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6. New Services / News

Zika virus: sample testing advice webpage has been updated

Highlights:

•    Zika virus testing is provided ONLY for individuals who have or have had symptoms, NOT for asymptomatic individuals, including asymptomatic pregnant women; this is consistent with WHO guidelines
•    Zika virus serology is now provided for individuals with previous Zika–like symptoms, as well as those with current symptoms
•    Clinicians are advised to consider the possibility of sexually acquired infection in the symptomatic partners of travellers to Zika-affected countries
•    The updated guidance includes a table showing what standard samples to send to RIPL for Zika virus testing
•    RIPL must be contacted for discussion before special (i.e. non-standard) samples such as semen or amniotic fluid are submitted for testing
•    Patients should never be directed to call RIPL to discuss Zika virus testing 

The RCOG algorithm and guidance for the management of pregnant women exposed to Zika virus has also been updated to take account of Zika virus serology test results.  

Highlights:

•    Pregnant cases diagnosed with Zika virus by serological testing are managed in exactly the same way as those diagnosed by PCR, i.e. they should be referred to Fetal Medicine Unit
•    Symptomatic pregnant returned travellers with negative Zika virus antibody results on serum collected 4 or more weeks after the last possible travel-associated or sexual exposure do not require further extra fetal ultrasound follow-up. That is, these women for whom 4-weekly fetal ultrasound scans were previously advised, can return to normal pregnancy care, unless there are additional concerns
•    Note that for asymptomatic pregnant returned travellers, fetal USS at specific time points is now recommended instead of consideration of 4 weekly fetal USS; this is consistent with WHO guidelines

Please contact the WoSSVC with any question you have regarding Zika virus (tel: 38722 / 0141 201 38722)

NHS Greater Glasgow & Clyde Microbiology is changing the methodology formycological detection of dermatophytes in clinical samples such as hair, nails and skin scrapings.

The current method employs PCR detection with samples processed at the WoSSVC. Some specimens are also processed for microbiological culture in microbiology.

Following a review of Mycology service provision and discussion with specialist Mycology centres in the United Kingdom, it has been decided to discontinue molecular testing of skin and nail samples and to introduce microscopy as the primary, rapid diagnostic service for these specimen types. Culture will continue to be performed when indicated, for example, scalp specimens and specimens from cases of seborrheic dermatitis or where Malassezia folliculitis is suspected. These changes are in line with guidance from BIA.

This service change will come into effect on Monday 13th June 2016 and will result in all mycology specimens being sent to Microbiology at Glasgow Royal Infirmary. The WoSSVC will no longer process these specimens.

To facilitate this testing a change will be made in Trakcare and GP ICE on Monday 13th June to move the orderable request item in Trakcare and GP ICE from the Virology catalogue to the Microbiology catalogue. The orderable request item will be displayed as “Mycology Dermatophytes”. If you require any further information regarding these changes before 13 June 2016 please contact: John Mallon, Microbiology Technical Services Manager ([email protected]).

Rubella (German measles) susceptibility (IgG) screening in pregnancy ended on the 1st of June 2016.

The decision to stop screening follows a review of evidence by the UK National Screening Committee (UK NSC) in 2003 and 2012.

On both occasions the Committee found that screening for rubella susceptibility during pregnancy no longer met the criteria for a screening programme and should be discontinued because:

  • rubella infection levels in the UK are so low they are defined as eliminated by the World Health Organization
  • rubella infection in pregnancy is very rare
  • being fully immunised with the measles, mumps and rubella (MMR) vaccine before becoming pregnant is more effective in protecting women against rubella in pregnancy
  • the screening test used can potentially give inaccurate results and cause unnecessary stress among women

The decision to end screening for rubella susceptibility in pregnancy has been made possible by the high levels of vaccination rates achieved through the MMR immunisation programme.

Source: Public Health England

Rubella IgG is no longer be available to order on TrakCare. PLEASE CONTINUE TO USE ‘ANC – SET’ FOR ANTENATAL SCREENING TESTS, THIS ORDER SET HAS BEEN UPDATED.

If you have any questions please don't hesitate to contact the virus laboratory on 58721 / 58722.

Further resources: Health Protection Scotland: Rubella

WoSSVC user survey 2016

The West of Scotland Specialist Virology Centre is committed to providing a high quality service to our users. This questionnaire is to enable us to be sure we are achieving these objectives and to highlight areas for quality improvement. Please help us to improve our service by answering the following questions. There is also a space provided for any comments you wish to make.

New WoSSVC request form - Version 4 - 06/04/16

Please use the update request form from today, thank you.

New Point of Care (PoC) Respiratory Syncytial Virus (RSV) testing at The Royal Hospital For Children, Glasgow (RHC)

RSV Point of Care Testing for nasopharyngeal aspirates in RHC virus transport medium is now available in the Emergency Department at RHC as of 18:00 on the 16th of November 2015, for the winter respiratory season.

The RSV POC TrakCare order set: 'Paediatric Respiratory Point of Care' item is now available to order.

Royal College of Pathologists: National Pathology Week

National Pathology Week (NPW) for members, students and the general public.

For more information on all competitions please visit www.ilovepathology.org/events/national-pathology-week/competitions-and-prizes/ or contact the Public Engagement team at [email protected] The winning entries will be published on the College website and featured in the College Bulletin.

Molecular Microbiology Services (Virology, Bacteriology and Mycology) for NHS GG&C

As from Tuesday 25th August 2015 all Molecular Microbiology Services (Virology, Bacteriology and Mycology) for NHS GG&C will be centralised in the West of Scotland Specialist Virology Centre.

The West of Scotland Specialist Virology Centre will be routinely offering Bordetella pertussis PCR on all routine respiratory samples submitted to the laboratory. This will replace the service previously on offer at microbiology at the Southern General Hospital.

The pertussis PCR assay will be included in the current routine respiratory screen alongside existing viral pathogens and Mycoplasma pneumoniae. As a result there is no longer any need to submit two separate respiratory samples.

Please use the following sample guide:

• For URT illness (including whooping cough/pertussis ) please send one of:

Throat swab / nasal swab / throat-nasal swab combined / gargle / nasopharyngeal aspirate / nasopharyngeal swab

• For LRT illness please send one of:

BAL / sputum / endotracheal aspirate

The introduction of this service will allow simultaneous testing for pertussis and other respiratory pathogens which will in turn lead to the detection of atypical pertussis illness or viral illness presenting like whooping cough.

This will also have service benefits as there will no longer be duplication of sampling/testing within NHS GG&C.

As per previous it should be noted that PCR should be considered useful up to 3 weeks post the onset of illness. However, PCR should not be carried out if a patient has received 5 days of antibiotic therapy.

TrakCare item: Resp virus / Mycoplasma / Pertussis PCR tests for:

  • Bordetella pertussis
  • Influenza A (including the H275Y oseltamivir resistance mutation)
  • Influenza B, respiratory syncitial virus (RSV)
  • Human metapneumovirus (HuMP)
  • Parainfluenza-1/2/3/4
  • Coronavirus
  • Rhinovirus / enterovirus
  • Adenovirus
  • Mycoplasma pneumoniae 

TrakCare item: BAL screen ( Resp virus / PCP / CMV / Pertussis ) tests for:

  • Pneumocystis jirovecii
  • Cytomegalovirus (CMV)
  • Bordetella pertussis
  • Influenza A (including the H275Y oseltamivir resistance mutation)
  • Influenza B, respiratory syncitial virus (RSV)
  • Human metapneumovirus (HuMP)
  • Parainfluenza-1/2/3/4
  • Coronavirus
  • Rhinovirus / enterovirus
  • Adenovirus
  • Mycoplasma pneumoniae 

In addition as from Monday 24th August 2015 all routine Helicobacter serology (antibody testing) will be relocating from QEUH, Microbiology Laboratory to the West of Scotland Specialist Virology Centre.

Current testing provided by the Scottish Microbiology Reference Laboratories, Glasgow remain unchanged.

Please note that all requests processed after the 24th August 2015 will be available on Clinical Portal within the appropriate results section where the analysis is now performed.

As of the 25th August 2015, TrakCare and GP Ice system catalogues will be fully available for users and will have been altered to reflect the changes noted above.

Bartonella serology

Testing for Bartonella on clotted blood is not currently available, however testing is available on tissue samples.

The Bartonella serology service at PHE Colindale has been suspended, effective from the 1st of July 2015 due to quality considerations. Samples received after this date will not be tested.

Tissue samples may still be sent for 16S rRNA gene sequencing for the diagnosis of Bartonella. Work continues in PHE to develop other options for Bartonella serodiagnosis.

Abbott ARCHITECT® HCV antigen (Ag) test

Routine diagnosis of HCV infection is based on the detection of HCV IgG antibodies (evidence of infection in the past, but not current infection) and if HCV antibody positive, testing for the HCV RNA genome.

HCV IgG antibody is positive in ongoing active infection and a recovered infection (via natural clearance or treatment). HCV IgG antibody is negative in the window of 45-68 days between HCV infection and seroconversion to HCV IgG.

HCV RNA (by polymerase chain reaction, PCR) provides the diagnosis of an ongoing, active HCV infection. PCR assays are expensive, involve considerable technical skill and are labour-intensive.

The Abbott ARCHITECT HCV antigen (Ag) assay detects a viral protein which surrounds the RNA genome. The test is less expensive and less time-consuming than PCR and identifies current HCV infection. In the same way that hepatitis B surface antigen (HBsAg) is used to test for current infection with hepatitis B, HCV antigen tests for current infection with hepatitis C.

The Abbott ARCHITECT HCV antigen assay is not as sensitive as PCR for current infection. The sensitivity of the Architect HCV-Ag assay is reported to be 428 - 2,700 IU/mL HCV RNA, depending on the HCV genotype. In HCV antibody positive, HCV antigen negative samples, a PCR test will be performed if not previously tested.

Chlamydia trachomatis and Neisseria gonorrhoeae testing

Self-collected vulvovaginal swabs are the sample of choice (have the highest sensitivity) for both chlamydia and gonorrhoea testing in women, regardless of whether patients have symptoms. Endocervical swabs are no longer recommended for chlamydia and gonorrhoea testing due to their reduced sensitivity compared to vulvovaginal swabs.

Please see:

Schoeman SA, Stewart CM, Booth RA, et al. Assessment of best single sample for finding chlamydia in women with and without symptoms: a diagnostic test study. BMJ. 2012;345:e8013.

Stewart CM, Schoeman SA, Booth RA, et al. Assessment of self taken swabs versus clinician taken swab cultures for diagnosing gonorrhoea in women: single centre, diagnostic accuracy study. BMJ. 2012;345:e8107.

HCV genotyping

As of the 12th of November 2014 the WoSSVC will no longer perform HCV genotyping on patients who have had a genotype performed within the last 5 years.

Exceptions to this will be if the patient was previously genotype 1 (no subtype performed) or if re-infection is suspected (i.e. the patient has had a negative HCV PCR, followed by a positive HCV PCR).

If any issues, please speak to Dr Amanda Bradley-Stewart, Principle Clinical Scientist

HBV genotyping

As of 15th September 2014, the WoSSVC BBV specialist testing section we will no longer offer HBV genotyping. Please note that we will continue to offer Hepatitis D virus testing (detection and quantification - if positive) on all new HBV detections.

All HDV RNA positive results will now be reported in International Units (IU/mL).

We continue to offer HBV resistance testing on a request basis.

Any questions, please speak to Dr Amanda Bradley-Stewart, Principle Clinical Scientist

Change to the reporting of CMV/EBV/adenovirus quantitative PCR

National Institute of Biological Standards and Control (NIBSC), UK standards are available for CMV and EBV. These standardized reference materials will enable results to be compared between laboratories.

The conversion factors are as follows:

1 IU/ml CMV = 2 Glasgow copies/ml (or 1 Glasgow copy = 0.5 IU/ml)
1,250 IU/ml (log 3.10) replaces the previous lowest level of quantitation (2,500 copies/ml (log 3.40))


1 IU/ml EBV =  3 Glasgow copies/ml (or 1 Glasgow copy = 0.33 IU/ml)
1,670 IU/ml (log 3.22) replaces the previous lowest level of quantitation (5,000 copies/ml (log 3.70))

For adeno there is no NIBSC standard available so there is no change in the final report.

Change to Dried Blood Spot testing

The way we test dried blood spots (DBS) will be changing from September 15th 2014.  We are moving to a fully automated system for HCV, HBV and HIV screening.  This will improve quality and accuracy of testing for HCV antibody, HBV surface antigen, HBV core antibody and HIV antigen/antibody.

We will now require 5 full DBS spots per card.  Four full spots will be required for the new automated screening process (regardless of the number of tests requested) and one full spot for PCR testing (if the patient is HCV antibody positive).

Please see the letter and the updated DBS instructions on the DBS webpage

New Virology related order set on TrakCare for NHSGGC users

Severe Community Acquired Pneumonia (CAP) screen search for ‘severe’ in item on TrakCare:

Respiratory Viral PCR, blood culture, general bacterial culture, Legionella (antigen and serology).

Please note: Adults with bacterial pneumonia and children with recurrent bacterial pneumonia should be recommended to have an HIV test. Please consider HIV testing if appropriate.
Please see www.bhiva.org/HIVTesting2008.aspx

The Glandular Fever Study

All acute EBV diagnoses from GPs within NHSGGC will receive the following comment on the laboratory report regarding "The Glandular Fever Study" (REC No: 14/WS/0025):

"This patient is eligible to participate in The Glandular Fever Study.  A member of the study team will be in contact with the study details and to request your help and participation."

The Glandular Fever Study is an investigation of the EBV specific immune response following primary infection in relation to genetic risk factors associated with Epstein Barr virus positive disease.

For further information please see The Glandular Fever Study

NEW SERVICE: HIV antibody avidity testing

BACKGROUND

For the last 18 months HIV avidity testing has been available on all new HIV diagnoses attending the HIV services in Greater Glasgow and Clyde and Lothian regions. From the 1st April 2014 this service will be made available to all new HIV diagnoses in Scotland.

An additional sample will not be required as all new diagnoses are confirmed in either the Glasgow or Edinburgh labs and this sample will be used for the avidity test.

THE TEST

An avidity test is a guide to the recency of infection. In our hands a low avidity result is consistent with an infection acquired in the last 4 months. High avidity results indicate more long standing infection ie infection acquired >4 months previously.

Occasionally low avidity results may occur in the setting of advanced HIV infection and is referred to as “false recency”, in most cases this should be obvious from the clinical features.

RESULTS

Results will be available within 14 days to the requesting physician on a named patient basis, and will also be sent to HPS for epidemiological purposes (Sexual Health and BBv Framework outcome indicator 1 on HIV transmission). One of the following comments will be used:

a. AI <40%
HIV avidity test - Result consistent with recently acquired HIV infection
These findings indicate that HIV seroconversion may have occurred within 3-4 months of the sample date. False recency is occasionally associated with advanced disease. For further advice please discuss with local HIV Specialist

b. AI >40%
HIV avidity test - HIV infection unlikely to have been acquired within the last 3-4 months
These findings indicate that HIV seroconversion probably occurred more than 3-4 months ago. For further advice please discuss with your local HIV Specialist.

c. AI Equivocal
HIV avidity test - Result possibly indicative of recently acquired HIV infection. 
The findings indicate that HIV seroconversion may have occurred within the last 3-4 months. However as the result was very close to the cut-off for the test we cannot rule out declining HIV antibody from a long standing infection. For further advice please discuss with your local HIV Specialist.

d. Antibody level too low for avidity testing.
This is a rare occurrence, and is due to low levels of antibody. Please send a further sample in 2 weeks.

e. Antibody level too high for avidity testing. 
Levels of anti-HIV are too high to accurately perform an incidence assay.

If you have any questions regarding the new test please contact one of the consultants whose details are available under menu option "Contact Us", and the secondary option "Staff Contacts".