Embed Size (px)
Citation preview
NICD
-NHL
S QU
ICK
REFE
RENC
E GU
IDE
FOR
THE
LABO
RATO
RY
DIAG
NOSI
S OF
PR
IORI
TY C
OMMU
NICA
BLE
DISE
ASES
Deve
lope
d by
: Th
e Nat
iona
l Inst
itute
for C
omm
unica
ble D
iseas
es (N
ICD)
A
divis
ion
of th
e Nat
iona
l Hea
lth L
abor
ator
y Ser
vice (
NHLS
)
Ve
rsio
n 2.1
La
st u
pdat
ed: 2
Feb
ruar
y 201
2
Tabl
e of C
onte
nt
1. Int
rodu
ction
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
......3
2.
Acute
Flac
cid P
araly
sis or
Poli
o (IC
D-10
A80
)......
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
..4
3. An
thrax
(ICD
-10 A
22)..
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
....5
4. Bo
tulism
(ICD
-10 A
05.1
/ A48
.5)....
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
.6
5. Ch
olera
(ICD
-10 A
05.8)
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
...7
6. Di
phthe
ria (I
CD-1
0 A36
)......
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
....8
7. Le
gione
llosis
(ICD
-10 A
48.1)
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
...9
8. Me
asles
(ICD
-10 B
05)..
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
.10
9. Pe
rtuss
is (IC
D-10
A37
)......
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
....11
10
. Me
ningo
cocc
al Di
seas
e (IC
D-10
A39
)......
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
.....1
2 11
. Pl
ague
(ICD
-10 A
20)..
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
...13
12
. Ra
bies d
iseas
e in h
uman
s (IC
D-10
A82
).....
........
........
........
........
........
........
........
........
........
........
.......
........
........
........
........
........
........
........
........
........
........
........
........
..14
13.
Rift V
alley
feve
r (IC
D-10
A92
.4)....
........
........
........
........
........
........
........
........
........
........
........
.......
........
........
........
........
........
........
........
........
........
........
........
........
........
.15
14.
SARS
(Pro
vision
al IC
D-10
U04
.9)....
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
.....1
6 15
. Sm
allpo
x (IC
D-10
B03
)......
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
....17
16
. Ty
phoid
Fev
er (I
CD-1
0 A01
.0)....
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
...18
17
. Vi
ral H
emor
rhag
ic Fe
vers
(ICD-
10 A
96)..
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
......1
9 18
. Vi
ral H
epati
tis (I
CD-1
0 B15
-19)
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
.....2
0 19
. Ye
llow
Feve
r (IC
D-10
A95
)......
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
......2
1 20
. Cl
uster
s (ou
tbrea
ks) o
f Gas
troint
estin
al Di
seas
e/Foo
dbor
ne D
iseas
e.....
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
.....2
2 20
.1.
Bacte
rial id
entifi
catio
n (hu
man s
pecim
ens)
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
..22
20.2.
Vi
ral id
entifi
catio
n.....
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
....23
20
.3.
Envir
onme
ntal S
ampli
ng: F
ood,
Milk
and W
ater T
estin
g.....
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
24
20.4.
Co
ntact
detai
ls for
gastr
ointes
tinal
disea
se ou
tbrea
ks....
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
........
.....2
5 Pr
efix
and
Dis
clai
mer
Th
is ma
terial
is in
tende
d for
use
by
healt
hcar
e pr
ofess
ionals
. Whil
e the
gre
atest
care
has
bee
n tak
en in
the
deve
lopme
nt of
the d
ocum
ent,
the N
ation
al De
partm
ent o
f Hea
lth a
nd th
e Na
tiona
l Insti
tute
for C
ommu
nicab
le Di
seas
es, o
f the
Nati
onal
Healt
h La
bora
tory S
ervic
e, do
not
acce
pt re
spon
sibilit
y for
any
er
rors
or o
miss
ions.
All h
ealth
care
pro
fessio
nals
shou
ld ex
ercis
e the
ir ow
n pr
ofess
ional
judge
ment
in co
nfirm
ing a
nd in
terpr
eting
the
findin
gs p
rese
nted
in the
guide
lines
. NI
CD-N
HLS
Labo
rator
y Han
dboo
k for
Diag
nosis
of P
riority
Com
munic
able
Dise
ases
, v2,
upda
ted 20
12/02
/02
2
NICD
-NHL
S La
bora
tory H
andb
ook f
or D
iagno
sis of
Prio
rity C
ommu
nicab
le Di
seas
es, v
2, up
dated
2012
/02/02
3
1. I
ntro
duct
ion
Usin
g th
is gu
ide:
This
guid
e se
rves
as a
refer
ence
for l
abor
atory
staff
and
healt
hcar
e wo
rkers
rega
rding
prio
rity c
ommu
nicab
le dis
ease
s. W
e pr
ovide
a
basic
guid
e re
gard
ing sp
ecim
en re
quire
ments
, tra
nspo
rtatio
n an
d sto
rage
requ
ireme
nts, a
nd a
vaila
ble te
sts fo
r a se
ries o
f prio
rity co
mmun
icable
dise
ases
. In
the e
vent
of oc
curre
nce
of a
spec
ific d
iseas
e, a
more
comp
rehe
nsive
guid
e wi
th sp
ecific
infor
matio
n on
that
comm
unica
ble d
iseas
e sh
ould
be co
nsult
ed.
Thes
e ar
e co
mmon
ly av
ailab
le on
the
NIC
D-NH
LS w
ebsit
e (w
ww.ni
cd.ac
.za/?p
age=
guide
lines
&id=
73)
and/o
r the
Dep
artm
ent
of He
alth
webs
ite
(www
.doh.g
ov.za
), an
d fur
ther a
dvice
shou
ld be
obta
ined
from
spec
ialist
s in
the fie
ld an
d/or t
he N
ICD-
NHLS
via
the d
octor
on
call (
NICD
Hotl
ine: 0
82-8
83-
9920
) if ne
eded
. Ca
se in
vest
igat
ion
form
s: D
iseas
e-sp
ecific
case
inve
stiga
tion f
orms
and t
est r
eque
st for
ms m
entio
ned
in thi
s doc
umen
t may
be
found
on
the N
ICD-
NHLS
we
bsite
(www
.nicd
.ac.za
/?pag
e=gu
idelin
es&i
d=73
).
Notif
icatio
ns: A
ll prio
rity c
ondit
ions
here
in ar
e ad
dition
ally
notifi
able
medic
al co
nditio
ns a
s pe
r the
Sou
th Af
rican
nati
onal
healt
h re
gulat
ions.
Healt
hcar
e wo
rkers
must
notify
all
susp
ected
cas
es to
the
relev
ant l
ocal
Depa
rtmen
t of H
ealth
auth
oritie
s, pr
ior to
labo
rator
y dia
gnos
is, to
ens
ure
a tim
ely a
nd
adeq
uate
publi
c hea
lth re
spon
se.
Gene
ral p
oint
s on
labo
rato
ry in
vest
igat
ions
: You
sho
uld a
lso a
lert t
he te
sting
labo
rator
y ab
out s
pecim
ens
they
will r
eceiv
e or
nee
d to
refer
. All t
ests
requ
ested
, and
clini
cal in
forma
tion,
shou
ld be
clea
rly st
ated
on re
ques
t for
ms to
pre
vent
incor
rect/
unne
cess
ary t
ests
being
per
forme
d. Fin
ally,
many
of t
he
prior
ity co
nditio
ns lis
ted h
ave
spec
ific sp
ecim
en su
bmiss
ion/ca
se in
vesti
gatio
n for
ms th
at mu
st be
comp
leted
and
acc
ompa
ny sp
ecim
ens.
Neve
rthele
ss, a
ll sp
ecim
ens s
hould
be ac
comp
anied
by th
e foll
owing
mini
mum
set o
f legib
le inf
orma
tion:
Pa
tient’
s full
name
, sur
name
, age
and g
ende
r;
Name
and c
ontac
t num
bers
of the
atten
ding h
ealth
wor
ker,
hosp
ital n
ame a
nd w
ard;
Na
me an
d con
tact n
umbe
rs (in
cl. ce
ll pho
ne) o
f key
inve
stiga
tors (
to fac
ilitate
comm
unica
tion o
f res
ults a
nd re
spon
se);
Clini
cal fe
ature
s and
relev
ant h
istor
y (e.g
. date
of ill
ness
onse
t, tra
vel, i
nsec
t bite
s, etc
.);
Sp
ecim
en ty
pe; a
nd,
A
clear
test
requ
est.
Some
prac
tical
advic
e for
spec
imen
s refe
rred t
o the
NIC
D-NH
LS:
Th
e NIC
D do
es no
t hav
e a sp
ecim
en co
llecti
on se
rvice
, but
serve
s as a
refer
ral la
bora
tory.
Inf
orm
the sp
ecific
NIC
D lab
orato
ry if y
ou ar
e sen
ding a
n urg
ent s
pecim
en fo
r tes
ting o
f a pr
iority
comm
unica
ble di
seas
e.
Use
a re
liable
cou
rier f
or u
rgen
t spe
cimen
s. Re
cord
the
wayb
ill/tra
cking
num
ber a
nd c
ommu
nicate
this
to the
app
ropr
iate
labor
atory
for tr
ackin
g pu
rpos
es (c
ontac
t deta
ils su
pplie
d in t
his do
cume
nt).
Af
ter-h
ours
spec
imen
s mus
t be
left a
t gate
secu
rity, N
OT a
t any
othe
r loc
ation
insid
e the
comp
lex. C
ourie
rs wi
ll not
be p
ermi
tted
onto
the ca
mpus
be
fore 7
h30 a
nd af
ter 16
h00 o
n wee
kday
s, an
d all h
ours
over
wee
kend
s/pub
lic ho
liday
s. Pr
oced
ures
are i
n plac
e to k
eep t
he co
ld ch
ain an
d rec
ord
the ch
ain of
custo
dy of
the s
pecim
ens a
fter r
eceip
t at th
e main
gate.
2. A
cute
Fla
ccid
Par
alys
is o
r Pol
io (I
CD
-10
A80
) In
stru
ctio
ns fo
r Hea
lthca
re W
orke
rs:
Path
ogen
, clin
ical s
ympt
oms &
co
mm
ents
Sa
mpl
e col
lectio
n Te
sts t
o re
ques
t Se
nd to
Fo
rms t
o co
mpl
ete
Polio
virus
– Ac
ute fla
ccid
para
lysis
(AFP
) or s
uspe
cted p
olio
Two s
tools
colle
cted 2
4-48
hour
s apa
rt an
d wi
thin 1
4 day
s of o
nset
of pa
ralys
is. W
here
stoo
ls ca
nnot
be ob
taine
d, a r
ectal
swab
mus
t be
subm
itted f
or te
sting
. See
App
endix
1 for
furth
er
detai
ls.
AFP
or P
olio
NICD
Rec
eiving
Offic
e 1 M
odde
rfonte
in Rd
., San
dring
ham,
Ga
uteng
, 219
2 Inf
orm
NICD
Rec
eiving
Offic
e prio
r to
send
ing to
ensu
re co
rrect
samp
le tra
nspo
rt an
d tra
cking
: 01
1 386
6404
/631
4 /64
66
AFP
case
inv
estig
ation
form
Labo
rato
ry te
st in
form
atio
n:
Avail
able
test
s Sp
ecial
Inst
ruct
ions
Tu
rn-a
roun
d tim
e Te
stin
g lab
orat
ory
Viru
s Iso
lation
Ma
inten
ance
of co
ld ch
ain is
reco
mmen
ded f
rom
colle
ction
to re
ceipt
at N
ICD.
See
the c
ase
inves
tigati
on fo
rm an
d spe
cimen
colle
ction
guide
for f
urthe
r deta
ils.
14 da
ys
Enter
oviru
s Sec
tion,
Vira
l Diag
nosti
c Unit
, NI
CD-N
HLS
011 3
86 64
21/2
NICD
-NHL
S La
bora
tory H
andb
ook f
or D
iagno
sis of
Prio
rity C
ommu
nicab
le Di
seas
es, v
2, up
dated
2012
/02/02
4
3. A
nthr
ax (I
CD
-10
A22
) In
stru
ctio
ns fo
r Hea
lthca
re W
orke
rs:
In th
e eve
nt o
f a su
spec
ted
delib
erat
e ant
hrax
expo
sure
(bio
terro
rism
or ‘
white
pow
der’
incid
ent):
Move
away
and d
o not
attem
pt to
colle
ct or
send
powd
er or
othe
r sus
piciou
s mate
rial to
the l
abor
atory.
Imme
diatel
y rev
iew th
e NIC
D-NH
LS H
ealth
care
Wor
kers
Hand
book
on B
ioter
roris
m Se
ction
5.1 f
or de
tails
on th
e req
uired
resp
onse
. In
the
case
of s
uspe
cted
clin
ical a
nthr
ax in
fect
ions
: hum
an s
pecim
ens
shou
ld be
sen
t to
the S
pecia
l Bac
terial
Path
ogen
s Re
feren
ce U
nit.
Plea
se
note:
SBP
RU m
ust b
e noti
fied t
hat s
pecim
ens a
re be
ing se
nt.
Path
ogen
, clin
ical
sym
ptom
s &
com
men
ts
Sam
ple c
ollec
tion
Test
s to
requ
est
Send
to
Form
s to
com
plet
e
Bacil
lus a
nthr
acis
(ant
hax)
De
pend
ing on
site
affec
ted. S
afety
prec
autio
ns sh
ould
be
taken
whe
n han
dling
all s
ample
s.
1. Cu
taneo
us
anthr
ax
Vesic
ular f
luid f
rom
prev
iously
unop
ened
vesic
le or
skin
fluid
from
unde
r edg
e of e
scha
r sho
uld be
obtai
ned;
subm
it 2x
swab
s in b
acter
ial tr
ansp
ort m
edium
e.g.
Cary-
Blair
. Ma
ke sm
ears
on sl
ides t
o sub
mit a
t sam
e tim
e.
Anthr
ax: m
icros
copy
and c
ultur
e
Sputu
m / g
astric
was
hings
An
thrax
: micr
osco
py an
d cult
ure
Bloo
d for
cultu
re
Anthr
ax
2. Inh
alatio
nal
Anthr
ax
Bloo
d for
sero
logy (
paire
d ser
um ta
ken 2
-3 w
eeks
apar
t) An
thrax
sero
logy
Bloo
d for
cultu
re
Anthr
ax
3. Ga
stro-
intes
tinal
anthr
ax
Bloo
d for
sero
logy (
paire
d ser
um ta
ken 2
-3 w
eeks
apar
t) An
thrax
sero
logy
Bloo
d for
cultu
re
Anthr
ax
Bloo
d for
sero
logy (
paire
d ser
um ta
ken 2
-3 w
eeks
apar
t) An
thrax
sero
logy
4. An
thrax
me
ningit
is CS
F An
thrax
: micr
osco
py an
d cult
ure
Spec
ial B
acter
ial
Patho
gens
Refe
renc
e Un
it (SB
PRU)
, NI
CD-N
HLS
1 Mod
derfo
ntein
Rd.,
Sand
ringh
am, G
auten
g, 21
92
**Lab
el ou
tsid
e of b
ox
with
“Do
not o
pen.
Su
spec
ted
Anth
rax.
SBPR
U m
ust b
e no
tified
that
spec
imen
s are
be
ing se
nt St
anda
rd N
HLS
spec
imen
su
bmiss
ion fo
rm
Labo
rato
ry te
st in
form
atio
n:
Avail
able
test
s Sp
ecial
Inst
ruct
ions
Tu
rn-a
roun
d tim
e Te
stin
g lab
orat
ory
Anthr
ax -
ELIS
A An
thrax
cultu
re an
d con
firmati
on
5 day
s
Anthr
ax P
CR
SBPR
U m
ust b
e noti
fied
that s
pecim
ens a
re be
ing
sent.
3 d
ays
Spec
ial B
acter
ial P
athog
ens R
efere
nce U
nit, N
ICD
011 5
55 03
06
011 5
55 03
31
NICD
-NHL
S La
bora
tory H
andb
ook f
or D
iagno
sis of
Prio
rity C
ommu
nicab
le Di
seas
es, v
2, up
dated
2012
/02/02
5
4. B
otul
ism
(IC
D-1
0 A
05.1
/ A
48.5
) In
stru
ctio
ns fo
r Hea
lthca
re W
orke
rs:
Pa
thog
en, c
linica
l sy
mpt
oms &
co
mm
ents
Sam
ple c
ollec
tion
Test
s to
requ
est
Send
to
Form
s to
com
plet
e
Clott
ed bl
ood (
20 to
30 m
l)
Seru
m (1
0 to 1
5 ml)
Stoo
l (25 t
o 50 g
)
Gastr
ic wa
shing
Vo
mitus
Clos
tridi
um b
otul
inum
(b
otul
ism)
Susp
ected
food
Botul
inum
inves
tigati
on: a
nti-to
xin as
say,
cultu
re an
d con
firmati
on
Spec
ial B
acter
ial
Patho
gens
Refe
renc
e Un
it (SB
PRU)
, NI
CD-N
HLS,
1 M
odde
rfonte
in Rd
., Sa
ndrin
gham
, Ga
uteng
, 219
2
Conta
ct SB
PRU
or
NICD
Hotl
ine
imme
diatel
y for
ad
vice p
rior t
o su
bmitti
ng an
y sp
ecim
ens
Stan
dard
NHL
S sp
ecim
en su
bmiss
ion
form
In th
e eve
nt o
f a su
spec
ted
delib
erat
e exp
osur
e (bi
oter
roris
t atta
ck):
Cons
ult th
e NIC
D-NH
LS H
ealth
care
Wor
kers
Hand
book
on B
ioter
roris
m for
de
tails
on th
e req
uired
resp
onse
. La
bora
tory
test
info
rmat
ion:
Av
ailab
le te
sts
Spec
ial In
stru
ctio
ns
Turn
-aro
und
time
Test
ing
labor
ator
y Bo
tulinu
m – A
nti-to
xin as
say
Botul
inum
– Cult
ure a
nd co
nfirm
ation
Bo
tulinu
m – P
CR
SBPR
U m
ust b
e noti
fied t
hat
spec
imen
s are
being
sent.
Tr
ansp
ort s
pecim
ens a
t 2-8C
Up to
4 we
eks
Spec
ial B
acter
ial P
athog
ens R
efere
nce U
nit, N
ICD-
NHLS
, 1 M
odde
rfonte
in Rd
., San
dring
ham,
Gau
teng,
2192
01
1 555
0306
01
1 555
0331
NICD
-NHL
S La
bora
tory H
andb
ook f
or D
iagno
sis of
Prio
rity C
ommu
nicab
le Di
seas
es, v
2, up
dated
2012
/02/02
6
5. C
hole
ra (I
CD
-10
A05
.8)
Inst
ruct
ions
for H
ealth
care
Wor
kers
: Pa
thog
en, c
linica
l sy
mpt
oms &
co
mm
ents
Sam
ple c
ollec
tion
Test
s to
requ
est
Send
to
Form
s to
com
plet
e
Vibr
io ch
oler
ae O
1 Ac
ute w
atery
diarrh
oea,
with
or w
ithou
t sign
s of
dehy
drati
on
Stoo
l spe
cimen
, or r
ectal
swab
if sto
ol ca
nnot
be ob
taine
d. If s
tool s
pecim
en ca
nnot
be pr
oces
sed w
ithin
2 hou
rs: us
e a co
tton-
tippe
d swa
b to
samp
le sto
ol sp
ecim
en. P
lace s
wab w
ith sa
mpled
stoo
l in C
ary-B
lair t
rans
port
mediu
m. S
ubmi
t both
the i
nitial
conta
iner w
ith st
ool a
nd sw
ab in
tran
spor
t med
ium to
the
lab.
Tran
spor
t refr
igera
ted, d
o NOT
free
ze.
See s
pecim
en co
llecti
on gu
ide fo
r sus
pecte
d cho
lera c
ases
(App
endix
2)
MCS
includ
ing
chole
ra
Loca
l NHL
S lab
orato
ry Co
ntact
NICD
Hotl
ine
to fac
ilitate
labo
rator
y tes
ting.
St
anda
rd N
HLS
spec
imen
subm
ission
for
m
Labo
rato
ry te
st in
form
atio
n:
Avail
able
test
s Sp
ecial
Inst
ruct
ions
Tu
rn-
arou
nd
time
Test
ing
labor
ator
y
Prim
ary i
denti
ficati
on, s
eroty
ping a
nd an
timicr
obial
susc
eptib
ility
Conta
ct NI
CD H
otline
to fa
cilita
te lab
orato
ry tes
ting.
Liaise
with
loc
al NH
LS
Spec
imen
s sho
uld be
refer
red t
o loc
al/re
giona
l NH
LS la
bora
tory f
or pr
imar
y ide
ntific
ation
. Iso
lates
to be
refer
red t
o Ente
ric D
iseas
es
Refer
ence
Unit
(EDR
U), N
ICD-
NHLS
. Fu
rther
iden
tifica
tion a
nd te
sts of
fered
at N
ICD:
Exten
ded s
eroty
ping
An
timicr
obial
susc
eptib
ility t
estin
g
Scre
ening
for e
xtend
ed sp
ectru
m be
ta-lac
tamas
e (ES
BL)
Ch
olera
enter
otoxin
detec
tion v
ia PC
R
Bioty
ping v
ia PC
R
DNA
finge
rprin
ting o
f stra
ins vi
a PFG
E an
alyse
s
Cultu
re is
olates
sent
from
other
lab
orato
ries:
Isolat
es su
bcult
ured
on
to Do
rset tr
ansp
ort m
edium
, inc
ubate
d at 3
7 deg
rees
over
night
at lab
orato
ry of
origi
n, pr
ior to
su
bmiss
ion to
EDR
U. D
orse
t slop
e to
be ke
pt at
room
temp
eratu
re up
on
rece
ipt at
NIC
D.
1-4 d
ays
Enter
ic Di
seas
es R
efere
nce U
nit, N
ICD-
NHLS
01
1 555
0333
01
1 555
0334
NICD
-NHL
S La
bora
tory H
andb
ook f
or D
iagno
sis of
Prio
rity C
ommu
nicab
le Di
seas
es, v
2, up
dated
2012
/02/02
7
6. D
ipht
heria
(IC
D-1
0 A
36)
Inst
ruct
ions
for H
ealth
care
Wor
kers
: Pa
thog
en, c
linica
l sym
ptom
s & co
mm
ents
Sa
mpl
e col
lectio
n Te
sts t
o re
ques
t Se
nd to
Fo
rms t
o co
mpl
ete
Cultu
re fo
r dip
hther
ia
Loca
l labo
rator
y for
cultu
re
Thro
at sw
abs:
Rub
vigo
rous
ly ov
er
any m
embr
ane,
white
spots
, or
inflam
ed ar
eas;
apply
sligh
t pre
ssur
e wi
th ro
tating
mov
emen
t. If m
embr
ane
is pr
esen
t, lift
the ed
ge an
d swa
b be
neath
it.
Naso
phar
ynge
al sp
ecim
ens:
gentl
y int
rodu
ce th
e swa
b alon
g the
floor
of
the na
sal c
avity
, und
er th
e midd
le tur
binate
until
the ph
aryn
geal
wall i
s re
ache
d.
Cory
neba
cter
ium
dip
hthe
riae
and
rare
ly Co
ryne
bact
eriu
m u
lcera
ns
(Dip
hthe
ria)
Loca
l sym
ptoms
as a
resu
lt of a
non-
invas
ive re
spira
tory t
ract
infec
tion:
inclu
de: a
toug
h gre
y to w
hite a
dher
ent m
embr
ane
(pse
udom
embr
ane)
on th
e ton
sils,
phar
ynx,
and/o
r nas
al ca
vity s
ore t
hroa
t, pro
blems
swall
owing
, bloo
dy w
atery
drain
age f
rom
the no
se, d
rooli
ng, h
oarse
ness
, cro
up-lik
e co
ugh,
strido
r, dif
ficult
y bre
athing
or ta
chyp
noea
, enla
rged
lym
ph no
des i
n the
neck
, “Bu
ll nec
k” ap
pear
ance
due t
o se
vere
cervi
cal ly
mpha
deno
pathy
and o
edem
a of th
e ante
rior
cervi
cal ti
ssue
s.
Syste
mic s
ympto
ms du
e to s
econ
dary
disse
mina
tion o
f the
toxin
throu
gh th
e bloo
dstre
am to
othe
r org
ans s
uch a
s the
he
art, k
idney
s, an
d ner
vous
syste
m. M
yoca
rditis
is th
e mos
t co
mmon
poten
tially
life-
threa
tening
comp
licati
on.
Skin
lesio
ns: c
lean l
esion
s with
ste
rile no
rmal
salin
e and
remo
ve
cruste
d mate
rial; p
ress
the s
wab
firmly
into t
he le
sion.
Toxin
tes
ting
NHLS
Gre
en P
oint m
ay ac
cept
refer
red s
ample
s for
toxin
tes
ting,
depe
nding
on th
e av
ailab
ility o
f anti
toxin.
Con
tact
the la
bora
tory t
o mak
e en
quirie
s prio
r to s
endin
g any
sp
ecim
ens.
Ol
d City
Hos
pital
Comp
lex,
Portw
ood R
oad,
Gree
npoin
t, 80
00.
021-
417-
9328
02
1-41
7-93
44
Conta
ct NI
CD
Hotlin
e to
facilit
ate
labor
atory
testin
g. St
anda
rd N
HLS
spec
imen
su
bmiss
ion
form.
Labo
rato
ry te
st in
form
atio
n:
Avail
able
test
s Sp
ecial
Inst
ruct
ions
Tu
rn-a
roun
d tim
e Te
stin
g lab
orat
ory
Cultu
re
Loca
l To
xin
testin
g
Thro
at sw
abs a
re no
t rou
tinely
cultu
red s
o it is
impo
rtant
to inf
orm
the la
bora
tory t
hat d
iphthe
ria is
susp
ected
. Ob
serve
infec
tion p
reve
ntion
and c
ontro
l pro
tocols
whe
n coll
ectin
g and
hand
ling s
pecim
ens,
and s
end t
o the
lab
orato
ry im
media
tely.
If tra
nspo
rtatio
n is l
ikely
to be
delay
ed, c
onsid
er us
ing an
appr
opria
te tra
nspo
rt me
dium
such
as A
mie’s
gel m
edium
. If th
e tra
nsit t
ime w
ill ex
ceed
24 ho
urs,
the sw
ab sh
ould
be pr
eser
ved i
n a sp
ecial
pa
ck co
ntaini
ng a
desic
cant
such
as si
lica g
el.
Cons
ult
testin
g lab
orato
ry NH
LS G
reen
Poin
t Ol
d City
Hos
pital
Comp
lex, P
ortw
ood
Road
, Gre
enpo
int, 8
000.
02
1-41
7-93
28
021-
417-
9344
NICD
-NHL
S La
bora
tory H
andb
ook f
or D
iagno
sis of
Prio
rity C
ommu
nicab
le Di
seas
es, v
2, up
dated
2012
/02/02
8
7. L
egio
nello
sis
(ICD
-10
A48
.1)
Inst
ruct
ions
for h
ealth
care
wor
kers
: Pa
thog
en, c
linica
l sym
ptom
s & co
mm
ents
Sa
mpl
e col
lectio
n Te
sts t
o re
ques
t Se
nd to
Fo
rms t
o co
mpl
ete
Urine
Le
gione
lla ur
inary
antig
en te
st (re
comm
ende
d)
Legi
onne
lla p
neum
ophi
la (L
egio
nello
sis / L
egio
nnair
es’ D
iseas
e)
Flu-lik
e illn
ess,
follow
ed by
a dr
y cou
gh an
d fre
quen
tly
prog
ress
es to
pneu
monia
Bl
ood
Bl
ood c
ultur
e for
Le
gione
lla sp
p.
NH
LS In
fectio
n Con
trol
Servi
ces L
abor
atory
NH
LS G
roote
Sch
uur
or
NH
LS P
ublic
Hea
lth
Labo
rator
y KZN
Stan
dard
NHL
S sp
ecim
en
subm
ission
form
Co
ntact
testin
g lab
orato
ry pr
ior
to se
nding
spec
imen
s.
Wat
er te
stin
g fo
r Leg
ione
lla
(to be
done
by E
nviro
nmen
tal H
ealth
Pra
ctitio
ners
only)
W
ater a
s per
EHP
gu
idelin
es
Legio
nella
NH
LS In
fectio
n Con
trol
Servi
ces L
abor
atory
NHLS
-ICSL
Spe
cimen
su
bmiss
ion fo
rm
Labo
rato
ry te
st in
form
atio
n:
Avail
able
test
s Sp
ecial
inst
ruct
ions
Tu
rn-a
roun
d tim
e Te
stin
g lab
orat
ory
Legio
nella
urina
ry an
tigen
This
is a r
apid
test th
at de
tects
Legio
nella
antig
ens i
n urin
e, an
d has
very
good
sens
itivity
and s
pecif
icity.
This
is th
e rec
omme
nded
diag
nosti
c tes
t. W
ithin
a few
hour
s
Cultu
re
Colle
ct sp
utum,
or lo
wer r
espir
atory
tract
secre
tions
or bl
ood o
r pleu
ral
fluid
10-1
4 day
s
NHLS
Infec
tion C
ontro
l Ser
vices
Labo
rator
y W
its M
edica
l Sch
ool, L
evel
3, Ro
om 3T
09
7 Yor
k Roa
d, Pa
rktow
n Jo
hann
esbu
rg, 2
193
Tel: 0
11-4
89-8
579/8
0 NH
LS M
icrob
iolog
y Lab
orato
ry (C
18)
Groo
te Sc
huur
Hos
pital
Main
Road
, Obs
erva
tory,
Cape
Tow
n, 79
25
Tel: 0
21-4
04-4
129 /
5137
NH
LS P
ublic
Hea
lth La
bora
tory K
ZN
3rd F
loor,
149 P
rince
Stre
et, D
urba
n, 40
01.
Tel: 0
21-4
17-9
354 /
9355
W
ater t
estin
g /
envir
onme
ntal
studie
s
Vol: 1
000m
l, con
taine
r: cle
an/ne
w/ste
rile, tr
ansp
ort te
mp: R
T (if
deliv
ered
the
same
day),
rejec
ted af
ter: >
72 hr
s at R
T Lia
ise w
ith te
sting
lab
orato
ry NH
LS In
fectio
n Con
trol S
ervic
es La
bora
tory
Note
: Othe
r tes
ts su
ch as
sero
logy (
IFA)
and P
CR ar
e NOT
reco
mmen
ded a
s firs
t-line
diag
nosti
cs te
sts fo
r Leg
ionell
osis.
A si
ngle
posit
ive se
rolog
y res
ult do
es N
OT
confi
rm ac
tive L
egion
ella i
nfecti
on.
NICD
-NHL
S La
bora
tory H
andb
ook f
or D
iagno
sis of
Prio
rity C
ommu
nicab
le Di
seas
es, v
2, up
dated
2012
/02/02
9
8. M
easl
es (I
CD
-10
B05
) In
stru
ctio
ns fo
r Hea
lthca
re W
orke
rs:
Path
ogen
, clin
ical
sym
ptom
s &
com
men
ts
Sam
ple c
ollec
tion
Test
s to
requ
est
Send
to
Form
s to
com
plet
e
Meas
les
Bl
ood (
5ml c
lotted
or in
EDT
A tub
e)
PLUS
one
of t
he fo
llowi
ng:
Na
soph
aryn
geal/
thro
at sw
ab in
vira
l tran
spor
t med
ium (V
TM~3
ml),
OR
Urine
Re
comm
ende
d swa
bs: D
acro
n tip
and a
lumini
um or
plas
tic sh
aft or
Vi
rocu
lt floc
ked s
wabs
. Un
suita
ble sw
abs:
wood
en, c
otton
, calc
ium al
ginate
swab
s Sa
mples
shou
ld re
ach t
he la
bora
tory w
ithin
3 day
s of c
ollec
tion
Meas
les
Vira
l Diag
nosti
cs U
nit
(VDU
), NI
CD-N
HLS,
1 M
odde
rfonte
in Rd
., Sa
ndrin
gham
, Gau
teng,
2192
Meas
les C
ase
Inves
tigati
on F
orm
Labo
rato
ry te
st in
form
atio
n:
Avail
able
test
s Sp
ecial
Inst
ruct
ions
Tu
rn-a
roun
d tim
e Te
stin
g lab
orat
ory
Meas
les Ig
M an
d IgG
EI
A Tr
ansp
ort a
t 2-8
°C. M
ainten
ance
of co
ld ch
ain is
reco
mmen
ded
from
colle
ction
to re
ceipt
at N
ICD.
7 d
ays
Sero
logy,
VDU,
NIC
D-NH
LS
011 3
86 63
98/64
35
Meas
les P
CR an
d se
quen
cing t
o dete
rmine
ge
notyp
e (su
rveilla
nce)
Tran
spor
t at 2
-8°C
14
days
Sp
ecial
ized M
olecu
lar D
iagno
stics
Unit
: Me
asles
, NIC
D-NH
LS
011 3
86 63
43
Cell c
ultur
e (su
rveilla
nce)
Tr
ansp
ort a
t 4ºC
. Sam
ple sh
ould
reac
h lab
orato
ry wi
thin 7
2hrs.
1 m
onth
Viru
s Iso
lation
, VDU
-NHL
S
011 3
86 63
73
NICD
-NHL
S La
bora
tory H
andb
ook f
or D
iagno
sis of
Prio
rity C
ommu
nicab
le Di
seas
es, v
2, up
dated
2012
/02/02
10
9. P
ertu
ssis
(IC
D-1
0 A
37)
Inst
ruct
ions
for H
ealth
care
Wor
kers
: Pa
thog
en, c
linica
l sym
ptom
s & co
mm
ents
Sa
mpl
e co
llect
ion
Test
s to
requ
est
Send
to
Form
s to
com
plet
e Cu
lture
for
B. p
ertu
ssis
Loca
l NHL
S lab
orato
ry Bo
rdet
ella p
ertu
ssis
or B
. pap
aper
tuss
is (p
ertu
ssis)
Di
seas
e typ
ically
man
ifests
in 3
stage
s: a c
atarrh
al sta
ge w
ith si
gns a
nd sy
mptom
s of a
n URT
I, the
clas
sical
paro
xysm
al sta
ge w
ith a
coug
h las
ting >
2 wee
ks, a
nd a
conv
alesc
ent s
tage.
In the
pa
roxy
smal
stage
, chil
dren
may
pres
ent w
ith pa
roxy
sms o
f sev
ere c
ough
ing, in
spira
tory
whoo
ping,
and p
osttu
sive v
omitin
g. Inf
ants
below
6 mo
nths-o
ld, am
ong w
hom
seve
re m
orbid
ity
& mo
rtality
risks
are h
ighes
t, pre
sent
atypic
ally w
ith ep
isode
s of a
pnoe
a, cy
anos
is an
d gag
ging.
Adult
s and
adole
scen
ts, w
ho co
nstitu
te an
impo
rtant
sour
ce of
infec
tion f
or no
n-im
mune
infan
ts,
also p
rese
nt wi
th aty
pical
clinic
al ma
nifes
tation
s suc
h as m
ild LR
TI w
ith pr
olong
ed pa
roxy
smal
coug
hing.
Addit
ionall
y, pe
rtuss
is sh
ould
be co
nside
red i
n per
sons
of al
l age
s who
are i
n con
tact
with
a kno
wn pe
rtuss
is ca
se.
Dupl
icate
po
ster
ior
naso
phar
ynge
al sw
abs o
r as
pira
tes
PCR
for
B. p
ertu
ssis
NHLS
Infec
tion
Contr
ol Se
rvice
s La
bora
tory
or
NHLS
Gro
ote
Schu
ur
Stan
dard
NH
LS
spec
imen
su
bmiss
ion
form
Labo
rato
ry te
st in
form
atio
n:
Avail
able
test
s Sp
ecial
Inst
ruct
ions
Tu
rn-
arou
nd ti
me
Test
ing
labor
ator
y
Cultu
re
Loca
l NHL
S La
bora
tory
PCR
Us
e Dac
ron o
r Ray
on sw
ab. D
o not
use c
alcium
algin
ate sw
abs o
r cott
on sw
abs a
s the
se
inhibi
t PCR
reac
tions
and g
rowt
h of B
. per
tuss
is for
cultu
re.
Th
e mod
e and
timing
of sp
ecim
en co
llecti
on, a
s well
as ra
pid tr
ansp
ort to
the l
abor
atory,
are
impo
rtant
for op
timal
yield
of cu
lture
.
Gentl
y pas
s the
swab
thro
ugh t
he no
stril t
o the
poste
rior n
asop
haryn
x. Do
not fo
rce th
e sw
ab; r
esist
ance
will
be fe
lt whe
n the
poste
rior n
asop
haryn
x is r
each
ed. R
otate
the sw
ab
and l
eave
in pl
ace f
or 30
seco
nds o
r unti
l the p
atien
t cou
ghs.
Inocu
late t
he fir
st sw
ab im
media
tely o
nto th
e sur
face o
f Reg
an-L
owe c
harco
al ag
ar (o
btain
from
local
labor
atory)
at pa
tients
beds
ide.
Re
peat
the pr
oced
ure t
hrou
gh th
e sec
ond n
ostril
. Sen
d swa
b in u
niver
sal c
ontai
ner f
or P
CR.
Liaise
with
tes
ting
labor
atory
NHLS
Infec
tion C
ontro
l Ser
vices
Lab
Wits
Med
ical S
choo
l, Lev
el 3,
Room
3T09
7 Y
ork R
oad,
Parkt
own
Joha
nnes
burg
, 219
3 Te
l: 011
-489
-857
9/80
NHLS
Micr
obiol
ogy L
abor
atory
(C18
) Gr
oote
Schu
ur H
ospit
al, M
ain R
oad,
Obse
rvator
y, Ca
pe T
own,
7925
Te
l: 021
-404
-412
9 / 51
37
Notes
: o
PC
R is
the m
ost s
ensit
ive a
nd, t
here
fore,
reco
mmen
ded
for ro
utine
clin
ical d
iagno
sis. P
CR m
ay re
main
posit
ive in
late
disea
se a
nd a
fter r
eceip
t of a
ntibio
tic
treatm
ent. R
esult
s mus
t be i
nterp
reted
in co
njunc
tion w
ith cl
inica
l featu
res o
f dise
ase.
o
Cu
lture
is th
e go
ld sta
ndar
d, ho
weve
r sen
sitivi
ty is
varia
ble –
high
est i
n the
first
2 w
eeks
(cata
rrhal
phas
e) a
nd is
redu
ced
in lat
er s
tages
and
follo
wing
anti
biotic
tre
atmen
t. o
Se
rolo
gy a
nd d
irect
fluo
resc
ents
ant
ibod
y te
sts
are
not r
ecom
mend
ed fo
r rou
tine
diagn
osis.
The
se te
sts h
ave
poor
sen
sitivi
ty an
d sp
ecific
ity (g
iving
false
ne
gativ
es an
d fals
e pos
itives
) and
no lo
cal c
ut-off
s are
avail
able
to int
erpr
et se
rolog
y res
ults.
NI
CD-N
HLS
Labo
rator
y Han
dboo
k for
Diag
nosis
of P
riority
Com
munic
able
Dise
ases
, v2,
upda
ted 20
12/02
/02
11
10. M
enin
goco
ccal
Dis
ease
(IC
D-1
0 A
39)
Inst
ruct
ions
for H
ealth
care
Wor
kers
: Pa
thog
en, c
linica
l sy
mpt
oms &
com
men
ts
Sam
ple c
ollec
tion
Test
s to
requ
est
Send
to
Form
s to
com
plet
e
Neiss
eria
men
ingi
tidis
Depe
nden
t on c
linica
l pre
senta
tion:
CSF
MCS,
Latex
agglu
tinati
on (w
here
ind
icated
) 1.
Menin
gitis
Bloo
d Bl
ood c
ultur
e 2.
Septi
caem
ia Bl
ood
Bloo
d cult
ure
Bloo
d Bl
ood c
ultur
e 3.
Foca
l infec
tions
(e.g.
se
ptic a
rthriti
s, pn
eumo
nia)
Othe
r spe
cimen
s (e.g
. syn
ovial
fluid,
pe
ritone
al / p
erica
rdial
fluid,
sputu
m)
MCS
Bloo
d Bl
ood c
ultur
e 4.
Conju
nctiv
itis
Conju
nctiv
al sw
ab
MCS
for su
spec
ted m
ening
ococ
cus
Bloo
d Bl
ood c
ultur
e 5.
Petec
hial ra
sh
Skin
lesion
biop
sy (N
ote: th
is is
not a
se
nsitiv
e tes
t but
may b
e help
ful if
posit
ive)
Gram
stain
and c
ultur
e
Loca
l NHL
S lab
orato
ry.
Spec
imen
s may
be
refer
red t
o a re
giona
l NH
LS la
bora
tory
depe
nding
on
capa
city a
t the l
ocal
level.
Stan
dard
NHL
S sp
ecim
en su
bmiss
ion
form
Labo
rato
ry te
st in
form
atio
n:
Avail
able
test
s Sp
ecial
Inst
ruct
ions
Tu
rn-a
roun
d tim
e Te
stin
g lab
orat
ory
Prim
ary i
denti
ficati
on of
Neis
seria
men
ingitid
is, la
tex ag
glutin
ation
, sus
cepti
bility
tes
ting
Refrig
erati
on pr
eferre
d but
not e
ssen
tial.
Liaise
with
loc
al lab
Lo
cal N
HLS
labor
atory
Furth
er id
entifi
catio
n of N
eisse
ria m
ening
itidis
-isola
tes su
bmitte
d to N
ICD
for
natio
nal s
urve
illanc
e (GE
RMS-
SA):
2 day
s
Antim
icrob
ial su
scep
tibilit
y tes
ting (
disc a
nd m
inimu
m inh
ibitor
y con
centr
ation
- MI
C) -
as pa
rt of
surve
illanc
e or t
o con
firm re
sults
2 d
ays
Pulse
d-fie
ld ge
l elec
troph
ores
is (P
FGE)
- Ou
tbrea
k inv
estig
ation
/ mole
cular
ep
idemi
ology
1 w
eek
Multil
ocus
sequ
ence
typin
g (ML
ST) -
Mole
cular
char
acter
izatio
n 3 d
ays
Sero
typing
/sero
grou
ping (
slide
agglu
tinati
on) -
routi
ne su
rveilla
nce,
or to
asse
ss
vacc
ine re
spon
se, o
r guid
e men
ingoc
occa
l vac
cine u
se
Isolat
es on
Dor
set tr
ansp
ort m
edium
inoc
ulated
as
per N
IC01
84. N
o refr
igera
tion r
equir
ed. D
o not
batch
, as i
solat
es w
ill los
e viab
ility.
2 day
s
Polym
eras
e cha
in re
actio
n (PC
R) fo
r iden
tifica
tion -
cultu
re-n
egati
ve sp
ecim
ens
1 day
PC
R for
sero
typing
/sero
grou
ping -
cultu
re-n
egati
ve sp
ecim
ens
Who
le blo
od, c
lotted
bloo
d (se
rum)
, unc
lotted
ED
TA bl
ood,
CSF.
Refr
igera
tion p
refer
red b
ut no
t es
senti
al 1 d
ay
RMPR
U, N
ICD-
NHLS
01
1 555
0315
01
1 555
0317
NICD
-NHL
S La
bora
tory H
andb
ook f
or D
iagno
sis of
Prio
rity C
ommu
nicab
le Di
seas
es, v
2, up
dated
2012
/02/02
12
11. P
lagu
e (IC
D-1
0 A
20)
Inst
ruct
ions
for H
ealth
care
Wor
kers
: Pa
thog
en, c
linica
l sy
mpt
oms &
com
men
ts
Sam
ple c
ollec
tion
Test
s to
requ
est
Send
to
Form
s to
com
plet
e Ye
rsin
ia pe
stis
(plag
ue)
Depe
nden
t on c
linica
l pre
senta
tion.
Safet
y pre
cauti
ons s
hould
be ta
ken w
hen h
andli
ng sa
mples
. Bu
bo as
pirate
plus
2x sw
abs i
n bac
terial
tra
nspo
rt me
dia (e
.g. C
ary-B
lair).
Abs
orb a
few
drop
s of s
ample
on a
sterile
swab
.
Plag
ue in
vesti
gatio
n ( m
icros
copy
, cult
ure a
nd
confi
rmati
on)
1. B
ubon
ic pla
gue
Bloo
d for
sero
logy (
paire
d ser
um ta
ken 2
-3
week
s apa
rt)
Plag
ue se
rolog
y
Bloo
d cult
ure b
ottle
Plag
ue in
vesti
gatio
n ( m
icros
copy
, cult
ure a
nd
confi
rmati
on)
2. Se
ptica
emic
plagu
e
Bloo
d for
sero
logy (
paire
d ser
um ta
ken 2
-3
week
s apa
rt)
Plag
ue se
rolog
y
Sputu
m plu
s 2x s
wabs
in ba
cteria
l tran
spor
t me
dia (e
.g. C
ary-B
lair)
Plag
ue in
vesti
gatio
n ( m
icros
copy
, cult
ure a
nd
confi
rmati
on)
Bloo
d cult
ure b
ottle
Plag
ue in
vesti
gatio
n ( m
icros
copy
, cult
ure a
nd
confi
rmati
on)
3. Pn
eumo
nic pl
ague
Bloo
d for
sero
logy (
paire
d ser
um ta
ken 2
-3
week
s apa
rt)
Plag
ue se
rolog
y
Bloo
d for
cultu
re
Cultu
re fo
r plag
ue
Bloo
d for
sero
logy
Plag
ue se
rolog
y 4.
Othe
r man
ifesta
tions
(e
.g. m
ening
itis,
phar
yngit
is)
CSF,
phar
ynge
al sw
ab, e
tc.
Plag
ue in
vesti
gatio
n ( m
icros
copy
, cult
ure a
nd
confi
rmati
on)
Spec
ial B
acter
ial
Patho
gens
Re
feren
ce U
nit
(SPB
RU),
NI
CD-N
HLS,
1 M
odde
rfonte
in Rd
, San
dring
ham,
Jo
hann
esbu
rg,
2192
* L
abel
outsi
de of
bo
x with
“Do n
ot op
en. S
uspe
cted
Plag
ue”
Conta
ct SB
PRU
or
NICD
Hotl
ine
imme
diatel
y for
ad
vice p
rior t
o su
bmitti
ng an
y sp
ecim
ens.
Stan
dard
NHL
S sp
ecim
en
subm
ission
form
.
In th
e eve
nt o
f a su
spec
ted
delib
erat
e exp
osur
e (bi
oter
roris
t atta
ck):
Cons
ult th
e NIC
D-NH
LS H
ealth
care
Wor
kers
Hand
book
on B
ioter
roris
m for
de
tails
on th
e req
uired
resp
onse
.
La
bora
tory
test
info
rmat
ion:
Av
ailab
le te
sts
Spec
ial In
stru
ctio
ns
Turn
-aro
und
time
Test
ing
labor
ator
y Pl
ague
- EL
ISA
2 day
s Pl
ague
- cu
lture
and c
onfirm
ation
5 d
ays
Plag
ue -
DFA
2 day
s Su
rveilla
nce p
lague
- EL
ISA
SBPR
U m
ust b
e noti
fied
that s
pecim
ens a
re be
ing
sent.
21
days
Spec
ial B
acter
ial P
athog
ens R
efere
nce U
nit, N
ICD-
NHLS
, 1 M
odde
rfonte
in Rd
., San
dring
ham,
Gau
teng,
2192
01
1 555
0306
01
1 555
0331
NICD
-NHL
S La
bora
tory H
andb
ook f
or D
iagno
sis of
Prio
rity C
ommu
nicab
le Di
seas
es, v
2, up
dated
2012
/02/02
13
12. R
abie
s di
seas
e in
hum
ans
(ICD
-10
A82
) In
stru
ctio
ns fo
r Hea
lthca
re W
orke
rs:
Path
ogen
, clin
ical s
ympt
oms &
com
men
ts
Sam
ple c
ollec
tion
Test
s to
requ
est
Send
to
Form
s to
com
plet
e
Saliv
a (an
te-mo
rtem,
mos
t sen
sitive
) CS
F (n
ot pr
eferre
d but
co-su
bmit w
ith
other
spec
imen
s if a
vaila
ble)
Nuch
al bio
psy (
ante-
or po
st-mo
rtem)
Br
ain sp
ecim
en (p
ost-m
ortem
)
Rabi
es
Fu
rious
rabi
es: h
alluc
inatio
ns, a
gitati
on,
hydr
opho
bia, b
izarre
beha
viour
, enc
epha
litis
Pa
ralyt
ic ra
bies
: asc
endin
g flac
cid pa
ralys
is A
histor
y of a
nimal
expo
sure
may
prov
ide in
sight.
Ac
cura
te da
tes of
expo
sure
, ons
et an
d pro
gres
sion
of dis
ease
are v
ital in
our in
vesti
gatio
n.
Bloo
d/ser
um fo
r ser
ology
(not
sens
itive
but m
ay co
-subm
it with
othe
r spe
cimen
s)
Rabie
s Co
ntact
NICD
Hotl
ine
imme
diatel
y for
advic
e prio
r to
subm
itting
spec
imen
s.
Refer
to th
e Rab
ies S
pecim
en
Colle
ction
Guid
e for
infor
matio
n an
d com
plete
the N
ICD
Susp
ect
Rabie
s Cas
e Hist
ory F
orm.
Po
st-va
ccina
tion a
ntibo
dy tit
re m
easu
reme
nt Bl
ood/s
erum
for s
erolo
gy
Rabie
s an
tibod
y
Spec
ial P
athog
ens
Unit,
NICD
-NHL
S,
1 Mod
derfo
ntein
Rd, S
andr
ingha
m,
Gaute
ng, 2
192
Stan
dard
NHL
S sp
ecim
en
subm
ission
form
for c
linica
l sp
ecim
ens.
La
bora
tory
test
info
rmat
ion:
Av
ailab
le te
sts
Spec
ial In
stru
ctio
ns
Turn
-aro
und
time
Test
ing
labor
ator
y Se
rolog
y: flu
ores
cent
antib
ody t
est, p
ost-v
accin
ation
an
tibod
y titre
deter
mina
tion
24-4
8 hou
rs
Sero
logy:
fluor
esce
nt an
tibod
y tes
t, clin
ical c
ases
Bloo
d tub
es se
aled i
n plas
tic ba
gs, a
nd la
belle
d bioh
azar
dous
. Stor
e an
d tra
nspo
rt at
4 °C
(or o
n ice
pack
s).
24-4
8 hou
rs Vi
rus i
solat
ion: a
nte-m
ortem
3 w
eeks
PC
R: an
te-mo
rtem
At le
ast 2
00 ul
in pl
astic
scre
w top
conta
iners,
pack
aged
in se
cond
ary
conta
iner;
label
as bi
ohaz
ardo
us an
d for
rabie
s inv
estig
ation
. Add
ress
to
Spec
ial P
athog
ens L
abor
atory;
conta
ct lab
orato
ry, an
d stor
e and
tra
nspo
rt at
4 °C
(or o
n ice
pack
s).
24-4
8 hou
rs
Viru
s iso
lation
: pos
t-mor
tem
3 wee
ks
PCR:
post-
morte
m (o
nly pe
rform
ed if
antig
en de
tectio
n is
not c
onclu
sive)
24
-48 h
ours
Antig
en de
tectio
n (flu
ores
cent
antib
ody t
est):
post-
morte
m
Who
le, ha
lf or c
ubes
of re
pres
entat
ive re
gions
of br
ain su
bmitte
d in 5
0 %
glyc
erol-
salin
e in p
lastic
scre
w top
conta
iners.
Labe
l as
bioha
zard
ous,
store
and t
rans
port
at 4 °
C (o
r on i
ce pa
cks).
24
-48 h
ours
Spec
ial
Patho
gens
Unit
, NI
CD-N
HLS
011 3
86
6339
/6376
Note:
Tes
ting o
f a fu
ll rep
ertoi
re of
spec
imen
s (i.e
. sali
va, C
SF, n
ucha
l biop
sy, p
ost-m
ortem
brain
biop
sy, b
lood/s
erum
) is re
comm
ende
d to c
onclu
sively
co
nfirm
or ru
le ou
t rab
ies. T
estin
g of r
epea
t sali
va sp
ecim
ens i
s also
requ
ired a
s viru
s is s
hed i
nterm
ittentl
y in t
his bo
dy flu
id. S
erolo
gy is
gene
rally
not v
ery
sens
itive f
or di
agno
stic u
se.
NICD
-NHL
S La
bora
tory H
andb
ook f
or D
iagno
sis of
Prio
rity C
ommu
nicab
le Di
seas
es, v
2, up
dated
2012
/02/02
14
13. R
ift V
alle
y fe
ver (
ICD
-10
A92
.4)
Inst
ruct
ions
for H
ealth
care
Wor
kers
: Pa
thog
en, c
linica
l sym
ptom
s & co
mm
ents
Sa
mpl
e co
llect
ion
Test
s to
requ
est
Send
to
Form
s to
com
plet
e
Rift
Valle
y fev
er (R
VF) v
irus
Feve
r with
flu-lik
e sym
ptoms
(inclu
ding m
yalgi
a, ar
thralg
ia or
head
ache
), ne
ck st
iffnes
s, se
nsitiv
ity to
light
(pho
topho
bia),
pain
behin
d the
eyes
, loss
of
appe
tite an
d vom
iting.
Comp
licati
ons m
ay in
clude
ocula
r (re
tinal)
dise
ase,
menin
goen
ceph
alitis
, hep
atitis
, or h
aemo
rrhag
ic fev
er. D
irect
conta
ct wi
th tis
sues
/fluids
of si
ck/de
ad ru
mina
nt an
imals
is co
nside
red a
majo
r risk
facto
r. Ac
cura
te da
tes of
expo
sure
, ons
et an
d pro
gres
sion o
f dise
ase i
s vita
l in ou
r inv
estig
ation
.
Bloo
d: Cl
otted
blo
od or
seru
m (re
d/yell
ow to
p tub
e)
RVF
Spec
ial P
athog
ens
Unit,
NICD
-NHL
S,
1 Mod
derfo
ntein
Rd.,
Sand
ringh
am,
Gaute
ng, 2
192
NICD
RVF
susp
ected
case
inv
estig
ation
form
Re
fer to
the H
ealth
care
Wor
kers
Hand
book
on R
VF fo
r fur
ther
infor
matio
n. Co
ntact
NICD
hotlin
e for
su
spec
ted R
VF ca
ses w
ith
haem
orrh
age/e
ncep
haliti
s. La
bora
tory
test
info
rmat
ion:
Av
ailab
le te
sts
Spec
ial In
stru
ctio
ns
Turn
-aro
und
time
Test
ing
labor
ator
y Se
rolog
y HAI
5 d
ays
IgM E
LISA
2-4 d
ays
PCR
24-4
8 hou
rs Vi
rus i
solat
ion
Pack
age a
s bioh
azar
dous
mate
rial, s
tored
an
d tra
nspo
rted a
t 4°C
.
18 da
ys
Spec
ial P
athog
ens U
nit, N
ICD-
NHLS
01
1 386
6376
01
1 386
6339
Note:
Con
ducti
ng a
full re
perto
ire of
sero
logica
l and
viro
logica
l tests
is st
rong
ly re
comm
ende
d. Te
st re
sults
are h
ighly
depe
nden
t on t
iming
of sp
ecim
en
colle
ction
in re
lation
to di
seas
e ons
et; th
erefo
re, te
sting
of ac
ute an
d con
vales
cent
spec
imen
s are
stro
ngly
reco
mmen
ded t
o con
firm/ex
clude
RVF
dia
gnos
is.
Simi
lar la
bora
tory p
roce
dure
for o
ther a
rbov
iruse
s, inc
lundin
g: ch
ikung
unya
, den
gue,
Wes
t Nile
, yell
ow fe
ver a
nd S
indbis
NI
CD-N
HLS
Labo
rator
y Han
dboo
k for
Diag
nosis
of P
riority
Com
munic
able
Dise
ases
, v2,
upda
ted 20
12/02
/02
15
14. S
AR
S (P
rovi
sion
al IC
D-1
0 U
04.9
) In
stru
ctio
ns fo
r Hea
lthca
re W
orke
rs:
Path
ogen
, clin
ical s
ympt
oms &
com
men
ts
Sam
ple c
ollec
tion
Test
s to
requ
est
Send
to
Form
s to
com
plet
e
Naso
phar
ynge
al/
orop
haryn
geal
swab
s Re
comm
ende
d swa
bs:
Swab
s with
Dac
ron t
ip an
d an
alumi
nium
or pl
astic
shaft
OR
Viro
cult f
locke
d swa
bs
All s
wabs
mus
t be p
laced
into
VTM
(vira
l tran
spor
t med
ium)
to pr
eser
ve th
e viru
s par
ticles
St
ool
SARS
coro
navir
us
High
feve
r (tem
p > 38
°C) w
ith ot
her s
ympto
ms th
at ma
y inc
lude
head
ache
, an o
vera
ll fee
ling o
f disc
omfor
t and
body
ache
s. So
me pe
ople
also h
ave m
ild re
spoir
atory
symp
toms a
t the o
utset.
10-2
0% of
patie
nts
have
diar
rhoe
a. Af
ter 2-
7 day
s, SA
RS pa
tients
may
deve
lop a
dry c
ough
. Mo
st pa
tients
deve
lop pn
eumo
nia.
Clott
ed bl
ood f
or se
rolog
y
SARS
Sp
ecial
Path
ogen
s Un
it, NI
CD-N
HLS,
1 M
odde
rfonte
in Rd
., Sa
ndrin
gham
, Ga
uteng
, 219
2.
Conta
ct NI
CD
Hotlin
e for
advic
e an
d to f
acilit
ate
labor
atory
testin
g.
Labo
rato
ry te
st in
form
atio
n:
Avail
able
test
s Sp
ecial
Inst
ruct
ions
Tu
rn-a
roun
d tim
e Te
stin
g lab
orat
ory
PCR
ELIS
A IgM
and
IgG
Obse
rve ap
prop
riate
infec
tion p
reve
ntion
and c
ontro
l pro
tocols
whe
n coll
ectin
g and
ha
ndlin
g spe
cimen
s. Pa
ckag
e as b
iohaz
ardo
us m
ateria
l, and
stor
e and
tran
spor
t at 4
°C.
Liaise
with
Spe
cial
Patho
gens
Unit
Sp
ecial
Path
ogen
s Unit
, NIC
D-NH
LS
011 3
86 63
39/63
76
NICD
-NHL
S La
bora
tory H
andb
ook f
or D
iagno
sis of
Prio
rity C
ommu
nicab
le Di
seas
es, v
2, up
dated
2012
/02/02
16
15. S
mal
lpox
(IC
D-1
0 B
03)
Inst
ruct
ions
for H
ealth
care
Wor
kers
: Pa
thog
en, c
linica
l sym
ptom
s &
com
men
ts
Sam
ple c
ollec
tion
Test
s to
requ
est
Send
to
Form
s to
com
plet
e
Small
pox v
irus
Feve
r, ma
laise
, hea
d and
body
ache
s, vo
mitin
g, pu
stular
rash
.
Cutan
eous
lesio
n sca
bs
OR pu
stule
fluid
Small
pox
Spec
ial P
athog
ens U
nit, N
ICD-
NHLS
, 1 M
odde
rfonte
in Rd
., Sa
ndrin
gham
, Gau
teng,
2192
Sp
ecim
ens r
eferre
d to U
S CD
C for
fur
ther t
estin
g.
Conta
ct NI
CD H
otline
for a
dvice
an
d to f
acilit
ate la
bora
tory t
estin
g.
Note:
Sma
llpox
was
decla
red e
radic
ated i
n 198
0 (i.e
. the v
irus d
oes n
ot cir
culat
e any
more
); ho
weve
r, it i
s con
sider
ed a
risk f
or us
e as a
biolo
gical
warfa
re
agen
t. In t
he ev
ent o
f a su
spec
ted de
liber
ate ex
posu
re (b
ioter
roris
t atta
ck):
Cons
ult th
e NIC
D-NH
LS H
ealth
care
Wor
kers
Hand
book
on B
ioter
roris
m for
de
tails
on th
e req
uired
resp
onse
. La
bora
tory
test
info
rmat
ion:
Av
ailab
le te
sts
Spec
ial In
stru
ctio
ns
Turn
-aro
und
time
Test
ing
labor
ator
y PC
R Ob
serve
appr
opria
te inf
ectio
n pre
venti
on an
d con
trol p
rotoc
ols w
hen c
ollec
ting a
nd ha
ndlin
g sp
ecim
ens.
Liaise
with
Spe
cial
Patho
gens
Unit
Sp
ecial
Path
ogen
s Unit
, NI
CD-N
HLS
011 3
86 63
39/63
76
NICD
-NHL
S La
bora
tory H
andb
ook f
or D
iagno
sis of
Prio
rity C
ommu
nicab
le Di
seas
es, v
2, up
dated
2012
/02/02
17
16. T
ypho
id F
ever
(IC
D-1
0 A
01.0
) In
stru
ctio
ns fo
r Hea
lthca
re W
orke
rs:
Path
ogen
, clin
ical s
ympt
oms
& co
mm
ents
Sa
mpl
e col
lectio
n Te
sts t
o re
ques
t Se
nd to
Fo
rms t
o co
mpl
ete
Salm
onell
a Typ
hi De
pend
ent o
n cas
e pre
senta
tion a
nd hi
story
Bloo
d for
cultu
re*
Bone
mar
row
aspir
ate
1. En
teric
fever
Stoo
l (or r
ectal
swab
if sto
ol ca
nnot
be
obtai
ned)
Bl
ood
2. Ex
traint
estin
al co
mplic
ation
s (e
.g. en
doca
rditis
, pne
umon
ia,
menin
gitis,
arthr
itis, fo
cal
absc
esse
s)
Foca
l infec
tions
: sub
mit a
ppro
priat
e sp
ecim
en (e
.g. sp
utum,
CSF
, syn
ovial
flu
id, pu
s)
Cultu
re fo
r typ
hoid
Loca
l NHL
S lab
orato
ry. S
pecim
ens m
ay
be re
ferre
d to a
regio
nal N
HLS
labor
atory
depe
nding
on ca
pacit
y at th
e loc
al lev
el.
NICD
-NHL
S, E
nteric
Dise
ases
Refe
renc
e Un
it (ED
RU),
will v
erify
the i
solat
e whe
re
poss
ible,
and c
an pe
rform
mole
cular
tes
ts (P
CR) w
hen u
rgen
t co
nfirm
ation
/diag
nosis
is re
quire
d.
Stan
dard
NHL
S sp
ecim
en
subm
ission
form
for c
linica
l sp
ecim
ens.
Fo
r cas
e inv
estig
ation
s, co
mplet
e NIC
D typ
hoid
fever
case
inve
stiga
tion
form.
*Bloo
d cult
ure i
s the
diag
nosti
c tes
t of c
hoice
for a
cute
case
s of ty
phoid
feve
r.
Labo
rato
ry te
st in
form
atio
n:
Avail
able
test
s Sp
ecial
Inst
ruct
ions
Tu
rn-
arou
nd
time
Test
ing
labor
ator
y
Prim
ary i
denti
ficati
on, s
eroty
ping a
nd
antim
icrob
ial su
scep
tibilit
y If s
tool s
pecim
en ca
nnot
be pr
oces
sed w
ithin
2 hou
rs: us
e a co
tton-
tippe
d swa
b to
samp
le sto
ol sp
ecim
en. P
lace s
wab w
ith sa
mpled
stoo
l in C
ary-B
lair t
rans
port
mediu
m. S
ubmi
t both
the i
nitial
conta
iner w
ith st
ool a
nd sw
ab in
tran
spor
t med
ium to
the
lab.
Tran
spor
t refr
igera
ted, d
o NOT
free
ze.
Liaise
with
loc
al lab
Lo
cal N
HLS
labor
atory
Furth
er id
entifi
catio
n 2-
3 day
s Ex
tende
d ser
otypin
g 5-
7 day
s An
timicr
obial
susc
eptib
ility t
estin
g 2-
3 day
s PC
R 1
day
DNA
finge
rprin
ting o
f stra
ins vi
a PFG
E an
alyse
s 4 d
ays
DNA
finge
r prin
ting o
f stra
ins vi
a MLV
A
For s
tool /
recta
l swa
b spe
cimen
s: se
e note
abov
e. Cu
lture
isola
tes se
nt fro
m oth
er la
bora
tories
: Isola
tes su
bcult
ured
onto
Dorse
t tra
nspo
rt me
dium
incub
ated a
t 37 d
egre
es ov
ernig
ht at
sour
ce la
bora
tory,
prior
to
subm
ission
to E
DRU.
Dor
set s
lope t
o be k
ept a
t roo
m tem
pera
ture u
pon r
eceip
t at
NICD
2 d
ays
Enter
ic Di
seas
es
Refer
ence
Unit
(E
DRU)
, NIC
D-NH
LS
011 5
55 03
33
011 5
55 03
34
Note:
Ser
ologic
al tes
ting (
the W
idal te
st) is
NOT
reco
mmen
ded d
ue to
the l
ow se
nsitiv
ity an
d spe
cifici
ty of
this t
est.
Susp
ected
typh
oid fe
ver c
ases
shou
ld ha
ve ap
prop
riate
spec
imen
s sub
mitte
d for
cultu
re as
detai
led ab
ove.
NICD
-NHL
S La
bora
tory H
andb
ook f
or D
iagno
sis of
Prio
rity C
ommu
nicab
le Di
seas
es, v
2, up
dated
2012
/02/02
18
17. V
iral H
emor
rhag
ic F
ever
s (IC
D-1
0 A
96)
Inst
ruct
ions
for H
ealth
care
Wor
kers
: Pa
thog
en, c
linica
l sym
ptom
s & co
mm
ents
Sa
mpl
e col
lectio
n Te
sts t
o re
ques
t Se
nd to
Fo
rms t
o co
mpl
ete
Bloo
d: Cl
otted
bloo
d (re
d/yell
ow to
p tub
e)
and E
DTA
blood
(p
urple
top t
ube)
Vira
l hae
mor
rhag
ic fe
vers
Fe
ver,
head
ache
, arth
ralgi
a, my
algia,
rash
, hae
morrh
agic
manif
estat
ions,
gastr
ointes
tinal
symp
toms,
patho
logy l
ab in
dicato
rs (in
cludin
g thr
ombo
cytop
enia,
raise
d live
r tra
nsam
inase
s). R
ecen
t trav
el an
d exp
osur
e eve
nts (e
.g. co
ntact
with
anim
als, b
ats, ti
ck bi
tes, s
ick
patie
nts) m
ay pr
ovide
insig
ht.
Accu
rate
dates
of ex
posu
re, o
nset
and p
rogr
essio
n of d
iseas
e are
vital
in
our in
vesti
gatio
n.
Othe
r spe
cimen
s whe
re
indica
ted e.
g. CS
, live
r bio
psies
in po
st mo
rtem
case
s.
VHF
Spec
ial P
athog
ens U
nit,
NICD
-NHL
S, 1
Modd
erfon
tein R
d.,
Sand
ringh
am, G
auten
g, 21
92
All c
ases
to be
notifi
ed
to the
NIC
D Ho
tline.
Case
s will
be re
ferre
d ac
cord
ingly.
Co
mplet
e the
NIC
D VH
F Te
st Re
ques
t For
m
Labo
rato
ry te
st in
form
atio
n:
Avail
able
test
s Sp
ecial
Inst
ruct
ions
Tu
rn-a
roun
d tim
e Te
stin
g lab
orat
ory
Sero
logy:
fluor
esce
nt an
tibod
y tes
t, IgG
and
IgM
24-4
8 hrs
Sero
logy:
ELIS
A, Ig
G an
d IgM
3-
5 day
s PC
R 24
-48 h
rs Vi
rus i
solat
ion
Institu
te im
media
te inf
ectio
n pre
venti
on an
d con
trol m
easu
res.
Pa
ckag
e as b
iohaz
ardo
us m
ateria
l, and
stor
e and
tran
spor
t at
4°C.
3 w
eeks
Spec
ial P
athog
ens U
nit, N
ICD-
NHLS
01
1 386
6339
/6376
Note
: Con
ducti
ng a
full re
perto
ire of
sero
logica
l and
viro
logica
l tests
is m
anda
tory.
Test
resu
lts ar
e high
ly de
pend
ent o
n tim
ing of
spec
imen
colle
ction
in
relat
ion to
dise
ase o
nset;
ther
efore
, mult
iple s
pecim
ens a
re re
quire
d to c
onfirm
/exclu
de di
agno
sis.
Infe
ctio
n pr
even
tion
and
cont
rol f
or vi
ral h
aem
orrh
agic
feve
rs:
Comp
rehe
nsive
docu
ments
detai
ling t
he ne
cess
ary p
reca
ution
s and
appr
opria
te inf
ectio
n con
trol p
racti
ce ca
n be a
cces
sed a
s foll
ows:
Re
feren
ce
guide
for
he
althc
are
worke
rs:
WHO
Inf
ectio
n Co
ntrol
for
viral
haem
orrh
agic
fever
s in
the
Afric
an
healt
h ca
re
settin
g: htt
p://w
ww.w
ho.in
t/csr/
reso
urce
s/pub
licat i
ons/e
bola/
WHO
_EMC
_ESR
_98_
2_EN
/en/
Re
feren
ce g
uide
for la
bora
tory
staff:
Q-Pu
lse, d
ocum
ent n
umbe
r GPL
089
0 (In
fectio
n Co
ntrol
Servi
ces
Labo
rator
y, Jo
hann
esbu
rg) a
nd G
PL 0
947
(Viro
logy L
abor
atory,
Gro
ote S
chuu
r Hos
pital)
.
NICD
-NHL
S La
bora
tory H
andb
ook f
or D
iagno
sis of
Prio
rity C
ommu
nicab
le Di
seas
es, v
2, up
dated
2012
/02/02
19
18. V
iral H
epat
itis
(ICD
-10
B15
-19)
In
stru
ctio
ns fo
r Hea
lthca
re W
orke
rs:
Path
ogen
, clin
ical s
ympt
oms
& co
mm
ents
Sa
mpl
e col
lectio
n Te
sts t
o re
ques
t Se
nd to
Fo
rms t
o co
mpl
ete
Hepa
titis A
viru
s HA
V IgM
He
patiti
s B vi
rus
sAg,
sAb,
cIgM,
total
core
Ab
, eAg
, eAb
He
patiti
s C vi
rus
Bloo
d: Pl
asma
in E
DTA
tube o
r ACD
tube
, an
d/or s
erum
(SST
tube
)
HCV
Antib
ody
Loca
l NHL
S lab
orato
ry St
anda
rd N
HLS
spec
imen
su
bmiss
ion fo
rm
Labo
rato
ry te
st in
form
atio
n:
Avail
able
test
s Sp
ecial
Inst
ruct
ions
Tu
rn-a
roun
d tim
e Te
stin
g lab
orat
ory
HAV
IgM
sAg,
sAb,
cIgM,
total
core
Ab,
eAg,
eAb
HCV
Antib
ody
Perfo
rmed
at al
l regio
nal a
nd pr
ovinc
ial la
bora
tories
: lia
ise w
ith in
dividu
al lab
orato
ry Lo
cal N
HLS
labor
atory
HBV
PCR
HBV
viral
load
HBV
geno
typing
10 da
ys
HCV
PCR
15 da
ys
HCV
geno
typing
HCV
viral
load
4°C
to ro
om te
mper
ature
, mini
mum
1500
µl pl
asma
10 da
ys
Spec
ialize
d Mole
cular
Diag
nosti
cs
Unit,
NICD
-NHL
S
011 3
86 64
39
NICD
-NHL
S La
bora
tory H
andb
ook f
or D
iagno
sis of
Prio
rity C
ommu
nicab
le Di
seas
es, v
2, up
dated
2012
/02/02
20
19. Y
ello
w F
ever
(IC
D-1
0 A
95)
Inst
ruct
ions
for H
ealth
care
Wor
kers
: Pa
thog
en, c
linica
l sym
ptom
s & co
mm
ents
Sa
mpl
e col
lectio
n Te
sts t
o re
ques
t Se
nd to
Fo
rms t
o co
mpl
ete
Yello
w fe
ver v
irus (
an ar
bovir
us)
Rash
, arth
ralgi
a, my
algia,
feve
r, en
ceph
alitis
, trav
el his
tory/i
nsec
t bit
esTr
avel
to ye
llow
fever
area
s with
out p
re-tr
avel
vacc
inatio
n. Pa
tients
are e
xpos
ed th
roug
h mos
quito
bites
.
Clott
ed bl
ood a
nd se
rum
Othe
r spe
cimen
s whe
re
indica
ted: C
SF, li
ver b
iopsie
s in
post-
morte
m ca
ses.
Yello
w fev
er
Post
-vac
cinat
ion
yello
w fe
ver a
ntib
odies
Cl
otted
bloo
d and
seru
m Ye
llow
fever
an
tibod
ies
Spec
ial P
athog
ens
Unit,
NICD
-NHL
S, 1
Modd
erfon
tein R
d.,
Sand
ringh
am,
Gaute
ng, 2
192.
Stan
dard
NHL
S sp
ecim
en
subm
ission
form
.
Labo
rato
ry te
st in
form
atio
n:
Avail
able
test
s Sp
ecial
Inst
ruct
ions
Tu
rn-a
roun
d tim
e Te
stin
g lab
orat
ory
Sero
logy:
HAI
5 day
s IgM
Elis
a/IFA
2-
4 day
s PC
R 24
-48 h
ours
Viru
s iso
lation
Obse
rve ap
prop
riate
infec
tion p
reve
ntion
and c
ontro
l pro
tocols
whe
n coll
ectin
g and
hand
ling
spec
imen
s. Pa
ckag
e as b
iohaz
ardo
us m
ateria
l, and
stor
e and
tran
spor
t at 4
°C (o
r on i
ce
pack
s).
18 da
ys
Spec
ial P
athog
ens U
nit,
NICD
-NHL
S 01
1 386
6339
/6376
Note:
Con
ducti
ng a
full re
perto
ire of
sero
logica
l and
viro
logica
l tests
is st
rong
ly re
comm
ende
d. Te
st re
sults
are h
ighly
depe
nden
t on t
iming
of sp
ecim
en
colle
ction
in re
lation
to di
seas
e ons
et; th
erefo
re, te
sting
of ac
ute an
d con
vales
cent
spec
imen
s is s
trong
ly re
comm
ende
d to c
onfirm
/exclu
de ye
llow
fever
dia
gnos
is.
Testi
ng of
post-
vacc
inatio
n anti
bodie
s is u
suall
y not
indica
te bu
t is of
ten re
ques
ted fo
r tra
vel c
leara
nce p
urpo
ses.
Vacc
inated
patie
nts m
ay no
t nec
essa
rily
deve
lop de
tectab
le an
tibod
y res
pons
e and
ther
e are
not s
tanda
rd an
tibod
y cut-
offs t
hat in
dicate
immu
nity.
Yello
w fev
er va
ccina
tion s
hould
be re
peate
d in
trave
llers
to en
demi
c cou
ntries
ever
y 10 y
ears
and r
ecor
ded o
n vac
cinati
on ca
rds.
NICD
-NHL
S La
bora
tory H
andb
ook f
or D
iagno
sis of
Prio
rity C
ommu
nicab
le Di
seas
es, v
2, up
dated
2012
/02/02
21
20. C
lust
ers
(out
brea
ks) o
f Gas
troi
ntes
tinal
Dis
ease
/Foo
dbor
ne D
isea
se
Inves
tigati
ons s
hould
be in
itiated
in th
e eve
nt of
2 or m
ore l
inked
case
s of g
astro
enter
itis or
food
born
e illn
ess.
Depa
rtmen
t of H
ealth
or N
ICD
foodb
orne
illne
ss ca
se
inves
tigati
on fo
rms s
hould
be co
mplet
ed. A
line l
ist sh
ould
addit
ionall
y be c
omple
ted fo
r all i
nves
tigati
ons.
Refer
to th
e NIC
D-NH
LS H
andb
ook f
or D
iagno
sis of
Foo
dbor
ne
Illnes
s Outb
reak
s and
the N
ICD
Quick
Refe
renc
e Guid
e for
Inve
stiga
tion o
f Foo
dbor
ne D
iseas
e Outb
reak
s for
furth
er in
forma
tion.
Samp
les of
the i
mplic
ated
food/b
ever
age A
ND cl
inica
l hum
an sa
mples
(i.e.
stool,
recta
l swa
bs an
d/or v
omitu
s) sh
ould
be co
llecte
d for
all o
utbre
aks w
hen p
ossib
le, an
d ALL
samp
les co
llecte
d sh
ould
be re
ferre
d to t
he de
signa
ted N
HLS
Publi
c Hea
lth La
bora
tory .
20.1
. B
acte
rial i
dent
ifica
tion
(hum
an s
peci
men
s)
Inst
ruct
ions
for h
ealth
care
wor
kers
: Pa
thog
en, c
linica
l sy
mpt
oms &
com
men
ts
Sam
ple c
ollec
tion
Test
s to
requ
est
Send
to
Form
s to
com
plet
e Vo
mitin
g: vo
mitus
/ gas
tric co
ntents
Di
arrh
oea:
stool
spec
imen
, or r
ectal
swab
if sto
ol ca
nnot
be ob
taine
d. If s
tool
spec
imen
cann
ot be
proc
esse
d with
in 2 h
ours:
use a
cotto
n-tip
ped s
wab t
o sa
mple
stool
spec
imen
. Plac
e swa
b with
samp
led st
ool in
Car
y-Blai
r tra
nspo
rt me
dium.
Sub
mit b
oth th
e init
ial co
ntaine
r with
stoo
l and
swab
in tr
ansp
ort
mediu
m to
the la
b. Tr
ansp
ort r
efrige
rated
, do N
OT fr
eeze
. Fe
ver:
blood
cultu
re an
d ser
um
Envir
onme
ntal is
olates
in w
ater/f
ood-
born
e dise
ase o
utbre
aks o
nly.
Food
born
e illn
ess
inves
tigati
on
Bacte
rial p
athog
ens
Neur
ologic
al fea
tures
: ser
um, s
tool a
nd vo
mitus
/gastr
ic co
ntents
Bo
tulism
Spec
imen
s mus
t be
refer
red t
o the
de
signa
ted P
ublic
He
alth L
abor
atory
for sp
ecial
ised
testin
g (se
e con
tact
detai
ls be
low)
Clini
cal s
pecim
ens:
stand
ard N
HLS
spec
imen
su
bmiss
ion fo
rm,
clear
ly sta
ting
‘food
born
e illn
ess
inves
tigati
on’.
Whe
n en
teric
patho
gens
(suc
h as
Salm
onell
a sp
p.) a
re c
ultur
ed, w
e re
ques
t tha
t iso
lates
are
refer
red
to the
Ente
ric D
iseas
es C
entre
, NIC
D for
furth
er
char
acter
isatio
n. Th
is wi
ll ena
ble th
e dete
ction
of w
idesp
read
food
born
e illn
ess o
utbre
aks,
in ad
dition
to fu
lly ch
arac
terisi
ng lo
cal o
utbre
aks.
La
bora
tory
test
info
rmat
ion:
Av
ailab
le te
sts
Spec
ial In
stru
ctio
ns
Turn
-aro
und
time
Test
ing
labor
ator
y Mi
crosc
opy,
cultu
re an
d anti
micro
bial s
usce
ptibil
ity (M
C&S)
Ba
cteria
l toxin
detec
tion
Tran
spor
t refr
igera
ted, d
o NO
T fre
eze.
Liaise
with
lab
Desig
nated
NHL
S Pu
blic
Healt
h Lab
orato
ry Di
arrh
oeag
enic
E. co
li: Ide
ntific
ation
2-
3 day
s Di
arrh
oeag
enic
E. co
li: Ex
tende
d ser
otypin
g 5-
7 day
s Di
arrh
oeag
enic
E. co
li: Vi
rulen
ce ge
ne id
entifi
catio
n via
multip
lex P
CR
2 day
s Di
arrh
oeag
enic
E. co
li: DN
A fin
gerp
rintin
g of s
trains
via P
FGE
analy
ses
4 day
s Sa
lmon
ella a
nd S
higell
a: Ide
ntific
ation
2-
3 day
s Sa
lmon
ella a
nd S
higell
a: Ex
tende
d ser
otypin
g 5-
7 day
s Sa
lmon
ella a
nd S
higell
a: DN
A fin
gerp
rintin
g of s
trains
via P
FGE
analy
ses a
nd M
LVA.
Isolat
es su
b-cu
lture
d onto
Do
rset tr
ansp
ort m
edium
inc
ubate
d at 3
7ºC
over
night
at so
urce
lab
orato
ry, pr
ior to
su
bmiss
ion to
EDR
U 4 d
ays
Enter
ic Di
seas
es R
efere
nce
Unit (
EDRU
), NI
CD-N
HLS
011-
555-
0333
/4
Botul
ism te
sting
Tr
ansp
ort r
efrige
rated
, do
NOT
freez
e. Lia
ise w
ith la
b Sp
ecial
Bac
terial
Path
ogen
s Re
feren
ce U
nit, N
ICD-
NHLS
, 011
-555
-030
6/31
NICD
-NHL
S La
bora
tory H
andb
ook f
or D
iagno
sis of
Prio
rity C
ommu
nicab
le Di
seas
es, v
2, up
dated
2012
/02/02
22
20.2
. Vi
ral i
dent
ifica
tion
Te
sts fo
r vira
l path
ogen
s tha
t may
be
the c
ause
of f
oodb
orne
illne
ss in
ciden
ts ar
e no
t rou
tinely
per
forme
d, an
d the
se n
eed
to be
requ
ested
spe
cifica
lly
throu
gh lia
ison a
nd di
scus
sion w
ith th
e Vira
l Gas
troen
teritis
Unit
and t
he O
utbre
ak R
espo
nse U
nit, N
HLS-
NICD
. In
stru
ctio
ns fo
r hea
lthca
re w
orke
rs:
Path
ogen
, clin
ical s
ympt
oms &
com
men
ts
Sam
ple c
ollec
tion
Test
s to
requ
est
Send
to
Form
s to
com
plet
e Ad
enov
irus t
ype 4
0/41,
astro
virus
, ent
eric
aden
iviru
s, no
rovir
us, r
otav
irus:
Di
arrh
oea,
vomi
ting,
fever
Stoo
l (note
, rec
tal sw
abs a
re un
suita
ble
spec
imen
s)
Vira
l ga
stroe
nteriti
s Vi
ral
Gastr
oente
ritis
Unit,
NICD
-NHL
S.
NICD
Vira
l Ga
stroe
nteriti
s Unit
Sp
ecim
en fo
rm.
Thro
at sw
ab (in
vira
l tran
spor
t med
ium)
Urine
St
ool
Conju
nctiv
al sw
ab (in
vira
l tran
spor
t med
ium),
Aden
oviru
s: R
TI, h
aemo
rrhag
ic cy
stitis
, ga
stroe
nteriti
s
Resp
irator
y spe
cimen
s: tra
chea
l asp
irate,
naso
-ph
aryn
geal
aspir
ate, b
ronc
ho-a
lveola
r lava
ge, e
tc.
Aden
oviru
s Vi
rus I
solat
ion,
NICD
-NHL
S
Echo
virus
: 1. D
iarrh
oea,
vomi
ting,
fever
St
ool s
pecim
en (o
r rec
tal sw
ab in
vira
l tran
spor
t me
dium
if stoo
l can
not b
e obta
ined)
En
terov
irus
CSF
in ca
se of
men
ingitis
/ enc
epha
litis
Stoo
l spe
cimen
(or r
ectal
swab
in vi
ral tr
ansp
ort
mediu
m if s
tool c
anno
t be o
btaine
d)
Echo
virus
: 2. M
ening
itis/ e
ncep
haliti
s
Thro
at sw
ab (in
vira
l tran
spor
t med
ium)
Enter
oviru
s/ en
ceph
alitis
Spec
ialise
d Mo
lecula
r Di
agno
stics
Unit
(S
MDU)
, NIC
D-NH
LS.
Ad
enov
irida
e, As
trovir
idae
, Birn
aviri
dae,
Calic
ivirid
ae, C
oron
oviri
dae,
Pico
rnav
irida
e, Re
oviri
dae:
Ga
stroe
nteriti
s, AF
P
Stoo
l Vi
ral
gastr
oente
ritis
Elec
tron
Micro
scop
y Unit
, NI
CD-N
HLS
Stan
dard
NHL
S sp
ecim
en su
bmiss
ion
form
for cl
inica
l sp
ecim
ens.
Labo
rato
ry te
st in
form
atio
n:
Avail
able
test
s Sp
ecial
Inst
ruct
ions
Tu
rn-a
roun
d tim
e Te
stin
g lab
orat
ory
Shell
vial
cultu
re
Tran
spor
t at 4
ºC. S
ample
shou
ld re
ach
labor
atory
withi
n 72h
rs 5 d
ays
Viru
s Iso
lation
, NIC
D-NH
LS
011-
386-
6420
/22
Aden
oviru
s typ
e 40/4
1 dete
ction
– EL
ISA
Astro
virus
, ente
ric ad
enivi
rus,
noro
virus
– re
al-tim
e PCR
Ro
taviru
s dete
ction
– EL
ISA/
dipsti
ck, r
eal-ti
me P
CR
Liaise
with
lab
Viru
s Iso
lation
21
days
Vira
l Gas
troen
teritis
Unit
, NIC
D-NH
LS. 0
11-5
55-0
370
Enter
oviru
s dete
ction
– re
al-tim
e PCR
Stor
e and
tran
spor
t at 4
ºC. M
ainten
ance
of
cold
chain
is re
comm
ende
d fro
m co
llecti
on to
re
ceipt
at N
ICD
5 d
ays
Spec
ialise
d Mole
cular
Diag
nosti
cs
Unit,
011 3
86 63
30 or
011 3
86 64
39
Vira
l scre
ening
(neg
ative
stain
ing w
ith 2%
PTA
).
Refrig
erate
d tra
nspo
rt. M
ay be
dried
smea
r on
slide
. Tes
ts ca
n’t be
used
for in
itial d
iagno
sis.
3.5hr
s El
ectro
n Micr
osco
py U
nit, N
ICD-
NHLS
. 011
-386
-631
8 NI
CD-N
HLS
Labo
rator
y Han
dboo
k for
Diag
nosis
of P
riority
Com
munic
able
Dise
ases
, v2,
upda
ted 20
12/02
/02
23
20.3
. En
viro
nmen
tal S
ampl
ing:
Foo
d, M
ilk a
nd W
ater
Tes
ting
Conta
ct the
Pub
lic H
ealth
Lab
orato
ry for
instr
uctio
ns o
n sp
ecim
en co
llecti
on a
nd su
bmiss
ion. S
ampli
ng sh
ould
be sy
stema
tic, a
nd sh
ould
cove
r as w
ide a
ra
nge
as p
ossib
le. W
here
pos
sible,
diffe
rent
types
of f
oods
mus
t be
place
d in
sepa
rate
conta
iners.
The
qua
ntity
of foo
d tak
en m
ust b
e su
fficien
t. An
en
viron
menta
l hea
lth p
racti
tione
r mus
t noti
fy the
own
er/m
anag
er a
t the
food
pro
ducti
on/ca
tering
facil
ity th
at sa
mples
nee
d to
be ta
ken
(pro
vide
a re
ason
). Sa
mples
for m
icrob
iolog
ical a
nalys
is mu
st be
coll
ected
with
dec
ontam
inated
equ
ipmen
t (im
merse
equ
ipmen
t in
70%
alco
hol a
nd fl
ame
using
a p
ortab
le sp
irit bu
rner
until
alcoh
ol ev
apor
ates,
allow
cooli
ng be
fore u
sing)
. In
stru
ctio
ns fo
r Env
ironm
enta
l Hea
lth P
ract
ition
ers (
and
othe
r hea
lth au
thor
ities
):
Path
ogen
, clin
ical
sym
ptom
s & co
mm
ents
Sa
mpl
e col
lectio
n Te
sts t
o re
ques
t Se
nd to
Fo
rms t
o co
mpl
ete
Food
: Vol:
100g
(con
taine
r full
), Co
ntaine
r: ste
rile, tr
ansp
ort te
mp: 2
- 8 d
eg C
, reje
cted
after
: >48
hour
s at r
oom
tempe
ratur
e (RT
) Mi
lk: V
ol: 10
0ml, c
ontai
ner:
origi
nal/ s
terile
, tran
spor
t temp
: 2 -
8 deg
C, r
ejecte
d afte
r: >2
4 hrs
at RT
W
ater
(pot
abilit
y): V
ol: 12
0ml, c
ontai
ner:
sterile
, tran
spor
t temp
: 2 -8
deg C
, reje
cted
after
: >24
hrs a
t RT
Food
- and
wat
er-b
orne
pa
thog
ens
Wat
er (S
almon
ella s
pp., V
. cho
lerae
, etc
.): V
ol: 10
00ml
for e
ach t
est, c
ontai
ner:
clean
/ne
w / s
terile
, tran
spor
t temp
: RT
(if de
liver
ed th
e sam
e day
), re
jected
after
: >48
hrs a
t RT
Liaise
with
tes
ting
labor
atory
Desig
nated
NH
LS
Publi
c He
alth
Labo
rator
y
See S
ectio
n 20.4
for
the d
esign
ated
Publi
c Hea
lth
Labo
rator
y Su
bmiss
ion F
orms
.
Tabl
e: T
estin
g of
clin
ical a
nd en
viron
men
tal s
pecim
ens b
y spe
cialis
ed la
bora
torie
s for
food
- and
wat
erbo
rne o
utbr
eaks
La
bora
tory
N
HLS
-ICSL
NH
LS P
ort E
lizab
eth
N
HLS
Pub
lic H
ealth
, KZN
NH
LS G
reen
Poi
nt
Spec
imen
type
C
linic
al1
Env2
C
linic
al1
Env2
C
linic
al1
Env2
C
linic
al1
Env2
Sal
mon
ella
spp
.
Shi
gella
spp
.
E. c
oli O
157
x
x
x B
acill
us c
ereu
s
Clo
strid
ium
per
fring
ens
Cam
pylo
bact
er s
pp.
x
x
x Li
ster
ia m
onoc
ytog
enes
x
x
x S
taph
loco
ccus
are
us
Vib
rio s
pp.
Bac
teria
l tox
ins3
x
x
x 1 C
linica
l spe
cimen
s: sto
ol, vo
mitus
. 2 Env
ironm
ental
spec
imen
s: foo
d, wa
ter, m
ilk. 3 S
. aur
eus a
nd B
. cer
eus e
ntero
toxin
tests
from
isolat
es. C
. per
fring
ens e
ntero
toxin
from
stools
and i
solat
es
NICD
-NHL
S La
bora
tory H
andb
ook f
or D
iagno
sis of
Prio
rity C
ommu
nicab
le Di
seas
es, v
2, up
dated
2012
/02/02
24
NICD
-NHL
S La
bora
tory H
andb
ook f
or D
iagno
sis of
Prio
rity C
ommu
nicab
le Di
seas
es, v
2, up
dated
2012
/02/02
25
20.4
. C
onta
ct d
etai
ls fo
r gas
troi
ntes
tinal
dis
ease
out
brea
ks
It is
esse
ntial
for p
ublic
hea
lth o
fficial
s / h
ealth
care
wor
kers
inves
tigati
ng fo
odbo
rne i
llnes
s outb
reak
s to n
otify
the N
HLS
staff
when
spec
imen
s are
colle
cted
as pa
rt of
an ou
tbrea
k. AL
L spe
cimen
s coll
ected
shou
ld be
refer
red t
o one
of th
e des
ignate
d pub
lic he
alth l
abor
atorie
s: Ta
ble:
Des
igna
ted
NHLS
Pub
lic H
ealth
Lab
orat
ories
cont
act d
etail
s and
test
s offe
red
* P
rovin
ces r
efer
ring
to d
esig
nate
d pu
blic
healt
h lab
orat
ory
Labo
rato
ry
Addr
ess
Cont
act P
erso
n
Test
s offe
red
1 Ga
uteng
Lim
popo
Mp
umala
nga
North
ern C
ape
Free
Stat
e
NHLS
Infec
tion C
ontro
l Ser
vice
Labo
rator
y (IC
SL),
Joha
nnes
burg
Pu
blic H
ealth
Sam
ple S
ubmi
ssion
For
m
Wits
Med
ical S
choo
l, Roo
m 3T
09, 7
Yor
k Rd.
Parkt
own,
Joha
nnes
burg
, 219
3.
Mr. R
ob S
tewar
t Te
l. 011
-489
-857
8/9 or
011-
717-
2496
2 Kw
aZulu
Nata
l NH
LS P
ublic
Hea
lth La
bora
tory K
ZN
Publi
c Hea
lth S
ample
Sub
miss
ion F
orm
3rd F
loor,
149 P
rince
Stre
et,
Durb
an, 4
001.
Mr
. Leo
n Tay
lor / M
s Ind
rani
Chett
y Te
l: 031
-327
-674
3 / 67
52
Full r
ange
of fo
odbo
rne
patho
gen t
ests
offer
ed
3 W
ester
n Cap
e NH
LS P
ublic
Hea
lth La
bora
tory,
Gree
n Po
int
Publi
c Hea
lth S
ample
Sub
miss
ion F
orm
Old C
ity H
ospit
al Co
mplex
, Po
rtwoo
d Roa
d, Gr
eenp
oint,
8000
.
Mr. J
ohan
n Stey
l / Ms
An
thene
tte H
eyde
nryc
h Te
l: 021
-417
-935
4 / 93
55
4 Ea
stern
Cap
e NH
LS P
ublic
Hea
lth La
bora
tory,
Port
Eliza
beth
Publi
c Hea
lth S
ample
Sub
miss
ion F
orm
Corn
er of
Buc
kingh
am an
d Ea
stbor
ne R
oad,
Moun
t Cro
ix,
Port
Eliza
beth,
6000
.
Ms V
anes
sa P
earce
Te
l: 041
-395
-617
4
** Fo
odbo
rne p
athog
ens:
Testi
ng fo
r E. c
oli O
157,
Cam
pylob
acte
r spp
., Lis
teria
mon
ocyto
gene
s, &
Bacte
rial to
xins i
s re
ferre
d to N
HLS-
ICSL
.
* Sam
ples /
spec
imen
s may
also
be tr
ansp
orted
dire
ctly t
o the
NHL
S-IC
SL fo
r tes
ting;
** Pu
blic H
ealth
Labo
rator
ies to
refer
to N
HLS-
ICSL
, Joh
anne
sbur
g He
althc
are w
orke
rs an
d lab
orato
ry sta
ff may
addit
ionall
y utili
se th
e foll
owing
conta
ct po
ints f
or di
scus
sion o
f cas
es/ou
tbrea
ks if
need
ed:
NI
CD H
otlin
e: 08
2-88
3-99
20 (f
or us
e by h
ealth
care
profe
ssion
als on
ly)
NI
CD D
ivisio
n of
Sur
veilla
nce,
Outb
reak
Res
pons
e an
d Tr
avel
Healt
h: M
s Ch
arlen
e Ja
cobs
: 011
-555
054
1, ch
arlen
ej@nic
d.ac.z
a; Dr
. Aya
nda
Ceng
imbo
: 011
-555
-054
1, ay
anda
c@nic
d.ac.z
a ; Mr
. Bre
tt Arch
er: 0
11-3
86-6
354,
brett
a@nic
d.ac.z
a;
NH
LS In
fect
ion
Cont
rol S
ervic
es L
abor
ator
y (IC
SL):
Mr. R
ob S
tewar
t: 011
-489
-857
8/9 or
011-
717-
2496
, rob
.stew
art@
nhls.
ac.za
NHLS
Pub
lic H
ealth
Lab
orat
ory K
ZN :
Mr. L
eon T
aylor
: 031
-327
-674
3, leo
n.tay
lor@
nhls.
ac.za
NHLS
Pub
lic H
ealth
Lab
orat
ory G
reen
Poi
nt: M
r. Jo
hann
Stey
l: 021
-417
9354
, joha
n.stey
l@nh
ls.ac
.za
NH
LS P
ublic
Hea
lth L
abor
ator
y Por
t Eliz
abet
h: M
s Van
essa
Pea
rce: 0
41-3
95-6
174,
vane
ssa.p
earce
@nh
ls.ac
.za
