-
https://repository.netecweb.org/files/original/1e7391d48c512c4930d95dbeed2e169d.png
a6ca9a7385243728a118bbb46e890b8d
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Guide
Document providing operation or response information, general guidance documents.
URL
https://netec.org/2023/04/03/laboratory-resources-for-highly-pathogenic-avian-influenza-hpai/
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Laboratory Resources for Highly Pathogenic Avian Influenza (HPAI) (Blog post)
Subject
The topic of the resource
Laboratory
Description
An account of the resource
<p>NETEC experts in safe laboratory practices for high-consequence infectious diseases have developed a <a href="https://repository.netecweb.org/items/show/1668" target="_blank" rel="noreferrer noopener">resource on laboratory testing, specimen handling, and shipping for Highly Pathogen Avian Influenza (HPAI)</a>. This is a part of a series of one-page resource guides for laboratorians.<br /><br />This related NETEC blog post discusses avian influenza in birds and humans, when to test for HPAI, diagnostic testing for HPAI, collecting specimens for testing, packaging and shipping HPAI specimens, managing and testing routine clinical specimens.</p>
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2023-04-03
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-04-03
Highly Pathogenic Avian Influenza (HPAI)
Lab
Laboratory
Laboratory Testing
Packing and Shipping
Specimen Collection
Specimen Handling
Specimen Transport
-
https://repository.netecweb.org/files/original/7e9e906b1fafe5eebb4416d9e524f0b4.png
47b67db210c26a7173bce3c79f6a7280
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Guide
Document providing operation or response information, general guidance documents.
URL
https://netec.org/2022/10/11/laboratory-testing-for-ebola/
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Laboratory Testing for Ebola
Subject
The topic of the resource
Laboratory
Description
An account of the resource
This NETEC blog post discusses how Ebola is diagnosed in the laboratory, what to do if Ebola is suspected, assessing the risks prior to specimen collection, collecting and shipping clinical specimens, and managing and testing routine clinical specimens.
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2022-10-11
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2023-10-11
Blog
Ebola
Laboratory
Laboratory Testing
R-Lab
Specimen Collection
Specimen Handling
Specimen Transport
-
https://repository.netecweb.org/files/original/6222fb93ac347a08f7c954ef48345be9.png
3f717cb041f477cec35f2eceb25ae5bc
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Guide
Document providing operation or response information, general guidance documents.
URL
https://netec.org/2022/07/22/course-monkeypox-specimen-collection/
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Mpox Specimen Collection - Interactive Resource
Subject
The topic of the resource
Laboratory
Description
An account of the resource
Learn how to collect a specimen for Mpox virus diagnostic testing. This course module covers equipment considerations, specimen collection, and packaging.
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2022-07-22
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2023-07-25
Laboratory
Online Course
R-Lab
Specimen Collection
Specimen Handling
-
https://repository.netecweb.org/files/original/a5837f59a6652bc99bcc787d5cafd680.png
5ede261c674743104939340e28ff4466
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Video
A video iframed into the item.
URL
https://youtu.be/62vqwMzmnIg
Player
Field for the html for a video player.
<br /><iframe width="560" height="315" src="https://www.youtube.com/embed/62vqwMzmnIg" title="YouTube video player" frameborder="0"></iframe>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Monkeypox Specimen Collection: Breaking the Swab Shaft
Subject
The topic of the resource
Laboratory
Description
An account of the resource
This video is a brief demonstration of how to break a monkeypox specimen collection swab's shaft in a safe manner.
Date
A point or period of time associated with an event in the lifecycle of the resource
2022-07-22
Creator
An entity primarily responsible for making the resource
NETEC
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2023-07-25
Just in Time training (JIT)
Laboratory
Mpox
R-Lab
Skills Video
Specimen Collection
Specimen Handling
-
https://repository.netecweb.org/files/original/b4dfc2e0477e8df9b89162c8d9e01fc0.png
4b123674c383973cc4912843006d897d
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Video
A video iframed into the item.
URL
https://youtu.be/kEYfW9rVmRI
Player
Field for the html for a video player.
<br /><iframe width="560" height="315" src="https://www.youtube.com/embed/kEYfW9rVmRI" title="YouTube video player" frameborder="0"></iframe>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Monkeypox Specimen Collection
Subject
The topic of the resource
Laboratory
Description
An account of the resource
In this video, you will be introduced to collecting an appropriate specimen for monkeypox virus diagnostic testing.
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2022-07-22
Relation
A related resource
N
Format
The file format, physical medium, or dimensions of the resource
Video
Language
A language of the resource
English
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2023-07-25
Just in Time training (JIT)
Laboratory
Mpox
R-Lab
Skills Video
Specimen Collection
Specimen Handling
-
https://repository.netecweb.org/files/original/06daf462d1a19c4b6d5033b90c51333d.png
ffa8193d03702a0b82a1a1ca19b763a4
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Deploy
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Webinar
Portal access to a webinar
Duration
Length of time involved (seconds, minutes, hours, days, class periods, etc.)
January 31st, 2020, 2:00-3:00pm Eastern Standard Time
Event Type
COCA Call/Webinar
URL
https://emergency.cdc.gov/coca/calls/2020/callinfo_013120.asp
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Outbreak of 2019 Novel Coronavirus (2019-nCoV)—Interim Guidance for Clinicians
Subject
The topic of the resource
Infection Control
Description
An account of the resource
During this COCA Call, clinicians will learn about the current epidemiology, infection control and prevention recommendations, specimen collection and testing, and clinical management for patients with 2019-nCoV infection.
Creator
An entity primarily responsible for making the resource
CDC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-01-31
Contributor
An entity responsible for making contributions to the resource
2022-12-07 general asset review - IPC
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2023-12-10
Clinical Care Guidelines
Coronavirus
COVID-19
Epidemiology
Infection Prevention and Control
Laboratory Testing
R-IPC
Specimen Collection
-
https://repository.netecweb.org/files/original/9a42c07cccf849a374b33a5ad7645d9b.pdf
327fce4aeaa6fba3bd35f4e6e6e60b5f
PDF Text
Text
Collection Checklist (Partner Method)
Collection & Transport of Specimens Suspected To Contain Special
Pathogens
This document is designed to be an example template. Exercise the process and make changes
to this document to reflect what works best for your facility. Add detail and/or change the
wording to more accurately describe the step-by-step tasks needed to collect specimens in your
isolation area. Make it specific for your facility before implementing in your facility’s protocol.
Prior to collecting specimens for testing at your designated Public Health
Laboratory, contact the appropriate persons. Ensure that you have the
appropriate permission as well as collection, packaging and shipping
information BEFORE starting the collection process. Notification protocols may
vary from state to state, but may include the following:
• Local Health Department 24/7/365 contact number:
_____________
• DHHS Office of Epidemiology:
________________________________
• Public Health Lab 24/7 emergency number:
_____________________
Work together with your Public Health Department to determine the
appropriate notification protocol for your facility.
PRIOR TO COLLECTION (Cold Zone):
Gather and organize supplies to take into PUI isolation area (hot zone):
o Appropriate specimen container(s)
Note: Consult with public health laboratory if collecting screening specimens
o Appropriate collection supplies such as:
• Collection device
o For blood collection - IV kit, vacutainer adapter system with safety lock,
needle or syringe and needle with transfer device, vacutainer tubes
o For Respiratory - Nasopharyngeal Swab
o Other?
• Collection prep supplies i.e.) alcohol pads, iodine preps, cotton balls, Band-Aids
• Tourniquet
o Disinfectant wipes
FUNDED BY ASPR & CDC
�o
o
o
o
o
o
o
o
o
Large adsorbent pads/chux
Medical waste container and sharps container
Multiple sizes of gloves
Printed patient labels with 2 identifiers
Permanent Blue or Black pen or marker
Small bio-hazard bags with ABSORBENT MATERIAL
Large bio-hazard bags
Trained observer/Partner Collection checklist
DO NOT TAKE RIGID OUTER SHIPPING BOX OR TRANSPORT KIT INTO HOT ZONE
Follow facility PPE protocol for PUI
Enter hot zone with needed supplies, small/large specimen bags and checklist
Tasks performed in isolation area (hot zone):
Work slowly, methodically, be aware of possible contamination.
If a breach is observed, STOP critically think through the situation.
HCW#1 (HEALTH CARE WORKER) – COLLECT SPECIMEN(S)
TO#2 (TRAINED OBSERVER) - READ STEP-BY-STEP CHECKLIST
Pre-position supplies on tray/table, adjacent to patient arm used to collect blood.
Logistically place supplies; work from clean to dirty side with medical waste
container nearby.
Set out several disinfectant wipes and remove gloves from box for easy access.
Prep patient according to specimen type required, (blood, respiratory, etc.)
HCW#1 collects appropriate specimen(s), in specific order: Clear, Blue, Red, Gold,
Green, Purple Grey top. Mix well, place on clean disinfectant wipe.
CHANGE OUTER GLOVES USING GOOD GLOVE-IN-GLOVE TECHNIQUE put on new
outer gloves or hand sanitize.
With new wipe, pick up top of tube.
Pick up 2nd wipe, and clean bottom of tube with good friction
Holding the bottom of tube with the wipe, use the other hand to wipe the TOP of
vacutainer lid (thoroughly remove blood droplets from indent of rubber stopper).
Lay specimen container down on new disinfectant wipe to dry, discard used wipes.
Repeat disinfection step with each tube or device collected, using new wipes,
FUNDED BY ASPR & CDC
� Let each tube or container dry during next glove change.
CHANGE OUTER GLOVES USING GOOD GLOVE-IN-GLOVE TECHNIQUE, put on new
outer gloves or hand sanitize.
Place pre-printed label on specimen(s) or manually write with two (2) identifiers.
Write initials, date and time on each specimen collected on label with ink pen.
Trained observer #2 hold SMALL biohazard bag open, touching only side (do not hold
top).
HCW #1 with new wipe, pick up and place only one specimen into SMALL bag
containing adsorbent material, Avoid touching gloves to the sides of the bag. Discard
used wipe.
TO#2 will place the SMALL biohazard bag flat on sterile wipe or pad.
HCW #1: Take new wipe in each hand, thoroughly clean outside of bag on both
sides, work tube to bottom. Clean from bottom to top.
Fold bag over several times to expel air, and rub seal closed.
Multiple specimens - Repeat same method above, placing each additional specimen
into separate SMALL bag (including short draws - Do NOT discard or store). Fold, seal
and place on clean wipe.
TO#2 hold LARGE biohazard bag open at side.
Lead Partner #1 with new wipe, pick up and place SMALL folded bag(s) into LARGE
bag.
TO#2: place ARGE bag flat on new adsorbent pad.
When all specimens are in larger bag, Lead Partner #1: take new
wipes in each hand, rub outside of the bag on both sides, work
specimen(s) to bottom if possible. Fold the bag several times to
expel air, rub seal shut.
HCW #1: CHANGE OUTER GLOVES USING GOOD GLOVE-INGLOVE TECHNIQUE, put on new outer gloves or hand sanitize.
HCW #1: Using new wipe between fingertips and bag, carefully
hand off larger bag to clean side, placing directly into white
Tyvek™ envelope without touching envelope. (Fig 1).
Document number and types of specimens collected, notify the
onsite manager or lead nurse on clean side when the specimens
are ready.
Figure 1
FUNDED BY ASPR & CDC
�Final packaging performed in Clean Zone:
Personnel designated to accept specimens on clean side near isolation room can wear
routine lab coat and gloves. (*Follow your facility’s PPE protocol)
Final packaging of specimen is determined by the final destination:
I.
Onsite Laboratory - Use rigid container to transport through patient or public
areas of same facility. Specimens MUST be triple packaged, with primary
specimen containers double bagged, then securely placed in rigid outer container
to transport to the onsite laboratory.
Note: Consider keeping a log of the number and type of specimen being
transported. Consider security or second person to assist in transport of
specimens.
II.
Commercial Courier – Person packaging and shipping MUST be DOT certified
within 2 yrs
o Commercial Ground courier – PHL might be able to provide guidance to
appropriate couriers. (Couriers must be vetted and meet specific
requirements to ship Category A) Shipper Declaration required. Only use
UN specified Category A shipping box.
Note: Consider a chain of custody document to accompany specimens to
destination.
o FedEx – Airbill, Shipper Declaration required.
III.
Government Courier – Use only in emergency situations, such as when shipper is
not DOT certified. DHHS must approve.
FUNDED BY ASPR & CDC
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Checklist
Checklist for processes.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Collection Checklist: Partner Method
Subject
The topic of the resource
Laboratory
Description
An account of the resource
Collection & Transport of Specimens Suspected To Contain Special Pathogens
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2019-11-08
Relation
A related resource
Y - D0.1Lab/D0.2Lab Qualtrics # 1018, original # 9
Y - D0.1Lab/D0.2Lab Qualtrics # 1019, original # 10
Contributor
An entity responsible for making contributions to the resource
2023-10-03 from Trisch - this badly needs updating - is going on the list
2023-12-18 by Lab (Vicki and Kim), 1 yr
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-01-01
Frontline Facilities Tools
Lab
Laboratory
R-Lab
Specimen Collection
Specimen Handling
Specimen Transport
-
https://repository.netecweb.org/files/original/319de4d429f263b40f89ea97e22096ca.pdf
68dd0365b6c396c0f6595818ebf1b07e
PDF Text
Text
POLICIES AND PROCEDURES M ANUAL
System
Department
Section:
Biocontainment Unit
Subject:
Obtaining and Processing Laboratory Specimens
Number:
1210
Attachments:
Date Effective:
Supersedes:
Date Reviewed:
March 2005
January 2008; March 2009; September 2010;
December 2011; March 2013; October 2014; June
2015: January 2018, May 2018
The Nebraska Biocontainment Unit (NBU)
Obtaining and Processing Laboratory Specimens
Policy:
It is the policy of the NBU to collect laboratory specimens in compliance with the Nebraska Medicine Policy and
Procedure LAB06 Collection to Venous and Capillary Blood.
Purpose:
To obtain and process laboratory specimens while maintaining infection control practices.
Materials:
Required collection container (tubes, culture bottles and plates)
Biohazard Ziploc bags
Required collection devices (needles, syringes, skin cleanser, tourniquet, Band aids, Cotton Balls or 4x4s, tape)
Absorbent pad (goes in the bag with the specimen)
Bleach Wipes
Barrier devices (chux)
Procedure for handling specimens:
Registered Nurses (RN’s) donned in appropriate PPE shall draw lab(s) either peripherally, from a centrally
located venous catheter, arterial line or finger stick. Other lab collection sites include urinary catheter ports,
nasal/ nasal pharyngeal, fecal or others as required for a specific lab test.
Specimens shall be collected in accordance with Nebraska Medicine Nursing Policy and Procedure Manual Lab
1, Lab 2, Lab 6, Lab 7 and Lab 9.
Specimens shall be labeled in accordance with The Nebraska Medicine Policy and Procedure Labeling Policy
TX06.
Specimens to be obtained from patients weighing < 10kg shall be obtained in accordance with Nebraska
Medicine Clinical Laboratory Maximum Blood Draw Protocol for Pediatric Patients SS-21.
Last printed 9/27/2018 11:29 AM
4
Page 1 of
�If the NBU has been activated for Viral Hemorrhagic Fevers (VHF) or Smallpox the Nebraska Public Health Lab
(NPHL) shall activate the satellite lab located in room 7219 in the NBU and shall follow their procedures for
handling NBU patient specimens (see appendix A).
After the NPHL staff has processed the specimen(s) they shall package them according to NPHL policy and
bleach wipe the exterior of the package.
They shall pass the package to the NBU Doffing Partner at the door to the NPHL satellite lab while holding the
bag with a bleach wipe.
The Doffing Partner shall receive the bagged specimen(s) with a bleach wipe and transport the package to the
doors separating the clean and warm zones. The Tasker shall open the door and receive the bagged specimen(s)
with a bleach wipe. The Tasker shall then close the door. The Doffing Partner shall perform hand hygiene and
change their outer gloves.
The Tasker shall take the bagged specimens to the vestibule and place it in NPHL cooler for collection by NPHL
or phlebotomy staff. The Tasker shall now remove their gloves, perform hand hygiene and don clean gloves.
Note: There will be times when specimens do not need to go through the NPHL Satellite Lab (room 7219). In
those instances, the Doffing Partner shall wipe the outside of the clear plastic zip top bag with bleach wipes,
carry it with a clean bleach wipe to pass to the Tasker at the doors separating the clean and warm zones. The
Tasker shall receive the bagged specimen(s) with a bleach wipe and shall take the bagged specimens to the
vestibule and place it in NPHL cooler for collection by NPHL or phlebotomy staff. Tasker shall now remove their
gloves and perform hand hygiene and don clean gloves.
Obtaining Blood Cultures from patients with VHF or Smallpox diagnosis:
Draw specimen following facility protocols using plastic BD Vacutainer blood culture bottles.
If drawing from a central line request MD instructions as to which line to draw from if not already provided.
For diseases other than VHF or Smallpox:
The Nebraska Medicine Core Laboratory (559-8780) shall conduct all specimen testing unless decided otherwise
by the NBU Medical Director.
All lab orders shall be entered into the patient’s electronic health record (EHR) and acknowledged by the NBU
RN.
Lab labels shall print from the CLM printer in the patient care room and will be attached to the specimen
container after the specimen is obtained and the container has been decontaminated.
Last printed 9/27/2018 11:29 AM
4
Page 2 of
�NBU specimen(s) going to the Nebraska Medicine Core Laboratory shall be sealed in clear plastic zip top bags by
the Doffing Partner who shall wipe the outside of the bag with bleach wipes, and transport the package to the
doors separating the clean and warm zones. The Tasker shall open the door and receive the bagged specimen(s)
with a bleach wipe. The Tasker shall then close the door. The Doffing Partner shall perform hand hygiene and
change their outer gloves.
The Tasker shall take the bagged specimens to the vestibule and place it in NPHL cooler for collection by
phlebotomy staff. Tasker shall now remove their gloves and perform hand hygiene and don clean gloves.
Procedure for Specimen Collection:
1.
2.
3.
4.
5.
6.
7.
8.
NBU staff collecting the specimen shall identify the patient following The Nebraska Medicine Patient
Identification Policy RI10 and print labels from the CLM printer in the patient care room.
Prior to collecting the specimen(s) prepare the work area by wiping hard surfaces with bleach wipes
and allowing time to air dry.
Place barrier (chux) over the bed rail and in areas that may be exposed.
Prepare a surface (i.e. bedside table) to place the specimen(s) after collection by cleaning with a
bleach wipe and placing a clean bleach wipe on the table to lay the specimen(s) on.
After specimen collection, perform hand hygiene and change gloves.
Use the bleach wipe the specimen(s) were laid on to pick them up and wipe prior to labeling.
When the specimen container(s) are dry, attach label.
Notify the Doffing Partner when ready to pass the specimen(s) out the room.
Passing the specimen(s) out the patient care room:
1.
2.
3.
The Doffing Partner outside the patient room shall hold a biohazard lab bag with an absorbent pad
inside open for the LABELED specimen container(s) to be dropped in.
This bag is to be sealed immediately and the external surfaces of the bag are to be wiped with a
bleach wipe.
The packaged specimen is to be placed into a second bag which is also to be sealed (if the sample
requires the specimen to be placed in ice; a sealed pouch of ice shall be put into the second bag). Ice
needs to be kept separate from specimens.
Transporting the specimen:
The Tasker shall call security to escort laboratory staff to the laboratory.
Special procedures: Glucometer, I-STAT, Hemochron:
Last printed 9/27/2018 11:29 AM
4
Page 3 of
�Glucometer testing:
1.
NBU staff shall perform glucometer testing.
2.
Testing shall be done in the patient care room following the Nebraska Medicine Policy and
Procedure for glucose monitoring ;
3.
Take only the meter (no tote), test strip, lancet (if performing finger stick), or other blood collection
device, alcohol wipe, and a cotton ball into the patient care room).
4.
After the procedure, dispose of the lancet and the test strip in the sharps container.
5.
Other supplies may go into the autoclave bag lined trash can.
6.
Wipe the outside of meter with a bleach wipe. Change gloves then pass the glucometer out of the
room to the Doffing Partner who shall return the glucose meter to the tote to upload the results to
the patients EHR.
I-STAT and/or Hemochron:
I-STAT and/or Hemochron testing shall be performed in the NBU’s NPHL Satellite laboratory in room 7219. NBU
staff shall obtain the sample from the patient and a NPHL Lab Technician shall perform the test. Reference:
Laboratory Specimen Labeling TX06 Patient Identification RI10
Staff Accountability:
Nebraska Biocontainment Unit Leadership
Nebraska Biocontainment Unit Policy and Procedure Workgroup
Infection Control Department
Nebraska Public Health Laboratory Biosecurity Section
Department Approval
Signed | s |:
Kate Boulter
Title:
Nurse Manager
Department:
NBU
Last printed 9/27/2018 11:29 AM
4
Administrative Approval
Signed | s |: Michele Schwedhelm
Title:
Executive Director
Page 4 of
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Obtaining and Processing Laboratory Specimens
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Protocol
Protocol documentation
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Obtaining and Processing Laboratory Specimens
Subject
The topic of the resource
Laboratory
Creator
An entity primarily responsible for making the resource
University of Nebraska Medical Center / Nebraska Medicine
Date
A point or period of time associated with an event in the lifecycle of the resource
2018-05-01
Description
An account of the resource
Policies and Procedures Manual: To obtain and process laboratory specimens while maintaining infection control practices.
Contributor
An entity responsible for making contributions to the resource
2022-12-07 general asset review - IPC (change to R-Lab)
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2023-12-10
Infection Prevention and Control
Lab
Laboratory
Protocol
R-Lab
Specimen Collection
Specimen Handling
Specimen Transport
Standard Operating Procedure (SOP)
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Guide
Document providing operation or response information, general guidance documents.
URL
https://www.kdhe.ks.gov/1505/Ebola-Virus-Disease
Objectives
See Resources under the "For Health Care Providers" section of the page. Requires login.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Kansas Highly Infectious Disease and Pandemic Plan
Subject
The topic of the resource
Emergency Management
Description
An account of the resource
The Kansas Department of Health and Environment (KDHE) developed a preparedness and response plan following the 2014 Ebola outbreak in West Africa in response to the possibility of cases affecting Kansas. This "Kansas Ebola Virus Preparedness and Response Plan" has been updated to the "Kansas Highly Infectious Disease and Pandemic Plan."<br /><br /><a href="https://www.kdhe.ks.gov/1505/Ebola-Virus-Disease" target="_blank" rel="noreferrer noopener">https://www.kdhe.ks.gov/1505/Ebola-Virus-Disease</a>
Creator
An entity primarily responsible for making the resource
Kansas Department of Health and Environment
Date
A point or period of time associated with an event in the lifecycle of the resource
2023-01
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-01
Communications
CONOPS
Decontamination
Ebola
Emergency Management
EMS
Epidemic
Federal
Identify
Infection Prevention and Control
Inform
Isolate
Lab
Laboratory
Laboratory Testing
Medical Surveillance
Outbreaks
Patient Transport
Person Under Investigation (PUI)
Personal Protective Equipment (PPE)
Public Health
Quarantine
R-EM
Region 7
Specimen Collection
Specimen Handling
Specimen Transport
Temperature Monitoring
Waste Management
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Guide
Document providing operation or response information, general guidance documents.
URL
https://www.fda.gov/downloads/BiologicsBloodVaccines/GuidanceComplianceRegulatoryInformation/Guidances/Blood/UCM475072.pdf
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Recommendations for Assessment of Blood Donor Eligibility, Donor Deferral and Blood Product Management in Response to Ebola Virus
Subject
The topic of the resource
Treatment & Care
Creator
An entity primarily responsible for making the resource
U.S. Food and Drug Administration
Date
A point or period of time associated with an event in the lifecycle of the resource
2017-01-01
Description
An account of the resource
This guidance represents the current thinking of the Food and Drug Administration (FDA or Agency) on this topic. It does not establish any rights for any person and is not binding on FDA or the public. You can use an alternative approach if it satisfies the requirements of the applicable statutes and regulations. To discuss an alternative approach, contact the FDA staff responsible for this guidance as listed on the title page (FDA, page 1).
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-09-27
Contributor
An entity responsible for making contributions to the resource
2022-09-27 - general asset review - Treatment & Care group
Ebola
Example
Lab
Laboratory
Public Health
R-T&C
Specimen Collection
Specimen Handling
Therapeutics
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Webinar
Portal access to a webinar
Duration
Length of time involved (seconds, minutes, hours, days, class periods, etc.)
77 minutes 46 seconds.
URL
http://www.ndhealth.gov/microlab/BTWorkshop/Emerging_Diseases_2017/index.htm
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Emerging Diseases and Implementation of Emergency Use Authorizations
Subject
The topic of the resource
Laboratory
Description
An account of the resource
Emerging Infections and Implementation of Emergency Use Authorizations content was developed by Susanne Norris Zanto of Laboratory SolutionZ. The narrator is Tracy Hoke, the BT Coordinator at the North Dakota Department of Health, Division of Laboratory Services.
Creator
An entity primarily responsible for making the resource
North Dakota Department of Health
Date
A point or period of time associated with an event in the lifecycle of the resource
2017-06-23
Contributor
An entity responsible for making contributions to the resource
2023-12-18 by Lab (Vicki and Kim), 3 yr / Example
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2026-12-18
Diagnosis
Ebola
Epidemic
Example
Lab
Laboratory
Laboratory Testing
Public Health
R-Lab
Special Pathogens
Specimen Collection
Specimen Handling
-
https://repository.netecweb.org/files/original/9b358e234f47bd42e387a0f4d5ff5826.docx
19850692d023e4f6168fd353b2d67b65
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Skills Drill: Objectives
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Deploy
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Exercise
Exercise templates for training and education.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Skills Drill: Objectives
Creator
An entity primarily responsible for making the resource
University of Nebraska Medical Center / Nebraska Medicine
Subject
The topic of the resource
Training and Exercises
Description
An account of the resource
Leadership Toolbox, More Tools: Skills Drill Objectives
Date
A point or period of time associated with an event in the lifecycle of the resource
2018-01-25
Contributor
An entity responsible for making contributions to the resource
2022-07 by Gary, Special Populations Treatment & Care group
2022-03-08 by PPE group UNMC (JC) - sp. date (both said 1 year)
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2023-08-22 ** Specific review date
Relation
A related resource
Y - D0.1TE/D0.2TE Qualtrics # 413, original # new item 7
Y - D0.1TE/D0.2TE Qualtrics # 418, original # 305 (additional resources)
Y - D0.1TE/D0.2TE Qualtrics # 438, original # 329 (additional resources)
Decedent Management
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U.S. Ebola Treatment Center Clinical Laboratory Support
Katelyn C. Jelden,a Peter C. Iwen,b,c Jocelyn J. Herstein,a Paul D. Biddinger,d,e Colleen S. Kraft,f,g Lisa Saiman,h,i Philip W. Smith,j
Angela L. Hewlett,j Shawn G. Gibbs,a,k John J. Lowea
Department of Environmental, Agricultural, and Occupational Health, University of Nebraska Medical Center, Omaha, Nebraska, USAa; Department of Pathology and
Microbiology, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USAb; Nebraska Public Health Laboratory, Omaha, Nebraska, USAc;
Department of Emergency Medicine, Division of Emergency Preparedness, Massachusetts General Hospital, Boston, Massachusetts, USAd; Department of Emergency
Medicine, Harvard Medical School, Boston, Massachusetts, USAe; Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia, USAf;
Department of Medicine, Division of Infectious Diseases, Emory University, Atlanta, Georgia, USAg; Department of Pediatrics, Columbia University Medical Center, New
York, New York, USAh; Department of Infection Prevention and Control, New York-Presbyterian Hospital, New York, New York, USAi; Department of Internal Medicine,
Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska, USAj; Department of Environmental Health, Indiana University School of Public
Health, Bloomington, Indiana, USAk
T
he ongoing West African Ebola virus disease (EVD) epidemic,
and the occurrence of three domestic EVD cases in the United
States, has prompted national revision of strategies to combat
EVD and other highly infectious diseases (1, 2). The U.S. Department of Health and Human Services (HHS), through the Centers
for Disease Control and Prevention (CDC) in coordination with
the Office of the Assistant Secretary for Preparedness and Response (ASPR), has created interim guidance for hospitals and
health departments intended to assist them in developing preparedness plans for evaluating patients under investigation for
EVD and for patients with confirmed EVD (3). HHS also recommends that hospitals work to develop a coordinated, networked
approach by designating medical facilities frontline health care
facilities, Ebola assessment hospitals (EAHs), or Ebola treatment
centers (ETCs) (4). Personnel in frontline facilities (e.g., hospitalbased emergency departments, critical-access hospitals, and urgent-care clinics) should be trained to quickly detect and isolate
patients and notify local and state public health departments when
patients present with EVD-related symptoms in combination
with an Ebola virus exposure history (4). Patients who meet the
criteria for a patient under investigation (PUI) are recommended
to be transported to an EAH for supportive care and for diagnostic
testing by the jurisdictional public health laboratory (PHL) to
evaluate patients for the presence of EVD (Fig. 1) (5). Patients
identified with a presumptive positive test for EVD would subsequently have specimens sent to the CDC for confirmatory testing
(5). If EVD is confirmed, patients would then be transferred to an
ETC, where the patient with EVD is cared for in an isolated patient
room for the remainder of the disease course.
April 2016 Volume 54 Number 4
Patients with EVD become critically ill several days into their
illness, requiring high levels of supportive care, including aggressive intravenous fluid resuscitation and management of electrolytes due to the high rates of fluid loss in the fulminant stages of the
disease (6, 7). The CDC recommends that hospitals caring for a
PUI and/or a patient with confirmed EVD be able to perform a
variety of laboratory tests, including a complete blood cell count,
measurement of basic electrolyte levels, liver function tests, coagulation studies, blood cultures, urinalysis, as well as tests for the
presence of other infectious diseases such as malaria and influenza
(8). Hospital planning to provide aggressive intensive care therapies for a patient with fulminant EVD has been complicated. The
highly infective nature of the patients’ body fluids has prompted
many laboratorians to be concerned about their ability to safely
provide support for the care of EVD patients using standard hospital laboratory equipment (9). Indeed, perspectives from West
African ETCs during the 2014-2015 outbreak emphasized the lab-
Received 5 November 2015 Returned for modification 3 December 2015
Accepted 21 January 2016
Accepted manuscript posted online 3 February 2016
Citation Jelden KC, Iwen PC, Herstein JJ, Biddinger PD, Kraft CS, Saiman L, Smith
PW, Hewlett AL, Gibbs SG, Lowe JJ. 2016. U.S. Ebola treatment center clinical
laboratory support. J Clin Microbiol 54:1031–1035. doi:10.1128/JCM.02905-15.
Editor: A. J. McAdam
Address correspondence to John J. Lowe, jjlowe@unmc.edu.
Copyright © 2016, American Society for Microbiology. All Rights Reserved.
Journal of Clinical Microbiology
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Fifty-five hospitals in the United States have been designated Ebola treatment centers (ETCs) by their state and local health authorities. Designated ETCs must have appropriate plans to manage a patient with confirmed Ebola virus disease (EVD) for the
full duration of illness and must have these plans assessed through a CDC site visit conducted by an interdisciplinary team of
subject matter experts. This study determined the clinical laboratory capabilities of these ETCs. ETCs were electronically surveyed on clinical laboratory characteristics. Survey responses were returned from 47 ETCs (85%). Forty-one (87%) of the ETCs
planned to provide some laboratory support (e.g., point-of-care [POC] testing) within the room of the isolated patient. Fortyfour (94%) ETCs indicated that their hospital would also provide clinical laboratory support for patient care. Twenty-two (50%)
of these ETC clinical laboratories had biosafety level 3 (BSL-3) containment. Of all respondents, 34 (72%) were supported by
their jurisdictional public health laboratory (PHL), all of which had available BSL-3 laboratories. Overall, 40 of 44 (91%) ETCs
reported BSL-3 laboratory support via their clinical laboratory and/or PHL. This survey provided a snapshot of the laboratory
support for designated U.S. ETCs. ETCs have approached high-level isolation critical care with laboratory support in close proximity to the patient room and by distributing laboratory support among laboratory resources. Experts might review safety considerations for these laboratory testing/diagnostic activities that are novel in the context of biocontainment care.
�Jelden et al.
oratories’ vital role in monitoring pathophysiology in patients
with EVD (10).
As of August 2015, 55 U.S. hospitals were designated ETCs by
state and local health authorities. To validate EVD care capabilities, these hospitals volunteered for assessments by the Rapid
Ebola Preparedness (REP) teams of CDC personnel and subject
matter experts (5, 8, 11). As part of this designation, ETC-qualifying medical facilities had arranged to have “laboratory procedures/protocols, dedicated space, [and] if possible, point-of-care
testing, equipment, staffing, reagents, training, and specimen
transport” capabilities available (11). The CDC has offered additional guidance on personal protective equipment (PPE), risk assessment and mitigation, laboratory instruments, point-of-care
(POC) testing, transportation of specimens with Ebola virus, decontamination, and waste management (8). In addition, Emory
University and Nebraska Medicine, as part of their treatment protocols, reported lists of essential and supplemental laboratory
equipment and tests for high-risk patient care (9, 12, 13).
Although limited standards for laboratory support have been
identified for the 55 ETCs, no documentation on their current
capabilities has been reported. This report discloses the laboratory
support for participating U.S. ETCs as they prepared to care for
patients with EVD in their hospital biocontainment setting.
MATERIALS AND METHODS
Referencing European Network of Infectious Diseases (EUNID) checklists (14), a survey was developed to determine current structural and
operational features of U.S. ETCs, including laboratory characteristics,
infection control infrastructure, laboratory location, costs of establishment and operation, and patient capacity. These checklists were derived
from EUNID consensus agreements on the structural aspects of highlyinfectious-disease patient care units in Europe (http://www.eunid.eu/)
(14). Survey questions related to laboratories are listed in Table 1.
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The location of ETC laboratory support in relation to the isolation
unit was defined as a location within the patient care room, within the
unit, on the same campus as the unit, or within the same city as the unit or
a combination of these locations. A patient care room was defined as the
room in which the ETC planned to contain the patient within the isolation
TABLE 1 Laboratory capability survey questions distributed to U.S.
Ebola treatment centers
Survey question
Location of nearest laboratory support (check all that apply)
Patient care room, yes or no
Isolation unit, yes or no
Same campus, yes or no
Same city, yes or no
No information/other (please specify)
Classification of laboratory support (check all that apply)
Bedside point-of-care testing, yes or no
Clinical laboratory, yes or no
Public health laboratory, yes or no
No information/other (please specify)
Biosafety designation of accessible clinical laboratory
BSL-2
BSL-3
BSL-4
No information/other (please specify)
Biosafety designation of accessible public health laboratory
BSL-2
BSL-3
BSL-4
No information/other (please specify)
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April 2016 Volume 54 Number 4
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FIG 1 Communication flow for diagnosing and transferring a PUI for EVD and a patient with EVD after confirmatory testing.
�U.S. Ebola Treatment Center Laboratory Support
TABLE 2 Reported location closest to the patient room and
classification of laboratory support in caring for patients with Ebola
virus disease from U.S. Ebola treatment centersa
Location or classification of
laboratory support
No. (%) of ETCs
Locationb
Patient care room
Isolation unit
Same campus
41 (87)
3 (6)
3 (6)
Classification
Bedside POC testing
Clinical laboratory
Public health laboratory
41 (87)
44 (94)
34 (72)
a
unit. The isolation unit was defined as the patient care area separated from
other patient care wards, with access restricted to personnel entering under appropriate isolation precautions.
Types of laboratory support available for the ETCs were classified as
bedside POC testing, clinical laboratory support, PHL support, or a combination of these types of support. Laboratory containment was defined as
biosafety level 2 (BSL-2), BSL-3, or BSL-4 (15).
Surveys were distributed electronically in April 2015 for self-completion to the directors and/or assistant directors of the 55 U.S. ETCs. Survey
responses were collected via e-mail. Any discrepancies were followed up
by email, phone call, or referencing of information available online. Responses were coded and analyzed for the number and percentage of ETCs
indicating their specific location of laboratory support, classification of
laboratory support, BSL containment of accessible hospital laboratories,
and BSL containment of PHLs by using Microsoft Excel (Microsoft Corporation, Redmond, WA).
RESULTS
Survey responses were obtained from 47 of the 55 ETCs (85%). Of
these ETCs, 41 (87%) reported that the patient room was the
nearest location of some laboratory support relative to the location of the patient (Table 2). Of the six ETCs without laboratory
support in the patient room, three each had laboratory support
within the unit and on the same campus. Each of the ETCs with
laboratory support limited to the same campus as their isolation
unit indicated support from a clinical laboratory and/or their jurisdictional PHL.
All ETCs provided at least one type of laboratory support (i.e.,
POC testing within the patient room, clinical laboratory, or PHL).
In classifying the type of laboratory support, 41 (87%) of the respondents indicated that bedside POC testing was available (Table
2). Forty-four (94%) ETCs indicated that they were supported by
a clinical laboratory, and 34 (72%) indicated that they were supported by their jurisdictional PHL. Overall, 30 (64%) of the ETCs
offered a combination of bedside POC testing and assistance from
a clinical laboratory and their PHLs, with all but 1 of these ETCs
having access to a BSL-3 laboratory.
Of 42 ETCs responding regarding clinical laboratory containment, 20/42 (43%) reported BSL-2 containment, and 22/42 (52%)
reported BSL-3 containment. Thirty-four of 47 (72%) ETCs reported that they had access to their jurisdictional PHL, all of which
(34/34) have available BSL-3 containment laboratories.
April 2016 Volume 54 Number 4
DISCUSSION
This survey investigated laboratory support for the 55 CDC-designated ETCs. A majority of these ETCs offered laboratory testing
in close proximity to the patient room while simultaneously dispersing support through their clinical laboratory and PHL. Given
the critical nature of EVD and the potential need to assess patients
for other diagnoses, laboratory support is well recognized as a
crucial aspect of the optimum clinical care of patients with or
without EVD (6).
The location of the laboratory to support a patient with EVD
was defined as the location nearest the patient room. Previously
reported laboratory support located within an isolation area was
found to reduce specimen processing times, provide personnel
improved safety assurance for handling of specimens, and decrease exposure risks (9, 13, 16). In this study, we noted that many
ETCs have adopted at least some portion of a contained laboratory
care model in which the location of the laboratory is located in
close proximity to the patient care area to allow rapid laboratory
processing and enhanced laboratory safety and patient supportive
care.
Conversely, laboratory support within the patient room or isolation unit may be disadvantageous. For instance, laboratory technologists may be required to enter the isolation unit where space
may be limited to minimize the risks of occupational exposures
(8). Exclusion of laboratory personnel from the isolation unit requires that clinicians with less familiarity with POC technologies
complete testing while simultaneously performing other care activities. Additionally, the isolation unit may not have a contained
area large enough for the placement of a biosafety cabinet for the
safe processing of specimens.
The Nebraska Biocontainment Unit (NBU) described the safe
utilization of multiple laboratories to care for patients with EVD
to include an in-unit BSL-3 laboratory, a BSL-3 laboratory at the
on-campus PHL, and a core hospital laboratory (9). In contrast,
Emory University contained nearly all laboratory testing (excluding specimens sent to the CDC or other government agencies for
testing) within the patient care isolation unit (13). Both models
have proven to be safe and effective in providing laboratory care
for patients with EVD (9, 13). ETCs have equally approached providing laboratory support within the patient room and/or isolation unit (44/47 [94%]) as well as from their hospital clinical laboratory (44/47 [94%]). Of the 47 surveyed ETCs, 30 (64%) have
laboratory support including bedside POC testing, a clinical laboratory, and assistance from their PHLs, likely sharing responsibilities among resources. Distributing laboratory tasks among
various locations may, however, also introduce exposure risks for
additional laboratory personnel in each setting. A laboratory risk
assessment at each location can help to reduce these risks (8, 12).
Of the hospitals in the United States that have cared for patients with EVD, both BSL-2 and BSL-3 containment laboratories
have been used for clinical laboratory testing, with BSL-3 containment being available in 40/44 (91%) ETCs (8).
In comparison, a survey of European high-level isolation units
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The number of responders was 47.
The laboratory support location is defined as follows: patient care room indicates a
location within the patient’s room, isolation unit is located in a designated space
contained within the isolation unit, and same campus is located within the same
medical facility.
b
In total, 40 of the 44 ETCs (91%) reported that they had access
to a BSL-3 laboratory facility (a clinical laboratory and/or PHL),
while 4 (9%) reported that they had access to BSL-2 laboratory
facilities. Of the four latter facilities, three were supported by POC
tests in the patient room. The remaining facility was supported by
a laboratory within the isolation unit.
�Jelden et al.
TABLE 3 Comparison of U.S. ETC and European HLIU laboratory supporta
No. of centers with support/total no. of centers surveyed (%)
European HLIUs
Laboratory support
U.S. ETCs overall
Microbiological test
Routine test
Testing within isolation unitb
Testing in hospital laboratoryc
Testing in reference BSL-3 laboratoryd
Access to BSL-3 containment laboratorye
Access to BSL-4 containment laboratorye
44/47 (94)
44/47 (94)
34/47 (72)
40/44 (91)
0/47 (0)
8/47(17)
24/47 (51)
32/47 (68)
13/48 (27)
41/48 (85)
15/48 (31)
Overall
39/48 (81)
11/48 (23)
a
See reference 17.
Within isolation unit was defined as a location within the patient room or other room contained in the isolation area.
c
Hospital laboratory testing was defined as access to a clinical laboratory for U.S. ETCs and tests performed in a central hospital laboratory (general laboratory with or without
closed-type automated analyzers) for European high-level isolation units.
d
Reference laboratory for U.S. ETCs was defined as access to a public health laboratory.
e
European high-level isolation units reported access to BSL-3 and BSL-4 containment facilities for diagnosis within the same facility/city, while U.S. ETCs reported BSL-3 and
BSL-4 containment facilities within accessible clinical and public health laboratories.
b
ACKNOWLEDGMENTS
We thank the U.S. Highly Infectious Disease Network and the dedicated
Nebraska Biocontainment Unit and Emory Serious Communicable Dis-
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eases Unit for their unwavering commitment to patient care, quality improvement, and safety.
This research received no specific grant from any funding agency in
the public, commercial, or not-for-profit sectors.
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(HLIUs) showed that only 17 and 27% of these units performed
microbiological and routine tests, respectively, within the isolation patient care area (Table 3) (17). Overall, 32/47 (68%) and
15/48 (31%) of these HLIUs sent specimens for microbiological
testing and routine clinical testing, respectively, to a reference
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HLIUs had access to BSL-3 containment laboratories for diagnosis
within the same city/facility as the unit, and 11/48 (23%) had
access to BSL-4 containment laboratories (with overlap in access
to BSL-3 and BSL-4 containment laboratories).
Limitations of this study included that the survey did not differentiate which tests, diagnostic or routine, were performed
within the isolation unit, clinical laboratory, or PHL. Some ETCs
responded to the survey question on the location of laboratory
support by making only a single selection rather than checking all
that applied, so answers were interpreted as laboratory support in
closest proximity to the patient room. Thus, the cross-sectional
design of this survey provided a limited snapshot of the current
laboratory capabilities of U.S. ETCs. One ETC also indicated simultaneous construction of a BSL-3 laboratory within their isolation unit during completion of the survey.
In general, U.S. ETCs were rapidly created in response to the
Ebola epidemic of 2014 to 2015, and the care and laboratory capabilities of these facilities will continue to transform as plans for
sustainability and the national role in responses to highly infectious diseases are refined.
Further details need to be considered regarding specific recommendations for the types of tests that need to be available to care
for a patient with a highly infectious pathogen, the locations that
are optimal for laboratory testing, the types of PPE utilized and
training available, and qualified staff to perform laboratory testing. An expanded future survey to demonstrate the evolution of
ETC facilities and to gain a more complete picture of national
capabilities within this area is planned.
�U.S. Ebola Treatment Center Laboratory Support
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Jelden, K. C., P. C. Iwen, J. J. Herstein, P. D. Biddinger, C. S. Kraft, L. Saiman, P. W. Smith, A. L. Hewlett, S. G. Gibbs and J. J. Lowe (2016). "U.S. Ebola Treatment Center Clinical Laboratory Support." J Clin Microbiol 54(4): 1031-1035.
Abstract
Fifty-five hospitals in the United States have been designated Ebola treatment centers (ETCs) by their state and local health authorities. Designated ETCs must have appropriate plans to manage a patient with confirmed Ebola virus disease (EVD) for the full duration of illness and must have these plans assessed through a CDC site visit conducted by an interdisciplinary team of subject matter experts. This study determined the clinical laboratory capabilities of these ETCs. ETCs were electronically surveyed on clinical laboratory characteristics. Survey responses were returned from 47 ETCs (85%). Forty-one (87%) of the ETCs planned to provide some laboratory support (e.g., point-of-care [POC] testing) within the room of the isolated patient. Forty-four (94%) ETCs indicated that their hospital would also provide clinical laboratory support for patient care. Twenty-two (50%) of these ETC clinical laboratories had biosafety level 3 (BSL-3) containment. Of all respondents, 34 (72%) were supported by their jurisdictional public health laboratory (PHL), all of which had available BSL-3 laboratories. Overall, 40 of 44 (91%) ETCs reported BSL-3 laboratory support via their clinical laboratory and/or PHL. This survey provided a snapshot of the laboratory support for designated U.S. ETCs. ETCs have approached high-level isolation critical care with laboratory support in close proximity to the patient room and by distributing laboratory support among laboratory resources. Experts might review safety considerations for these laboratory testing/diagnostic activities that are novel in the context of biocontainment care.
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https://journals.asm.org/doi/10.1128/JCM.02905-15
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U.S. Ebola Treatment Center Clinical Laboratory Support
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Jelden, K. C., P. C. Iwen, J. J. Herstein, P. D. Biddinger, C. S. Kraft, L. Saiman, P. W. Smith, A. L. Hewlett, S. G. Gibbs and J. J. Lowe
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Laboratory
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Fifty-five hospitals in the United States have been designated Ebola treatment centers (ETCs) by their state and local health authorities.
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2016-04-01
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2023-12-18 by Lab (Vicki and Kim), 1 yr / Example
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2024-12-18
Biosafety
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Ebola
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Isolation/Biocontainment
Lab
Laboratory
Laboratory Testing
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Specimen Collection
Specimen Handling
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https://repository.netecweb.org/files/original/7946b4a9d7253b996b7b691654a6538b.pdf
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N Engl J Med. Author manuscript; available in PMC 2015 December 18.
Published in final edited form as:
N Engl J Med. 2015 June 18; 372(25): 2423–2427. doi:10.1056/NEJMoa1500306.
Persistence of Ebola Virus in Ocular Fluid during Convalescence
Author Manuscript
Jay B. Varkey, M.D., Jessica G. Shantha, M.D., Ian Crozier, M.D., Colleen S. Kraft, M.D., G.
Marshall Lyon, M.D., Aneesh K. Mehta, M.D., Gokul Kumar, M.D., Justine R. Smith, M.B.,
B.S., Ph.D., Markus H. Kainulainen, Ph.D., Shannon Whitmer, Ph.D., Ute Ströher, Ph.D.,
Timothy M. Uyeki, M.D., M.P.H., M.P.P., Bruce S. Ribner, M.D., M.P.H., and Steven Yeh, M.D.
Department of Medicine, Division of Infectious Diseases (J.B.V., C.S.K., G.M.L., A.K.M., B.S.R.),
the Department of Ophthalmology (J.G.S., G.K., S.Y.), and the Department of Pathology and
Laboratory Medicine (C.S.K.), Emory University School of Medicine, and the Centers for Disease
Control and Prevention (M.H.K., S.W., U.S., T.M.U.) — both in Atlanta; the Infectious Diseases
Institute, Mulago Hospital Complex, Kampala, Uganda (I.C.); and Flinders University, Adelaide,
SA, Australia (J.R.S.)
SUMMARY
Among the survivors of Ebola virus disease (EVD), complications that include uveitis can develop
during convalescence, although the incidence and pathogenesis of EVD-associated uveitis are
unknown. We describe a patient who recovered from EVD and was subsequently found to have
severe unilateral uveitis during convalescence. Viable Zaire ebolavirus (EBOV) was detected in
aqueous humor 14 weeks after the onset of EVD and 9 weeks after the clearance of viremia.
Author Manuscript
The current outbreak of EVD is believed to have begun in December 2013.1 As of April 26,
2015, a total of 26,312 cases of EVD (including 10,899 deaths) had been reported in six
countries in West Africa (i.e., Sierra Leone, Liberia, Guinea, Mali, Nigeria, and Senegal),
the United States, the United Kingdom, and Spain.2 The outbreak has also resulted in the
largest number of EVD survivors in history.
Author Manuscript
Among survivors of EVD, late complications that include ocular disease can develop during
convalescence.3,4 However, few systematic studies have been conducted on post-EVD
sequelae, so the incidence and clinical manifestations of post-EVD ocular complications are
unclear. Here, we report the clinical course of a man in whom severe, acute, unilateral
uveitis developed during the convalescent phase of EVD. We also report the detection of
viable EBOV in aqueous humor obtained from the inflamed eye 14 weeks after the onset of
the initial symptoms of EVD and 9 weeks after the clearance of viremia.
CASE REPORT
A previously healthy 43-year-old male physician received a diagnosis of EVD on September
6, 2014, while he was working in an Ebola treatment unit in Kenema, Sierra Leone. He was
Address reprint requests to Dr. Yeh at the Department of Ophthalmology, Emory University School of Medicine, 1365B Clifton Rd.
NE, Atlanta, GA 30322, or at steven.yeh@emory.edu.
Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.
�Varkey et al.
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transferred to Emory University Hospital in Atlanta and arrived 4 days after the onset of
symptoms. He was treated with an experimental small interfering RNA antiviral agent
(TKM-100802, Tekmira Pharmaceuticals), convalescent plasma, and aggressive supportive
care.5
Author Manuscript
The hospital course was complicated by multiorgan system failure requiring mechanical
ventilation for 12 days and hemodialysis for 24 days.6 After extubation, the patient had
altered mental status, difficulty walking related to severe proximal weakness and
deconditioning, and extreme fatigue. On day 44 of the illness, hemodialysis was no longer
required and his mental status had markedly improved, with some residual mild wordfinding difficulty. Ambulation was limited to short distances because of exertional fatigue.
Blood and urine tested negative for EBOV on quantitative reverse-transcriptase–
polymerasechain-reaction (RT-PCR) assay on serial specimens, and he was discharged
home. A semen sample obtained on the day of discharge was positive for EBOV RNA on
quantitative RT-PCR assay, and EBOV was isolated from semen by means of culture at the
Centers for Disease Control and Prevention (CDC).7 The patient was advised to abstain
from sex or to use condoms for at least 3 months.8 Longitudinal monitoring of semen
specimens for EBOV is ongoing.
Author Manuscript
After discharge, 10 weeks after the onset of EVD symptoms, the patient’s word-finding
difficulty and exercise tolerance were markedly improved, but he had new symptoms,
including low back pain involving the right lumbar and sacroiliac region, bilateral enthesitis
of the Achilles’ tendon, and paresthesias involving the distal lower limbs. Ophthalmic
symptoms, which began shortly after discharge from the hospital, included occasional
bilateral ocular burning, foreign-body sensation, and photophobia. He required an
adjustment in his prescription for reading glasses, which suggested an accommodative
change. His ocular history was clinically significant only for myopia. He was referred to the
Emory Eye Center for further evaluation.
On initial evaluation in November 2014, the patient’s visual acuity was 20/15 bilaterally
while wearing eyeglasses. Intraocular pressure, pupils, ocular motility, and confrontational
visual fields were normal. The examination of the anterior eye by means of slit lamp was
normal. The examination of the dilated posterior eye revealed previously undocumented
multiple, peripheral chorioretinal scars with hypopigmented halos in both eyes and a small
intraretinal hemorrhage adjacent to one scar in the left eye (Fig. 1). He received the
diagnosis of posterior uveitis (i.e., chorioretinitis), a likely sequela of EVD. Close clinical
follow-up was planned.
Author Manuscript
One month later, 14 weeks after the diagnosis of EVD, he presented with an acute onset of
redness, blurred vision with halos, pain, and photophobia in the left eye. Visual acuity was
measured at 20/15 in the right eye and 20/20 in the left eye. The left intraocular pressure was
highly elevated at 44 mm Hg (normal value, 10 to 21). Slit-lamp examination of the left eye
showed conjunctival injection, mild corneal edema, rare nongranulomatous keratic
precipitates, and grade 1+ leukocytes and protein (flare) in the anterior chamber (Fig. 2).
Examination of the anterior chamber with gonioscopy indicated no signs of angle closure.
Dilated funduscopic examination showed stable chorioretinal scars in both eyes with no
N Engl J Med. Author manuscript; available in PMC 2015 December 18.
�Varkey et al.
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other signs of ocular inflammation. He received a diagnosis of anterior uveitis and ocular
hypertension in the left eye. Treatment was started with eyedrops containing 1%
prednisolone acetate four times daily and with ocular hypotensive agents including
acetazolamide (at a dose of 500 mg orally twice daily), eyedrops containing 0.2%
brimonidine twice daily, and eyedrops containing 2% dorzolamide and 0.5% timolol twice
daily. Results of laboratory testing, including measurement of the erythrocyte sedimentation
rate and C-reactive protein, were normal; rapid plasma reagin testing and serologic analysis
for Toxoplasma gondii were negative.
Author Manuscript
Author Manuscript
Because of escalating anterior-chamber inflammation and worsening symptoms during the
subsequent 48 hours, the frequency of administration of prednisolone acetate was increased
to every 2 hours, and eyedrops containing 1% atropine twice daily were added. After
another 24 hours of increasing inflammation and concern about an infectious cause,
paracentesis of the anterior chamber was performed, with aspiration of 170 µl of aqueous
humor through a sterile 30-gauge needle while the practitioner was wearing gloves and a
surgical mask. The specimen was double-bagged and delivered to a dedicated laboratory at
Emory University Hospital for testing samples from patients with EVD. Testing was
performed by clinical laboratory technologists who were trained in the safe handling of
infectious pathogens and with the use of the standard institutional operating protocols.9 The
aqueous humor tested positive for EBOV RNA on quantitative RT-PCR assay, with a cycle
threshold value of 18.7. EBOV was isolated from this specimen by means of a viral culture
performed at the CDC.7 A conjunctival swab obtained before the procedure and tear-film
specimens collected before the procedure and 24 hours after the procedure tested negative
for EBOV RNA on quantitative RT-PCR assay. In addition, a specimen of peripheral blood
tested negative for EBOV RNA on quantitative RT-PCR assay. Preliminary analyses of
EBOV sequenced from blood during the patient’s hospitalization for symptomatic EVD, as
compared with EBOV sequenced from ocular fluid, identified a single nonsynonymous
mutation, as well as two silent mutations and two mutations in noncoding regions. The
significance of these mutations is unknown. However, these findings are in contrast to
results that showed no changes in viral consensus sequences acquired over several days from
a single patient.10 All personal protective equipment and materials that were used during
paracentesis and laboratory testing were sterilized by means of autoclaving before
disposal.11
Author Manuscript
The uveitis continued to progress; by 5 days after the onset of symptoms, visual acuity in the
left eye was decreased to 20/60. Anterior-segment examination revealed scleritis and
persistent anterior uveitis. Intermediate uveitis (i.e., vitritis, with grade 0.5+ haze) was noted
on examination of the dilated posterior segment. Oral prednisone (at a dose of 1 mg per
kilogram of body weight per day) was started. Ophthalmic drops of 1% prednisolone acetate
every 2 hours, 0.5% timolol twice daily, and 1% atropine twice daily were continued in the
left eye.
During the subsequent 72 hours, the patient’s condition improved, with resolution of the
scleritis and a decrease in the anterior uveitis. Despite this improvement in the anteriorsegment inflammation, the vitritis worsened, resulting in a decrease in visual acuity to
20/400 in the left eye at 1 week (Fig. 3). Continued clinical deterioration of the patient’s left
N Engl J Med. Author manuscript; available in PMC 2015 December 18.
�Varkey et al.
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eye prompted the initiation of treatment with topical difluprednate (Alcon Laboratories), a
21-day course of oral favipiravir (MediVector), a periocular injection of oral prednisone. On
examination 3 months after presentation with uveitis, the vitritis was resolving and left
visual acuity had recovered to 20/15. Follow-up ophthalmic evaluations are ongoing.
DISCUSSION
Author Manuscript
We describe the detection of viable EBOV in the aqueous humor of the eye in a patient in
recovery from EVD with acute panuveitis (a combination of anterior, intermediate, and
posterior uveitis). In a previous EVD outbreak, EBOV RNA was detected on RT-PCR assay
in a conjunctival sample obtained from a 25-year-old patient 22 days after the onset of
symptoms and 10 days after viremia had cleared. In that patient, 45 days after the onset of
EVD symptoms, posterior uveitis developed; the patient did not undergo any additional
testing of ocular tissue.4 Marburg virus, a filovirus like EBOV, has also been associated
with uveitis during convalescence. In 1975, Marburg virus was cultured from the aqueous
humor of a patient with acute anterior uveitis that developed nearly 3 months after the onset
of acute illness.12 Viral culture of the patient’s aqueous humor that was sampled 2 weeks
later was negative.13
Author Manuscript
Although the pathogenesis of EVD-associated uveitis is unknown, we believe that the
severe, acute panuveitis that developed in our patient was a direct cytopathic effect of active
replication of EBOV persisting in an immune-privileged organ. The acute onset of
symptoms, unilateral location, and extreme elevation of intraocular pressure that were seen
in our patient are clinical findings similar to infectious uveitis syndromes caused by
herpesviruses, in which the pathogenesis is known to be a direct consequence of active viral
replication.14,15 Although the relative contribution of lytic viral infection, as compared with
immunologic reaction to EBOV, in the pathogenesis of our patient’s aggressive panuveitis is
unclear, the low cycle threshold on quantitative RT-PCR assay shows that a high burden of
viable EBOV was present at the time that the patient’s ocular symptoms were worsening.
Further studies to investigate the mechanisms responsible for the ocular persistence of
EBOV and the possible presence of the virus in other immune-privileged sites (e.g., in the
central nervous system, gonads, and articular cartilage) are warranted.
Author Manuscript
Few systematic studies have examined post-EVD sequelae, so the incidence and clinical
manifestations of post-EVD ocular complications are uncertain. Of 71 EVD survivors from
the 1995 Ebola outbreak in the Democratic Republic of Congo, 20 were enrolled in a small,
retrospective study.4 Three of the 20 survivors in this limited sample were found to have
evidence of uveitis (anterior, posterior, or panuveitis) that occurred 42 to 72 days after the
onset of EVD. Data on the incidence of ocular complications among survivors of the current
West African EVD outbreak are also limited. Although 40% of participants in a recent
survey of 85 EVD survivors in Sierra Leone reported having “eye problems,” the incidence
of uveitis in this cohort is unknown.16
In conclusion, our patient’s recovery from EVD was complicated by acute anterior uveitis,
which rapidly evolved into a sight-threatening panuveitis with detection of persistent EBOV
within the eye. This case highlights an important complication of EVD with major
N Engl J Med. Author manuscript; available in PMC 2015 December 18.
�Varkey et al.
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implications for both individual and public health that are immediately relevant to the
ongoing West African outbreak. It is reassuring that samples of conjunctivae and tears tested
negative for EBOV, a finding that supports previous studies suggesting that patients who
recover from EVD pose no risk of spreading the infection through casual contact.3,17 Further
studies are needed to assess the persistence of EBOV during convalescence, to elucidate the
mechanisms underlying this persistence in ocular and other immune-privileged tissue sites,
and to identify effective treatment strategies for the clinical management of EVD
complications.
Acknowledgments
The findings and conclusions in this report are those of the authors and do not necessarily represent the official
position of the CDC.
Author Manuscript
Supported by a grant from the National Center for Advancing Translational Sciences of the National Institutes of
Health (UL1TR000454, to the Atlanta Clinical and Translational Science Institute), an unrestricted grant from
Research to Prevent Blindness and a grant from the National Eye Institute (P30-EY06360, to the Department of
Ophthalmology, Emory University School of Medicine), and a fellowship grant from the Australian Research
Council (FT130101648, to Dr. Smith). Favipiravir was provided by the Department of Defense Joint Project
Manager Medical Countermeasure Systems.
We thank Alison Boess and the family of Dr. Ian Crozier; staff members at the Biotechnology Core Facility Branch
of the CDC for their assistance in generating viral sequences; Dr. William Bornstein, Dr. Bryce Gartland, Crystal
Evans, Maureen Lindsey, Brian Frislie, Emily Beck, Connie Wilbanks, Paula DesRoches, and all the investigators
at the Emory Serious Communicable Diseases Unit; Kimberly Lovitt, Rhonda Waldron, Debora Jordan, Jannah
Dobbs, Matthew Raeber, and the staff at the Department of Ophthalmology at Emory University; Dr. Monica
Farley and the staff at the Division of Infectious Diseases at Emory University; and MediVector.
References
Author Manuscript
Author Manuscript
1. Global alert and response: Ebola virus disease. Geneva: World Health Organization; 2014. (http://
www.who.int/csr/don/archive/disease/ebola/en).
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www.who.int/csr/disease/ebola/situation-reports/en/?m=20141231).
3. Kibadi K, Mupapa K, Kuvula K, et al. Late ophthalmologic manifestations in survivors of the 1995
Ebola virus epidemic in Kikwit, Democratic Republic of the Congo. J Infect Dis. 1999; 179(Suppl
1):S13–S14. [PubMed: 9988158]
4. Sierra Leone: helping the Ebola survivors turn the page. Geneva: World Health Organization; 2014.
(http://www.who.int/features/2014/post-ebola-syndrome/en).
5. Kraft CS, Hewlett AL, Koepsell S, et al. The use of TKM-100802 and convalescent plasma in 2
patients with Ebola virus disease in the United States. Clin Infect Dis. 2015 Apr 22. (Epub ahead of
print).
6. Connor MJ Jr, Kraft C, Mehta AK, et al. Successful delivery of RRT in Ebola virus disease. J Am
Soc Nephrol. 2015; 26:31–37. [PubMed: 25398785]
7. Rodriguez LL, De Roo A, Guimard Y, et al. Persistence and genetic stability of Ebola virus during
the outbreak in Kikwit, Democratic Republic of the Congo, 1995. J Infect Dis. 1999; 179(Suppl
1):S170–S176. [PubMed: 9988181]
8. Ebola (Ebola virus disease): Q&As on transmission. Atlanta: Centers for Disease Control and
Prevention; 2015. (http://www.cdc.gov/vhf/ebola/transmission/qas.html).
9. Hill CE, Burd EM, Kraft CS, et al. Laboratory test support for Ebola patients within a highcontainment facility. Lab Med. 2014; 45(3):e109–e111. [PubMed: 25184220]
10. Gire SK, Goba A, Anderson KG, et al. Genomic surveillance elucidates Ebola virus origin and
transmission during the 2014 outbreak. Science. 2014; 345:1369–1372. [PubMed: 25214632]
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11. Ebola (Ebola virus disease): Ebola-associated waste management. Atlanta: Centers for Disease
Control and Prevention; 2015. (http://www.cdc.gov/vhf/ebola/hcp/medical-wastemanagement.html).
12. Gear JS, Cassel GA, Gear AJ, et al. Outbreake of Marburg virus disease in Johannesburg. Br Med
J. 1975; 4:489–493. [PubMed: 811315]
13. Kuming BS, Kokoris N. Uveal involvement in Marburg virus disease. Br J Ophthalmol. 1977;
61:265–266. [PubMed: 557985]
14. Amano S, Oshika T, Kaji Y, Numaga J, Matsubara M, Araie M. Herpes simplex virus in the
trabeculum of an eye with corneal endotheliitis. Am J Ophthalmol. 1999; 127:721–722. [PubMed:
10372885]
15. Chee SP, Bacsal K, Jap A, Se-Thoe SY, Cheng CL, Tan BH. Clinical features of cytomegalovirus
anterior uveitis in immunocompetent patients. Am J Ophthalmol. 2008; 145:834–840. [PubMed:
18255045]
16. Trenchard T. Survivors cope with new Ebola after-effects. Al-Jazeera. 2014 (http://
www.aljazeera.com/news/africa/2014/12/survivors-cope-with-new-ebola-aftereffects-2014121573521561384.html).
17. Rowe AK, Bertolli J, Khan AS, et al. Clinical, virologic, and immunologic follow- up of
convalescent Ebola hemorrhagic fever patients and their household contacts, Kikwit, Democratic
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179(Suppl 1):S28–S35. [PubMed: 9988162]
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N Engl J Med. Author manuscript; available in PMC 2015 December 18.
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Figure 1. Montage Fundus Photographs 10 Weeks after the Onset of Ebola Virus Disease
Multiple peripheral chorioretinal scars with hypopigmented haloes are visible in the right
eye (Panel A) and left eye (Panel B) (white arrows). A small intraretinal hemorrhage (black
arrow) is adjacent to a chorioretinal scar in the left eye.
Author Manuscript
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N Engl J Med. Author manuscript; available in PMC 2015 December 18.
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Figure 2. Slit-Lamp Photograph of the Left Eye 14 Weeks after the Onset of Ebola Virus Disease
Mild corneal edema, rare keratic precipitates (arrows), and inflammatory cells and protein in
the anterior chamber are consistent with acute anterior uveitis.
Author Manuscript
N Engl J Med. Author manuscript; available in PMC 2015 December 18.
�Varkey et al.
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Figure 3. Fundus Photograph of the Left Eye 14 Weeks after the Onset of Ebola Virus Disease
Severe vitritis is indicated by the obscuration of the optic nerve and blood vessels.
Author Manuscript
N Engl J Med. Author manuscript; available in PMC 2015 December 18.
�
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Persistence of Ebola Virus in Ocular Fluid during Convalescence
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Varkey, J. B., J. G. Shantha, I. Crozier, C. S. Kraft, G. M. Lyon, A. K. Mehta, G. Kumar, J. R. Smith, M. H. Kainulainen, S. Whitmer, U. Stroher, T. M. Uyeki, B. S. Ribner and S. Yeh (2015). "Persistence of Ebola Virus in Ocular Fluid during Convalescence." N Engl J Med 372(25): 2423-2427.
Abstract
Among the survivors of Ebola virus disease (EVD), complications that include uveitis can develop during convalescence, although the incidence and pathogenesis of EVD-associated uveitis are unknown. We describe a patient who recovered from EVD and was subsequently found to have severe unilateral uveitis during convalescence. Viable Zaire ebolavirus (EBOV) was detected in aqueous humor 14 weeks after the onset of EVD and 9 weeks after the clearance of viremia.
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free online - Pubmed Central
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Title
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Persistence of Ebola Virus in Ocular Fluid during Convalescence
Creator
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Varkey, J. B., J. G. Shantha, I. Crozier, C. S. Kraft, G. M. Lyon, A. K. Mehta, G. Kumar, J. R. Smith, M. H. Kainulainen, S. Whitmer, U. Stroher, T. M. Uyeki, B. S. Ribner and S. Yeh
Subject
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Description
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Among the survivors of Ebola virus disease (EVD), complications that include uveitis can develop during convalescence, although the incidence and pathogenesis of EVD-associated uveitis are unknown.<br /><br />This article was corrected in volume 372 on page 2469.
Date
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2015-06-18
Type
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Publication
Contributor
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2022-01-10 by PPE group Shawn Gibbs
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-10
Ebola
Eye/Ocular Health
Follow up
Infection Prevention and Control
Laboratory Testing
Patient Care
Personal Protective Equipment (PPE)
R-PPE
R-Res&Pub
Specimen Collection
Specimen Handling
Survivors
-
https://repository.netecweb.org/files/original/8cffb8e5d14621bff5718cceb8efbd50.pdf
5a459f005a074c7525611ec76c918879
PDF Text
Text
Clinical Infectious Diseases
BRIEF REPORT
Ebola Virus Persistence in Semen
of Male Survivors
Timothy M. Uyeki,1,a Bobbie Rae Erickson,1,a Shelley Brown,1 Anita K. McElroy,1,2
Deborah Cannon,1 Aridth Gibbons,1 Tara Sealy,1 Markus H. Kainulainen,1
Amy J. Schuh,1 Colleen S. Kraft,2 Aneesh K. Mehta,2 G. Marshall Lyon III,2
Jay B. Varkey,2 Bruce S. Ribner,2 Richard T. Ellison III,3 Ellie Carmody,4 Gerard J. Nau,5
Christina Spiropoulou,1 Stuart T. Nichol,1 and Ute Ströher1
1
Centers for Disease Control and Prevention, and 2Emory University Hospital, Atlanta, Georgia;
Division of Infectious Diseases, University of Massachusetts Medical School, Worcester;
4
Division of Infectious Diseases, NYU School of Medicine, Bellevue Hospital Center, New York;
and 5Division of Infectious Diseases, Rhode Island Hospital, The Miriam Hospital, and the
Warren Alpert Medical School of Brown University, Providence
3
We investigated the duration of Ebola virus (EBOV) RNA and
infectious EBOV in semen specimens of 5 Ebola virus disease
(EVD) survivors. EBOV RNA and infectious EBOV was detected by real-time RT-PCR and virus culture out to 290 days and
70 days, respectively, after EVD onset.
Keywords. Ebola virus; semen; sexual transmission.
Recently, molecular evidence of sexual transmission of Ebola
virus (EBOV) from a male survivor of Ebola virus disease
(EVD) to a female partner that occurred 179 days after EVD
illness onset was reported in Liberia [1]. A semen specimen
from the survivor collected 199 days after illness onset had
detectable EBOV (Zaire ebolavirus species) RNA, and the
virus isolation attempt was negative [1]. This case highlights
the urgency of understanding EBOV persistence in semen
and assessing potential infectiousness to inform the risk of
transmission of EBOV from male survivors to their sexual
partners.
Limited data from testing of semen specimens collected from
a small number of male survivors of previous EBOV associated
EVD outbreaks indicated that EBOV RNA can be detected up
to 101 days after illness onset [2–4]. Recently, detection of
EBOV RNA in semen was reported up to 284 days after illness
onset [5]. However, the longest period from illness onset that
infectious EBOV has been recovered by viral culture of semen
was from a male survivor at 82 days after EVD symptoms began
[2–4]. Given these data, it was important to investigate the duration and infectiousness of EBOV in available semen specimens
Received 8 February 2016; accepted 24 March 2016; published online 3 April 2016.
a
T. M. U. and B. R. E. contributed equally to this work.
Correspondence: T. M. Uyeki, Centers for Disease Control and Prevention, Mailstop A-20,
1600 Clifton Rd, NE, Atlanta, GA 30329 (tuyeki@cdc.gov).
®
2016;62(12):1552–5
Clinical Infectious Diseases
Published by Oxford University Press for the Infectious Diseases Society of America 2016.
This work is written by (a) US Government employee(s) and is in the public domain in the
US. DOI: 10.1093/cid/ciw202
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voluntarily submitted by a small number of adult male survivors
of EVD in the United States.
METHODS
Semen specimens from 5 survivors who had experienced moderately severe to critical illness with EVD, all of whom received
different investigational therapeutics in addition to supportive
clinical management during their hospitalization [6], were tested after recovery during 2014–2015. These survivors submitted
semen specimens at different times when convenient after recovery from EVD for virologic testing at the Centers for Disease
Control and Prevention (CDC) as part of their follow-up clinical management during the post-EVD convalescent period.
Survivors were counseled by their physicians to abstain from
sex or to use condoms until there was no evidence of EBOV
RNA detected. Semen specimens were collected and transported as soon as possible or maintained at 4 degrees Celsius and
shipped overnight on frozen cold packs to CDC. The majority of
the specimens were processed within 0–3 days; however a few
were processed 5–8 days after collection. Only one specimen
that was collected 290 days post symptom onset was frozen
prior to virus culture. Semen specimens were processed at CDC
under biosafety level 4 (BSL4) conditions. Nucleic acid was extracted and tested by quantitative reverse-transcription polymerase chain reaction (qRT-PCR) for EBOV nucleoprotein (NP) as
well as an internal cellular control gene (beta 2-microglobulin
(b2m) (Thermo Fisher Scientific, #4326319E) [7]. The NP
assay has an estimated limit of detection of 400 TCID50/mL
based on several unpublished studies and from a similar performance profile of the NP EUA assay (http://www.fda.gov/
EmergencyPreparedness/Counterterrorism/MedicalCounter
measures/MCMLegalRegulatoryandPolicyFramework/ucm
182568.htm#ebola). Copies per mL that correspond with virus
load cannot be calculated because the assay detects genomic,
antigenomic, and mRNA; therefore, positive and negative controls are performed for each qRT-PCR run, but no standard
curve is generated. Cycle threshold (Ct) values <40 were considered positive. Interpretation of qRT-PCR results includes
analysis of the Ct values, curves, and the b2m results for each
specimen. Given the specimen type, studies are ongoing to determine the distribution of the internal control to provide information on specimen quality. To detect infectious virus, cell culture
virus isolation was attempted as previously described [2].
RESULTS
The results of EBOV RNA detection in available semen specimens over time from illness onset are shown in Figure 1. EBOV
RNA was detected in semen out to 290 days after symptom
�Figure 1. Ebola virus nucleoprotein (NP) quantitative reverse-transcription polymerase chain reaction (qRT-PCR) and virus isolation results on semen specimens. Each
diamond represents an independent semen specimen. NP qRT-PCR results are included inside the diamonds and rectangles as either the cycle threshold value or neg for
negative results. Red and black diamonds represent positive and negative virus isolation, respectively. The rectangles denote no virus isolation was attempted. The red dashed
diamond indicates a contaminated isolation attempt and infectious Ebola virus could not be confirmed. The black dashed line signifies the last day post onset of symptoms
when virus was isolated.
onset (272 days after the first negative blood specimen result)
(Supplementary Table 1). The first negative EBOV RNA result
in semen ranged from 222 to 393 days after illness onset. EBOV
was isolated from semen specimens collected from 3 survivors
and out to 70 days after illness onset (34 days after the first negative blood specimen result). The NP Ct values for semen specimens from which EBOV was isolated by viral culture ranged
from 26 to 30 (Supplementary Table 1). (Higher Ct values indicate lower concentration of the target sequence).
DISCUSSION
We describe the detection of EBOV RNA and infectious virus in
semen specimens collected from 5 male patients who were hospitalized for EVD in the United States during 2014 and recovered. EBOV RNA was detected out to 290 days after illness
onset, whereas infectious EBOV was isolated from semen collected out to 70 days after illness onset. This is similar to the
reported timeframe of 82 days for isolating infectious virus
from semen after illness onset in a previous EVD outbreak [2].
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�Infection of the testes by EBOV likely occurs through viremia
during acute EVD. EBOV antigens were identified in seminiferous tubules from one fatal EVD case [8], and inflammation was
reported with identification of EBOV particles in interstitial
cells, endothelium, and monocytes of testicular tissue of experimentally infected nonhuman primates [9]. EBOV in the testes
may be shielded from the immune response, and therefore active viral replication can continue for prolonged periods. Much
more research is needed to understand the pathogenesis and
maintenance of EBOV in immune-privileged organs. The impact of any investigational therapeutics administered during
clinical management of EVD upon EBOV persistence in the testes during the post-EVD recovery period is unknown, although
the half-life of these experimental therapies is likely far shorter
than the period for which EBOV could be detected in semen
specimens.
Until recently, the World Health Organization (WHO) and
CDC recommended abstinence or condom use for at least
3 months after recovery from EVD [1]. Based upon uncertainty
about the duration of infectious EBOV in semen and concern of
EBOV sexual transmission through exposure to semen of a recovered male EVD survivor, WHO now recommends that male
EVD survivors should abstain from sex or practice safe sex with
correct condom use until semen has tested negative twice with at
least a 1-week interval by RT-PCR [10]. Information about the
limitations of the tests should also be discussed when providing
results. WHO also recommends that if semen has not been tested, safe sex should be practiced for at least 12 months after onset
of EVD. CDC recommends that until more information is
known about the persistence of EBOV in semen, contact with
semen from a recovered EVD patient should be avoided [1, 11].
Our findings are limited by the overall small number of
semen specimens that were submitted for Ebola virus testing
at different time intervals from illness onset. The longevity of
EBOV RNA detection in semen of male EVD survivors requires
further investigation to determine if there is a correlation between viral RNA detection and infectious virus. It may be
that higher viral loads during the acute phase of the illness
leads to increased seeding of these immune privileged sites
and therefore prolonged presence of both infectious and noninfectious EBOV. The sensitivity of virus isolation from semen
specimens could be affected by several factors such as storage
time and temperature, host factors, fungal or bacterial contaminants, or presence of unknown inhibitors. Efforts were made to
minimize the time from specimen collection to cell culture inoculation. Processing of a few specimens were delayed because of
transportation issues, but even at day 5 post collection, a positive
isolate was obtained. The case of suspected EBOV sexual transmission 179 days from symptom onset has raised some questions
about the sensitivity of virus isolation [1], but because the specimen that tested positive by qRT-PCR and negative by virus
culture was collected 20 days after the suspected transmission
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event, it is possible that infectious virus was no longer present
in semen by the time of sampling.
In conclusion, the reported results support previous data suggesting the potential for sexual transmission of EBOV through
semen exposure to a susceptible sexual partner from a recovered
adolescent or adult male EVD survivor out to at least 82 days
after EVD illness onset. Given the case report of suspected
EBOV sexual transmission 179 days after EVD onset [1], the detection of EBOV RNA in semen for 4–6 months after EVD
onset in 43% of survivors in a cross-sectional study [5], and
our findings, it seems prudent to adhere to the WHO recommendation for male survivors to practice abstinence or safe sex with
condom use for up to 6 months after EVD onset if semen cannot
be tested. Counseling of all adolescent and adult male survivors
and their sexual partners about the potential for sexual transmission of EBOV through semen exposure is essential. Broader epidemiological and scientific studies are needed to assess the risk
of sexual transmission of EBOV from semen as well as vaginal
fluid of EVD survivors to their partners, compliance with
WHO and CDC recommendations, and effectiveness of condoms to reduce sexual transmission of EBOV.
Supplementary Data
Supplementary materials are available at http://cid.oxfordjournals.org.
Consisting of data provided by the author to benefit the reader, the posted
materials are not copyedited and are the sole responsibility of the author, so
questions or comments should be addressed to the author.
Notes
Acknowledgments. We thank the following individuals for their contributions: David Gilchrist MD, Thomas Greenough MD (University of
Massachusetts Medical School, Worcester, Massachusetts); Cynthia Condon, Michael Pentella PhD, Tanya Swanson (William A. Hinton State Laboratory Institute, Jamaica Plain, MA), Larry Madoff, MD, Cheryl Gauthier
MA (Massachusetts Department of Public Health, Boston, MA); Patricia
Costa (The Miriam Hospital, Providence, Rhode Island); Cynthia Vanner,
Toby Bennett, Utpala Bandy MD, MPH (Rhode Island Department of
Health, Providence, RI); Jennifer Rakeman PhD (New York City Public
Health Laboratory, Department of Health and Mental Hygiene,
New York, NY); Sean Cloonan MD (NYU School of Medicine, Bellevue
Hospital Center, New York, NY); and the Ebola virus disease survivors
who submitted clinical specimens for this work.
Disclaimer. The views expressed are those of the authors and do not
necessarily represent the official position of the Centers for Disease Control
and Prevention.
Potential conflicts of interest. All authors: No reported conflicts. All
authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content
of the manuscript have been disclosed.
References
1. Mate SE, Kugelman JR, Nyenswah TG, et al. Molecular evidence of sexual transmission of Ebola virus. N Engl J Med 2015; 373:2448–54.
2. Rodriguez LL, De Roo A, Guimard Y, et al. Persistence and genetic stability of
Ebola virus during the outbreak in Kikwit, democratic republic of the Congo,
1995. J Infect Dis 1999; 179(Suppl 1):S170–6.
3. Emond RT, Evans B, Bowen ET, Lloyd G. A case of Ebola virus infection. Br Med J
1977; 2:541–4.
4. Rowe AK, Bertolli J, Khan AS, et al. Clinical, virologic, and immunologic followup of convalescent Ebola hemorrhagic fever patients and their household contacts,
�Kikwit, Democratic Republic of the Congo. Commission de Lutte contre les Epidémies à Kikwit. J Infect Dis 1999; 179(Suppl 1):S28–35.
5. Deen GF, Knust B, Broutet N, et al. Ebola RNA persistence in semen of Ebola virus
disease survivors: preliminary report. N Engl J Med 2015. PMID: 26465681.
6. Uyeki TM, Mehta AK, Davey RT Jr, et al. Clinical management of Ebola virus disease in the United States and Europe. N Engl J Med 2016; 374:636–46.
7. Southern TR, Racsa LD, Albariño CG, et al. Comparison of FilmArray
and quantitative real-time reverse transcriptase PCR for detection of Zaire
Ebola virus from contrived and clinical specimens. J Clin Microbiol 2015;
53:2956–60.
8. Martines RB, Ng DL, Greer PW, Rollin PE, Zaki SR. Tissue and cellular tropism,
pathology and pathogenesis of Ebola and Marburg viruses. J Pathol 2015;
235:153–74.
9. Baskerville A, Fisher-Hoch SP, Neild GH, Dowsett AB. The pathology of experimental Ebola virus infection in monkeys. J Pathol 1985; 147:199–209.
10. World Health Organization. Interim Guidance, Clinical care for survivors of Ebola
virus disease. 2016. Available at: http://www.who.int/csr/resources/publications/
ebola/guidance-survivors/en/.
11. Centers for Disease Control and Prevention. Ebola (Ebola virus disease). Q&As on
Transmission. Available at: http://www.cdc.gov/vhf/ebola/transmission/qas.html.
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Ebola Virus Persistence in Semen of Male Survivors
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Uyeki, T. M., B. R. Erickson, S. Brown, A. K. McElroy, D. Cannon, A. Gibbons, T. Sealy, M. H. Kainulainen, A. J. Schuh, C. S. Kraft, A. K. Mehta, G. M. Lyon, 3rd, J. B. Varkey, B. S. Ribner, R. T. Ellison, 3rd, E. Carmody, G. J. Nau, C. Spiropoulou, S. T. Nichol and U. Stroher (2016). "Ebola Virus Persistence in Semen of Male Survivors." Clin Infect Dis 62(12): 1552-1555.
Abstract
We investigated the duration of Ebola virus (EBOV) RNA and infectious EBOV in semen specimens of 5 Ebola virus disease (EVD) survivors. EBOV RNA and infectious EBOV was detected by real-time RT-PCR and virus culture out to 290 days and 70 days, respectively, after EVD onset.
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free online - Oxford Academic
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Title
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Ebola Virus Persistence in Semen of Male Survivors
Creator
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Uyeki, T. M., B. R. Erickson, S. Brown, A. K. McElroy, D. Cannon, A. Gibbons, T. Sealy, M. H. Kainulainen, A. J. Schuh, C. S. Kraft, A. K. Mehta, G. M. Lyon, 3rd, J. B. Varkey, B. S. Ribner, R. T. Ellison, 3rd, E. Carmody, G. J. Nau, C. Spiropoulou, S. T. Nichol and U. Stroher
Subject
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Description
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We investigated the duration of Ebola virus (EBOV) RNA and infectious EBOV in semen specimens of 5 Ebola virus disease (EVD) survivors.
Date
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2016-06-15
Type
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Publication
Ebola
Follow up
Laboratory Testing
Public Health
R-Res&Pub
Specimen Collection
Specimen Handling
Survivors
Viral Hemorrhagic Fever
-
https://repository.netecweb.org/files/original/b4b91e09d2c8bbe44553e79ad1d68d36.pdf
f6709c9377c098057c3c619907dc2cbc
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Text
HHS Public Access
Author manuscript
Author Manuscript
Ophthalmology. Author manuscript; available in PMC 2017 December 01.
Published in final edited form as:
Ophthalmology. 2016 December ; 123(12): 2626–2628.e2. doi:10.1016/j.ophtha.2016.07.013.
Long-term management of panuveitis and iris heterochromia in
an Ebola survivor
Jessica G. Shantha, M.D.1, Ian Crozier, M.D.2, Jay B. Varkey, M.D.3, Colleen S. Kraft, M.D.3,4,
G. Marshall Lyon III, M.D., M.M.Sc.3, Aneesh K. Mehta, M.D.3, Renee Donahue Carlson, M.D.
3, Charles E. Hill, M.D., PhD.,
Author Manuscript
Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta,
GA
Gokul Kumar, M.D.1, Matthew R. Debiec, M.D.1, Purnima S. Patel, M.D.1, Timothy W. Olsen,
M.D.1, Robert B. Nussenblatt, M.D., M.P.H.5, Daniel F. Martin, M.D.6, Ute Ströher, Ph.D.7,
Timothy M. Uyeki, M.D., M.P.H., M.P.P7, Bruce S. Ribner, M.D., M.P.H.3, Justine R. Smith,
FRANZCO, PhD8, and Steven Yeh, M.D.1
1Emory
Author Manuscript
Eye Center, Department of Ophthalmology, Emory University School of Medicine, Atlanta,
GA 2Infectious Diseases Institute, Mulago Hospital Complex, Kampala, Uganda 3Division of
Infectious Disease, Department of Medicine, Emory University School of Medicine, Atlanta, GA
4Department of Pathology and Laboratory Medicine, Emory University School of Medicine,
Atlanta, GA 5National Eye Institute, National Institutes of Health, Bethesda, MD 6Cole Eye
Institute, The Cleveland Clinic, Cleveland, OH 7Centers for Disease Control and Prevention,
Atlanta, GA 8Flinders University, Adelaide, Australia
Introduction
The 2013-2016 West African Ebola virus disease (EVD) outbreak has been the largest in
history with 28,616 cases and 11,310 deaths in the highest transmission countries of Sierra
Leone, Guinea, and Liberia.1 Reports of uveitis have emerged in EVD survivors.2-3 Herein
Author Manuscript
Corresponding Author Steven Yeh, M.D., 1365B Clifton Road NE, Atlanta, GA 30322, Phone: 404-778-5070 Fax: 404-778-4380,
steven.yeh@emory.edu.
Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our
customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of
the resulting proof before it is published in its final citable form. Please note that during the production process errors may be
discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Disclaimer: The views expressed are those of the authors and do not necessarily represent the official position of the Centers for
Disease Control and Prevention.
Meeting Presentations
American Academy of Ophthalmology Annual Meeting, “Ophthalmic manifestations of Ebola virus disease”, AAO Symposium
“Ebola and the Eye: A Story of Survivors”, November 15, 2015, Las Vegas, NV
American Society of Retina Specialists Annual Meeting, “Clinical Features and Multimodality Diagnostic Imaging in Ebola VirusAssociated Panuveitis: Insights into Pathogenesis”, July 12, 2015, Vienna, Austria
American Society of Retina Specialists Annual Meeting, “Panuveitis associated with Ebola Virus Disease: Clinical Management”,
July 12, 2015, Vienna, Austria
ARVO Keynote Series Closing Session: “Ebola and the Eye: A Story of Discovery and Uncertainty”, May 7, 2015, Denver, Colorado
�Shantha et al.
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Case Report
Author Manuscript
we discuss clinical features, multimodality imaging, and long-term management of
aggressive, sight-threatening panuveitis, in an EVD survivor, providing insight into the
pathogenesis of this condition.
Acute hypertensive anterior uveitis
Acute Ebola virus disease and early post-Ebola syndrome
A 43-year-old physician developed EVD in Kenema, Sierra Leone. After 40 days of
hospitalization at Emory University, he was discharged with serum and urine testing
negative by quantitative reverse transcription-polymerase chain reaction (qRT-PCR) assay
for EBOV RNA.4 One month after discharge, he experienced blurred vision, sacroilitis,
enthesitis, and word-finding difficulties. Ophthalmic evaluation showed visual acuities of
20/15 in both eyes and multiple peripheral chorioretinal scars with hypopigmented haloes
bilaterally, consistent with inactive chorioretinitis requiring no intervention (Supplemental
Figure 1).
Fourteen weeks after EVD diagnosis, the patient presented with acute, left hypertensive
anterior uveitis with visual acuity of 20/20 and intraocular pressure (IOP) of 44 mmHg in
the left eye.2 Treatment was initiated with topical prednisolone acetate 1% (Pred Forte 1%) 4
times daily, brimonidine 0.2% and dorzolamide 2%/timolol 0.5%, and acetazolamide.
Serologies for syphilis, cytomegalovirus, herpes simplex virus-1 and -2, and Toxoplasma
gondii. HLA-B27 was negative.
Author Manuscript
Left anterior chamber paracentesis yielded aqueous humor positive for EBOV by qRT-PCR
with a cycling threshold of 18.7 and a positive EBOV culture. Pre- and 24-hours postprocedure, conjunctival swab and tear film tested negative for EBOV RNA.2
Anterior scleritis, and intermediate uveitis
On day 5 of the acute ocular illness, left visual acuity declined to 20/60 and the IOP was 15
mmHg. Diffuse anterior scleritis and intermediate uveitis prompted addition of oral
prednisone 80 mg, with the topical Pred Forte 1% every 2 hours, timolol 0.5%, and atropine
1% (Supplemental Figure 2).
Left visual acuity declined to 20/150 at day 6 of illness, and examination revealed grade 2+
AC cell, a 0.5 mm hypopyon, and grade 1-2+ vitreous haze. OCT scan showed mild left
retinal thickening (Supplemental Figure 2).
Author Manuscript
Despite symptomatic improvement, left visual acuity worsened to 20/250 at day 9, and IOP
declined to 6 mmHg. Corneal edema followed hypotony, with grade 2+ AC cell and grade
3+ vitreous haze (Supplemental Figure 2). Difluprednate 0.05% every 2 hours was
initiated.
Ophthalmology. Author manuscript; available in PMC 2017 December 01.
�Shantha et al.
Page 3
Optic neuropathy, and panuveitis
Author Manuscript
Left visual acuity deteriorated to 20/500 and IOP decreased to 2 mmHg at day 10. A left
relative afferent pupillary defect (RAPD) developed, indicating optic neuropathy. Iris
heterochromia developed at day 11, with a change from blue to green (Figure 1). Left
anterior segment OCT (AS-OCT) revealed iris stromal thickening (502 μm) when compared
to the right (376 μ m). Ultrasound biomicroscopy (UBM) showed ciliary body edema. A
dense grade 3+ vitreous haze persisted, prompting B-scan ultrasound, which revealed
shallow peripheral, choroidal effusions and optic nerve head edema (Figure 1).
Antiviral therapy with favipiravir
Author Manuscript
Due to clinical worsening, a 21-day course of oral favipiravir (T-705, Toyoma Chemical,
Japan) was initiated. After two loading doses of 2000 mg, favipiravir was administered 1200
mg twice daily. Three days after starting favipiravir (day 18 of illness), visual acuity had
declined to finger counting at 2 feet and IOP was 3 mmHg. A periocular triaminolone
acetonide injection (40 mg/1 ml) was administered in the Emory University Hospital Serious
Communicable Diseases Unit (SCDU). A post-procedure conjunctival swab tested negative
for EBOV RNA.
One day after the injection, left visual acuity was hand motions, but IOP increased to 9
mmHg. The patient was discharged on a course of favipiravir, and oral prednisone was
tapered, decreasing by 10 mg/day every two weeks. Topical difluprednate 0.05% and
atropine 1% were continued.
Long-term follow-up
Author Manuscript
Forty-five days after initial onset of acute ocular illness, the patient completed favipiravir
and remained on oral prednisone 15 mg daily and topical difluprednate 0.05%. Visual acuity
had improved to 20/15 with resolution of RAPD and IOP of 10 mmHg. Slit lamp
examination showed resolved corneal edema, endothelial pigment without KP, and trace AC
pigment. Posterior segment examination showed grade 0.5+ vitreous haze. The iris thickness
had decreased to 452 μm by day 32, with resolution of heterochromia (Figure 1)
At one-year follow-up, left visual acuity returned to 20/20 with IOP of 11 mmHg. After 18
months, visual acuity had declined to 20/60 with development of diffuse posterior capsular
cataract. Anterior uveitis was observed with diffuse stellate KP, 1+ AC cell and stable
posterior segment. Repeat AC paracentesis tested negative for Ebola virus by qRT-PCR.
PCR testing was also negative for CMV, HSV, and VZV DNA. Topical prednisolone acetate
taper was given over four weeks with resolution of anterior uveitis.
Author Manuscript
Discussion
The clinical and multimodal imaging features of this aggressive spectrum of ophthalmic
pathology highlight the mechanisms of inflammation and infection, which improved
following the administration of corticosteroids and antiviral medication.
Iris heterochromia coincided with iris and ciliary body edema by AS-OCT and UBM; this
was suggestive of heavy leukocyte infiltration and/or massive protein exudation related to an
Ophthalmology. Author manuscript; available in PMC 2017 December 01.
�Shantha et al.
Page 4
Author Manuscript
extreme inflammatory response associated with active EBOV replication. Immediate
improvement of IOP and recovery of ciliary body anatomy following the corticosteroid
injection supported the key role of appropriately timed anti-inflammatory therapy.
Although the precise role of favipiravir – a pyrazinecarboxamide derivative that inhibits viral
RNA replicase5 – was unclear, our patient’s disease process worsened initially on topical
and systemic corticosteroid. Following the initiation of favipiravir, a periocular
corticosteroid injection was administered because of concerns for recalcitrant hypotony,
ciliary body shutdown, and irreversible vision loss. The patient’s clinical improvement
paralleled the anatomic reduction in iris thickening by AS-OCT.
Author Manuscript
In summary, diagnostic ophthalmic imaging highlighted the anatomic and pathologic
changes that occurred during our patient’s sight-threatening panuveitis. The imaging
findings suggested severe reactive inflammation in the presence of EBOV viral replication,
emphasizing the need for consideration of management strategies that target infectious and
inflammatory processes in post-Ebola uveitis. Potential for uveitis recurrence mandates
long-term monitoring.
Supplementary Material
Refer to Web version on PubMed Central for supplementary material.
Acknowledgments
Financial Support
Author Manuscript
This project was supported by the National Center for Advancing Translational Sciences of the National Institutes
of Health Award Number UL1TR000454 (Atlanta Clinical and Translational Science Institute), an unrestricted
departmental grant from Research to Prevent Blindness, Inc. (New York, NY) and by NIH/NEI core grant P30EY06360 (Department of Ophthalmology, Emory University School of Medicine), an Alcon Research Institute
Young Investigator Grant (Dr. Yeh), a Heed Ophthalmic Fellowship Foundation Grant, Cleveland, OH (Dr.
Shantha), and a fellowship grant from the Australian Research Council (FT130101648, to Dr. Smith). Favipiravir
was provided by the Department of Defense Joint Project Manager Medical Countermeasure Systems.
References
Author Manuscript
1. Ebola situation report - 10 June 2016. World Health Organization; Geneva: 2016. http://
apps.who.int/iris/bitstream/10665/208883/1/ebolasitrep_10Jun2016_eng.pdf?ua=1
2. Varkey JB, Shantha JG, Crozier I, et al. Persistence of Ebola Virus in Ocular Fluid during
Convalescence. The New England journal of medicine. 2015; 372(25):2423–2427. [PubMed:
25950269]
3. Mattia JG, Vandy MJ, Chang JC, et al. Early clinical sequelae of Ebola virus disease in Sierra
Leone: a cross-sectional study. The Lancet. Infectious diseases. 2015
4. Kraft CS, Hewlett AL, Koepsell S, et al. The Use of TKM-100802 and Convalescent Plasma in 2
Patients With Ebola Virus Disease in the United States. Clinical infectious diseases : an official
publication of the Infectious Diseases Society of America. 2015; 61(4):496–502. [PubMed:
25904375]
5. Oestereich L, Ludtke A, Wurr S, Rieger T, Munoz-Fontela C, Gunther S. Successful treatment of
advanced Ebola virus infection with T-705 (favipiravir) in a small animal model. Antiviral research.
2014; 105:17–21. [PubMed: 24583123]
Ophthalmology. Author manuscript; available in PMC 2017 December 01.
�Shantha et al.
Page 5
Author Manuscript
Author Manuscript
Figure 1. Anterior segment photographs and digital imaging
Author Manuscript
(A) Slit lamp photograph of right eye with corresponding anterior segment OCT at baseline
shows iris thickness of 377 μm. (B) Slit lamp photograph and anterior segment OCT at day
11 show a green iris color with iris thickening at 502 μm. (C) By day 32, slit lamp
photograph shows reversal of iris color to original blue color and corresponding decrease in
iris edema to 452 μm. (D) Ultrasound biomicroscopy (UBM) show normal ciliary body
anatomy of the right eye. (E) UBM of left eye shows ciliary body swelling (green triangles)
and supraciliary/choroidal effusion (yellow areas) consistent with progressive panuveitis,
choroiditis and evolving hypotony at day 12. (F) Repeat UBM shows decreased ciliary body
swelling and resolution of supraciliary/choroidal effusion (yellow arrows) by day 32. (G) Bscan ultrasound shows choroidal thickening at day 11 and repeat at day 32. (H) shows
resolution of choroidal thickening.
Author Manuscript
Ophthalmology. Author manuscript; available in PMC 2017 December 01.
�
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Long-term Management of Panuveitis and Iris Heterochromia in an Ebola Survivor
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Develop
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<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
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https://www.ncbi.nlm.nih.gov/pubmed/27594198
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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5121070/
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Shantha, J. G., I. Crozier, J. B. Varkey, C. S. Kraft, G. M. Lyon, 3rd, A. K. Mehta, R. D. Carlson, C. E. Hill, G. Kumar, M. R. Debiec, P. S. Patel, T. W. Olsen, R. B. Nussenblatt, D. F. Martin, U. Stroher, T. M. Uyeki, B. S. Ribner, J. R. Smith and S. Yeh (2016). "Long-term Management of Panuveitis and Iris Heterochromia in an Ebola Survivor." Ophthalmology 123(12): 2626-2628 e2622.
Abstract
The 2013-2016 West African Ebola virus disease (EVD) outbreak has been the largest in history with 28,616 cases and 11,310 deaths in the highest transmission countries of Sierra Leone, Guinea, and Liberia. Reports of uveitis have emerged in EVD survivors. Herein we discuss clinical features, multimodality imaging, and long-term management of aggressive, sight-threatening panuveitis, in an EVD survivor, providing insight into the pathogenesis of this condition.
Accessibility
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free online - Pubmed Central
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Long-term Management of Panuveitis and Iris Heterochromia in an Ebola Survivor
Creator
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Shantha, J. G., I. Crozier, J. B. Varkey, C. S. Kraft, G. M. Lyon, 3rd, A. K. Mehta, R. D. Carlson, C. E. Hill, G. Kumar, M. R. Debiec, P. S. Patel, T. W. Olsen, R. B. Nussenblatt, D. F. Martin, U. Stroher, T. M. Uyeki, B. S. Ribner, J. R. Smith and S. Yeh
Subject
The topic of the resource
Treatment & Care
Description
An account of the resource
The 2013-2016 West African Ebola virus disease (EVD) outbreak has been the largest in history with 28,616 cases and 11,310 deaths in the highest transmission countries of Sierra Leone, Guinea, and Liberia.
Date
A point or period of time associated with an event in the lifecycle of the resource
2016-12-01
Type
The nature or genre of the resource
Publication
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-09-27
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2022-09-27 - general asset review - Treatment & Care group
Ebola
Example
Eye/Ocular Health
Follow up
Public Health
R-Res&Pub
R-T&C
Specimen Collection
Survivors
-
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<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
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<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
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https://asprtracie.hhs.gov/technical-resources/44/SARS-MERS/44
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ASPR TRACIE SARS/MERS
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ASPR TRACIE
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General
Description
An account of the resource
SARS/MERS | Technical Resources | TRACIE
Date
A point or period of time associated with an event in the lifecycle of the resource
2018-01-08
Contributor
An entity responsible for making contributions to the resource
2022-12-07 general asset review - IPC
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2023-12-10
Coronavirus
Federal
Identify
Infection Prevention and Control
Inform
Isolate
Lab
Laboratory
MERS-CoV
Patient Care
Person Under Investigation (PUI)
Public Health
Quarantine
R-IPC
Respiratory Pathogen
SARS
Specimen Collection
-
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Discover
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An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Hyperlink
A link, or reference, to another resource on the Internet.
URL
http://www.cdc.gov/coronavirus/mers/index.html
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Title
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CDC MERS-CoV
Creator
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CDC
Subject
The topic of the resource
General
Description
An account of the resource
MERS-CoV | Home | Middle East Respiratory Syndrome | Coronavirus | CDC
Date
A point or period of time associated with an event in the lifecycle of the resource
2018-01-08
Contributor
An entity responsible for making contributions to the resource
2022-12-07 general asset review - IPC
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2023-12-10
Coronavirus
Federal
Identify
Infection Prevention and Control
Inform
Isolate
Lab
Laboratory
MERS-CoV
Patient Care
Person Under Investigation (PUI)
Public Health
Quarantine
R-IPC
Respiratory Pathogen
Specimen Collection
-
https://repository.netecweb.org/files/original/d4f5875e09521fc5385cc261ff91ca4e.pdf
c588740e8bb8d809af0237c68b60fe3d
PDF Text
Text
Middle East Respiratory Syndrome Coronavirus (MERS Co-V) Lab Protocol for Person
Under Investigation (PUI) Main Campus
1
Routine blood work will be processed as usual in the core lab as MERS Co-V is not a blood borne
pathogen and may be drawn at any point during the patient encounter. Before a respiratory
specimen is collected, consultation with the Academic General Infectious Disease Attending MD On
Call and the state epidemiologist or county health department will be necessary. NPHL staff must be
notified prior to the collection of specimens (24/7 pager # 402-888-5588).
When Specimens Should Be Collected for MERS Co-V Testing
MERS Co-V is detected in nasal/oropharyngeal (NP/OP) swabs and lower respiratory tract specimens
(broncheoalveolar lavage, tracheal aspirate, and pleural fluid). MERS Co-V testing should take place
prior to other respiratory pathogen testing in a PUI meeting clinical criteria 1 or 2 in the MERS Co-V
Protocol. If test results prove negative the specimen will be reflexed to the hospital core lab for a
Respiratory Pathogen Panel (RPP). For PUI meeting clinical criteria 3, an RPP should be submitted to
the hospital core lab. If the RPP is negative the Academic General Infectious Disease Attending MD
On Call should be consulted for further instructions.
NOTE: A Respiratory Pathogen Panel (RESPP) requires collection of either a nasal wash or a
nasopharyngeal swab, both in 2-3ml of viral Transport Medium (VTM)
Test Name
Mers Co PCR
Assay
Preferred Specimen
NP wash + NP/OP swab in
2-3ml of VTM
Acceptable Specimen
NP/OP swab in 2-3ml of VTM
How to order
NPHL Requisition form
MERSC
Respiratory specimens should be collected as soon as possible after symptoms begin – ideally within 7
days. CDC recommends the following:
if symptom onset for a PUI with respiratory symptoms was less than 14 days ago, a single serum
specimen, and NP specimen OR lower respiratory specimen (BAL) should be collected for MERS
PCR testing.
if symptom onset for a PUI with an ongoing respiratory tract infection, especially lower, was 14
or more days ago, a single serum specimen for serologic testing in addition to a lower
respiratory specimen and an NP/OP specimen
Personnel required for Mers Co PCR Assay Specimen Collection
Primary nurse
Task nurse (Doffer)
Nebraska Public Health Laboratory (NPHL) Representative
Materials for all Specimen Collections
Biohazard Ziploc bags x2 per set of tubes
Bleach wipes
Nasal washing kit
Phlebotomy supplies (for peripheral/Central line draws)
Cooler for specimen transport (NO ICE)
Revised 3/15/17
�2
Preprinted specimen labels or patient chart labels (do not bring lab scanner/labeler into the
isolation room)
Procedure for all Specimens
Nursing Staff will collect specimens
Do not start the process unless the Task RN is present
Gather required materials:
Don MERS Co-V specific PPE before entering room
Set out a clean area for the procedure using a disposable chux
Label specimen per existing Nebraska Medicine/NPHL protocols
Prepare supplies
o Broncheoalveolar lavage, tracheal aspirate, pleural fluid: collect 2-3 mL into the sterile
leak proof container in Viral Transport Medium (VTM) per the usual lab protocol.
OR
o
o
NP wash/aspirate or nasal aspirates: Collect 2-3 mL into a sterile, leak-proof container using
VTM, per the usual lab protocol.
AND
NP swabs: insert a swab into the nostril parallel to the palate. Leave the swab in place for a few
seconds to absorb secretions. Swab both nasopharyngeal areas. Put swab into VTM per the
usual lab protocol.
Note: Use only FLOQSwab kit (synthetic fiber swabs with plastic shafts). Do not use calcium alginate swabs or
swabs with wooden shafts, as they may contain substances that inactivate some viruses and inhibit PCR testing.
Place swabs immediately into sterile tubes containing 2-3 ml of viral transport media. NP/OP specimens can be
combined, placing both swabs in the same vial.
Use NPHL procedure to collect: NASOPHARYNGEAL WASHINGS/Swab
Video Link: https://www.youtube.com/watch?v=DVJNWefmHjE
Washing:
1. Cut off the distal end of the butterfly catheter (needle and butterfly) catheter extension set so that
about 2-3 inches of tubing are left attached to the hub.
2. Draw up 2-3mls of saline into a syringe.
3. Attach syringe to hub of butterfly catheter. Purge tubing with saline.
Revised 3/15/17
�3
4. Gently remove excess mucous from patient's nose. (If patient is an adult, ask the patient to gently
blow nose. For pediatrics, a bulb syringe may be used to remove excess mucous.)
5. Position patient in supine position with the head of bed up 30°. The head should be turned to one
side and tilted slightly backward.
6. Stabilize the patient's head and gently place the catheter into the nare. Placement should be in the
nare (nasal wall), not the nasopharynx. Depending on the size of the patient, this should be about 1-2
cm in adults and 0.5 cm to 1.0 cm in children (0.5 cm in neonates). See Figure 1.
7. Instill .5 2 mls saline (.5 1mls for infants and children, 1 2mls for adults) into the nare and aspirate
back mucous, saline and epithelial cells.
8. Repeat this process using the same syringe until the sample is cloudy or appears to hold cellular
debris. (If the sample is inadequate, the process may be repeated on the opposite nare, using a second
sterile syringe and tubing. Usually one nare is sufficient.)
NOTE: There may be some blood streaks in the mucous. This is normal and patients/parents should be
told this is expected and will stop in a few minutes.
9. Transfer contents of tubing and syringe into transport media using the following process: Depress
syringe plunger and express fluid from syringe and tubing into transport media. Then withdraw
media/fluid back into syringe and tubing. Depress syringe plunger again, expressing fluid from syringe
and tubing back into transport media.
NOTE: This is necessary to recover any cells or virus adhering to the tubing or syringe.
Nasal Swab:
1. Insert a FLOQSwab into the same nares from which the wash was performed approximately 3 cm
and gently rub the mucosa.
2. Place the swab back into transport media containing aspirated material.
Packaging Specimen per NPHL protocol:
Staff in isolation room should hand off Mers Co PCR Assay Specimen to clean area as follows:
Place preprinted label on each specimen container with proper identifiers.
Wipe all surfaces of the specimen container with a hospital approved bleach wipe to remove
any residual secretions or blood
Task RN will hold a Biohazard bag, open for the LABELED specimen tubes to be dropped in
Revised 3/15/17
�4
For blood work going to the core lab: Multiple tubes can be placed in the same biohazard bag
Task RN will seal the bags
Task RN will wipe down outside of bag, with a bleach wipe and either place in NPHL transport
container or send to lab per the usual protocol
Mers Co PCR Assay Specimens will be retrieved by NPHL staff
Blood work going to the core lab will be wiped and packaged in the same manner to reduce
bioburden from the patient care room on specimen container.
Transportation of Mers Co PCR Assay Specimen
NPHL Staff will transport specimen(s) in durable, leak-proof container, such as a cooler. In
compliance with 29 CFR 1910.1030, specimens should be placed in this container for transport
within a facility and should be hand carried to laboratory. DO NOT use the pneumatic tube system.
Do NOT leave specimen unattended.
Transportation of blood specimens will be handled in the usual manner per policy as MERS Co-V
is not a blood borne pathogen.
Special Information
Collecting a respiratory specimen before approval is given should not be considered.
Routine blood work will be processed as usual in the core lab as MERS Co-V is not a blood borne
pathogen.
The approved CDC MERS Co-V molecular assay will be performed by NPHL upon receipt of the
specimens. This assay requires approximately 6 hours to completed once the specimen is received
and will be ordered as MERSC (Middle Eastern Respiratory Syndrome Coronavirus)
Labs in addition to the molecular assay (CBC, BMP etc.) will be performed in collaboration with
the core lab and NPHL for a patient under investigation for MERS Co-V infection.
Respiratory Pathogen Panel (RESPP): nasal wash or nasopharyngeal swab in 2-3 ml VTM per usual lab
protocol may be performed once MERS Co-V has been ruled out
Special Request for Biopsy Specimen
Prior to collecting a respiratory biopsy specimen, call the Dissection Laboratory (402-559-9208)
or page the pathologist resident on-call (888-1380) to obtain a Biopsy Kit (10% neutral buffered
formalin contained in a bottle and placed into a sealed plastic bag with absorbent). NPHL
personnel or other designated individual will obtain the kit from the Dissection Laboratory
(located at HL28270, next to the operating rooms) and transport the kit to the ED patient room
of the PUI. Following collection of the biopsy specimen, the specimen will be packaged as
described in this document and transported to the Dissection Laboratory. The specimen will
subsequently sit in 10% neutral buffered formalin at ambient temperature for 24 hours before
processing.
Test
Tissue biopsy
Revised 3/15/17
Order code
EXAM
Tube type
10% neutral buffered formalin
Performed at
Dissection lab (HL28270)
�5
References:
Nebraska Department of Health and Human Services Health Alert Network: Updated Guidance for the Evaluation of Severe
Respiratory Illness Associated with Middle East Respiratory Syndrome Coronavirus (MERS Co-V) 08/19/14
Nebraska Biocontainment Unit Policy # 1.210 Obtaining and Processing Laboratory Specimens
Centers for Disease Control and Prevention: Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens from
Patients Under Investigation (PUIs) for Middle East Respiratory Syndrome Coronavirus (MERS-CoV) - Version 2 Updated
6/2015
Revised 3/15/17
�
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Title
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MERS-CoV ED Lab Protocol - Main Campus
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Title
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Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Protocol
Protocol documentation
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Title
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MERS-CoV ED Lab Protocol - Main Campus
Creator
An entity primarily responsible for making the resource
University of Nebraska Medical Center / Nebraska Medicine
Subject
The topic of the resource
Laboratory
Description
An account of the resource
Nebraska - MERS CoV Resources
Date
A point or period of time associated with an event in the lifecycle of the resource
2017-03-15
Contributor
An entity responsible for making contributions to the resource
2023-12-18 by Lab (Vicki and Kim), 1 yr, Review to make sure practices are current
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-12-18
Emergency Department
Lab
Laboratory
Laboratory Testing
MERS-CoV
R-Lab
Respiratory Pathogen
Specimen Collection
Specimen Handling
Specimen Transport