Neurologic Surveillance and Testing (NST)
The California Department of Public Health (CDPH) is currently conducting enhanced viral testing and surveillance for patients with acute flaccid myelitis (AFM). If your patient has acute onset of limb weakness, please visit the AFM web page for instructions on how to report and submit specimens.
For all other neurologic illness concerns, please follow normal Neurologic Surveillance and Testing (NST) procedures (see below).
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.|
|Exposures||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 requirements to submit samples for testing:
1. Physicians must obtain approval from NST PRIOR TO the submission of patient samples. Please contact Kristen Wendorf (Kristen.Wendorf@cdph.ca.gov; (510) 620-3735) or Cynthia Yen(Cynthia.Yen@cdph.ca.gov; (510) 620-3987) to obtain approval for specimen testing.
2. If testing is approved, a completed 2-page Case History Form and Specimen Submittal Form (provided upon approval) 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.
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. For questions about specimen submittal, please contact the Viral and Rickettsial Disease Laboratory at (510) 307-8585.
Specimens will NOT be tested unless all 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).
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.