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UCLH NHS FOUNDATION TRUST

DEPARTMENT OF VIROLOGY

Services provided by HEATH SERVICES LABORATORIES LLP

USER MANUAL

Version 17

November 2016
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TABLE OF CONTENTS

MISSION STATEMENT ...................................................................................................... 1

INTRODUCTION ................................................................................................................. 1
LOCATION.......................................................................................................................... 1
POSTAL ADDRESS ........................................................................................................... 1
WORKING HOURS............................................................................................................. 2
CONTACTING US DURING WORKING HOURS ............................................................... 2
CONTACTING US OUT OF WORKING HOURS ............................................................... 2
KEY CONTACTS - LABORATORY .................................................................................... 3
KEY CONTACTS – CONSULTANTS ................................................................................. 3
SERVICES AVAILABLE ..................................................................................................... 4
HIGH RISK SPECIMENS AND SAFETY ............................................................................ 5
REQUEST FORMS ............................................................................................................. 5
SPECIMEN VOLUME ......................................................................................................... 6
COLLECTION OF SPECIMENS ......................................................................................... 6
SPECIMEN LABELLING .................................................................................................... 6
TRANSPORT OF SPECIMENS .......................................................................................... 7
VIROLOGY CUT OFF TIMES ............................................................................................. 7
COMMUNICATION OF RESULTS ..................................................................................... 8
MEDICAL ADVICE ............................................................................................................. 8
LIMITATIONS AND UNCERTAINTIES ............................................................................... 8
QUALITY ASSURANCE ..................................................................................................... 9
COMPLAINTS..................................................................................................................... 9
TURNAROUND TIMES, SPECIMEN TYPES and INVESTIGATIONS ............................... 9
RETENTION OF SPECIMENS AND REQUESTING OF ADDITIONAL TESTS ............... 10
REFERENCE LABORATORIES ....................................................................................... 10
OTHER SEROLOGY ........................................................................................................ 10
UCLH VIROLOGY TEST REPERTOIRE AND TURNAROUND TIMES ........................... 11

Appendix 1 CPA certificate

Appendix 2 EQA schemes / Interlaboratory comparisons
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MISSION STATEMENT

We aim to provide our users with:

 An exemplary diagnostic virology laboratory service
 An expert clinical advisory service for the diagnosis, management and control of infections
 Assistance with the investigation of infectious disease outbreaks
 Advisory support for emerging viral infections
 A rapid response to comments, requests and criticisms

INTRODUCTION

The Virology Laboratory, University College London Hospitals NHS Foundation Trust is accredited by
Clinical Pathology Accreditation (UK) Limited and performs in excess of 500,000 tests per year. The
department is also licenced by the HTA under the Quality and Safety (tissue and cells) Regulations,
Human Application Sector. In addition to the routinely available tests used to diagnose and monitor
viral infections the assay development group of the department develops and provides novel
molecular diagnostic assays. The Virology Laboratory is an acknowledged reference laboratory for
HIV, hepatitis B, hepatitis C and molecular diagnosis and has a special interest and expertise in:

(1) HIV and other retroviral infections

(2) Viral hepatitis, especially hepatitis B and C infections
(3) Respiratory viral infections
(4) Viral infections in the immunocompromised patient
(5) Viral infections of the foetus
(6) Molecular testing for MRSA, Chlamydia Trachomatis (CT) and Neisseria Gonorrhoea
(GC)

Medical and laboratory staff are happy to discuss any problems relating to the diagnosis and
management of patients with viral infections and also with any issues about the quality of the service
provided to you.

This manual is intended to enable all users to make best use of the various services provided,
ensuring an accessible, equitable and efficient service.

LOCATION

Health Services Laboratories, Virology Laboratories, are located in buildings at 60 Whitfield Street
and 307 Euston Road.

Nearest tube stations:

 Warren Street Tube Station
LABORATORY AT (Northern Line, Victoria Line)
307 EUSTON ROAD  Goodge Street Tube Station
LABORATORY AT 60
(Northern Line)
WHITFIELD STREET
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POSTAL ADDRESS

Health Services Laboratories,

Clinical Virology Laboratory
60 Whitfield Street
London
W1T 4EU

Internet address: [Link]

WORKING HOURS

Routine opening
Monday to Friday 8 am to 8 pm
Saturday and Sunday 9am to 3pm
Specimens cannot be received outside these times without prior arrangement.

Out of hours
Requests for the provision of laboratory testing outside normal working hours may be accommodated
under exceptional circumstances. These should be arranged with the consultant on-call who may be
air-called through the UCLH switchboard (020 3456 7890 / 0845 155 5000).

Consultant advice
Advice on the diagnosis, treatment and containment of viral infections in patients is available at any
time through the 24 hour consultant led on-call service. The consultant providing this cover is always
contactable through the UCLH switchboard (020 3456 7890 / 0845 155 5000).

Diagnostic Services provided by HSL (HSL is a progressive partnership between The Doctors
Laboratory, Royal Free London NHS Foundation Trust (the Royal Free London) and University
College London Hospitals NHS Foundation Trust (UCLH))

website link : [Link]

CONTACTING US DURING WORKING HOURS

To contact us regarding laboratory enquiries

General enquiries 020 344 78994

Fax 020 344 79211
Serology results 020 344 78994
Molecular results 020 344 78994
To contact us for medical advice

Duty SpR 020 344 78986 / 78975

07946 202 872 (mobile)

CONTACTING US OUT OF WORKING HOURS

On call Consultant via the UCLH Switchboard (020 3456 7890 / 0845 155 5000)
ask for the on-call Virologist (pager 299)
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KEY CONTACTS - LABORATORY

Mr Jim Waite BSc, FIBMS

Serology Section Head e-mail: [Link]@[Link]
020 344 78979

Souraya Yearoo BSC, MSC, FIBMS

Molecular Section Head e-mail: [Link]@[Link]
020 344 78990

KEY CONTACTS – CONSULTANTS

Dr Eleni Nastouli FRCPCH and FRCPath

Consultant / Honorary Senior Lecturer /Clinical lead
e-mail: [Link]@[Link]
020 3447 8987

Dr Frank Mattes MD PhD FRCPath

Consultant e-mail: [Link]@[Link]
020 3447 8397
Mobile 07950 018 586

Dr Stavroula Maria Paraskevopoulou MBBS, FRCPath

Consultant e-mail: [Link]@[Link]
0203 447 8989

Dr Heli Harvala PhD, FRCPath

Consultant e-mail: [Link]@[Link]
020 3447 8991

KEY CONTACTS – SERVICE

Souraya Yearoo BSC, MSC, FIBMS
Interim Head of Virology e-mail: [Link]@[Link]
020 3447 8990

The Laboratory’s Policy on Protection of Personal Information

It is a condition of employment within UCLH that staff observe and comply with the Trust Information
Governance Policy and related policies and procedures when handling personal data in the course of
their work. This includes personal data relating to any patient, employee, customer, client, third party
supplier or agent of UCLH. It is a condition of employment that under no circumstances will such
information be passed on or discussed with any unauthorised person

All users of UCLH data, whether employees, honorary contract holders, third party suppliers or other
employees of partner organizations are subject to the following:

Code of Conduct for Users of UCLH Information

Information Governance Policy
Information Systems - Acceptable Use Requirements
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Other related guidance and polices provided by UCLH.

These policies are available on the Trust intranet site at

[Link]

SERVICES AVAILABLE

Diagnosing viral infections: a brief guide

Tests for recent infection:

(1) Polymerase chain reaction (PCR) for detection of viral nucleic acid (either RNA or DNA) is our
front line assay to detect many viral pathogens. Preferred specimens are from the anatomical
site where the suspect virus is, as early as possible in the course of infection. For example, in
suspected respiratory infection please collect respiratory specimens rather than blood for
antibodies and, in patients with vesicular rash or genital ulcers, send us a lesion swab rather
than blood for antibodies.
(2) In non-specific illnesses such as malaise, tiredness, myalgia etc., unless there are localising
symptoms/signs, it is not worth sending blood specimens without discussion with Virology first.
(3) Blood specimens (EDTA) remain useful, especially for HIV, hepatitis viruses, HTLV, parvovirus
B19, measles, rubella and EBV. Please do not send blood for respiratory or gastrointestinal
viruses.
(4) Please provide brief patient clinical details with duration of illness (date of onset), which allows
us to choose appropriate tests and any relevant travel and exposure history.
(5) Our laboratory also provides a diagnostic service for syphilis (send clotted blood for serological
investigations and/or ulcer swab for PCR) and for Lyme disease (send clotted blood for
serological investigations). Please refer to Virology test repertoire table on page 15 for preferred
specimen type.
(6) Molecular MRSA testing service (send red topped swab).
(7) Molecular Chlamydia and GC testing service.

Please see also table showing diseases and specimens to be collected for virological diagnosis later
in this manual.

Tests for immunity:

(1) Post-vaccine testing for immunity is NOT routinely recommended for measles, mumps, VZV and
hepatitis A as the assays used are reliable to detect vaccine induced IgG.
(2) Please inform us of the dates and doses of HBV or rubella vaccines administered.
(3) We can test for previous exposure and / or immunity to: CMV, EBV, parvovirus B19, hepatitis A,
hepatitis B and VZV.

Urgent specimens
(1) Pregnant, in recent contact with a case of chickenpox: if there is clear history of chickenpox in
the past, no testing is necessary. Otherwise, please supply details of date of contact and type of
contact (face-to-face / same room for 15 mins / own child).
(2) For all other urgent testing please phone the laboratory so that we can identify your patient’s
specimen. Please include your contact number on the request form.

What NOT to do…….

In order to get the best out of the diagnostic service, please:
 avoid the terms ‘viral titres’ and ‘TORCH screen’, they are confusing and obsolete
 do not send ANY unsigned request forms, especially for HIV testing
 do not send request forms without the patient’s date of birth and your contact number
 do not send specimens from suspected chronic fatigue syndrome: contact Virologist first for
discussion.
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HIGH RISK SPECIMENS AND SAFETY

For suspected viral haemorrhagic fever or SARS or other exotic viruses in a returning traveller:
contact the duty Virologist and Infectious/Tropical Diseases team for discussion as investigating for
these pathogens might have significant infection control implications.

Specimens from patients with a suspected viral haemorrhagic fever (a history of having returned from
West Africa, within 21 days) are HIGH RISK. Contact the on-call Virologist before sending any
specimens to the laboratories. The consultant virologist will advise on the appropriate specimens to
be collected and appropriate transport. High risk specimens must be sent to the laboratory using
appropriate packaging.

VIRAL HAEMORRHAGIC FEVER (EBOLA, MARBURG, LASSA, CCHF)

AVIAN INFLUENZA / MERS CORONAVIRUS / H7N9 INFLUENZA

Contact Virologist immediately - Air call on call Virologist (pager 299) through UCLH
switchboard (020 3456 7890 / 0845 155 5000).

REQUEST FORMS

Request forms are clearly labelled as “Virology” request forms and have a bag attached for the
specimen. Please send requests for Virology on a separate form from requests going to other
departments. Ideally serology and molecular requests should be sent on separate request forms.
Specimens accompanied by the wrong, or inadequately completed, request form may result in
unnecessary delays.

Three unique patient identifiers are required for accepting a sample for testing in Virology.

These are:

 First name with family name + hospital number or NHS number + DOBSamples with a
complete Clinic code – e.g. GUM clinic coding are accepted
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All dataset options defined above must match on both request and sample for acceptance. The
sample is taken as the correct reference of information against which information on forms received
will be compared in the event of minor discrepancies.
Samples may be rejected if the minimum dataset is not provided.

Information also required on the request form includes

 Gender
 Location or contact details for the patient
 Ward or Address for report
 Requestor identification and contact details
 For hospital patients, please provide details of the patient’s consultant
 Date and time specimen taken
 Type of specimen
 Tests required. Please avoid general terms such as “viral screen” as this may lead to delays in
processing the specimen appropriately

Other useful details

 Bleep number or mobile number, in order to phone significant results
 All relevant clinical details including:
o Date of onset and duration of illness
o History of foreign travel including return dates
o If pregnant, please indicate the gestational age
o Relevant treatment history
o Exposure history
o History of drug administration

The importance of accuracy when completing the form, labelling the specimen, and the
provision of relevant clinical details cannot be over-emphasised. For patient safety reasons,
mislabelled specimens may not be processed.

If a decision is made to accept a sample that does not meet the criteria listed ABOVE a ‘disclaimer’ is
added to the final report explaining the limitations of the test and result issued for the situation.

Please see table for sample type and volumes required for different assays on page 16

COLLECTION OF SPECIMENS
In order to provide you with the best quality results, it is essential that good specimens are collected
properly and at the appropriate time. It is also important that they are transported to the laboratory
without undue delay. This enables the laboratory and the medical staff to provide a meaningful report
and an interpretation relevant to the patient's illness.

Inappropriate specimens or those that are damaged or leaking are liable to be discarded. Should this
occur, every attempt will be made to inform the user that a second specimen may be required.
If unvalidated samples are tested a disclaimer will be added to the final report explaining the
limitations of the test.

Specimen collection
Please ensure that the correct specimen container is used. If unsure which specimen type to examine
or how to collect a particular specimen type, please contact the laboratory (020 344 78994) for advice.
Information for Trust users on the proper collection of blood samples is available here on the
Phlebotomy page on Insight.
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[Link]
.aspx

Dry swabs are not appropriate. For genital ulcers, vesicular rash, eye swabs and respiratory swabs.
please use Copan brand swabs which come with their own vial of transport medium in the same
packet and which have a long shelf life at room temperature.

 These can be ordered through NHS Logistics; code HHD 116 for the small 1mL container
 Use the swab provided: snap off into the bottle and replace cap. Complete patient details

CSF should be sent in a sterile Universal container not in transport medium.

Please use red topped double headed swabs for molecular MRSA screening.
Aptima swabs are available for unisex and self-taken samples. Urine collection kits are also available
for CT/GC molecular tests.

Blood samples collected into EDTA purple capped containers OR EDTA plasma are required for all
molecular testing. Serum and blood samples collected in lithium heparin, or heparin are not suitable
for molecular tests and will be rejected.
For serological tests only a clotted (red top) or SST (yellow top) blood or serum are the samples of
choice. Other blood samples may be rejected.

IF BOTH VIRAL SEROLOGY (ANTIBODY TESTING) and MOLECULAR (PCR) INVESTIGATIONS

ARE REQUIRED, PLEASE SEND TWO BLOOD SPECIMENS - one clotted or yellow top for
serological investigations and one purple top for molecular investigations.

For most single investigations a minimum volume of 4-5ml of blood is required. Larger
volumes will be needed for multiple investigations or two separate specimens where both
serological and molecular testing is required. Neonatal / paediatric specimens should indicate
the priority tests when small volumes are sent.

Please contact the laboratory for further guidance on specimen volumes if only a small volume is
available.

If sending separated plasma or serum ensure all tubes are clearly labelled as to the contents.

SPECIMEN LABELLING

Complete patient details must be clearly marked on BOTH the request form AND the specimen
container before insertion into the plastic bag and before it is sealed ready for transportation. Do not
use pins or staples as this is hazardous.

The specimen must be labelled with the same patient details as that on the request form.
Please ensure that the full patient name and the date of specimen collection are legible. The sample
is taken as the correct reference of information against which information on forms received will be
compared in the event of minor discrepancies.

The importance of accuracy when completing the form, labelling the specimen, and the
provision of relevant clinical details cannot be over-emphasised. For patient safety reasons,
mislabelled specimens may not be processed.

TRANSPORT OF SPECIMENS
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Specimens should be sent direct to the Virology Specimen Reception at 60 Whitfield Street W1T 4EU
as soon as possible after collection. If there is a transport delay samples should be refrigerated.
Samples older than seven days since collection should be discarded and a repeat collected.

Routine specimens
Routine specimens from UCH should be sent via the pneumatic tube system. Specimens from other
sites, including GPs, should be sent using the regular courier service to 60 Whitfield Street.
Specimens may also be sent by post. Please refer to the Trust policy:
[Link]
nd%[Link]

Urgent requests – refer to Page 5 for the correct numbers

 During working hours – discuss with the laboratory first
 Out-of-hours – discuss with on-call Virologist, including transport to the laboratory

On rare occasions, the quickest way to get an urgent specimen to the Virology laboratory may be for
a member of ward staff to carry it instead of calling a medical courier. In this situation, staff should
always carry the specimen in a suitable rigid container. Such containers should be available on each
ward. Spare/replacement containers can be obtained from Virology Specimen Reception at 60
Whitfield Street.

The sender is responsible for ensuring the health and safety of any courier or taxi service that
is used to transport specimens to the Clinical Virology laboratory.

If sent by post or by external courier, specimens must be in a sealed container, sealed in a plastic
bag. The primary container must be surrounded by sufficient absorbent packing material to take up
any leakage from the primary container during transit. Bags must then be placed in an approved outer
container which satisfies current postal or other transport regulations.

Guidance on the transporting of specimens, including specimens requiring category A transport when
being transported by road in the UK, may be found at:
[Link]
[Link].

Guidance on sending samples via Royal Mail can be found at::

[Link]

VIROLOGY CUT OFF TIMES

Virology cut-off times for processing specimens with a same day turnaround time (TAT).
Cut for time for Results
Specimen type Assay
processing available
Respiratory PCR
Respiratory specimen (Influenza, RSV, ParaFlu, 11.00 16.30
Metapneumovirus, Adenovirus)

Gastro PCR
Faeces (Norovirus, Rotavirus, 11.00 16.30
Adenovirus)

COMMUNICATION OF RESULTS

 Electronic reports are exported to downstream systems (to CDR for UCLH, to CELLMA for
Mortimer Market and Archway clinics, and for General Practitioners to GPLINKS, GPPORTAL and
the Community Browser).
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 Automatic electronic faxing of reports is used for some requestors and this is set up within the
Laboratory Information System.
 Non-electronic reports are printed twice a day and are dispatched by post Monday to Friday.

All clinically relevant and urgent positive results are telephoned out to our users by one of the medical
staff. For reasons of confidentiality, results are only faxed to “safe-haven fax numbers”.

MEDICAL ADVICE

Advice on the diagnosis, treatment and containment of viral infections in patients is available at any
time through the 24 hour consultant led on-call service. The consultant providing this cover is always
contactable through the UCLH switchboard (020 3456 7890 / 0845 155 5000).

LIMITATIONS AND UNCERTAINTIES

A variety of key factors impact upon the uncertainty of results of virological testing.

Pre testing
Outside factors that can affect the outcome of investigations include the delay from specimen
collection to testing and sample storage conditions prior to and during transport to the laboratory. For
quantitative molecular testing in particular, a significant delay in transit to the laboratory may result in
inaccurate estimation of viral loads.

Note that if a patient has recently received a blood transfusion or blood products, this can result in
misleading antibody test results.

Most assays have not been validated for cadaveric specimens.

Copan swabs should be used and placed in viral transport medium. Swabs in bacterial transport
medium will not be tested.

Whole bloods should be sent to the laboratory to arrive within a maximum of 72 hours of being taken.
If sending is likely to be delayed, whole bloods may be separated and stored as plasma/serum prior to
transportation. This should be performed as soon as possible after collection.

Plasma or serum samples may be stored at 2-8C for no longer than 7 days. They should be frozen at
-20C or below if being stored longer. Repeated freeze-thaw cycles may reduce assay sensitivity.

Note that EDTA blood is the sample of choice for molecular assays, clotted or heparinised specimens
have not been validated and may give rise to erroneous results. If unvalidated samples are tested a
disclaimer will be added to the final report explaining the limitations of the test.
Urine samples for CT/GC testing should be kept refrigerated to prevent the overgrowth of bacteria
which may interfere with the result.

Testing
Results from specimens that are heat inactivated, haemolysed, and lipaemic or heavily bacterially
contaminated may not be accurate. Such specimens may be unsuitable for testing and should not be
sent.
Small volume samples:

Small volume urgent or precious samples may be diluted and tested at the discretion of the
laboratory. Diluting samples may compromise the accuracy of PCR. A repeat sample may
be requested if clinically indicated

- The maximum dilution allowed for a viral loads is 1:5 , For very small volume samples, an
“insufficient” comment will be issued.
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Post testing
All results must be interpreted with reference to clinical information. In many cases clinical comments
will be provided with results but it may not be possible to properly interpret results where clinical
information has not been provided with the request. Medical staff are available in the laboratory during
working hours and on-call (out of hours) to discuss cases and provide guidance on the diagnosis and
management of infectious diseases.

The absence of detectable markers does not necessarily exclude the possibility of infection,
especially in the early acute phase.

QUALITY ASSURANCE

The laboratory is accredited with CPA/UKAS. . For full details please refer to the UKAS website
[Link] The laboratory is
currently working towards meeting the requirements of ISO15189 and is due an inspection under
these standards in 2016. See appendix 1 for a copy of the current CPA certificate.

The results sent out by this laboratory are of the highest possible quality. To this end we have a
Quality Management System (QMS) that meets CPA/UKAS standards. The laboratory also
participates in various inter laboratory comparison schemes including the UK National External
Quality Assessment Scheme (UKNEQAS) and Quality Control for Molecular Diagnostics (QCMD) for
a wide range of virological investigations. Where tests performed are not covered by UKNEQAS or
QCMD, alternative sources of EQA material or exchange of samples with other laboratories is used to
provide external quality assurance. See appendix 2 for a copy of all EQA schemes and interlaboratory
comparisons the laboratory participates in. Our results and ongoing performance are available for
inspection.

An annual User Survey is undertaken to receive feedback on the service and to review testing profiles
and indicate where improvements to the overall service may be made.

COMPLAINTS

If you wish to make a complaint, please contact the Virology General Manager or Consultant Virologist
and your complaint will be dealt with promptly.

TURNAROUND TIMES, SPECIMEN TYPES and INVESTIGATIONS

In the following sections you will find details of the different diagnostic tests available in our lab, the
specimen required and the turnaround time for results. The tests are presented in the following
groups:
 Hepatitis viruses (hepatitis A, hepatitis B, hepatitis C, delta and hepatitis E viruses)
 Retroviruses (HIV-1, HIV-2, HTLV)
 Herpes viruses (CMV, EBV, herpes simplex virus, VZV, HHV-6 & 7, KSHV [aka HHV8])
 Exotic/tropical viruses (including arboviruses, dengue, West Nile virus, Lassa fever virus,
Avian influenza H5N1)
 Other viruses (or infective agents for which routine testing is performed in the Virology
laboratory) in alphabetical order, including lyme and syphilis testing
 Screening profiles (Antenatal, Occupational Health, Needlestick donor and Needlestick
recipient screening batteries)
 Molecular MRSA results are normally reported within the same working day if received by
2:30pm
 Chlamydia/GC molecular results are normally available with 48 hours of receipt of specimen
 Other reference laboratory investigations

Turnaround times in all the following tables are defined as the number of working days
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(Monday to Sunday) from receipt of the specimen to result authorisation and availability on IT.

RETENTION OF SPECIMENS AND REQUESTING OF ADDITIONAL TESTS

Original blood specimens are retained for approximately one week. Plasma from ante-natal booking
blood specimens, needlestick related specimens and aliquots from specimens for molecular tests are
retained for 2 years. Within this time frame, additional tests can be requested on these specimens by
telephone or fax. The corresponding period of retention for urine, swab and stool specimens is 3
weeks. Documentation for Donor and Recipient samples are stored for 10 and 30 years respectively,
in line with HTA regulations .

REFERENCE LABORATORIES

Samples may be referred to Reference laboratories for more specific tests where routine testing at
UCLH is not provided. These are listed throughout the tables on the following pages.

If an investigation you require is not listed in the following tables, please call the virology department
for advice. We will receive the specimen in our laboratory and refer it to the most appropriate
reference facility.

Turnaround times for the different tests vary. Please consult with the laboratory if specific information
re turnaround times is required. Further information may be obtainable direct from the individual
reference laboratories. Full addresses of the reference laboratories used and their other contact
details are available on request.

OTHER SEROLOGY

Serological and antibody/antigen detection:

Investigations for the following are performed:
o Anti-streptolysin-O (ASO)
o Brucella antibodies
o Investigations for H. pylori (Antigen test performed on faeces)
o Mycoplasma antibody
o Syphilis antibody on CSF
o Toxoplasma antibody
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DISEASES AND SPECIMENS TO BE COLLECTED FOR VIROLOGICAL DIAGNOSIS

 = Preferred specimen  = Second choice specimen Lesion specimens Respiratory specimens ( one is enough) Other specimens Blood
Copan swabs in VTM Others
Throat Acute
Common Conjun- Mouth / Throat NPA
System involved Clinical features Vesicle Eye
ctival
Genital
oral
and
gargle
Sputum
(children)
CSF Faeces +
pathogens nasal Post
Influenza (in the
Pyrexia    
season)
Systemic EBV (<40 years),
Lymphadenopathy CMV, consider HIV 
if risk factors exist
Common cold, Parainfluenza virus,
Respiratory croup, bronchiolitis, EBV, Adenovirus,    
‘flu’, pharyngitis Influenza virus
Rotavirus (infants
Gastroenteritis and elderly), 
Gastrointestinal
Norovirus
Hepatitis HAV, HBV, HCV 
Aseptic meningitis Enterovirus
   
Encephalitis HSV, VZV, Mumps
Nervous system Febrile convulsions Any virus    
Peripheral Viral aetiology is
Contact the duty Virologist to discuss possibilities based on the patient travel history
neuropathy rare in UK
Conjunctivitis, Adenovirus, HSV,
Ophthalmic  
Keratitis VZV
Suspected HIV 
Genito-urinary
Vesicles / ulcers Syphilis   
(GUM)
Vesicles / ulcers HSV  
Mouth ulcers HSV, Enterovirus  
Measles,
Parvovirus B19,
 
Maculopapular rash Enterovirus, 
measles measles
Rubella, HHV6&7,
Skin and Syphilis
mucosa
VZV, HSV,
Vesicular rash    
Enterovirus
Molluscum
Nodule Consider sending nodule biopsy
contagiosum
Warts or CIN HPV Contact the duty Virologist
Persistent anaemia Parvovirus B19 
Haematological
Thrombocytopenia EBV, Parvo B19 
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Atypical lymphocytes EBV, CMV 

UCLH VIROLOGY TEST REPERTOIRE AND TURNAROUND TIMES
In the following sections you will find details of the different diagnostic tests available in our laboratory, the specimen required and the turnaround time for
results. For most single investigations a minimum of 4-5 mls of blood is required. Larger volumes may be needed for multiple investigations or
two separate specimens where both serological and molecular testing is required. Neonatal / paediatric specimens should indicate the priority
tests when small volumes are sent

HEPATITIS VIRUSES
VIRUS TEST SPECIMEN FREQUENCY OF TEST TURNAROUND TIME
Hepatitis A Hepatitis A IgG + IgM Clotted blood Daily (Mon – Sun) 1-2 working days
All serological markers including anti-HBs Clotted blood Daily (Mon – Sun) 1-2 working days Same day if urgent
HBsAg quantitation EDTA blood On request 2-7 working days
Hepatitis B HBV DNA quantification
EDTA blood Daily (Mon – Fri) 3-7 working days
(with or without “e” markers: please specify)
HBV genotyping/resistance testing EDTA blood Twice weekly (Mon & Weds) 5-10 working days
Antibody Clotted blood Daily (Mon – Sun) 1-2 working days Same day if urgent
Hepatitis C HCV RNA detection/quantification EDTA blood Daily (Mon – Fri) 3-7 working days
HCV genotyping (including resistance) EDTA blood Twice weekly (Mon & Weds) 5-10 working days
Delta virus (HDV) serology screen Clotted blood Weekly 7-10 working days
Hepatitis D
HDV RNA detection / quantification EDTA blood Fortnightly 5-20 working days
Antibody Clotted blood Weekly 7-10 working days
Hepatitis E
HEV RNA EDTA blood Monthly / On request 15 working days

RETROVIRUSES
VIRUS TEST SPECIMEN FREQUENCY OF TEST TURNAROUND TIME
“HIV test” (antibody / antigen detection) Clotted blood Daily (Mon - Sun) 1-2 working days Same day if urgent
HIV-1 RNA (viral load) EDTA blood 4-5 times / week 2-5 working days
HIV-1 genome (DNA and RNA) EDTA blood Weekly (Mon) 2-6 working days
HIV-1 and 2
HIV-1 resistance testing EDTA blood Twice weekly (Mon & Weds) 3-9 working days
HIV-2 RNA (viral load) EDTA blood Fortnightly 5-20 working days
HIV-2 genome (DNA and RNA) EDTA blood Fortnightly 5-20 working days
HTLV-1 and 2 IgG screening Clotted blood Daily (Mon – Sun) 1-3 working days
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HERPESVIRUSES If the specimen type is not specified contact the Medical Virologist
VIRUS TEST SPECIMEN FREQUENCY OF TEST TURNAROUND TIME
Daily (Mon – Sun for IgG
CMV IgG + IgM Clotted blood 1-2 working days
Mon- Fri for IgM)
On demand (Contact Medical
CMV IgG avidity EDTA blood 2 working days
Virologist)
Cytomegalovirus
(CMV) CMV DNA qualitative detection EDTA blood,
CSF, urine, 3 times/week (Mon, Weds,
(This test has replaced CMV DEAFF test and 2-3 working days
broncho-alveolar Fri)
CMV culture) lavage
CMV DNA quantification EDTA blood Twice weekly (Tues & Thurs) 2-7 working days
EBV IgG antibodies Clotted blood Weekly (Weds) 3-8 working days
EBV IgM Clotted blood Weekly (Thurs) 3-8 working days
Epstein Barr Virus
(EBV) 3 times / week (Mon, Weds,
EBV DNA qualitative detection CSF 2-3 working days
Fri)
EBV DNA quantification EDTA blood Twice weekly (Tues & Thurs) 2-7 working days
Serology (usually not helpful) Reference lab test (PHE,
Clotted blood 15 working days
Please telephone to discuss Colindale)
Herpes Simplex Swabs: Daily (Mon - Fri)
(HSV) HSV-1 and 2 DNA detection (This test has Swab in VTM,
Other (e.g. CSF):
replaced both tissue culture and EM of vesicle CSF, broncho- 2-3 working days
fluid) alveolar lavage 3 times / week (Mon,
Weds, Fri)
3 times / week (Urgent 2-6 working days
VZV IgG screen Clotted blood
samples on demand) Same day if urgent
VZV IgM (Rarely useful: CSF or swab of On demand if clinically
Varicella Zoster skin/mucosal lesion for VZV-DNA detection is EDTA blood indicated: contact Medical 2-6 working days
Virus usually more helpful) Virologist
(VZV) Swabs: Daily (Mon - Fri)
Swab in VTM, Other (e.g. CSF):
VZV DNA detection Up to 5 working days
CSF 3 times / week (Mon,
Weds, Fri)
Human Herpes Reference lab test (PHE,
HHV6 & HHV7 DNA detection CSF 15 working days
viruses 6 & 7 Colindale)
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3 times / week (Mon, Weds,

Human Herpes HHV8 DNA qualitative detection EDTA blood Up to 5 working days
Fri)
virus 8
HHV8 DNA quantification EDTA blood Weekly (Fri) Up to 20 working days

EXOTIC / TROPICAL VIRUSES

VIRUS TEST SPECIMEN FREQUENCY OF TEST Ref Lab TURNAROUND TIME
Exotic viruses e.g. Reference lab test
dengue, yellow fever, Antibody / viral nucleic acid EDTA blood 15 working days
West Nile Virus (PHE Porton Down)

SCREENING
BATTERY TESTS SPECIMEN FREQUENCY OF TEST TURNAROUND TIME
Antenatal screen HBsAg, HIV, syphilis & Rubella IgG EDTA blood Daily (Mon – Sun) 1-2 working days Same day if urgent
Occupational Health May include: HBsAg, anti-HBs, Daily (Mon – Sun) except
Clotted blood 2-3 working days Same day if urgent
Screen Rubella IgG, VZV IgG & Measles IgG for VZV IgG (5 times / week )
Needlestick / sharps
HBsAg, HIV, anti-HCV, syphilis Clotted blood Daily (Mon – Sun) 1 working day
DONOR screen
These baseline samples are archived. They are only tested in the event
Needlestick / sharps
Save sample EDTA blood that a follow-up test on the individual shows them to have an infection
RECIPIENT
that might have been acquired from the sharps injury.
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OTHER VIRUSES (OR INFECTIVE AGENTS FOR WHICH ROUTINE TESTING IS PERFORMED IN THE VIROLOGY LABORATORY) IN ALPHABETICAL ORDER
VIRUS / AGENT TEST SPECIMEN FREQUENCY OF TEST TURNAROUND TIME
16S PCR 16S rDNA identification of bacterial pathogens Tissue Weekly 5-7 working days
Faecal adenovirus (serotypes 40 & 41) DNA Daily (Mon – Sat) if
Faeces 1-2 working days
detection by PCR required
Adenovirus DNA detection by PCR Nasopharyngeal aspirate / throat
Daily (Mon – Sat) if
(This test has replaced direct washing, conjunctival swab in 1-2 working days
7 required
Adenovirus immunofluorescence and tissue culture) VTM
EDTA blood. Stem cell transplant
patients only. (For other Twice Weekly (Tues &
Adenovirus DNA quantification 2-7 working days
patients/specimens contact the Thurs)
on-call Virologist)
Anti-Streptolysin O ASO EDTA Blood Daily (Mon – Fri) 1-2 working days
3 times / week (Mon,
BK virus BKV DNA detection Urine 2-3 working days
Weds, Fri)
EDTA blood Daily (Mon – Fri) 1-2 working days
Brucella Reference lab test
Confirmatory testing
(BRU, Liverpool)
1. For first catch urine (FCU),
transport to laboratory ideally
within 48 hours (unless placed
directly in to Aptima Urine
transport media, GUM ONLY).
2. Specimens older than 7 days
Chlamydia and cannot be processed. 1-3 working days
CT/GC NAAT screen Daily (Mon – Fri)
Gonorrhoea 3. Specimens usually retained Same day if urgent
for 7 days after testing.
4. Unisex/self-taken vaginal
swabs routinely available for
GUM Clinic specimens. All
other users by local
arrangement.
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VIRUS / AGENT TEST SPECIMEN FREQUENCY OF TEST TURNAROUND TIME

CSF in meningitis or encephalitis
Enteroviruses & Faeces (or rectal swab in VTM if 3 times / week (Mon,
Parechoviruses e.g. Enterovirus RNA detection 2-7 working days
no stool specimen is available), Weds, Fri)
coxsackie A and B, throat swab in VTM
ECHOvirus and
poliovirus Reference lab test
Enterovirus IgM EDTA blood 10 working days
(PHE Epsom)
H pylori Stool antigen Faeces Daily (Mon – Fri) 1-2 working days
3 times / week (Mon,
JC Virus JCV DNA detection CSF 2-3 working days
Weds, Fri)
Daily (Mon – Fri)
2-3 working days
Screening antibody test EDTA blood (Urgent samples on
Same day if urgent
demand)
Lyme
Reference lab test
Confirmatory antibody tests EDTA blood, CSF (PHE Porton Down, 15 working days
Southampton)
Throat swab in VTM
Urine Reference lab test
Measles RNA detection 15 working days
EDTA blood (PHE CfI, Colindale)
Oral fluid (“oracol”)
Measles Reference lab test
Measles IgM EDTA blood 10 working days
(PHE CfI, Colindale)
Daily (Mon – Fri)
Measles IgG screen (Limited indications – 1-3 working days
EDTA blood (Urgent samples on
please contact Virologist to discuss.) Same day if urgent
demand)
1-2 working days
MRSA MRSA screen Red topped swab Daily (Mon – Sat )
Same day if urgent
Twice a week (day
Mycoplasma EDTA Blood 2-3 working days
varies)
Twice weekly (Tues &
Parvovirus IgG and IgM EDTA blood 1-7 working days
Thurs)
Parvovirus B19
Reference lab tests
Parvovirus DNA detection EDTA blood 15 working days
(PHE, Colindale)
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VIRUS / AGENT TEST SPECIMEN FREQUENCY OF TEST TURNAROUND TIME

Respiratory viruses
i.e. influenza Viral nucleic acid detection by PCR
viruses, RSV, Para- Nose & throat swab in VTM,
(This test has replaced direct Daily (Mon – Sun) 1-2 working days
influenza viruses, BAL, NPA.
adenovirus and immunofluorescence and viral culture)
metapneumovirus
H5 Influenza A: Contact Virologist immediately - Air call Medical Virologist through the UCLH switchboard
Daily (Mon – Sun) if
Rotavirus Rotavirus RNA detection Faeces, vomit 1-2 working days
required
1-2 working days
Rubella IgG screen Clotted blood Daily (Mon – Sun)
Same day if urgent
Rubella
1-2 working days
Rubella IgM clotted blood Weekly (Thurs)
Same day if urgent
EDTA blood (For other specimens
Treponema pallidum antibody detection (and 1-2 working days
including CSF, contact
additional serological tests, including reference Daily (Mon – Sun)
Syphilis Microbiology Serology lab on Same day if urgent
lab testing at PHE CfI Colindale, as appropriate)
UCH 78994)
Treponema pallidum DNA PCR Swab in VTM Daily (Mon – Fri) Up to 5 working days
IgG and IgM antibody Clotted blood Daily (Mon – Fri) 1-2 working days
Toxoplasma Reference lab test
Confirmatory antibody tests Clotted blood 15 working days
(Swansea)
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OTHER INVESTIGATIONS WHERE TESTS ARE PERFORMED BY REFERENCE LABORATORIES

VIRUS / AGENT / TESTS SPECIMEN REFERENCE LABORATORY *
Anaplasma (Ehrlichia) serology Blood PHE, Porton Down
Anti-DNase B (Streptococcal) antibodies Blood PHE, Colindale
Aspergillus serology Clotted blood / serum Mycology Reference Centre, Leeds
Avian antigens Clotted blood / serum Mycology Reference Centre, Leeds
B pseudomallei (melioidosis) Clotted blood / serum PHE, Colindale
Bartonella serology Blood PHE, Colindale
Blastomyces serology Clotted blood / serum Mycology Reference Laboratory, Bristol
Bordetella pertussis serology Blood PHE, Colindale
Bordetella pertussis PCR
URT swab, NPA, tracheal aspirate, PHE, Colindale
For hospitalised patients < 1 year old ONLY
sputum, BAL
For patients > 1 year old Micropathology Ltd, Coventry
Campylobacter serology Blood Preston Microbiology Services
Candida serology Clotted blood / serum Mycology Reference Centre, Leeds
Coccidioides serology Clotted blood / serum Mycology Reference Laboratory, Bristol
Coxiella burnetti (Q fever) Blood PHE, Porton Down
Darunavir levels Blood Lab21 Ltd, Cambridge
Dimorphic fungi Clotted blood / serum Mycology Reference Laboratory, Bristol
Diphtheria antibody levels Clotted blood / serum Vaccine Evaluation Unit, Manchester
E coli serology Clotted blood / serum PHE, Colindale
Galactomannan antigen Clotted blood / serum Mycology Reference Laboratory, Bristol
Gancyclovir levels Clotted blood / serum Regional Antimicrobial Reference Laboratory, Bristol
H ducreyii Swab for molecular testing PHE, Colindale
H influenzae antibody levels Clotted blood / serum Vaccine Evaluation Unit, Manchester
Histoplasma serology Clotted blood / serum Mycology Reference Laboratory, Bristol
JC virus antibody Clotted blood / serum PHE, Colindale
Leptospira Clotted blood / serum Leptospira Reference Unit, Hereford
LGV Swab for molecular testing PHE, Colindale
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VIRUS / AGENT / TESTS SPECIMEN REFERENCE LABORATORY *

Meningococcal antibody Clotted blood / serum Vaccine Evaluation Unit, Manchester
Meningococcal PCR EDTA whole blood Meningococcal Reference Unit, Manchester
Paracoccidiodes serology Clotted blood / serum Mycology Reference Laboratory, Bristol
Pneumococcal antibody Clotted blood / serum Vaccine Evaluation Unit, Manchester
Pneumococcal PCR EDTA whole blood Meningococcal Reference Unit, Manchester
Rabies serology Blood Animal Health & Vet Labs Agency, Weybridge
Rickettsial serology Blood PHE, Porton Down
Salmonella serology Clotted blood / serum PHE, Colindale
Staphylococcal antibodies Blood PHE Colindale
Streptococcal antibodies Blood PHE Colindale
Tetanus antibody level Clotted blood / serum Vaccine Evaluation Unit, Manchester
VHF specimens (following a discussion with
EDTA whole blood PHE, Porton Down
the on-call Virologist)
Whipples PCR EDTA blood / CSF Camelia Botnar Laboratories, GOSH
Yersinia serology Clotted blood / serum PHE, Colindale

*More information is available if required

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Appendix 1
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Appendix 2
EQA schemes subscribed to by the Department of Clinical Virology at UCLH

NEQAS QCMD Quality Control for

Molecular Diagnostics
Blood borne viruses [Link]
[Link] & [Link] HIV drug resistance typing
CMV DNA quantification HIV drug resistance typing
(integrase)
Diagnostic serology exanthem
HIV RNA
Diagnostic serology hepatitis
HPV DNA
EBV DNA quantification
HSV DNA
HBV DNA quantification
Influenza virus A & B RNA
HCV RNA detection
JC & BK virus DNA
HIV serology
Metapneumovirus RNA
HIV-1 RNA quantification
Methicillin resistant [Link] DNA
Immunity screen
Neisseria gonorrhoeae DNA
Measles IgG serology
Norovirus RNA
MRSA screen
Parainfluenza virus RNA
Rubella IgG serology
Parechovirus RNA
Syphilis serology
RSV RNA
Toxoplasma serology
Viral gastroenteritis
Virus identification
VZV DNA
Viruses in CSF
Instand
QCMD Quality Control for [Link]
Molecular Diagnostics
HDV serology
[Link]
HEV IgG and IgM
Adenovirus DNA
Chlamydia trachomatis DNA Quality Control Centre Switzerland
([Link]).
CMV DNA
Lyme IgG and IgM
EBV DNA
Labquality (Finland)
Enterovirus RNA
[Link]
HBV DNA
Helicobacter Pylori antibodies
HBV drug resistance typing
Mycoplasma antibodies
HBV genotype
Parvovirus antibodies
HCV genotype
Interlaboratory Exchange samples
HCV RNA
16s
HEV RNA
Syphilis PCR
HIV DNA
KSHV (HHV8)
HIV 2 VL