As of 16 July 2009, the laboratory testing strategy has been modified to only conduct testing if a clinical decision warrants these investigations. Laboratory testing of mild illness (patients who fit the ILI case definition) is NOT recommended, as it provides very little advantage to the clinical management of individual patients. Furthermore, NICD will no longer be conducting routine laboratory testing of all suspected or probable cases for pandemic influenza. However, there is still an ongoing need in all countries to closely monitor unusual events, such as clusters of cases of severe or fatal H1N1 infection, clusters of respiratory illness requiring hospitalization, or unexplained or unusual clinical patterns associated with serious or fatal cases.
• Patients who meet the SARI case definition (i.e. severe infections) where a laboratory diagnosis will assist in patient management or patients hospitalised due to a lower-respiratory infection, and where no other explanation for illness is indicated and influenza forms part of the differential diagnosis.
• Patients with co-morbid disease and at risk for serious complications and who are symptomatic with SARI or ILI should be considered for testing if it will guide clinical management.
• Clusters of cases where a diagnosis of the cause of the outbreak is needed.
• An individual who has died where pandemic influenza A(H1N1) is suspected as the cause of death.
*NB* These recommendations for laboratory testing do not apply to surveillance activities managed by the NICD (e.g. Viralwatch, SARI surveillance, etc.). Please continue testing as guided by those individual surveillance programmes.
Laboratory testing capabilities are currently in a process of being decentralized from NICD towards diagnostic laboratories throughout the country. Private sector laboratories have begun to offer in-house diagnostic services for patients seen at private sector health facilities whilst, testing of patients attended to by public sector healthcare facilities will soon be conducted by selected NHLS sites, NICD will continue to support both sectors. Until such time as these systems have been implemented. However, the NICD will begin to focus on enhanced clinical and virological surveillance at specific sites around the country.
Patients seen at private sector healthcare facilities should be tested at private sector laboratories, in accordance with these guidlines. Please discuss with your individual laboratory about the requirements and recommendations for testing, as well the cost implications to the patient/medical aid.
The NICD and the Virology Department of the University of Stellenbosch at Tygerberg Hospital (for patients within Western Cape Province), will continue to provide diagnostic support for patients seen at public sector health facilities, until such time that this is available within the NHLS. Note, testing will be offered as a diagnostic service, and therefore will be charged for at a standard rate. Costs associated with testing may vary between laboratories and over time, therefore please consult that laboratory prior sending the specimens.
Source :
The National Institute for Communicable Diseases (NICD) of the National Health Laboratory Service (NHLS) In collaboration with: The South African National Department of Health and World Health Organisation (WHO).
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