Rabies Zoonotic Disease Laboratory  Emergency Examination Requests (Updated August 26, 2011) Some situations that occur after regular business hours may require rabies test results as soon as possible so that a medical determination about rabies PEP can be made. In these situations, on-call laboratory scientists are available; and specimens may be examined Fridays from 12:00 PM to 4:30 PM, on a weekend, SRD, or on a State holiday, with prior approval of DHMH IDEOR epidemiology staff. To obtain approval after hours, call the DHMH IDEOR Epidemiologist-On-Call page at 410-716-8194.   ONLY, after receiving approval for an emergency examination request, contact the Rabies Lab On-Call Number: 443-735-1291 (Backup # 443-799-9490)   Rabies Submission Presentation (PDF Version)   Animal Rabies Test   Specimen Submission Policy     Animal Rabies Submission Policy (including Packaging and Shipping) Document   Hours of Operation   The DHMH Laboratories Administration Rabies Laboratory operates from 8:00 AM to 4:30 PM weekdays (Monday through Friday except on holidays and salary reduction days [SRD]). On-call laboratory scientists are available for requests that require test results as soon as possible so that a medical determination on rabies post-exposure prophylaxis (PEP) can be made. Specimens must be received at the DHMH Laboratories Administration by 12:00 PM on Fridays to have the test results reported by Friday 4:30 PM. Specimens received on Fridays after 12:00 PM will have the results ready the next regular workday. Specimens received on evenings from Monday through Friday, Fridays from 12:00 PM to 4:30 PM, on a weekend, SRD, or on a State holiday will be processed on the next regular workday, except for situations that require test results as soon as possible so that a medical determination about rabies PEP can be made (emergency examination). In these situations, prior approval by epidemiology staff in the DHMH Office of Infectious Disease Epidemiology and Outbreak Response (IDEOR) is necessary before testing will be initiated by on-call laboratory scientists. (For details, please see the Emergency Examination Requests section below).   Delivery Procedures   Delivery of specimens must be from Monday through Friday 7:30AM to 6:00PM (regular workdays) to the DHMH Laboratory Tower in the Receiving Area on the Service Level of the O’Connor Building at 201 W. Preston Street. All animal submission of specimen must be routed through the local health department and sent via courier service. Do not use the U.S. Postal Service or other public transportation service to send specimens. (For emergency examination situations, please see the Emergency Examination Requests section below).   Ordering Tests   For routine testing Monday through Friday, all local health departments must use the DHMH Laboratories Administration’s MyLIMS (Laboratory Information Management Systems) (http://starlims.dhmh.md.gov/starlims10.dhmhlabs.prod/) for submission of specimens. The updated rabies submission form (DHMH 1188 11/10) will print out automatically when the animal rabies test is ordered through the MyLIMS system, and must be included in the cooler and attached to the specimen being submitted. One Rabies Submission Form should accompany each animal submitted. Specimens approved for emergency testing must be accompanied by a fully completed handwritten Rabies Submission Form if access to MyLIMS is not possible. An emergency contact name and phone number must be listed on the Rabies Submission Form. The updated rabies submission form (DHMH 1188 11/10) can be downloaded from our website at http://dhmh.state.md.us/laboratories/sitepages/rabies.aspx.   Criteria for Animal Submission   Terrestrial animals acceptable for submission to DHMH are rabies vector species (e.g., raccoons, foxes, skunks, etc.) that expose humans, livestock, or pets. Exposure is defined as a bite that breaks the skin or contact of mucous membranes or broken skin with either animal saliva or nervous tissue. Birds, fish, reptiles and amphibians will not be accepted for rabies testing under any circumstances. Small rodents, including squirrels, chipmunks, gerbils, guinea pigs, hamsters, rabbits, mice, rats, voles, shrews and moles, will not be accepted for testing unless (1) the animal has bitten a human and (2) prior approval for testing has been authorized by the DHMH IDEOR epidemiology staff . Most recent human cases of rabies in the U.S. have been associated with bats, and bat bites may be difficult to recognize Bats should be submitted for testing in all cases of direct human contact with a bat or when bite or mucous membrane contact cannot be ruled out.   Emergency Examination Requests   Some situations that occur after regular business hours may require rabies test results as soon as possible so that a medical determination about rabies PEP can be made. In these situations, on-call laboratory scientists are available; and specimens may be examined Fridays from 12:00 PM to 4:30 PM, on a weekend, SRD, or on a State holiday, with prior approval of DHMH IDEOR epidemiology staff. To obtain approval after hours, call the DHMH IDEOR Epidemiologist-On-Call pager at 410-716-8194. ONLY, after receiving approval for an emergency examination request, contact the Rabies Lab On-Call Number: 443-735-1291 (Backup # 443-799-9490)   Specimen Collection   Animals should be euthanized in a manner that will not destroy the brain tissues to be examined in the diagnosis of rabies. When possible, only the animal’s head should be submitted for diagnostic purposes. For animals weighing more than 20 pounds, particularly large dogs, only the head may be submitted for testing. If an animal is being submitted to DHMH Labs from an animal pathology or diagnostic laboratory, and the animal has already been prepared for necropsy, the submitter should submit all or a cross section of the brainstem and half of the cerebrum.   Packaging and Shipping   All rabies specimens must be placed into coolers that are clearly marked as rabies coolers. No other non-rabies clinical samples may be placed into rabies coolers or these samples will be rejected Rabies coolers must fully close and must be waterproof Each specimen must be individually packaged in a leak- proof bag and clearly labeled. Each specimen must be accompanied by a Rabies Submission Form for proper identification. All Rabies Submission Forms must be filled out correctly and legibly including exposure type. Coolers may be shipped with ice or ice packs but the ice should not occupy more than 1/3 of the cooler. Submitters should provide advanced notice and clear labeling for live bat submissions. All other animals being submitted for testing must be dead. Submitters should avoid freezing specimens. If frozen specimens are received, testing will be delayed. No trash should be sent in rabies coolers. Animal rabies packaging and training video available at http://dhmh.maryland.gov/laboratories/SitePages/rabies.aspx Animal Rabies Packaging and Shipping Training Video Part 1 Part 2 Specimen Submission Form (Updated: November 15, 2010) Specimen Submission Form (Word Document) Electronic Submission MyLIMS specimen submission MyLIMS Computer Requirements & Configuration Rabies MyLIMS Information and Protocol Rabies-DFA MyLIMS Frequently Asked Questions Rabies MyLIMS Screenshot Tutorial Animal Rabies MyLIMS Training Video Part 1 (November 1, 2010) Part 2 (November 1, 2010) MyLIMS Helpdesk For assistance or issues with MyLIMS, please contact the Laboratories IT Division (Monday thru Friday from 8:00AM - 4:30PM except holidays and salary reduction) by phone at 410-767-3573 or e-mail (OIMShelpdesk@dhmh.state.md.us).   RABIES ANTIBODY TITER (RFFIT) RFFIT Test (Physician's Guide)  A. Submission Requirements Specimen/Sample Acceptance and Rejection Criteria TRAB Authorization Memo List of Authorized Healthcare Providers Optimum Specimen Volume: 5 ml whole blood or 2 ml of serum B. Packaging and Shipping 1. Please complete a DHMH 4677 – Serological Test Form. It must follow the TRAB Authorization Guideline Please include the following immunization history: a. Date of vaccination b. Type of vaccine c. Route of inoculation – intramuscular or intradermal 2. Specimens including the DHMH 4677 – Serological Test Form should be shipped by an overnight courier on ice packs. Do not use wet ice or dry ice. 3. Ship using an overnight courier on ice packs to: ATTENTION: RFFIT MARYLAND DEPARTMENT OF HEALTH AND MENTAL HYGIENE LABORATORIES ADMINISTRATION 201 W. PRESTON STREET BALTIMORE, MD 21201 C. This is a restricted test. 1. Maryland Residents: No charge 2. Non-Maryland Residents: $120.00 charge per specimen. Please send a check to this amount made payable to the State of Maryland Laboratories Administration with the specimens. Maryland DHMH Related Links DHMH Center for Zoonotic and Vector-borne Diseases State Public Health Veternarian Infectious Disease and Environmental Health Administration Maryland Department of Health and Mental Hygiene 201 W. Preston St., 3rd floor Baltimore, MD 21201 410-767-5649 (main) 410-383-2420 (FAX) Maryland Rabies Epidemiology Webpage Other Rabies Related Links CDC Rabies Homepage Raising Rabies Awareness CDC Rabies Information for Doctors Archived Documents March 2011 Critical Link Article: Animal Rabies Testing Electronic Submission Guidelines 2011 MEMO: Updated Animal Rabies Testing Submission Guidelines November 29, 2010 HO Memo #10-045 Updated Maryland Animal Rabies Submission Policy, Rabies Testing Form, and Reporting Requirements December 10, 2010 Animal Rabies Submission Policy (including Packaging and Shipping) Document