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Chart 4: Laboratory Testing for Environmental Samples

Flow-chart depicting laboratory testing for suspect smallpox vaccine adverse event (vaccinia)
  1. Upon receipt of environmental samples, which law enforcement requires a credible threat assessment, initiate chain-of-custody documentation.
  2. Laboratory testing occurs in a LRN Reference Laboratory with Orthopoxvirus PCR capacity. All other laboratories refer.
  3. LRN Reference Laboratory with Orthopoxvirus PCR capabilities must use BSL-3 facilities to perform PCR screening panel for environmental biothreat agent DNA detection.
  4. If the Orthopoxvirus result from PCR screening panel is negative, Orthopoxvirus is ruled out.
    1. Assess need for further testing with law enforcement.
  5. If the Orthopoxvirus result from PCR screening panel is positive, Orthopoxvirus is possible.
    1. Perform Orthopoxvirus PCR assay to verify result from PCR screening panel.
      1. If Orthopoxvirus PCR is negative, Orthopoxvirus cannot be ruled out:
        1. Investigate the cause of discrepant PCR results between runs; implement corrective actions.
        2. If needed, contact CDC to discuss PCR results and the need for additional testing. The CDC Emergency Operations Center is available 24/7 at 770-488-7100.
      2. If Orthopoxvirus PCR is positive, Orthopoxvirus is possible:
        1. Contact CDC to submit specimen(s) for confirmatory testing and species typing. The CDC Emergency Operations Center is available 24/7 at 770-488-7100.

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