Difference between revisions of "Journal:Laboratory testing for coronavirus disease (COVID-19) in suspected human cases"

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Rapid collection and testing of appropriate [[Sample (material)|specimens]] from patients meeting the suspected case definition for COVID-19 is a priority for clinical management and outbreak control and should be guided by a laboratory expert. Suspected cases should be screened for the virus with [[Nucleic acid test|nucleic acid amplification tests]] (NAAT), such as [[Reverse transcription polymerase chain reaction]] (RT-PCR).
Rapid collection and testing of appropriate [[Sample (material)|specimens]] from patients meeting the suspected case definition for COVID-19 is a priority for clinical management and outbreak control and should be guided by a laboratory expert. Suspected cases should be screened for the virus with [[Nucleic acid test|nucleic acid amplification tests]] (NAAT), such as [[Reverse transcription polymerase chain reaction]] (RT-PCR).
If testing for COVID-19 is not yet available nationally, specimens should be referred. A list of WHO reference laboratories providing confirmatory testing for COVID-19 and shipment instructions can be found at the bottom of the WHO's national laboratories [https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/laboratory-guidance technical guidance page].
If case management requires it, patients should be tested for other respiratory pathogens using routine laboratory procedures, as recommended in local management guidelines for community-acquired pneumonia. Additional testing should not delay testing for COVID-19. As co-infections can occur, all patients who meet the suspected case definition should be tested for COVID-19 virus regardless of whether another respiratory pathogen is found.
In an early study in Wuhan, the mean incubation period for COVID-19 was 5.2 days among 425 cases, though it varies widely among individuals.<ref name="LiEarly20">{{cite journal |title=Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus–Infected Pneumonia |journal=The New England Journal of Medicine |author=Li, Q.; Guan, X.; Wu, P. et al. |year=2020 |doi=10.1056/NEJMoa2001316 |pmid=31995857}}</ref><ref name="GuanClinical20">{{cite journal |title=Clinical Characteristics of Coronavirus Disease 2019 in China |journal=The New England Journal of Medicine |author=Guan, W.; Ni, Z.; Hu, Y. et al. |year=2020 |doi=10.1056/NEJMoa2002032 |pmid=32109013}}</ref> [[Viral shedding|Virus shedding]] patterns are not yet well understood, and further investigations are needed to better understand the timing, compartmentalization, and quantity of viral shedding to inform optimal specimen collection. Although respiratory samples have the greatest yield, the virus can be detected in other specimens, including stool and blood.<ref name="LintonIncub20">{{cite journal |title=Incubation Period and Other Epidemiological Characteristics of 2019 Novel Coronavirus Infections with Right Truncation: A Statistical Analysis of Publicly Available Case Data |journal=Journal of Clinical Medicine |author=Linton, N.M.; Kobayashi, T.; Yang, Y. et al. |volume=9 |issue=2 |at=538 |year=2020 |doi=10.3390/jcm9020538 |pmid=32079150 |pmc=PMC7074197}}</ref><ref name="XuManage20">{{cite journal |title=Management of corona virus disease-19 (COVID-19): The Zhejiang experience |journal=Journal of ZheJiang University (Medical Sciences) |author=Xu, K.; Cai, H.; Shen, Y. et al. |volume=49 |issue=1 |year=2020 |doi=10.3785/j.issn.1008-9292.2020.02.02 |pmid=32096367}}</ref><ref name="ZhangMolec20">{{cite journal |title=Molecular and serological investigation of 2019-nCoV infected patients: Implication of multiple shedding routes |journal=Emerging Microbes & Infections |author=Zhang, W.; Du, R.-H.; Li, B. et al. |volume=9 |issue=1 |pages=386–89 |year=2020 |doi=10.1080/22221751.2020.1729071 |pmid=32065057 |pmc=PMC7048229}}</ref> Local guidelines on [[informed consent]] should be followed for specimen collection, testing, and potentially any future research.


==References==
==References==

Revision as of 21:56, 22 March 2020

Full article title Laboratory testing for coronavirus disease (COVID-19) in suspected human cases
Author(s) World Health Organization; Leitmeyer, Katrin; Zambon, Maria; Drosten, Christian; Koopmans, Marion; Poon, Leo; Gao, George;
Nahapetyan, Karen; Inbanathan, Francis; Pereyaslov, Dmitriy; Uhlenhaut, Christine; Grabovac, Varja; Vandemaele, Katelijn;
Samaan, Magdi; Fuster, Christian; Zhang, Wenqing; Stevens, Lisa; Oxenford, Chris; Cognat, Sebastian; Kojima, Kazunobu;
Dolea, Carmen; Brown, Caroline; Barnadas, Céline; Van Kerkhove, Maria; Carter, Lisa; Perkins, Mark D.; von Eije, Karin
Author affiliation(s) European Center for Disease Control, Public Health England, Charité - Universitätsmedizin Berlin,
Erasmus University Medical Center, Hong Kong University, Chinese Center for Disease Control and Prevention,
World Health Organization
Primary contact Email: WHElab at who dot int
Year published 2020
Volume and issue 2020.5
Page(s) 1–7
Distribution license Attribution-NonCommercial-ShareAlike 3.0 IGO
Website https://apps.who.int/iris/handle/10665/331501
Download https://apps.who.int/iris/bitstream/handle/10665/331501/WHO-COVID-19-laboratory-2020.5-eng.pdf (PDF)

Background

This document provides interim guidance to laboratories and stakeholders involved in COVID-19 virus laboratory testing of patients. It is based in part on the interim guidance on laboratory testing for Middle East Respiratory Syndrome (MERS) coronavirus.[1][2][3][4][5][6] Information on human infection with the COVID-19 virus is evolving and WHO continues to monitor developments and revise recommendations as necessary. This document will be revised as new information becomes available. Feedback is welcome and can be sent to WHElab@who.int.

The virus has now been named SARS-CoV-2 by the International Committee of Taxonomy of Viruses (ICTV)(2).[7] This virus can cause the disease named coronavirus disease 2019 (COVID-19). WHO refers to the virus as COVID-19 virus in its current documentation.

Laboratory testing guiding pricinciples for patients who meet the suspect case definition

The decision to test should be based on clinical and epidemiological factors and linked to an assessment of the likelihood of infection. Polymerase chain reaction (PCR) testing of asymptomatic or mildly symptomatic contacts can be considered in the assessment of individuals who have had contact with a COVID-19 case. Screening protocols should be adapted to the local situation. The case definitions are being regularly reviewed and updated as new information becomes available. For the WHO suspected case definition see Global surveillance for COVID-19 caused by human infection with COVID-19 virus.[8]

Rapid collection and testing of appropriate specimens from patients meeting the suspected case definition for COVID-19 is a priority for clinical management and outbreak control and should be guided by a laboratory expert. Suspected cases should be screened for the virus with nucleic acid amplification tests (NAAT), such as Reverse transcription polymerase chain reaction (RT-PCR).

If testing for COVID-19 is not yet available nationally, specimens should be referred. A list of WHO reference laboratories providing confirmatory testing for COVID-19 and shipment instructions can be found at the bottom of the WHO's national laboratories technical guidance page.

If case management requires it, patients should be tested for other respiratory pathogens using routine laboratory procedures, as recommended in local management guidelines for community-acquired pneumonia. Additional testing should not delay testing for COVID-19. As co-infections can occur, all patients who meet the suspected case definition should be tested for COVID-19 virus regardless of whether another respiratory pathogen is found.

In an early study in Wuhan, the mean incubation period for COVID-19 was 5.2 days among 425 cases, though it varies widely among individuals.[9][10] Virus shedding patterns are not yet well understood, and further investigations are needed to better understand the timing, compartmentalization, and quantity of viral shedding to inform optimal specimen collection. Although respiratory samples have the greatest yield, the virus can be detected in other specimens, including stool and blood.[11][12][13] Local guidelines on informed consent should be followed for specimen collection, testing, and potentially any future research.


References

  1. World Health Organization (January 2018). "Laboratory testing for Middle East Respiratory Syndrome coronavirus, interim guidance (revised), January 2018". WHO/MERS/LAB/15.1/Rev1/2018. World Health Organization. https://www.who.int/csr/disease/coronavirus_infections/mers-laboratory-testing/en/. 
  2. World Health Organization (2018). Managing epidemics: Key facts about major deadly diseases. World Health Organization. pp. 257. ISBN 9789241565530. https://apps.who.int/iris/handle/10665/272442. 
  3. World Health Organization (2011). WHO Global Influenza Surveillance Network: Manual for the laboratory diagnosis and virological surveillance of influenza. World Health Organization. pp. 140. ISBN 9789241548090. https://apps.who.int/iris/handle/10665/44518. 
  4. World Health Organization (October 2018). "Protocol to investigate non-seasonal influenza and other emerging acute respiratory diseases". WHO/WHE/IHM/GIP/2018.2. World Health Organization. https://www.who.int/influenza/resources/publications/outbreak_investigation_protocol/en/. 
  5. World Health Organization (October 1999). "WHO Recommended Surveillance Standards, Second Edition". WHO/CDS/CSR/ISR/99.2. World Health Organization. https://apps.who.int/iris/handle/10665/65517. 
  6. World Health Organization (2000). "Guidelines for the Collection of Clinical Specimens During Field Investigation of Outbreaks". WHO/CDS/CSR/EDC/2000.4. World Health Organization. https://apps.who.int/iris/handle/10665/66348. 
  7. Gorbalenya, A.E.; Baker, S.C.; Baric, R.S. et al. (2020). "Severe acute respiratory syndrome-related coronavirus: The species and its viruses – A statement of the Coronavirus Study Group". bioRxiv: 937862. doi:10.1101/2020.02.07.937862. 
  8. World Health Organization (20 March 2020). "Global surveillance for COVID-19 caused by human infection with COVID-19 virus: interim guidance, 20 March 2020". WHO/2019-nCoV/SurveillanceGuidance/2020.6. World Health Organization. https://apps.who.int/iris/handle/10665/331506. 
  9. Li, Q.; Guan, X.; Wu, P. et al. (2020). "Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus–Infected Pneumonia". The New England Journal of Medicine. doi:10.1056/NEJMoa2001316. PMID 31995857. 
  10. Guan, W.; Ni, Z.; Hu, Y. et al. (2020). "Clinical Characteristics of Coronavirus Disease 2019 in China". The New England Journal of Medicine. doi:10.1056/NEJMoa2002032. PMID 32109013. 
  11. Linton, N.M.; Kobayashi, T.; Yang, Y. et al. (2020). "Incubation Period and Other Epidemiological Characteristics of 2019 Novel Coronavirus Infections with Right Truncation: A Statistical Analysis of Publicly Available Case Data". Journal of Clinical Medicine 9 (2): 538. doi:10.3390/jcm9020538. PMC PMC7074197. PMID 32079150. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7074197. 
  12. Xu, K.; Cai, H.; Shen, Y. et al. (2020). "Management of corona virus disease-19 (COVID-19): The Zhejiang experience". Journal of ZheJiang University (Medical Sciences) 49 (1). doi:10.3785/j.issn.1008-9292.2020.02.02. PMID 32096367. 
  13. Zhang, W.; Du, R.-H.; Li, B. et al. (2020). "Molecular and serological investigation of 2019-nCoV infected patients: Implication of multiple shedding routes". Emerging Microbes & Infections 9 (1): 386–89. doi:10.1080/22221751.2020.1729071. PMC PMC7048229. PMID 32065057. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7048229. 

Notes

This presentation is faithful to the original, with only a few minor changes to presentation, grammar, and punctuation. In some cases important information was missing from the references, and that information was added. Their citation #8 referencing the Laboratory Biosafety Manual appears misplaced in the original document; it is appended in where it presumably should go in this version. Their citation #9 is placed where #8 was in the original, as it makes the most sense. Per the WHO's licensing agreement, this reproduction acknowledges the World Health Organization as the source, licensed under the CC BY-NC-SA 3.0 IGO license (see the infobox at top for full details).