Instructions for NP swabs

July 24, 2009

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A.  Context

Identification and investigation of hospitalized cases of influenza is needed to assess the effect of

Swine-origin influenza A/H1N1 virus (S-OIV) in BC.  The BC College of Physicians also sent an email on

July 2, 2009 to all physicians from the Provincial Health Officer that included this request to test for

influenza.  S-OIV continues to circulate in BC and in recent weeks, provinces have noted increasing

numbers of hospitalization due to S-OIV

B.  Guidelines for testing

TEST all patients admitted overnight (or longer) to hospital with a history of recent acute

respiratory illness (i.e., history of fever and new or worse cough/breathing difficulty, with or

without other flu-like symptoms such as sore throat, rhinorrhea, sneezing, myalgia, arthralgia,

headache, fatigue, etc.);

Test as soon as possible on admission to increase likelihood of virus detection;

Test even if the etiology appears to be bacterial;

Specimen collection for influenza testing may include a nasopharyngeal (NP) swab or

bronchoalveolar lavage (BAL). If patient presents with a rapidly progressive acute respiratory

illness that is negative by NP swab for influenza A/H1N1, additional testing should be performed

on tracheal or other pulmonary samples, if clinicians suspect influenza pneumonia diagnosis.

NP samples should be collected on viral swabs (ideally, COPAN flocked swabs);

Specimens should be submitted to BCCDC Public Health Microbiology & Reference Laboratory,

with “hospitalized” written in large letters on the requisition;

The requisition form, along with detailed instructions, can be found online at

http://www.phsa.ca/bccdcpublichealthlab (click on “Forms & Requisitions” on the left-hand panel,

then choose “H1N1 Flu Virus: Virus Culture Form”);

Start antivirals according to clinical judgment without waiting for test results.  Antivirals

are most effective when administered within 48 hours of illness onset.

C.  Reporting of Cases

Lab-confirmed S-OIV cases who are admitted to hospital must be reported to the Public Health

Unit in the area where the patient lives. Public health staff will follow-up with detailed investigation of

hospitalized, lab-confirmed S-OIV cases.

Abbotsford HU

Tel:  604-864-3400 Agassiz HU

Tel:  604-793-7160 Burnaby HU

Tel:  604-918-7605 Chilliwack HU

Tel:  604-702-4900 Cloverdale HU, Surrey

Tel:  604-575-5100 Guildford HU, Surrey

Tel:  604-587-4750

Hope HU

Tel:  604-860-7630 Langley HU

Tel:  604-539-2900 Maple Ridge HU

Tel:  604-476-7000 Mission HU

Tel:  604-814-5500 New Westminster HU

Tel:  604-777-6740 Newport HU, Port Moody

Tel:  604-949-7200

Newton HU, Surrey

Tel:  604-592-2000 North Delta HU

Tel:  604-507

-5400 North Surrey HU

Tel:  604-587-7900 Port Coquitlam HU

Tel:  604-777-8700 South Delta HU

Tel:  604-952-3550 White Rock HU

Tel:  604-542-4000

After Hours Public Health Emergency Pager:  604-527-4806.  Ask for the Medical Health Officer On-Call



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