Influenza Testing

There is no cost for this testing. If not a regular submitter, please reach out to Virology Supervisor for instructions prior to sending: 317-921-5843 or alucas@health.in.gov.

Nasopharyngeal (NP), throat, or nasal swab are preferred, but nasal aspirates, nasal wash, bronchoalveolar lavage (BAL), bronchial wash, tracheal aspirate, sputum and lung tissue are acceptable.

For patients with suspicion of HPAI, preapproval to test for Influenza A/H5 is needed through IDOH Infectious Disease Epidemiology & Prevention Division: https://www.in.gov/health/idepd/respiratory-disease/influenza/avian-influenza/

Specimen collection guidance for HPAI may be found here: https://www.cdc.gov/bird-flu/prevention/hpai-interim-recommendations.html

1. Viral or Universal Transport Media (VTM or UTM)-available commercially. Some require refrigeration before use, store according to the product guidance. No dry swabs will be accepted.
2. Swab - Swab material should be synthetic, i.e., rayon, polyester, or Dacron. No calcium alginate, charcoal-impregnated, or wood-shaft swabs.
3. Sterile containers and collection materials for sputum, wash, BAL, aspirates, or lung tissue.
4. Catheter with a suction trap or a bulb aspirator for collecting nasal aspirates.
5. Frozen cold packs or dry ice.
6. Insulated shipping boxes with appropriate shipping labels.

1. Specimen tube must be labeled with patient’s full name, patient’s date of birth, and date of specimen collection. Check these for accuracy and spelling.
2. Check the expiration date on the VTM tube to ensure product is acceptable and will continue to be acceptable once received at the IDOH Laboratory.
3. After collection, all specimens should be stored at refrigerated temperature (2-8°C) until shipped. Specimens must be received at lab within 3 days of collection if stored at refrigerated temperatures. If longer storage is required, place specimens (not whole blood) in a -70°C freezer. Avoid freeze-thaw cycles.
4. Specimen test requests are submitted to the IDOH Laboratory on LimsNet web portal, results will be available as PDF files when test is complete. To get a free LimsNet account established at your facility for electronic submission and results reporting, call the help desk at (317) 921-5506 or email LimsAppSupport@health.in.gov.
5. Special Instructions for Specimen Collection
   1. NP Swab: Insert Dacron-tipped swab through the nostril into the nasopharynx until tip reaches distance equivalent to that from the ear to the nostril of the patient. Rotate swab several times, remove and place swab into the VTM tube.
   2. Throat Swab: Rub the tonsils and posterior pharynx with a Dacron-tipped plastic swab. Place the swab into the VTM tube.
   3. Nasal Aspirates: Insert a small catheter with a suction trap or bulb aspirator though the nostrils into the nasopharynx. Apply suction while slowly removing the catheter or aspirator tip. The catheter or aspirator should be flushed with VTM. Place the specimen into the VTM tube.
   4. Nasal Wash: Place several milliliters of sterile saline into nostrils while patient's head is tilted back. Bring patient's head forward and catch saline flowing from the nostrils into a small container. Pour 1-2mL of specimen into the VTM tube.
   5. Sputum: Satisfactory quality implies the presence of mucoid or mucopurulent material, which is more important than overall volume. Ideally, a sputum specimen should have a volume of 3-5ml, although smaller quantities are acceptable if the quality is satisfactory.

1. Place the specimen and absorbent material in a biohazard specimen bag. Be sure to package each patient’s specimens individually to avoid cross-contamination.
2. The LIMSNet electronic entry will generate a Coversheet for your package with printed details of each specimen. Place the LIMSNet Coversheet in the side pocket of the biohazard bag or in a separate Ziploc bag. Never place the coversheet in with the specimen, in case the specimen leaks during transit.
3. Free shipment to IDOH Laboratory may be coordinated through a regional pickup site of the IDOHL STAT Courier system. Call toll-free (888) 592-7828 to discuss options with STAT Courier. If shipping via FedEx or UPS, place the specimen bag(s) in a Styrofoam container with sufficient frozen ice packs to maintain 2-8°C during shipment. For swabs, sputum, aspirates, and washes, if needed, dry ice can also be used if the specimen is frozen and/or transport time may be longer than 24 hours. If dry ice is used, do not form an airtight seal on the Styrofoam container because dry ice releases carbon dioxide gas which causes pressure buildup in airtight packages.
4. Seal the Styrofoam container into a similar-sized cardboard shipping box.
5. Ship or transport by courier, the box compliant with DOT and IATA regulations. Ship to:

Indiana Department of Health Laboratory
Attn: Virology Laboratory
550 W. 16th Street, Suite B
Indianapolis, IN 46202

Expected result turnaround time is 1-2 business days.

Test Referral: Specimens may be forwarded to the CDC for additional testing.