DoD-GEIS Supported LABORATORY TESTING & PATHOGEN EXPLORATION RESOURCES for Respiratory Disease Cases FOR SPECIMENS FROM

CLINICAL PATIENTS: Clinical specimens may be sent to The Air Force Institute for Operational Health (AFIOH) Virology and Bacteriology Laboratories, The Naval Health Research Center (NHRC) Respiratory Disease Laboratory, The Armed Forces Institute of Pathology (AFIP), and The US Army Medical Research Institute of Infectious Diseases (USAMRIID). Appropriate media and storage conditions are critical for optimal recovery and diagnosis. Therefore, please contact and consult with the receiving laboratory prior to shipping. AFIOH operates the Department of Defense Laboratory-Based Global Influenza Surveillance System.1 NHRC conducts the Department of Defense Febrile Respiratory Illness Surveillance System at military training centers.2

1. The Air Force Institute for Operational Health (AFIOH) Virology and
Bacteriology Laboratories: The US Air Force Virology Laboratory is prepared to evaluate specimens for influenza A, influenza B, parainfluenza viruses, coronaviruses (SARS, OC43, and 229E), respiratory syncytial virus (RSV), herpes viruses, adenoviruses and enteroviruses. In addition, SARS molecular diagnostic testing is available, courtesy of the CDC’s Laboratory Response Network (LRN). The Bacteriology Laboratory is prepared to identify Streptococcus pneumoniae, Mycoplasma pneumoniae, Haemophilus influenzae, group A (beta-hemolytic) streptococci (GABHS), and Bordetella pertussis. The laboratory also participates in the CDC’s LRN as a Level B facility and can provide initial confirmation testing for Bacillus anthracis, Yersinia pestis, Brucella spp., and Francisella tularensis. In addition to offering clinical reference and LRN services, this laboratory is prepared to support respiratory surveillance and emerging pathogen exploration in collaboration with the CDC and associated public health laboratories, the NHRC Respiratory Disease Laboratory, and civilian institutions. Throat swabs, nasal or nasalpharyngeal swabs, or sterile site specimens (e.g., pleural fluid, CSF) are the preferred specimens for evaluation. Sputum is acceptable. Tissue biopsy specimens are also acceptable. Blood specimens are not recommended for virus recovery. Prior to sending specimens, please contact Ms. Linda Canas, Mr. John Gaines, or one of their associates to discuss appropriate specimen types and submission procedures. Ms. Linda Canas Mr. John Gaines Chief, Diagnostic Virology Chief, Bacteriology 2730 Louis Bauer Drive 2730 Louis Bauer Drive Brooks City-Base, TX 78235-5132 Brooks City-Base, TX 78235-5132 TEL: 210-536-1679/1785 TEL: 210-536-8381/3759 FAX: 210-536-2638 FAX: 210-536-2638 EMAIL: Linda.Canas@brooks.af.mil EMAIL: John.gaines@brooks.af.mil Additional submission information is available in the laboratory guide, on the web at http://starview.brooks.af.mil/afioh/Laboratories/epidemiological_surveillance_laboratory.htm If problems are encountered in contacting Ms. Canas or Mr. Gaines, please contact The AFIOH 24-hour service center, TEL: 1-888-232-3764. Ms. Jennifer Rubenstein, TEL: 301-

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319-9072 or EMAIL: Jennifer.Rubenstein@na.amedd.army.mil can also assist you in contacting The AFIOH Virology Laboratory.
2. Naval Health Research Center (NHRC) Respiratory Disease Laboratory: The

NHRC Respiratory Disease Laboratory is prepared to evaluate specimens for bacterial and viral pathogens and can refer specimens to the Centers for Disease Control and Prevention (CDC), Atlanta, GA, and civilian universities for further evaluation. They are prepared to identify S. pneumoniae, C. pneumoniae, H. influenza, Mycoplasma spp., group A (beta hemolytic) streptococci (GABHS), B. pertussis, adenoviruses, influenza A, influenza B, parainfluenza viruses, coronaviruses (SARS, OC43, and 229E), respiratory syncytial virus (RSV), HSV, human metapneumovirus (hHMPV), rhinoviruses and enteroviruses. This laboratory is also prepared to do pathogen exploration in conjunction with the CDC, The Air Force Institute for Operational Health (AFIOH), Brooks City-Base, TX, and civilian universities. The NHRC Respiratory Disease Laboratory does not test for Legionella or the biowarfare/bioterrorist agents. Throat swabs, nasal or nasal pharyngeal swabs, or sterile site specimens (e.g., pleural fluid, CSF) are the preferred specimens for evaluation. Sputum is acceptable. Tissue biopsy specimens are also acceptable. Blood specimens are not recommended for virus recovery. Prior to sending specimens, please contact CDR Kevin Russell or one of his associates: CDR Kevin Russell, MC Naval Health Research Center Director, Respiratory Disease Laboratory P.O. Box 85122 San Diego, CA 92186-5122 TEL: 619-553-7628/8097/7607 FAX: 619-553-7601 EMAIL: Russell@nhrc.navy.mil Mailing address (e.g., for Fed-Ex): Naval Health Research Center McClelland Rd. & Patterson Rd. Gate 2, Building 315 San Diego, CA 92152 If problems are encountered in contacting CDR Russell or his associates, contact MAJ Pearse above, who will assist in arranging contact with the NHRC Respiratory Disease Laboratory.
3. AFIP Cellular Pathology Laboratory: Dr. Taubenberger’s Cellular Pathology

Laboratory at the AFIP is equipped to perform PCR analyses for the following viral pathogens: influenza A, influenza B, adenoviruses, measles virus, Orthopox viruses (variola and vaccinia), enteroviruses, Herpes family viruses (HSV1, HSV2, VZV, EBV, HHV8, CMV), and the SARS coronavirus. Throat swabs are the preferred specimens for evaluation. Sputum is acceptable. Blood specimens are not recommended for virus recovery. Prior to sending specimens, please contact Dr. Taubenberger or one of his associates: Jeffery K. Taubenberger, MD, PhD
Chief, Division of Molecular Pathology Department of Cellular Pathology and Genetics

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Armed Forces Institute of Pathology 1413 Research Blvd., Bldg. 101, Rm. 1057D Rockville, MD 20850-3125 USA TEL. 1-301-319-0323 (direct); 1-301-319-0200 (office) FAX. 1-301-295-9507 EMAIL: taubenbe@afip.osd.mil

If problems are encountered in contacting Dr. Taubenberger’s group, please contact MAJ Pearse above, who will assist in arranging contact with the Cellular Pathology laboratory personnel.

4. The US Army Medical Research Institute of Infectious Diseases (USAMRIID):
The USAMRIID diagnostic laboratory is prepared to evaluate specimens for the biowarfare/bioterrorist threat agents. In addition, the laboratory can test for many of the arthropod-borne viruses, the hemorrhagic fever viruses, the hantaviruses, and the SARS coronavirus. Throat swabs or pharyngeal lavage are the preferred specimens for evaluation for respiratory diseases, although other samples may be preferred depending on the clinical presentation. Serum specimens are recommended for some viral infections and for all serological analyses. For consultation and prior to shipment of any samples, please contact Dr. George Ludwig: Dr. George V. Ludwig Chief, Diagnostic Systems USAMRIID – Fort Detrick 1425 Porter Street Fort Detrick, MD 21702-5011 TEL: 301-619-4941 FAX: 301-619-2492 EMAIL: George.Ludwig@det.amedd.army.mil If problems are encountered in contacting Dr. Ludwig, please contact Ms. Jennifer Rubenstein, TEL: 301-319-9072 or EMAIL: Jennifer.Rubenstein@na.amedd.army.mil, and she will assist you in contacting USAMRIID. FOR SPECIMENS FROM DECEDENTS: CONTACT: Office of the Armed Forces Medical Examiner (OAFME), Armed Forces Institute of Pathology (AFIP): MAJ Lisa A. Pearse, MC Chief, DoD Mortality Surveillance Division Office of the Armed Forces Medical Examiner Armed Forces Institute of Pathology 1413 Research Blvd., Bldg. 102 Rockville, MD 20850-6000 DSN 285-0126 TEL: (301) 319-0126 FAX: (301) 319-0635 EMAIL: pearse@afip.osd.mil

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1. An AFIP Consultation Request form must be submitted. These can be obtained at:
http://www.afip.org/consult/ConsultationRequestForm.pdf. Packing and shipping instructions are at: http://www.afip.org/consult/AFIP40.pdf. 2. Specimens sent to the AFIP OAFME will be routed, as appropriate, to Pulmonary Pathology, Cellular Pathology, and Infectious Diseases Pathology. Additionally, radiologic review can be provided. A. Pulmonary Pathology (Dr. Travis) requests tissue preparations that will allow for an adequate number of microscopic slides, i.e., 3-5 slides per lobe, with representation of surface tissue, pleura, mid-zone and central zones. Formalin/gluteraldehyde fixation of tissue preparations is recommended, along with frozen tissue specimens. B. Cellular Pathology (Dr. Taubenberger) can perform polymerase chain reaction (PCR) testing on paraffin embedded or frozen tissue for the following respiratory viral pathogens: influenza A, influenza B, adenoviruses, measles virus, Orthopox viruses (variola and vaccinia), enteroviruses, Herpes family viruses (HSV1, HSV2, VZV, EBV, HHV8, CMV), and the SARS coronavirus. C. Infectious Diseases Pathology consultations will require tissue blocks and/ or slides from the tracheobronchial tree, in addition to the same slides requested for Pulmonary Pathology. D. Pulmonary Pathology (Dr. Jeffrey Galvin) can provide review of x-rays and correlation of radiologic results with other findings. Digitized images from the case can be copied to a compact disc (CD) and sent to the AFIP without loss of image resolution.

Ms. L Canas, CDR K Russell, MAJ L Pearse, Dr. G Ludwig, Dr. J Gaydos Revised September 17, 2003 REFERENCES: 1. Canas LC, Lohman K, Pavlin JA, Endy T, Singh DL, Pandey P, Shrestha MP, Scott RMc, Russell KL, Watts D, Hajdamowicz M, Soriano I, Douce RW, Neville J, Gaydos JC: The Department of Defense Laboratory-Based Global Influenza Surveillance System. Military Medicine 165:52-56, 2000. 2. Ryan M, Gray G, Hawksworth A, Malasig M, Hudspeth M, Poddar S: The Naval Health Research Center Respiratory Disease Laboratory. Military Medicine 165:32-34, 2000.

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