What to know
- Healthcare providers and veterinarians must consult their state health department and CDC before specimens are shipped for rabies testing.
- Qualified submitters must collect specimens, use appropriate shipping containers, complete required forms, and properly label, package, and ship the specimen according to regulations.
Specimen acceptance criteria
Consultation
Before requesting testing and shipping rabies specimens to CDC, you must consult with your state health department to determine if testing is necessary, which specimens should be submitted, and where the specimens should be sent.
After consultation with your state health department, if specimens need to be tested at the CDC National Rabies Reference Laboratory, you must contact the CDC rabies duty officer at 404-639-1050 or rabies@cdc.gov before shipping any specimens. The rabies duty officer will guide specimen collection, packaging, and shipping and arrange for the receipt of specimens.
Authorized specimen submitters
To submit rabies samples to CDC, you must hold one of the following positions:
- Employee of a state health department
- U.S. or non-U.S. physician
- U.S. or non-U.S. veterinarian
- Technician in a diagnostic laboratory
If you are a patient, contact your physician or local health department.
Types of rabies specimen testing
How the specimens are labeled, packaged, and shipped will depend on the kind of sample. Please consult with state or CDC laboratory experts before shipping to ensure that they are appropriately stored.The CDC rabies laboratory conducts several diagnostic tests to detect the rabies virus in humans and animals:
- Rabies Antemortem Human Testing
- Rabies Antibody Titer (Human)
- Rabies Confirmatory Testing (Animal)
- Rabies Antibody Titer (Animal)
- Rabies Postmortem Human Testing
- Rabies Virus Genetic Typing
- Rabies Special Study
- Rabies Field Surveillance
Documentation to include for all specimens
Provide the full name, title, complete mailing address, e-mail address, and telephone and fax numbers of the submitter. The final laboratory report will only be shared with the submitter indicated on the form.
Prior to shipping, it's optional but helpful to provide the CDC rabies duty officer with any available supportive documentation:
- Cover letter outlining a brief clinical history with relevant demographic/epidemiologic information; this can help expedite testing if necessary
- Copy of the autopsy/necropsy report (preliminary or final) or surgical pathology report
- Copies of pertinent laboratory results (microbiology, hematology, serology, culture, and/or biochemical)
- Images
Human specimens
Ensure you have all required samples for testing. Then, complete the necessary forms:
- Possible Human Rabies-Patient Information Form [PDF – 2 pages] (CDC Form 55.30) detailing the clinical history of the patient
- Provide the name, phone number, and email of the physician who should be contacted with the test results.
- This form must accompany any specimens sent to the CDC Rabies Laboratory.
- A separate completed CDC Form 50.34 must be submitted with each specimen type, even if they're from the same patient
Animal specimens
- Include completed CDC Form 50.34(s) with each specimen in your shipment.
- If a human exposure is involved with the animal for which specimens were submitted:
- Contact your state health department and the CDC rabies duty officer at 404-639-1050 to facilitate expedited testing.
- Include a complete patient history with all the known information regarding the exposure.
Specimen labeling and packaging
Labeling specimens
Each specimen must be clearly labeled with a unique identifier, which should also be listed on the completed CDC 50.34 submission form. One form is required for each specimen. The unique identifier on the specimen should match the unique identifier listed on the 50.34 submission form (see below for more information).
CDC will contact the submitter if there's a discrepancy matching the specimen to the submission form. If clarification is not possible, the requested testing will be canceled.
Packaging specimens
It is the submitter's responsibility to collect the specimen, provide appropriate containers, package the specimen safely for submission, and complete appropriate forms. Specimen(s) should be collected and properly shipped under optimal specimen storage conditions.
| Specimen Requirements | Serum | CSF | Saliva | Skin Tissue | Brain Tissue | Formal Fixed Tissues, Blocks, and Slides | ||
|---|---|---|---|---|---|---|---|---|
| Who is Eligible? |
|
Persons suspected of having rabies (human)
|
Persons suspected of having rabies (human)
|
Persons suspected of having rabies (human)
|
|
Case by case, pending consultation with CDC
|
||
| Sample Volume | >1 ml | >1 ml | 1 – 4 samples of >0.5 ml each | 5 – 6 mm biopsy | Brainstem and cerebellum | Case-by-Case basis | ||
| Pre-shipping storage requirements | Frozen <-20˚C (preferred) or refrigerated if storage is <3 days | Room Temperature | ||||||
| Preferred Shipping Condition | Dry Ice** | Room Temperature | ||||||
| Acceptable Shipping Condition | Frozen Cold Packs*** | None | ||||||
| Unacceptable Shipping Conditions | Room Temperature | Dry Ice & Frozen Gel Packs | ||||||
| Samples will be rejected if they arrive to CDC under these conditions: |
|
<0 ˚C | ||||||
* CDC's National Rabies Reference Laboratory does not typically offer this testing. Requests should be submitted through a State Public Health Department
** Formalin-fixed wet tissues should be packed in primary containers less than 30 mL, and the total volume should be less than 4L per package. Formal-fixed wet tissues should be shipped as UN 3373 Biological substance. Formalin-fixed paraffin-embedded blocks and glass slides with sections from paraffin-embedded blocks are considered non-hazardous and should be shipped at room (ambient) temperature without any special labeling required by the International Air Transport Association (IATA).
*** Dry ice shipments should comply with the International Air Transport Association (IATA) packing instructions 954 for UN 1845 and be shipped by a HAZMAT certified packer.
**** Use this method only as a last resort when dry ice is not available. The increased growth of bacterial contaminants within the refrigerated specimens may interfere with the ability to rule out the presence of rabies virus antigens, and antibodies. and nucleic acid. Human specimens intended for diagnostic testing may be rejected if out-of-range storage conditions are noted (e.g., received warm, or without cold packs or ice). If using this method, specimens should be packed using several cold packs.
Specimen shipping
It is the sender's responsibility to minimize the risk associated with shipping of infectious substances using proper packaging and packing in compliance with all regulations. All specimens and infectious substances submitted to CDC laboratories must be packed and shipped in compliance with the International Air Transport Association (IATA) Dangerous Goods Regulations (DGR) and US Department of Transportation Code of Regulation (CFR) Title 49, Parts 171-185.
- Packing of clinical specimens for rabies testing should fulfill the IATA regulations for the shipment of UN 3373 Biological substance Category B.
- Find specific regulations for the proper packaging, packing, marking, and labeling, and shipping:
Provide the shipper's package tracking number(s) to the CDC rabies duty officer as soon as it is available.
CDC rabies contact information
Please ship specimens to:
Rabies Duty Officer
Centers for Disease Control and Prevention
RDSB/STATT Unit 89
1600 Clifton Road, NE
Atlanta, GA 30333
404-639-1050
The CDC rabies duty officer can be reached at rabies@cdc.gov.