
This page provides information on the testing available at Public Health Ontario (PHO) for the following biosafety Risk Group 4 viruses that cause viral hemorrhagic fevers (VHF):
- Orthoebolaviruses: Bundibugyo virus, Ebola virus (Formerly Zaire virus), Sudan virus
- Orthomarburgviruses: Marburg virus
- Other VHF-causing viruses: Crimean-Congo Hemorrhagic Fever virus, Lassa virus
Testing for these viruses requires consultation with the Ministry of Health, PHO and other provincial health system partners. Refer to PHO’s Test Menu for information on other VHF causing viruses not listed above.
Testing Indications
Acceptance/Rejection Criteria
Specimens that are submitted to PHO for VHF testing where the appropriate notifications described in the Notification Pathway for Special Pathogens have not been followed are subject to cancellation.
IMPORTANT INSTRUCTIONS (Read before proceeding)
If you suspect an individual has a VHF, consult the Ministry of Health Notification Pathway for Special Pathogens which outlines the provincial algorithm for managing special pathogens, including VHFs.
It is recommended that a clinical risk assessment be conducted prior to initiating this process to assess the likelihood of a VHF infection. The information gathered through this assessment will inform subsequent coordination calls with provincial health system partners and subject matter experts, following consultation with the Ministry, and will support decision-making on testing, in accordance with the Notification Pathway for Special Pathogens.
PHO provides a symptom and exposure risk assessment form that can be accessed via PHO’s Viral Hemorrhagic Fevers webpage.
Specimen Requirements
| Test Requested | Required Requisition(s) | Specimen Type | Minimum Volume | Collection Kit |
Specify one or more of the following as appropriate based on clinical risk assessment: |
EDTA Blood |
2.0 ml per tube |
2 EDTA blood tubes |
Submission and Collection Notes
Clearly label the specimen container(s) with the patient’s first and last name, date of collection, and one other unique identifier such as the patient’s date of birth or Health Card Number. For additional information see Criteria for Acceptance of Patient Specimens. Failure to provide this information may result in rejection or testing delay.
List each virus for which testing has been agreed upon on a single General Test Requisition. This must accompany the specimens sent to PHO. PHO can test for multiple VHF-causing viruses from a single EDTA blood specimen; however, the assay is not a multiplex PCR.
Malaria testing can be performed at PHO alongside VHF testing. If requested, submit a third, separate EDTA blood tube in the same package as the specimens sent to PHO.
Specimen types that are not listed above are not validated for VHF testing at PHO; however, these may be considered acceptable on a case-by-case basis.
Timing of Specimen Collection
- Specimens for VHF testing should be collected only after the decision to proceed with testing has been discussed during the provincial health systems partners coordination call. Additional information on specimen collection and testing is available in Laboratory Guidance Diagnostic Testing for Viruses That Cause Hemorrhagic Fevers
- Appropriate infection prevention and control (IPAC) measures should be in place and a local risk assessment completed. Refer to PHO’s Viral Hemorrhagic Fevers webpage for guidance on IPAC considerations relating to specimen collection.
Storage and Transport
Federal shipping and transportation regulations, including the requirement to activate an Emergency Response Assistance Plan (ERAP), must be followed when handling or transporting specimens for VHF testing. All specimens must be shipped in compliance with the Transportation of Dangerous Goods Act. Refer to Laboratory Guidance Diagnostic Testing for Viruses That Cause Hemorrhagic Fevers for information on the transport and shipment of specimens to PHO for VHF testing.
Specimens should be stored at 2-8°C following collection and shipped to PHO on ice packs according to the ERAP procedure.
Test Frequency and Turnaround Time (TAT)
VHF testing at PHO is initiated only after the decision to proceed is made during the provincial health systems partners coordination call. Once specimens are received at PHO, testing will be performed as soon as possible.
The TAT for PHO testing and subsequent confirmatory testing at the NML, will be established on a case-by-case basis.
PHO tests for VHF-causing viruses by RT-PCR and uses assays and protocols developed and validated by the NML2-5. In accordance with federal recommendations, these results require confirmation by the NML.
One EDTA blood specimen can be used to test for multiple VHF-causing viruses; however, each test is performed independently.
Algorithm
One EDTA blood specimen from the package submitted to PHO will be used for VHF testing at PHO.
The second EDTA blood specimen will be used for malaria testing at PHO, if requested.
The third EDTA blood specimen included in the same package submitted to PHO will be forwarded by PHO to NML for confirmatory VHF testing, without waiting for the PHO VHF PCR results.
Interpretation
All results should be interpreted in the context of the clinical and epidemiologic history and other pathological findings. Refer to the Laboratory Guidance Diagnostic Testing for Viruses That Cause Hemorrhagic Fevers.
Reporting
Results are reported to the ordering physician, authorized health care provider (General O. Reg 45/22, s.18) or submitter as indicated on the requisition.
Test results are also reported to the Medical Officer of Health as per Health Protection and Promotion Act.
References
- De La Vega M-A, Caleo G, Audet J, Qiu X, Kozak RA, Brooks JI, et al. Ebola viral load at diagnosis associates with patient outcome and outbreak evolution. J Clin Invest [Internet]. 2015 [cited 2024 Jul 3];125(12):4421–8. Available from: https://pubmed.ncbi.nlm.nih.gov/26551677/
- Grolla A. Real-time and end-point PCR diagnostics for Ebola virus. In: Ebolaviruses. New York, NY: Springer New York; 2017. p. 341–52.
- Nikisins S, Rieger T, Patel P, Müller R, Günther S, Niedrig M. International external quality assessment study for molecular detection of Lassa virus. PLoS Negl Trop . 2015;9(5):e0003793. Available from: http://dx.doi.org/10.1371/journal.pntd.0003793
- Nsio J, Kapetshi J, Makiala S, Raymond F, Tshapenda G, Boucher N, et al. 2017 outbreak of Ebola virus disease in northern democratic republic of Congo. J Infect Dis. 2019 [cited 2024 Jul 3];221(5). Available from: https://pubmed.ncbi.nlm.nih.gov/30942884/
- Pang Z, Li A, Li J, Qu J, He C, Zhang S, et al. Comprehensive multiplex one-step real-time TaqMan qRT-PCR assays for detection and quantification of hemorrhagic fever viruses. PLoS One. 2014;9(4):e95635. Available from: http://dx.doi.org/10.1371/journal.pone.0095635
- Laboratory Guidance Diagnostic Testing for Viruses That Cause Hemorrhagic Fevers
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