Hantavirus
Testing Indications
Note: Due to biosafety considerations, if additional testing is required, a separate tube for hantavirus and one for other tests, must be submitted. All tests (hantavirus and non-hantavirus tests) can be listed on one PHO Laboratory requisition. Other laboratory tests will only be performed at PHO Laboratory after receiving the results for hantavirus testing from the National Microbiology Laboratory (NML).
Hantaviruses infect rodents but they are not usually symptomatic. Infected animals shed the virus in their urine, saliva and feces and can cause severe illness in humans. Two syndromes associated with hantavirus infections are hantavirus pulmonary syndrome (HPS) and hemorrhagic fever with renal syndrome (HFRS). Testing is available for both syndromes at the National Microbiology Laboratory (NML) in Winnipeg.
Seoul virus (a cause of HFRS) infections in the United States (US) and Canada:
Commencing December 2016, US health authorities have detected a number of humans and rats infected with Seoul virus, a type of hantavirus. All infections to date were directly linked to rat breeding facilities (ratteries) in certain states in the US and Ontario. While most cases of infection with Seoul virus are asymptomatic or mild, infected persons may develop a severe form of illness called hemorrhagic fever with renal syndrome (HFRS). When caused by Seoul virus, HFRS leads to death in 1-2% of patients.
Testing for Seoul virus is recommended for the following:
- Patients with compatible symptoms following rat exposure in any setting (e.g. at a rattery, to a pet rat, or a wild rat).
- Individuals with significant contact (e.g. work, frequent visits) with a rattery but no history of symptoms.
Testing recommendations may change as new information is obtained.
Specimen Requirements
| Test Requested | Required Requisition(s) | Specimen Type | Minimum Volume | Collection Kit |
Hantavirus serology |
Serology: Serum, or paired sera – acute and convalescent |
1 ml serum |
Collect in serum separator tubes (SST) in sterile 1.5-2.0 mL tube. |
|
Hantavirus PCR |
Molecular testing (RT-PCR): whole blood, lung tissue |
1.5 ml EDTA blood |
Collect whole blood in EDTA tubes, can be submitted as aliquots in sterile 1.5-2.0 mL tube. Submit lung tissue in a sterile container |
Submission and Collection Notes
Serology: serum, or paired sera – acute and convalescent (preferred)
Molecular testing (RT-PCR): whole blood, lung tissue. Molecular testing must be preapproved by PHO laboratory microbiologist.
Complete the following on the General Test Requisition Form:
- specific clinical syndrome suspected (HFRS or HPS) – this will dictate the specific hantavirus panel tested by the National Microbiology Laboratory (NML).
- onset date
- all relevant symptoms
- relevant travel history
- history of contact with rodents or their excrement (e.g. droppings/urine); and if these rodents are wild or domestic, and if they have confirmed hantavirus infection (e.g. Sin Nombre, Seoul)
To expedite testing by the National Microbiology Laboratory, include in your submission the NML Special Pathogens Requisition.
Limitations
Haemolysed, icteric, lipemic or microbially contaminated sera or plasma are not recommended for testing.
Preparation Prior to Transport
Store samples refrigerated or frozen until shipped for testing. Ship frozen samples on dry ice, and refrigerated samples on wet ice.
Special Instructions
Specimens should be transported according to TDG guidelines for Category A pathogens (UN2814 packaging). Submit one requisition with separate tubes when Hanta is requested along with other tests.
Test Frequency and Turnaround Time (TAT)
Serology and molecular testing is referred to the National Microbiology Laboratory (NML).
TAT is up to 28 days from receipt by the PHO laboratory.
Reporting
Results are reported to the ordering physician or health care provider as indicated on the requisition. Positive results are also reported to the Medical Officer of Health as per Health Protection and Promotion Act.
Testing is available for hantaviruses causing hantavirus pulmonary syndrome (HPS; e.g Sin Nombre virus, Andes virus) and hemorrhagic fever with renal syndrome (HFRS; e.g. Seoul, Hantaan virus). The specific hantavirus serology testing is performed using enzyme linked immunosorbent assays (ELISAs) to detect IgG and IgM antibodies; molecular testing is done by RT-PCR.
All hantavirus testing is performed at the National Microbiology Laboratory (NML). Note: Hantavirus results from NML are required before other PHO testing can be performed.
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