Tick-Borne Encephalitis (TBE) Serology and PCR
Testing Indications
Tick-borne encephalitis (TBE) is a human viral infectious disease involving the central nervous system, and occurring in many parts of Europe and Asia. The virus is transmitted by the bite of infected ticks, found in woodland habitats. There are three main subtypes: European, Far Eastern (Russian Spring-Summer), and Siberian subtypes.
Most TBE virus (TBEV) infections are asymptomatic. When causing symptoms, TBE is most often manifested as a two-phased illness. The first phase is associated with symptoms that include fever, fatigue, headache, muscular ache, and nausea. The second phase involves the neurological system with symptoms of meningitis (inflammation of the membrane that surrounds the brain and spinal cord) and/or encephalitis (inflammation of the brain).2
The Far Eastern (Russian Spring-Summer) variety of TBE causes a monophasic illness, and usually results in more severe disease than the other two subtypes.
TBEV test requests are referred out to the National Microbiology Laboratory (NML) for testing. All specimen types for TBE require shipping under the Emergency Response Assistance Plan (ERAP)3 regardless of patient’s clinical status and reason for testing. Submitters should ensure that a Transportation of Dangerous Goods (TDG) certified individual is available to ship the specimens. PHO’s laboratory will assist in facilitation of the ERAP process during the shipment.
Testing for TBEV requires prior approval by PHO’s laboratory. Prior to submission - ideally after a physician has seen the patient but before specimens are collected - contact PHO’s Laboratory Customer Service Centre at 416-235-6556/1-877-604-4567 or the After-Hours Emergency Duty Officer at 416-605-3113.
Submission and Collection Notes
Effective October 3, 2022, the Arbovirus (Non-Zika) Testing Intake Form is a mandatory requirement for Tick-borne encephalitis virus testing. PHO’s laboratory utilizes the information on the requisition and the mandatory intake form to assess testing criteria, assign appropriate tests, and provide mandatory information required by NML for relevant testing performed there.
Clinical information must be provided on the requisition before testing will be performed. Specimens not meeting criteria will be rejected for testing. Under special circumstances, testing will be considered on a case-by-case basis.
Collect serum in red top or serum separator tubes (SST), centrifugation of serum tubes is not needed and should be avoided.
Molecular testing is not a routine test. NML will determine if molecular testing is appropriate after serological testing is complete.
Limitations
Haemolysed, icteric, lipemic or microbial contaminated CSF, sera or plasma are not recommended for testing.
Storage and Transport
Requests for TBEV testing require prior approval by PHO’s laboratory. Contact PHO’s laboratory at 416-235-6556 or 1-877-604-4567 before collecting and sending the specimens.
Label the specimen with the patient’s full name, date of collection, and one other unique identifier such as the patient’s date of birth or Health Card Number. Failure to provide this information may result in rejection or testing delay.
Follow institutional and provincial guidelines as well as Transport Canada’s Transportation of Dangerous Goods Regulations (TDGR), including their Shipping Infectious Substance Bulletin for specimen collection, transportation and storage. Store specimens in refrigerator or frozen until they are being shipped for testing. Serum can be shipped refrigerated or frozen. Avoid freezing whole blood samples. Tissues should be shipped frozen. Ship frozen specimens on dry ice and refrigerated specimens on ice packs.
Special Instructions
Specimens should be shipped out as Category A, UN 2814, and require initiation of ERAP. Contact PHO’s laboratory Customer Service Centre to request assistance in shipping these types of samples.
Test Frequency and Turnaround Time (TAT)
Turnaround time for the different methodologies is 14 calendar days from receipt of specimens at NML.
- TBEV serology (IgG and IgM) using Enzyme Linked Immunosorbent Assay (ELISA)
- TBE Molecular Detection (PCR)
Specimens are sent from the PHO’s laboratory to the Special Pathogens Section at NML for both ELISA and PCR testing.
Screening test: Detection of antibodies against TBE virus by ELISA
Confirmatory test: Molecular detection of TBE virus by PCR amplification
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