1. SEARO – CSR Training on Outbreak Investigation SEARO - CSR Training on Outbreak Investigation Safe Transport Laboratory specimen: collection, safe transport and biosafety

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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.

9. Laboratory specimen: safe transport SEARO – CSR Training on Outbreak Investigation Biohazard Labels

10. Laboratory specimen: safe transport SEARO – CSR Training on Outbreak Investigation Category B, 650 package” Category B, “650 package” UN 3373 No biohazard label

11. Laboratory specimen: safe transport SEARO – CSR Training on Outbreak Investigation Category A“602 package” Category A “602 package” Labels: UN 2814 UN 2900 Biohazard

12. 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)

13. 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

14. 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

15. 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

16. Laboratory specimen: safe transport SEARO – CSR Training on Outbreak Investigation Recommended transport temperatures MediumTemperature CSF for culture in TI25 to 35-37°C, never refrigerated Blood culture bottle25 to 35-37°C, never refrigerated Blood smearsambient 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

17. 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)

18. 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

19. 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 virus Dengue virus (cultures only) Eastern equine encephalitis virus (cultures only) Escherichia coli, verotoxigenic (cultures only) Ebola virus Flexal virus Francisella tularensis (cultures only)

20. Laboratory specimen: safe transport SEARO – CSR Training on Outbreak Investigation Category A (cont’d) Guanarito virus Hantaan virus Hantaviruses causing haemorrhagic fever with renal syndrome Hendra virus Hepatitis 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 virus Kyasanur Forest disease virus Lassa virus Machupo virus Marburg virus Monkeypox virus Mycobacterium tuberculosis (cultures only) Nipah virus Francisella tularensis (cultures only)

21. Laboratory specimen: safe transport SEARO – CSR Training on Outbreak Investigation Category A (cont’d) Omsk hemorrhagic fever virus Poliovirus (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 virus Shigella dysenteriae type 1 (cultures only) Tick-borne encephalitis virus (cultures only) Variola virus Venezuelan equine encephalitis virus (cultures only) West Nile virus (cultures only) Yellow fever virus (cultures only) Yersinia pestis (cultures only)

22. 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)

23. 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

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