Specimen Collection, Storage, & Shipment

Serologic Testing

	Specimen Type: Blood (serum)
Minimum Amount	0.5-1 ml preferred; 0.1 ml minimum
Collection	Collect by venipuncture or by finger/heel stick. Optimum time-point for serum collection is 5 days after onset of symptoms (fever and rash). If serum collected less than 5 days after onset is negative, a second sample would be necessary to confirm/rule out rubella.
Storage	Can be stored at 4°C or at -20°C prior to shipping.
Shipping	Can be shipped overnight on a wet ice pack or frozen with dry ice.
Comments	Use tubes without additives. Centrifuge the tube to separate serum from clot. Gel separation tubes should be centrifuged no later than 2 hours after collection. Do not freeze the tube before serum has been removed. Aseptically transfer serum to a sterile tube that has an externally threaded cap with an o–ring seal. Capillary tubes can be utilized for infants. Capillary tubes require the submitter to have access to the appropriate centrifuge for these capillary tubes. At least 3 of the 50 ul hematocrit capillary tubes should be collected and spun in a hematocrit centrifuge. Hemolyzed and lipemic serum and plasma are noted and tested, often without apparent interferences.

 

Rubella RNA Detection by RT-PCR or Virus Isolation

	Specimen Type
	Throat (oropharyngeal) swab, nasal swab, or NP (nasopharyngeal) swab (preferred)	Urine
Minimum Amount	1-3ml of viral transport medium	10-50ml
Collection	Most successful when samples are collected the first day of rash through 3 days following rash onset. Detection may be successful as late as 7 to 10 days post rash onset.	Centrifuge at 1500 RPM for 10 minutes, preferably at 4°C. Re-suspend the sediment in 2-3 ml of sterile transport medium, tissue culture medium, or physiological buffered saline.
Storage	Freeze at -70°C or if ultra-low temperature freezers are not available, keep sample at 4°C.	If ultra-low freezers are available, freeze the re-suspended urine sediment at -70°C. If facilities for processing the urine are not available, keep the un-centrifuged urine sample at 4°C and ship on cold packs as soon as possible in a leak-proof container.
Shipping	Ship on cold packs if stored at 4°C, with dry ice if frozen at -70°C.	Ship on cold packs if stored at 4°C, with dry ice if frozen at -70°C
Comments	It is important to transport samples with cold packs as soon as possible following sample collection. Avoid repeat freeze-thaw cycles or freezing at -20°C (standard freezer temperature) because formation of ice crystals decreases infectivity. Do not allow swabs to dry out. Synthetic swabs are recommended. Do not use bacterial collection devices. Collect samples as soon after rash as possible. The sample should be collected at the first contact with a suspected case of rubella.	It is important to transport samples with cold packs as soon as possible following sample collection. Avoid repeat freeze-thaw cycles or freezing at -20°C (standard freezer temperature) because formation of ice crystals decreases infectivity. Collect sample as soon as possible. The samples should be collected at the first contact with a suspected rubella case.

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Clinical Samples from CRS Cases

Naso-pharyngeal swabs and urine samples should be collected as close to birth as possible and stored and shipped as described above for acute samples. To screen for shedding from confirmed CRS cases, naso-pharyngeal and/or urine samples should be collected monthly after the age of 3 months to determine if rubella RNA is still present in the specimen. Collection of samples can be stopped after two consecutive negative tests are obtained. In CRS cases where cataracts are present, surgically removed cataracts can be submitted for molecular testing. Rubella virus RNA has been detected in cataracts up to three years after birth.

Clinical Samples from Cases of Rubella Persistence

In some cases, rubella has been known to establish persistent infections in humans. An eye disease known as Fuchs’ Uveitis Syndrome (FUS) is associated with persistent rubella virus, and virus has been detected in aqueous humor decades after the original infection. Samples of aqueous humor removed from FUS cases, as part of clinical management of the case, can be submitted to CDC for molecular detection.

 

Specimen Shipping

Clinical specimens or rubella virus isolates should be sent along with CDC Form 50.34.

For additional information and to notify the CDC Measles Mumps Rubella and Herpesvirus Laboratory Branch of specimen shipments, please contact:

Email: Joseph Icenogle (jci1@cdc.gov) or Emily Abernathy (efa9@cdc.gov)

 

Shipping address for specimens:

STAT Unit #81 Attn: Dr. Icenogle
Centers for Disease Control and Prevention
1600 Clifton Road NE
Atlanta, GA 30329-4027

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