SEARO – CSR Training on Outbreak InvestigationE P I D E M I C A L E R T A N D R E S P O N S E SEARO - CSR Training on Outbreak Investigation

Safe Transport

Laboratory specimen: collection, safe transport and biosafety

Laboratory specimen: safe transport SEARO – CSR Training on Outbreak Investigation

Learning Objectives

• At the end of the session, the participant will be able to:– Explain the goals of safe transport of

laboratory specimen– Describe triple packaging system– Describe different aspects in safe transport

planning

Laboratory specimen: safe transport SEARO – CSR Training on Outbreak Investigation

How to send a sample?

2 main goals:

• Protect the environment, the carrier and the recipient person

• Protect the sample arrives in good condition to be analyzed

– If you do not have regular triple package, you have to prepare a system according to the requirements of the international dangerous goods transportation rules

Laboratory specimen: safe transport SEARO – CSR Training on Outbreak Investigation

The basic triple packaging system

• Three layers of protection are needed: – primary receptacle

– secondary packaging

– outer packaging

• IATA shipping guidelines provide details about definitions, packaging requirements, markings and labels, accompanying documentation, notification protocols and refrigerants

Laboratory specimen: safe transport SEARO – CSR Training on Outbreak Investigation

Triple packaging system:primary receptacle

• Leak-proof specimen container

• Packaged with sufficient absorbent material to absorb the entire content of the primary receptacle in case of breakage

Laboratory specimen: safe transport SEARO – CSR Training on Outbreak Investigation

Triple packaging system:secondary receptacle

• Leak-proof secondary container Encloses and protects the primary

receptacle(s)– several primary receptacles can be enclosed– sufficient additional absorbent material to

absorb all fluid in case of breakage

Laboratory specimen: safe transport SEARO – CSR Training on Outbreak Investigation

Triple packaging system:outer packaging

• Secondary packaging(s) are placed in outer shipping packaging with suitable cushioning material

• Outer packaging protects contents from outside influences, physical damage, while in transit

• Smallest overall external dimension 10 x10 cm

Laboratory specimen: safe transport SEARO – CSR Training on Outbreak Investigation

Infectious Substances

Substances which are known or are reasonably expected to contain pathogens

Two categories • Category A – causing permanent

disability, life-threatening or fatal disease in humans or animals.

• Category B – specimen does not meet the criteria for inclusion in Category A.

Laboratory specimen: safe transport SEARO – CSR Training on Outbreak Investigation

Biohazard Labels

Laboratory specimen: safe transport SEARO – CSR Training on Outbreak Investigation

Category B, Category B, “650 package” 650 package” UN 3373

No biohazard label

Laboratory specimen: safe transport SEARO – CSR Training on Outbreak Investigation

Category ACategory A “602 package”“602 package” Labels: UN 2814 UN 2900 Biohazard

Laboratory specimen: safe transport SEARO – CSR Training on Outbreak Investigation

What to send with the sample?

• Completed laboratory request form with the following:– Sampler/ sender name(s) and contact information

– Sample date and time– Patient’s name, age, sex– Suspected clinical diagnosis and main clinical signs– Context (outbreak confirmation, outbreak verification,

end of outbreak, routine surveillance, etc.)– Epidemiological or demographic identification (must be

provided in order to link laboratory and epidemiological data)

Laboratory specimen: safe transport SEARO – CSR Training on Outbreak Investigation

Where to send the sample?

• Depending on the analysis to be performed• Laboratory capacities to be assessed before sending the sample • An easily reachable recipient person to be identified before

sending• Usually to a good capacity laboratory, close to the area

– National reference laboratory– Hospital laboratory– WHO CC laboratory, polio network laboratory– Pasteur Institute network laboratory– CDC/ NAMRU/ others

• Some analysis (ex. Ebola) are performed in very few places• Depends also on the transportation ways & means

Laboratory specimen: safe transport SEARO – CSR Training on Outbreak Investigation

Transport planning 1

• Good coordination between the sender, the carrier and the receiver

Sender– Make arrangements with receiver– Make arrangements with carrier– Prepare necessary documentation– Notify the receiver

Laboratory specimen: safe transport SEARO – CSR Training on Outbreak Investigation

Transport planning 2

• Carrier– Provides shipping documents– Advice and ensure correct packaging– Select best routing– Notify any possible delay

• Receiver– Obtain necessary authorization, permits if

international– Arranges timely collection on arrival– Immediate acknowledges receipt to the sender

Laboratory specimen: safe transport SEARO – CSR Training on Outbreak Investigation

Recommended transport temperatures

Medium TemperatureCSF for culture in TI 25 to 35-37°C, never

refrigerated

Blood culture bottle 25 to 35-37°C, never refrigerated

Blood smears ambient temperature

Cultures in Petri Dishes +4°C

Cary Blair tubes +4°C

Serum in tube with cap +4°C

CSF for chemistry, microscopy +4°C

Tissue and bubo aspirates +4°C

Laboratory specimen: safe transport SEARO – CSR Training on Outbreak Investigation

• Transport of infectious substances is subject to strict national and international regulations:– proper use of packaging materials– proper labelling, notification

• Compliance:– reduces likelihood of damaging packages – minimizes exposure – improves carrier’s efficiency and confidence in

package delivery

Transport regulations (1)

Laboratory specimen: safe transport SEARO – CSR Training on Outbreak Investigation

Transport regulations (2)

• Subject to regular amendments– shippers refer to latest issuances of national and

international regulations for regulations

• International regulations not intended to supersede local or national requirements– where national requirements do not exist,

international regulations should be followed

Laboratory specimen: safe transport SEARO – CSR Training on Outbreak Investigation

Category A

Bacillus anthracis (cultures only)Brucella abortus (cultures only)Brucella melitensis (cultures only)Brucella suis (cultures only)Burkholderia mallei

[Pseudomonas mallei – Glanders](cultures only)

Burkholderia pseudomallei [Pseudomonas pseudomallei] (cultures only)

Chlamydia psittaci [avian strains] (cultures only)

Clostridium botulinum (cultures only)

Coccidioides immitis (cultures only)Coxiella burnetii (cultures only)Crimean-Congo hemorrhagic fever

virusDengue virus (cultures only)Eastern equine encephalitis virus

(cultures only)Escherichia coli, verotoxigenic

(cultures only)Ebola virusFlexal virusFrancisella tularensis (cultures only)

Laboratory specimen: safe transport SEARO – CSR Training on Outbreak Investigation

Category A (cont’d)

Guanarito virusHantaan virusHantaviruses causing

haemorrhagic fever with renal syndrome

Hendra virusHepatitis B virus (cultures

only)Herpes B virus (cultures only)Human immunodeficiency

virus (cultures only)Highly pathogenic avian

influenza virus (cultures only)

Japanese Encephalitis virus (cultures only)

Junin virusKyasanur Forest disease virusLassa virusMachupo virusMarburg virusMonkeypox virus Mycobacterium tuberculosis

(cultures only)Nipah virus Francisella tularensis (cultures

only)

Laboratory specimen: safe transport SEARO – CSR Training on Outbreak Investigation

Category A (cont’d)

Omsk hemorrhagic fever virusPoliovirus (cultures only)Rabies virus (cultures only)Rickettsia prowasekii (cultures

only)Rickettsia rickettsii (cultures

only)Rift Valley fever virus (cultures

only)Russian spring-summer

encephalitis virus (cultures only)

Sabia virusShigella dysenteriae type 1

(cultures only)Tick-borne encephalitis virus

(cultures only)Variola virusVenezuelan equine

encephalitis virus (cultures only)

West Nile virus (cultures only)Yellow fever virus (cultures

only)Yersinia pestis (cultures only)

Laboratory specimen: safe transport SEARO – CSR Training on Outbreak Investigation

Category A (cont’d)

• African swine fever virus (cultures only)

• Avian paramyxovirus Type 1 [Velogenic Newcastle disease virus] (cultures only)

• Classical swine fever virus (cultures only)

• Foot and mouth disease virus (cultures only)

• Lumpy skin disease virus (cultures only)

• Mycoplasma mycoides [Contagious bovine pleuropneumonia] (cultures only)

• Peste des petits ruminants virus (cultures only)

• Rinderpest virus (cultures only)

• Sheep-pox virus (cultures only)• Goatpox virus (cultures only)• Swine vesicular disease virus

(cultures only)• Vesicular stomatitis virus

(cultures only)

Laboratory specimen: safe transport SEARO – CSR Training on Outbreak Investigation

Reference

Most of the slides used in this presentation are developed by the Department of Epidemic and Pandemic Alert and Response of the World Health Organization with assistance from:

European Program for Intervention Epidemiology Training

Canadian Field Epidemiology Program

Thailand Ministry of Health

Institut Pasteur

Laboratory specimen: safe transport SEARO – CSR Training on Outbreak Investigation