Welcome to the State of California 

Neurologic Surveillance and Testing (NST)

What's New

The California Department of Public Health (CDPH) is currently conducting enhanced viral testing and surveillance for patients with acute flaccid paralysis. We are seeking information and specimens on patients meeting the following

Acute flaccid paralysis, including absent or significantly diminished reflexes in one or more limbs AND:

  • MRI showing grey matter involvment of the spinal cord OR
  • EMG showing anterior horn disease
  • With or without accompanying mental status changes
  • Without a confirmed traumatic, neoplastic, arboviral, or vascular etiology

If you are aware of a case meeting the following defintion or if you are interested in submitting patient samples, please complete the following steps:

To optimize laboratory testing, we are requesting the following sample types, collected as close to onset date as possible:

  • CSF (2-3cc, if available)
  • Acute phase serum, collected prior to treatment with IVIG (2-3cc in red or tiger-top tube)
  • Nasopharynx swab (in viral transport media)
  • Stool (quarter-sized amount in sterile wide-mouth container)

Please note that these specimen guidelines differ from those outlined for standard Neurologic Surveillance and Testing (NST) submissions. Instead of completing the normal 2-page case history form, we ask that you complete the AFP Case Summary Form instead. All other requirements remain the same.  Please submit specimens using the Specimen Submittal Form and we still require that submitters obtain approval from NST staff prior to submission. Submitters are also required to notify their local health departments of all cases tested through NST. Specimens will not be tested until the case has been reported to the local health department.

Samples can be sent on dry ice or cold packs to the below address for delivery Monday through Friday:

ATTN: Specimen Receiving
Viral and Rickettsial Disease Laboratory
850 Marina Bay Parkway
Richmond, CA 94804

If you are aware of a case meeting the above definition, or you are interested in submitting patient samples, please contact Anna Clayton (anna.clayton@cdph.ca.gov; 510‐620.3777) or Patrick Ayscue (patrick.ayscue@cdph.ca.gov; 510‐620‐5847).

About Neurologic Surveillance and Testing (NST)

Neurologic Surveillance and Testing (NST) was initiated in 2012 as a collaboration between the Communicable Disease Emergency Response (CDER) Branch and the Viral and Rickettsial Disease Laboratory (VRDL) at the California Department of Public Health (CDPH).  It is designed to provide consultation and limited diagnostic testing for neurologic illness presumed to be of infectious origin. 

Neurologic Surveillance and Testing was created after the closure of the California Encephalitis Project (CEP), which investigated thousands of encephalitis cases from 1998 through 2011.

Neurologic Surveillance and Testing staff will be available for consultation on cases of unusual or unexplained neurologic illness or clusters of illnesses, though testing will be offered for only a select group of patients. Cases that will be considered for testing include those that meet any of the following criteria:


Clinical Characteristics

Rapidly progressive encephalitis, paralysis with associated encephalitis, neurologic illness with associated rash, OR unexplained culture negative meningitis that appears to be bacterial.


Epi-links to other case(s) of neurologic illness; foreign travel <3 weeks; animal bite/scratch (especially wildlife); thought to be related to a recent immunization (<4 weeks); significant mosquito or tick exposure (e.g. outdoor activities in non-urban areas)

Unexplained Neuro-Deaths

Hallmarks of infection (e.g. fever, rash, CSF pleocytosis); in particular, pediatric deaths


Testing will be tailored to each case as determined by clinical picture, laboratory values, and exposure history. [Please note that anti-NMDA receptor testing is NOT performed at VRDL.]

Requirements for Sending Samples

Physicians must meet the following three requirements to submit samples for testing:

1. Physicians must obtain approval from NST PRIOR TO the submission of patient samples.  This can be accomplished by filling out the NST case history form and faxing it to 916-440-5940 or emailing  to NeuroSurveillance@cdph.ca.gov.  Physicians will be notified if their case is appropriate to send.

2. A completed 2-page Case History Form and Specimen Submittal Form must be sent along with a full set of specimens.  Required samples are:  

  • CSF (2-3cc, if available)
  • Acute phase serum, collected prior to treatment with IVIG (2-3cc in red or tiger-top tube)
  • Nasopharynx swab (in viral transport media)

Additional samples may also be requested, such as a rectal swab, stool, or convalescent serum. Tissues will be requested for autopsy cases, and additional samples may be requested for suspect rabies cases.

3. The local public health department must be notified of all cases submitted for testing. 

Specimens will NOT be tested unless all three requirements have been met. Please note that, regardless of NST’s involvement, ALL cases of encephalitis and meningitis should be reported to your local health department (as per Title 17, Section 2500).

NST Documents:

If a case is accepted for testing through NST, samples can be sent via overnight courier (such as FedEx or GSO) to the following address:

ATTN: Specimen Receiving
Neurologic Surveillance and Testing
850 Marina Bay Parkway
Richmond, CA  94804

Please send samples for delivery Monday through Friday ONLY as we are closed on weekends.


Physicians:  It is imperative that you include the name, pager number, and fax number for both a current physician caring for the patient, as well as the primary care physician, to ensure that results are relayed in a timely manner. 

Patients and family members:  Please contact the patient’s physician for test results.  We are unable to relay test results to anyone other than a physician caring for the patient in order to protect patient confidentiality. 

Contact Information:

For questions about Neurologic Surveillance and Testing, please contact:

Anna Clayton
Phone: (510) 620-3777
Fax: (916) 440-5940
Email: Anna.Clayton@cdph.ca.gov

In the event of an urgent clinical question or emergency, Dr. Carol Glaser can be reached at (510) 307-8613.

You may also contact the Viral and Rickettsial Disease Laboratory at (510) 307-8585.

Last modified on: 11/12/2014 9:32 AM