Form CDC 55.31A CDC 55.31A US WHO Collaborating Laboratories Flu Testing Methods As

U.S World Health Organization (WHO) Collaborating Laboratories Influenza Testing Methods Assessment
Form Approved
OMB No. 0920-0004
Lab Name:
Lab ID Number:
1.

2.

3.

Does your lab test specimens that have already been
tested for influenza (prescreened) prior to receipt by
your laboratory AND the results of that test influence
whether or not the sample is submitted?
 No, the samples are not prescreened OR the
results have no impact on the decision of which
samples are sent
 Yes, we receive at least some prescreened
samples throughout the year.
o Approximate % prescreened
%
 Yes, we receive prescreened samples, but only
during certain times of the year.
o Timeframe
o Approximate % prescreened
%
If you answered ‘Yes’ in previous question, what
specimens do you request from prescreening sites?
 A pos. only
 A and B pos. only
 A, B pos. and small # of negative
 Other
Specify: _________________________
What influenza testing methods does your lab
conduct? (check all that apply and give approximate
percentage of specimens tested by each method. Total
% may be > 100%)
 Commercial rapid diagnostic
_____ %
 Viral culture
_____ %
 Immunofluorescent antibody testing _____ %
 RT-PCR
_____ %
 Other
_____ %
Specify: _________________________

4.

What best describes the origin of specimens received
in the last year? Please rank order the following
sources from 1 (source from which you obtain the
most specimens) to 6 (source from which you receive
the least specimens).
____ ILINet surveillance sites
____ Local health departments
____ Managed care
____ Private physicians
____ Hospitals
____ Other
Specify: _________________________

5.

Does your lab test for respiratory viruses other than
influenza? If yes, please answer a and b below.
 No
 Yes
a)

In what situations do you test respiratory
specimens for respiratory viruses other than
influenza? (check all that apply)
 If initial screening results are negative
for influenza
 During the summer or fall when
influenza circulation is not suspected
 If a particular viral pathogen is suspected
due to clinical symptoms
 If a clinician requests the test
 As part of a panel to screen for
respiratory viruses
 Never
 Other
Specify:

b) Does your lab use a multiplex PCR
respiratory virus assay? If yes, please specify
assay used.
 No
 Yes
Specify:

CDC 55.31A 9-95 This report is authorized by law (Public Health Service Act, 42 USC 241). Public reporting burden
for this collection of information is estimated to average 10 minutes per response, including time for reviewing
instructions, searching existing data sources, gathering and measuring the data needed, and completing and returning
the collection of information. Send comments regarding the burden estimate or any other aspect of the collection of
information, including suggestions for reducing the burden to PHS Reports Clearance Officer; ATTN: PRA, Hubert
H. Humphrey Bldg., Rm 721-B; 200 Independence Ave., SW; Washington, DC 20201, and to the Office of
Management and Budget; Paperwork Reduction Project (0920 0004); Washington, DC 20503.

Please fax completed survey to 1-888-232-1322.