Submitting Specimens for Rabies Testing

Key points

  • If rabies testing might be needed, healthcare providers and veterinarians must consult with their state health department and CDC before specimens are shipped for testing.
  • Qualified people who need to submit specimens for rabies testing must: collect the needed specimens; use appropriate shipping containers; complete the required forms; and package and ship the specimen according to regulations.
  • Proper labeling and documentation are needed to ensure the correct tests are run and that specimens are appropriately prioritized for testing.
Person wearing a lab coat and blue gloves carrying cardboard boxes.

Rabies specimen testing

The Rabies Laboratory at the CDC conducts many diagnostic tests to detect the rabies virus in humans and animals, which include:

Healthcare providers, veterinarians, and other medical professionals must follow the steps specified below when requesting, collecting, packaging, and shipping specimens to be tested for rabies.

Consultation

Before requesting testing and shipping specimens to CDC, you must consult with your state health department to determine if testing is necessary, what specimens should be submitted, and where the specimens should be sent. If you suspect a patient is suffering from rabies, you must consult with your state health department and CDC before collecting and shipping specimens. You can find the contact information for state health departments here and rabies consultations can be arranged by contacting Rabies@cdc.gov.

If after consultation it's decided that specimens need testing at the CDC National Rabies Reference Laboratory, you must contact the 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 make arrangements for the receipt of specimens.

Who is authorized to send specimens to CDC?

You may submit a specimen to the CDC for evaluation if the CDC Rabies Duty Officer authorizes you to submit specimens and are a(n):

  • 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

You may not submit specimens directly to CDC if you are not listed above.

If you are a patient, contact your physician or local health department.

Specimen collection

Specimens may contain infectious agents. You should know the health risks and handle, store, and dispose of them according to safety regulations. Follow the hyperlinks for more information about collecting specimens from humans and animals.

For rabies testing, the following specimens may be needed:

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.

Documentation to include

Human specimens (Skin biopsy, saliva, serum, and CSF should be submitted for each patient)

  • Complete the Possible Human Rabies-Patient Information Form [PDF – 2 pages] detailing the clinical history of the patient and 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. For more information about specimens that are required, see antemortem testing.
  • A separate completed CDC Form 50.34 must be submitted with each specimen type. If three different specimen types are submitted for one patient, three different CDC Form 50.34 should be submitted with these specimens.

Animals 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 Rabies Duty Officer to facilitate expedited testing.
    • Include a complete patient history with all the known information regarding the exposure.

Important information 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 this form.

Prior to shipping, provide the Rabies Duty Officer with any supportive documentation that is available (optional):

  • A cover letter outlining a brief clinical history with relevant demographic/epidemiologic information. This can help expedite testing if necessary.
  • A 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

Packaging and labeling guidelines

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.

Specimens must be stored at the correct temperature and arrive at CDC by a certain time. See test directory for Storage & Preservation of the Specimen Before Shipping.

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.

The submitter will be contacted if there is a discrepancy matching the specimen to the submission form. If clarification is not possible, the requested testing will be canceled.

Specimen Requirements Serum CSF Saliva Skin Tissue Brain Tissue Formal Fixed Tissues, Blocks, and Slides
Packaging guidelines for rabies specimens
Who is Eligible?
  • Persons suspected of having rabies (human)
  • Post-vaccination serological testing (human)*
  • Prospective serological monitoring (animal)*
 Persons suspected of having rabies (human)

 

 Persons suspected of having rabies (human)

 

 Persons suspected of having rabies (human)

 
  • Persons suspected of having rabies (human)
  • Animals suspected of having rabies (animal)
 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:
  • Transit time <3 days: Packaging must arrive at 8˚C or colder
  • Transit time 4 – 21 days: Packaging must arrive at -20˚C or colder
  • Transit times >21 days may not be eligible for testing
 <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.

  • Provide the shipper's package tracking number(s) to the Rabies Duty Officer as soon as it is available.

Contact information

Please ship specimens to the following address:

Rabies Duty Officer Centers for Disease Control and Prevention

RDSB/STATT Unit 89

1600 Clifton Road, NE

Atlanta, GA 30333

The CDC contact phone number, to be included on the shipping forms, is (404) 639-1050.

Resources

Specific regulations for the proper packaging, packing, marking and labeling, and shipping may be found at:

CDC Specimen Management

CDC Biosafety

International Air Transport Association (IATA)

Packing Instruction 650 (for UN 3373 Biological substance Category B) [PDF – 100KB]

Infectious Substances Classification pdf icon[PDF – 46KB]

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Content Source:
National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)