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Laboratory Testing

During the initial SARS outbreaks, there were no laboratory tests available to detect the SARS virus. Fortunately, new laboratory methods have been developed, including ELISA antibody tests and PCR-based methods. Details about these tests are provided below.

It is important to note that these tests are relatively new and test sensitivity and specificity need to be studied further to determine how reliable results will be. Positive laboratory test results indicate that a patient has been recently infected with the coronavirus. Negative tests do not imply that the patient does not have SARS. Another unanswered question is whether an individual with antibodies against SARS possesses long-term protection against future SARS infections.

Table of Contents
  PCR and Genetics
  ELISA and Immunology
  Investigation Protocols
  Forms
  Biosafety Guidelines
  Specimen Collection
  Other

Case Definitions

Polymerase chain reaction (PCR) can detect genetic material of the SARS-CoV in various specimens (blood, stool, respiratory secretions or body tissues Sampling for Severe Acute Respiratory Syndrome (SARS) diagnostic tests). Primers, which are the key pieces for a PCR test, have been made publicly available by WHO network laboratories on the WHO web site.

For information about PCR testing in Ontario, click here.
WHO: PCR primers for SARS developed by WHO Network Laboratories [04/17/03]
     
WHO: Recommendations for laboratories testing by PCR for presence of SARS coronavirus -RNA [04/29/03]
     
WHO: Severe Acute Respiratory Syndrome (SARS): Laboratory diagnostic tests (PCR result interpretation) [04/29/03]
     
CDC: SARS Coronavirus Sequencing Information [05/02/03]
     
SARS coronavirus, complete genome [NCBI] Helpful [04/14/03]

Case Definitions

These tests detect antibodies produced in response to the SARS coronavirus infection. Different types of antibodies (IgM and IgG) appear and change in level during the course of infection. They can be undetectable at the early stage of infection. IgG usually remains detectable after resolution of the illness.
WHO: Severe Acute Respiratory Syndrome (SARS): Laboratory diagnostic tests (Antibody test result interpretation) [04/29/03]
     
CDC: Coronavirus Antibody Testing at State Public Health Laboratories
[07/24/03]

Investigation Protocols
Health Canada: SARS-CoV Laboratory Investigation Protocol for the SARS Post-Outbreak Period Non-outbreak [11/07/03]
     
The Canadian Public Health Laboratory Network (CPHLN) Laboratory Testing for Patients with Severe Respiratory Illness (SRI) Not Yet Diagnosed (NYD) [11/07/03]
     
The Canadian Public Health Laboratory Network (CPHLN) Recommendations on Laboratory Evidence of SARS CoV Infection [11/07/03]
     
Recommended Laboratory Investigation of Severe Acute Respiratory Syndrome [03/20/03]
     
Communication Regarding Laboratory Tests for SARS in Ontario Helpful [12/04/03]
     
  WHO: Use of laboratory methods for SARS diagnosis [05/01/03]
     
Recommended laboratory tests to identify influenza A/H5 virus in specimens from patients with an influenza-like illness
[02/19/03]
     
Update on Influenza A(H5N1) and SARS: Interim Recommendations for Enhanced U.S. Surveillance, Testing, and Infection Control
[02/03/03]
     
In the Absence of SARS-CoV Transmission Worldwide: Guidance for Surveillance, Clinical and Laboratory Evaluation, and Reporting
[12/18/03]
     
CDC: Interim Guidelines for Laboratory Diagnosis of SARS-CoV Infection [07/03/03]
     

Forms

Severe Respiratory Illness (SRI) / Severe Acute Respiratory Syndrome (SARS)
Investigation Report Form
[01/20/04]
     
SARS Lab Requisition Coversheet [03/20/03]
     
Physician Case Form
     
Information to submitters of nasopharyngeal swabs to the Public Health Laboratory for the investigation of respiratory infection
     
CDC: Specimen Submission Form for Potential Cases of SARS [05/01/03]
     

Biosafety Guidelines
WHO guidelines for the storage and transport of human and animal specimens for laboratory diagnosis of influenza A/H5 infection [02/06/04]
     
WHO SARS International Reference and Verfication Laboratory Network:
Policy and Procedures in the Inter-Epidemic Period
[01/24/04]
     
WHO post-outbreak biosafety guidelines for handling of SARS-CoV specimens and cultures Helpful [12/18/03]
     
WHO Laboratory Biosafety Manual, 3rd edition  
     
WHO: Biosafety guidelines for handling of SARS specimens [04/25/03]
     
WHO: Recommendations on SARS and Blood Safety [05/15/03]
     
Health Canada: Biosafety Advisory for Severe Acute Respiratory Syndrome [03/25/03]
     
CDC: Interim Laboratory Biosafety Guidelines for Handling and Processing Specimens Associated with Severe Acute Respiratory Syndrome (SARS) [08/18/03]
     

Specimen Collection
WHO guidelines for the collection of human specimens for laboratory diagnosis of influenza A/H5 infection [02/06/03]
     
The Canadian Public Health Laboratory Network (CPHLN) Recommended Specimens for the Diagnosis of SARS CoV [11/07/03]
     
Nasopharyngeal Specimen Collection (Diagram of proper technique)  
     
WHO: Sampling for Severe Acute Respiratory Syndrome (SARS) diagnostic tests [04/29/03]
     
CDC: Guidelines for Collection of Specimens from Potential Cases of SARS [07/14/03]
     

Other
  WHO: Summary of the discussion and recommendations of the SARS Laboratory Workshop, 22 October 2003 [11/01/03]
     
WHO: Meeting on SARS virus detection and survival in food and water, Madrid, 8-9 May 2003
   
WHO: First data on stability and resistance of SARS coronavirus compiled by members of WHO laboratory network
   

 

 
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