Avian Influenza (H5N1)

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Brief Description

Presumptive identification of Influenza A/H5N1 (Asian lineage)

Laboratory Unit



Real-Time RT-Polymerase Chain Reaction

Specimen Collection

Avian Flu Information

Avian Influenza Kit ONLY

Avian Influenza Testing for suspect cases of highly pathogenic avian influenza (H5N1) are available from the MSPHL only if indicated after a case investigation has been initiated. Refer to the Department of Health and Senior Service's (DHSS) Pandemic Influenza website, for instructions and to report any suspect case of avian influenza to DHSS.  Note: primary point of contact is Eddie Hedrick, Emerging Infections Coordinator (573-882-9881/(800) 392-0272)

Consultation with the MSHPL at 573-751-3334 is required prior to collecting clinical specimens.


Kits for the submission of avian influenza A (H5N1) specimens are certified for the transportation of infectious substances.  These kits will be provided only after consultation with the Department of Health and Senior Services State Public Health Lab. It is REQUIRED that specimens for avian influenza A (H5N1) testing are packed and shipped using the container and instructions supplied by the Missouri State Public Health Laboratory.  Please note that these are NOT the kits supplied for seasonal influenza surveillance.

Acceptable Specimen

Oropharyngeal swab
Autopsy Specimens
Paired serum
Nasopharyngeal Swab
Nasopharyngeal Wash
Bronchial Wash
Nasal Aspirate
Endotrachial Aspirate
See Avian Flu Information link above.

Test Request Form(s)

Virology Test Request Form

Possible Results

Results and interpretation will be provided after testing.

Reference Range


Unacceptable Conditions

Received warm
Improperly identified
Specimen not identified
Specimen not in viral transport medium
Not approved by MSPHL
Specimen collected with improper collection device
Specimen not an acceptable type

Interfering Substances

Use only viral transport medium and synthetic Dacron/flocked swab or equivalent.  Do not use wooden shaft or cotton swab.

Result Reported

Directly to submitting agency upon completion of testing.


None.  Testing performed only after laboratory consultation.

CPT Codes




Additional Information

Because the sensitivity of commercially available rapid diagnostic tests for influenza may not always be optimal, RT-PCR testing may be performed even if influenza rapid diagnostic testing is negative on patients meeting the clinical criteria for avian influenza infection.

Highly pathogenic avian influenza A (H5N1) is classified as a select agent and must be worked with under stringent Biosafety Level (BSL) 3+ laboratory conditions. Therefore, respiratory virus cultures should not be performed in most clinical laboratories and such cultures should not be ordered for patients suspected of having H5N1 infection.

Requests for Respiratory Virus collection kits (these kits should be requested for all novel strains of influenza including highly pathogenic avian influenza) should be directed to the SPHL at 573-751-3334. Instructions for specimen collection and transport may be found in the MO SPHL Avian Influenza Laboratory Information instruction sheet (below).

Refer to the CDC infection control precautions when collecting and handling laboratory specimens.

Avian Influenza (H5N1) Lab Fact Sheet

Laboratory Guidelines For Influenza Testing With The Presence Of Avian Influenza A H5N1

Pandemic Influenza

Agricultural Select Agent Program

CDC – Avian Flu