Guidance for Collection, Transport and Submission of Specimens for Marburgvirus Testing

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Purpose of this guidance

To provide guidance for hospitals and clinical laboratories on collecting, transporting, and submitting specimens to laboratories to test for marburgviruses. CDC will continue to evaluate new information as it becomes available and will update this guidance as needed.

Scope

This document provides guidance for clinical laboratories on testing needed for assessment and care of patients for whom Marburg virus disease (MVD) may be a concern, while minimizing risk to laboratory personnel.

This guidance is based on input from numerous hospital and laboratory directors, infectious disease physicians, CDC response teams, partners, and state health officials.

Key Points

  1. MVD is a rare and deadly disease. In humans, it is caused by an infection with a marburgvirus, a zoonotic (or animal-borne) RNA virus of the filovirus family, of which ebolaviruses are also members. Learn more about the viruses that causes MVD.
  2. Early consideration of MVD in the differential diagnosis when appropriate based on clinical and epidemiologic factors is important for providing appropriate and prompt patient care and to prevent the spread of infection. It is important to systematically assess patients through a screening process.
  3. Clinicians with concerns about MVD in a patient should contact their jurisdictional health department immediately (via 24-hour Epi On Call contact list) and follow jurisdictional protocols for patient assessment. If a diagnosis of MVD is considered, clinical teams should coordinate with public health officials and CDC to ensure appropriate precautions are taken to help prevent potential spread and coordinate care. In the hospital setting, where policies and procedures should be in place to safeguard health care workers, consideration of MVD should not delay diagnostic assessments, laboratory testing, and appropriate care for other, more likely medical conditions.
    • CDC’s Viral Special Pathogens Branch (VSPB) is available 24/7 for consultations on MVD or other viral hemorrhagic fevers by calling the CDC Emergency Operations Center at 770-488-7100 and requesting VSPB’s on-call epidemiologist.
    • Marburgvirus testing should be performed only after consultation with public health officials (including those at their jurisdictional health department immediately (24-hour Epi On Call contact list) and at CDC) to determine that the individual meets criteria for testing as a suspect case of MVD. These criteria include:
      • Symptoms including measured (≥100.4°F/38.0°C) or subjective fever, severe headache, fatigue, muscle pain, vomiting, diarrhea, abdominal pain, or unexplained hemorrhage
      • An epidemiological risk factor within the 21 days preceding the onset of symptoms
  1. The United States Occupational Safety and Health Administration (OSHA) developed Bloodborne Pathogens Standard (29 CFR 1910.1030)to reduce the potential exposure of personnel to bloodborne pathogens. All U.S. laboratories handling patient specimens must comply with this standard at all times. Strict adherence is an initial step to protecting personnel.
  2. Prior to receiving specimens, the laboratory director, safety officer, and/or other responsible persons should already have a site-specific risk assessment to minimize risk to personnel from potential exposure from sprays, splashes, or aerosols generated during laboratory activities. Risks should be mitigated by implementing engineering controls, administrative and work practice controls, and use of appropriate personal protective equipment (PPE). A plan for appropriate waste management should also exist and be implemented.
  3. Marburgviruses are Department of Transportation (DOT)-classified Category A infectious substances.
  4. Immediately report potential exposures to blood, body fluids, or other infectious materials according to your institution’s policies and procedures.
  5. Marburgviruses and ebolaviruses are in the same virus family Filoviridae and are closely related. Guidance for ebolaviruses can be applied to marburgviruses.

Specimen Collection and Testing

If marburgvirus testing is recommended after consultation with public health officials and CDC, a specimen should be collected.

  • Wear appropriate personal protective equipment (PPE) when collecting clinical specimens from suspect or confirmed cases. Depending on the patient’s stage of illness, refer to PPE guidance for healthcare workers during management of clinically stable or clinically unstable patients with suspect or confirmed MVD.
  • For adults, collect two 4 mL tubes of whole blood in a plastic tube preserved with EDTA. For pediatric patients, collect a minimum of 1 mL whole blood in a pediatric-sized collection tube preserved with EDTA.
    • Do not transport or ship specimens in glass containers or in heparinized tubes.
    • Do not separate and remove serum or plasma from the primary collection container.
  • Public health authorities will determine where marburgvirus testing will occur.
  • If the specimen test result is negative and the patient’s symptoms have been present for less than three days, a second sample should be collected 72 hours after symptoms and in consultation with public health officials.

Storing Clinical Specimens for Marburgvirus Testing

If short-term storage is necessary, keep specimens at 2-8°C for shipping to the LRN laboratory. Specimens must be tested at CDC within 7 days of the date of specimen collection and may be temporarily stored prior to shipment to CDC. Specimens sent to CDC for testing must be sent on dry ice and arrive at <-20°C.

Transporting Marburgvirus Specimens from Site of Care Through the Facility

  • Perform a site-specific risk assessment to determine the PPE to be worn during specimen transport within the facility. Required PPE may vary among facilities. Recommendations for PPE include disposable fluid-resistant closed lab coats, disposable gloves, covered legs and closed-toed shoes.
  • In compliance with OSHA Bloodborne Pathogens Standard (29 CFR 1910.1030), package sealed specimen containers in a durable, leakproof secondary container.
  • Before removing patient specimens from the site of care:
  • For added safety/security, carry specimens in a durable, leakproof secondary container to the laboratory or packaging area by hand. DO NOT use pneumatic tube systems (automated or vacuum specimen delivery system) to transport specimens.
  • Once the specimen has been removed from the transport secondary container, disinfect the container.

Note: Recommended disinfectants for use against marburgviruses are found in List L [United States Environmental Protection Agency’s (EPA’s) Disinfectants for Use Against Ebola Virus] and List Q (EPA’s Disinfectants for Emerging Viral Pathogens). These lists of registered disinfectants meet the CDC’s criteria for use against marburviruses on hard, non-porous surfaces.

Packaging and Transporting Specimens for Marburgvirus Testing Outside the Facility

Packaging Diagram

Packaging and Shipping Clinical Specimens Diagram

  • Marburgviruses are a Department of Transportation (DOT)-classified Category A infectious substances. Specimens that are presumptive marburgvirus positive or those from patients with suspected MVD should also be packaged and shipped as Category A infectious substances in accordance with the DOT’s Hazardous Materials Regulations (HMR) Title 49 Code of Federal Regulations (CFR) 173.196
  • All people involved in packaging and shipping infectious substances should be trained and certified in compliance with DOT or the International Air Transport Association (IATA) requirements every two years.
  • Do not open collection tubes while packaging specimens to be shipped for marburgvirus testing. Opening tubes will break the vacuum seal and increase the risk of leakage during transport, exposing the packer to the contents.
  • Package specimens following the triple packaging system, which consists of (1) a primary container (a sealable specimen container) wrapped with absorbent material, (2) a secondary container (watertight, leak-proof), and (3) an outer shipping package that meet Cat A shipping requirements.
  • For questions about (packaging) transportation regulations, contact the U.S. DOT Hazardous Materials Information Center at 1-800-467-4922.
  • Coordinate with the receiving laboratory on appropriate transport conditions (e.g., cold packs for LRN laboratories or frozen on dry ice for shipment to CDC).
  • CDC will not accept specimens without prior consultation and approval. CDC’s Viral Special Pathogens Branch (VSPB) is available 24/7 for consultations by calling the CDC Emergency Operations Center at 770-488-7100 and requesting VSPB’s on-call epidemiologist. Learn more about submitting specimens to CDC for marburgvirus testing.

Occupational Health

Immediately report potential exposures to blood, body fluids, or other infectious materials according to your institution’s policies and procedures.

Additional Resources and Information