Reportable Diseases/Conditions

• Clinical Description Resource (CDC): Anthrax

• Culture and identification of B. anthracis or Bacillus spp. expressing anthrax toxins from clinical specimens; OR
• Demonstration of B. anthracis antigens in tissues by immunohistochemical (IHC) staining; OR
• Detection of antibodies to protective antigen (PA; one of the anthrax toxins) in sera using quantitative anti-PA IgG ELISA testing in an unvaccinated person; OR
• Detection of B. anthracis or anthrax toxin genes by polymerase chain reaction and/or sequencing in clinical specimens collected from a normally sterile site (e.g., blood, CSF) or lesion of other affected tissue (skin, pulmonary, reticuloendothelial, or gastrointestinal); OR
• Detection of lethal factor (LF) in clinical serum specimens by LF mass spectrometry or FDA cleared commercial assays (e.g., InBios AAD Plus and First Light Diagnostics SensiTox); OR
• Positive result from a laboratory developed test in a CLIA-accredited laboratory

• All suspect Bacillus anthracis isolates must be sent to the PHL.
• PHL Test Menu:  Highly Hazardous/Suspect Biothreat Organisms
• Call the 24/7/365 PHL Hotline at (405) 406–3511 to notify PHL staff prior to submission.

• A bioterrorism attack defined by CDC is the deliberate release of viruses, bacteria, or other germs (agents) used to cause illness or death in people, animals, or plants. These agents are typically found in nature, but it is possible that they could be changed to increase their ability to cause disease, make them resistant to current medicines or to increase their ability to be spread into the environment. Biological agents can be spread through the air, through water, or in food.
• Specific potential bioterrorism agents of concern include but are not limited to: Anthrax, Botulism, Plague, Smallpox, Tularemia and Viral Hemorrhagic Fevers.
• If a health care provider suspects bioterrorism as the cause for a patient’s clinical presentation, the Epidemiologist-on-Call must be notified immediately at (405) 426-8710. Once notified, the Epidemiologist-on-Call will provide an assessment of the situation and guidance for specimen submission and disease investigation.

• During the consultation with the Epidemiologist-on-Call, report all relevant laboratory testing results. Refer to the specific pathogen for specific laboratory reporting criteria.

• Must consult with the Epidemiologist-on-Call (405) 426-8710 for instructions on what specimens need to be collected for testing. 

• Clinical Description Resource (CDC): Botulism

• The Epidemiologist-on-Call is available for consultation 24/7/365 at (405) 426–8710 when botulism is suspected to assist in facilitating treatment with anti-toxin and laboratory testing (if botulism investigation criteria are met).
• Due to the potential for botulism to be used in bioterrorism, it should be reported immediately upon suspicion.

• Ingestion of a home-canned food within the previous 48 hours
• Persons who ate the same food as persons who have laboratory-confirmed botulism
• Person with a history of a fresh, contaminated wound during the 2 weeks before onset of symptoms
• History of injection drug use within the 2 weeks before onset of symptoms
• Person who received botulinum toxin administration in the 7 days before symptom onset.

• Detection botulinum toxin in serum, stool, other clinical specimen, or a patient’s food; OR
• Isolation of Clostridium botulinum from stool, wound, or other clinical specimen

• If Human Botulinum Antitoxin is released, the health care provider will be asked to submit specimens for testing. The Epidemiologist-on-Call (405) 426-8710 will provide instructions on what specimens need to be collected for testing.
• PHL Test Menu:  Highly Hazardous/Suspect Biothreat Organisms Botulism
• Call the 24/7 PHL Hotline at (405) 406–3511 to notify PHL staff prior to submission.

• Clinical Description Resource (CDC): Diphtheria

• The Epidemiologist-on-Call is available for consultation 24/7/365 at (405) 426–8710 when diphtheria is suspected to assist in facilitating treatment with antitoxin and laboratory testing (if diphtheria investigation criteria are met).

• Person reporting international travel in the 14 days prior to symptom onset
• Person without history of vaccination reporting direct contact to a confirmed case

• Isolation of C. diphtheriae from any site; OR
• Histopathologic diagnosis

• To assist with clinical diagnosis and informing the public health investigation, providers may be requested to submit specimens to the PHL.
• Providers must consult with the Epidemiologist-on-Call (405) 426-8710 for testing approval and instructions on what specimens need to be collected for testing.
• PHL Test Bacterial (Non-Enteric) Pathogen, Isolate Identification

• Clinical Description Resource (CDC): Amebic Meningitis

• The Epidemiologist-on-Call is available for consultation 24/7/365 at (405) 426–8710 when Primary Amebic Meningoencephalitis (PAM) or other free-living amebae infections are suspected.

• Person who has had contact with or been submerged in warm, fresh water in the 7 days prior to symptom onset.
• Use of tap water in medical use equipment such as a CPAP or sinus rinse device.

• Detection of Naegleria fowleri, Balamuthia mandrillaris, or Acanthamoeba spp. antigen or nucleic acid from a clinical specimen (e.g., immunohistochemical/immunofluorescent staining, PCR); OR
• Visualization of motile amebae in a wet mount of CSF; OR
• Isolation of N. fowleri, B. mandrillaris, Acanthamoeba spp. in culture from a clinical specimen

• To assist with clinical diagnosis and informing the public health investigation, providers may be able to submit specimens to the PHL.
• Providers must consult with the Epidemiologist-on-Call (405) 426-8710 for testing approval and instructions on what specimens need to be collected for testing.

• Clinical Description Resource (CDC): Hepatitis B
  • Hepatitis B is a vaccine-preventable liver infection. HBV is transmitted when blood, semen, or another body fluid from a person infected with the virus enters the body of someone who is uninfected. HBV can be either acute or chronic, and many people infected with hepatitis B virus won’t experience symptoms.

• CDC now recommends use of the triple panel test, which includes testing for:
  • BsAg
  • Anti-HBs
  • Total antibody to hepatitis B core antigen (total anti-HBc)
• Any periodic follow-up testing can use tests as appropriate based on the results of the triple panel.
• For all pregnant patients who are HBsAg-positive, clinicians should test for HBV DNA.
• Clinical Testing and Diagnosis for Hepatitis B
• Clinical Guidance for Perinatal Hepatitis B Testing

• If any of the HBsAg+, anti-HBc-IgM+, HBeAg+, or HBV DNA+ are positive, then all test results on the hepatitis panel must be reported.
• For infants ≤18 months, all hepatitis B related tests ordered, regardless of test result, must be reported.

• Different serologic markers or combinations of markers are used to identify different phases of HBV infection. They determine whether a patient has acute or chronic HBV infection, is immune to HBV as a result of prior infection, vaccination, or is susceptible to infection.
• Understanding Hepatitis B Blood Tests (Hepatitis B Foundation)

• Clinical Description Resource (CDC): Measles

• The Epidemiologist-on-Call is available for consultation 24/7/365 at (405) 426–8710 when measles is suspected.
• Measles is characterized by:
  • Generalized, maculopapular rash AND
  • Temperature ≥101°F or 38.3°C; AND
  • Cough, coryza, or conjunctivitis

In the 21 days prior to symptom onset:

• Contact of a confirmed measles case
• Belonging to a defined risk group during an outbreak
• Residence in a geographic area where measles is endemic or an outbreak of measles is occurring
• Travel during past 21 days to a geographic area where measles is endemic or an outbreak of measles is occurring

• Isolation of measles virus from a clinical specimen; OR
• Detection of measles-virus specific nucleic acid from a clinical specimen using polymerase chain reaction; OR
• A positive serologic test for measles immunoglobulin M antibody

• To assist with clinical diagnosis and informing the public health investigation, providers may be able to submit specimens to the PHL.
• Providers must consult with the Epidemiologist-on-Call (405) 426-8710 for testing approval and instructions on what specimens need to be collected for testing.

• Clinical Description Resource (CDC): Meningococcal Disease

• The Epidemiologist-on-Call is available for consultation 24/7/365 at (405) 426–8710 when meningococcal invasive disease is suspected.

• Gram-negative diplococci, not yet identified, isolated from a normally sterile body site (e.g., blood or CSF)
• Detection of N. meningitidis antigen
  • In formalin-fixed tissue by immunohistochemistry (IHC); OR
  • In CSF by latex agglutination
• Detection of N. meningitidis-specific nucleic acid in a specimen obtained from a normally sterile body site (e.g., blood or CSF), using a validated polymerase chain reaction (PCR) assay
• Isolation of N. meningitidis
  • From a normally sterile body site (e.g., blood or CSF, or less commonly, synovial, pleural, or pericardial fluid); OR
  • From purpuric lesions

• All sterile site Neisseria meningitidis isolates must be sent to the PHL.
• PHL Test Menu: Bacterial (Non-Enteric) Pathogen, Isolate Identification

• The Epidemiologist-on-Call is available for consultation 24/7/365 at (405) 426–8710 when a novel coronavirus infection is suspected.

• Travel to a foreign or domestic location with documented or suspected recent transmission of a Novel coronavirus, OR
• Close contact with a confirmed case of a Novel coronavirus disease, OR
• Close contact with a person with mild-to-moderate or severe respiratory illness and with history of travel in the 14 days before onset of symptoms to a foreign or domestic location with documented or suspected recent transmission of a Novel coronavirus

• To assist with clinical diagnosis and informing the public health investigation, providers may be requested to submit specimens to the PHL.
• Providers must consult with the Epidemiologist-on-Call (405) 426-8710 for testing approval and instructions on what specimens need to be collected for testing.

• Clinical Description Resource (CDC): Novel Influenza A

• The Epidemiologist-on-Call is available for consultation 24/7/365 at (405) 426–8710 when a novel influenza A infection is suspected.

• Close contact with a confirmed human case of novel influenza A virus infection
• Share a common exposure (such as an agricultural fair or live animal market) with a confirmed novel influenza A case
• Direct or indirect contact (such as touching an animal, their environment, or their raw or unprocessed animal products) with animals with confirmed or suspected influenza A
• Inadequate use or breach of personal protective equipment (PPE) and exposed to novel influenza A virus in a laboratory

• Positive or presumptive positive result for a novel influenza subtype (i.e. Unsubtypeable on most panels) using molecular diagnostic test, such as real-time polymerase chain reaction, on a clinical specimen, OR
• Isolation of a novel influenza virus from a clinical specimen, OR
• Genetic sequence indicative of novel influenza A strain, OR
• Virus testing results indicative of variant influenza, such as H1v or H3v, as determined in consultation with subject matter experts at CDC, OR
• Positive influenza A test result that is inconclusive for subtype or is negative for seasonal human influenza strains. If the assay provides a CT level for the influenza A target, only report those with CT value below 35.

• To assist with clinical diagnosis and informing the public health investigation, providers may be requested to submit specimens to the PHL.
• Providers must consult with the Epidemiologist-on-Call (405) 426-8710 for testing approval and instructions on what specimens need to be collected for testing.
• PHL Test Menu: Respiratory Infections

• The Epidemiologist-on-Call is available for consultation 24/7/365 at (405) 426–8710 when an outbreak of an infectious disease is suspected.
• Physicians, infection control preventionists, laboratorians, and other healthcare providers should report any cluster or outbreak of apparent infectious disease of known or unknown etiology regardless of whether it is a reportable disease.
• An outbreak of an apparent infectious disease is a cluster (two or more) of cases within different households. The cases would have a similar clinical syndrome of a potentially infectious disease, toxin, or agent of known or unknown etiology. Examples of such outbreaks include but are not limited to a cluster of cases of gastrointestinal illness, respiratory illness, or rash illness of known or unknown etiology.

• During the consultation with the Epidemiologist-on-Call (405) 426-8710, report all relevant laboratory testing results. Refer to the specific pathogen for specific laboratory reporting criteria.

• To assist with clinical diagnosis and informing the public health investigation, providers may be requested to submit specimens to the PHL.
• Providers must consult with the Epidemiologist-on-Call (405) 426-8710 for testing approval and instructions on what specimens need to be collected for testing.

• Clinical Description Resource (CDC): Mpox

The Epidemiologist-on-Call is available for consultation 24/7/365 at (405) 426–8710 when Mpox is suspected.

In the 21 days prior to symptom onset:

• Direct contact with a confirmed case or their surroundings such as objects, fabric, and other environmental surfaces
• International travel to a location experiencing ongoing transmission.
• Contact with an exotic animal.

• Detection of monkeypox virus nucleic acid by molecular testing in a clinical specimen; OR
• Detection of monkeypox virus by genomic sequencing in a clinical specimen; OR
• Detection of orthopoxvirus nucleic acid by molecular testing in a clinical specimen AND no laboratory evidence of infection with another non-variola orthopoxvirus; OR
• Detection of presence of orthopoxvirus by immunohistochemistry in tissue; OR
• Detection of orthopoxvirus by genomic sequencing in a clinical specimen; OR
• Detection of anti-orthopoxvirus Immunoglobulin M (IgM) antibody using a validated assay on a serum sample.

• To assist with clinical diagnosis and informing the public health investigation, providers may be able to submit specimens to the PHL.
• Providers must consult with the Epidemiologist-on-Call (405) 426-8710 for testing approval and instructions on what specimens need to be collected for testing.
• PHL Test Menu: Emerging Infectious Disease
• Call the 24/7 PHL Hotline at (405) 406–3511 to notify PHL staff prior to submission.

• Clinical Description Resource (CDC): Smallpox

• The Epidemiologist-on-Call is available for consultation 24/7/365 at (405) 426–8710 when smallpox is suspected.

• Polymerase chain reaction (PCR) identification of variola DNA in a clinical specimen, OR
• Isolation of smallpox (variola) virus from a clinical specimen (CDC only; confirmed by variola PCR).

• To assist with clinical diagnosis and informing the public health investigation, providers may be requested to submit specimens to the PHL.
• Providers must consult with the Epidemiologist-on-Call (405) 426-8710 for testing approval and instructions on what specimens need to be collected for testing.
• PHL Test Menu: Emerging Infectious Disease
• Call the 24/7 PHL Hotline at (405) 406–3511 to notify PHL staff prior to submission.

• Clinical Description Resource (CDC): Plague

• The Epidemiologist-on-Call is available for consultation 24/7/365 at (405) 426–8710 when plague is suspected.

In the 7 days prior to symptom onset:

• Travel to the western United States or international location considered endemic (Maps and Statistics | Plague | CDC)
• Contact with a sick animal, particularly cats
• Contact with an infected animal or bites from infected fleas.

• Any laboratory order for Y. pestis testing, including for culture, direct fluorescent antibody assay, or PCR, with or without results, OR
• Any identification of Y. pestis in a clinical laboratory (e.g., isolation or detection of Y. pestis specific antigens by fluorescent antibody assay, immunohistochemical assay, or PCR).

• All suspect Yersinia pestis isolates must be sent to the PHL. 
• PHL Test Menu: Highly Hazardous /Suspect Biothreat Organisms
• Call the 24/7 PHL Hotline at (405) 406–3511 to notify PHL staff prior to submission.

• Clinical Description Resource (CDC): Poliomyelitis

• The Epidemiologist-on-Call is available for consultation 24/7/365 at (405) 426–8710 when poliomyelitis or acute flaccid myelitis (AFM) is suspected. Because AFM cannot be differentiated from polio based on clinical symptoms only, lab testing must be done to rule out the presence of polio in those instances.
• Acute onset of flaccid paralysis with decreased or absent tendon reflexes in the affected limbs, in the absence of a more likely alternative diagnosis.

• Diagnostic test for poliovirus is ordered, OR
• Poliovirus detected in clinical specimen using a properly validated assay.

• To assist with clinical diagnosis and informing the public health investigation, providers may be requested to submit specimens to the PHL.
• Providers must consult with the Epidemiologist-on-Call (405) 426-8710 for testing approval and instructions on what specimens need to be collected for testing.

• Suspected cases of animal rabies should be reported immediately to the OSDH Epidemiologist on Call (405) 426-8710 for consultation regarding human and animal exposures and submission of specimens for testing by the Oklahoma Animal Disease Diagnostic Laboratory (OADDL).

• A positive rabies virus direct fluorescent antibody test; OR
• A positive rabies virus direct rapid immunohistochemical test (dRIT); OR
• A positive rabies virus test by immunohistochemistry (IHC) on formalin-fixed tissue; OR
• A positive pan-lyssavirus probe-based real time reverse transcription-polymerase chain reaction RT-PCR test; OR
• Detection of lyssavirus nucleic acid by genomic sequencing; OR
• Isolation of rabies virus (in cell culture or in a laboratory animal).

• Submitting an Animal for Rabies Testing | OSDH

• Clinical Description Resource (CDC): Human Rabies

• The Epidemiologist-on-Call is available for consultation 24/7/365 at (405) 426–8710 when human rabies is suspected.
• Rabies is an acute encephalomyelitis that almost always progresses to coma or death within 10 days after the first symptom.

• Reported animal bite or contact with a high-risk mammal (e.g., skunk, bat, etc.) in the last 3-12 months without administration of rabies postexposure prophylaxis.

• Detection of Lyssavirus antigens in a clinical specimen (preferably the brain or the nerves surrounding hair follicles in the nape of the neck) by direct fluorescent antibody test, OR
• Isolation (in cell culture or in a laboratory animal) of a Lyssavirus from saliva or central nervous system tissue, OR
• Identification of Lyssavirus specific antibody (i.e. by indirect fluorescent antibody (IFA) test or complete rabies virus neutralization at 1:5 dilution) in the cerebrospinal fluid (CSF), OR
• Identification of Lyssavirus specific antibody (i.e. by indirect fluorescent antibody (IFA) test or complete rabies virus neutralization at 1:5 dilution) in the serum of an unvaccinated person, OR
• Detection of Lyssavirus viral RNA (using reverse transcriptase-polymerase chain reaction [RT-PCR]) in saliva, CSF, or tissue.

• To assist with clinical diagnosis and informing the public health investigation, providers may be requested to submit specimens to the PHL.
• Providers must consult with the Epidemiologist-on-Call (405) 426-8710 for testing approval and instructions on what specimens need to be collected for testing.

• Clinical Description Resource (CDC): Typhoid Fever

• The Epidemiologist-on-Call is available for consultation 24/7/365 at (405) 426–8710 when typhoid fever is suspected.

• Recent travel to regions where typhoid is common, particularly South Asia and portions of Africa. Those who were not vaccinated at least 2 weeks prior to travel are at an increased risk of infection.
• Activities involving areas with inadequate hygiene and sanitation increase likelihood of exposure, including consumption of contaminated food and water.

• Typhoid Fever
  • Isolation of S. Typhi from a clinical specimen, OR
  • Detection of S. Typhi in a clinical specimen using a culture-independent diagnostic test (CIDT; e.g. polymerase chain reaction (PCR), nucleic acid amplification tests (NAATs) and immunoassays).
• Paratyphoid Fever
  • Isolation of S. Paratyphi A, B (tartrate negative), or C from a clinical specimen, OR
  • Detection of S. Paratyphi A, B (tartrate negative), or C in a clinical specimen using a culture-independent diagnostic test (CIDT).

• All Salmonella isolates (or specimens if no isolate is available) must be sent to the PHL.
• Laboratories should attempt to reflex culture positive Salmonella CIDT samples. If unable to perform reflex culture, submitters shall submit positive CIDT stool samples in modified Cary Blair transport media to the OSDH PHL ideally within 48-96 hours of collection. Specimens received > 96 hours (> 4 days) from time of collection will be tested for surveillance purposes only (results not reported to submitter).
• PHL Test Menu: Enteric Pathogen, Isolate Identification

• Clinical Description Resource (CDC): Viral Hemorrhagic Fevers

• The Epidemiologist-on-Call is available for consultation 24/7/365 at (405) 426–8710 when viral hemorrhagic fever (VHF) is suspected.

• Contact with a person who had known, or suspected VHF or any object contaminated by their body fluids
• Residence in or travel to a VHF endemic area or area with active transmission and participated in activities that could result in exposure to a VHF
• Handles specimens that contain or might contain replication competent VHF viruses
• Handles bats, rodents, or primates from a VHF endemic area or area with active transmission
• Exposure to body fluids (i.e., urine, saliva, sweat, vomit, breast milk, amniotic fluid, semen, aqueous humor, or cerebral spinal fluid) from a person who clinically recovered from a VHF.

• A person for whom a diagnostic test specific for VHF has been ordered, OR
• Detection of VHF-specific nucleic acid in blood or other body fluids, blood products, or tissues using a diagnostic molecular test (e.g., NAAT, genome sequencing), OR
• Detection of VHF-specific IgM by ELISA, OR
• Detection of VHF-specific IgG from a sample, OR
• VHF viral isolation in cell culture for blood, blood products (e.g., serum), or tissues.

• To assist with clinical diagnosis and informing the public health investigation, providers may be requested to submit specimens to the PHL.
• Providers must consult with the Epidemiologist-on-Call (405) 426-8710 for testing approval and instructions on what specimens need to be collected for testing.
• PHL Test Menu: Highly Hazardous /Suspect Biothreat Organisms
• Call the 24/7 PHL Hotline at (405) 406–3511 to notify PHL staff prior to submission.

• Clinical Description Resource (CDC): Tuberculosis

• Only if no additional testing is performed or subsequent testing is indicative of Mycobacterium tuberculosis complex.

• Any positive AFB smear without subsequent testing is required to be sent to the Oklahoma State Department of Health Public Health Laboratory (PHL). Please refer to the instructions in the PHL’s Laboratory Testing page for the proper procedures to send in isolates or specimens. A copy of the PHL Specimen Submission Form or a printout of the submitted web-based OSDH PHL Test Requisition Form must accompany each isolate. 

• Clinical Description Resource (CDC): HIV (AIDS)
  • Persons diagnosed with HIV receive an AIDS diagnosis when their CD4 cell count drops below 200 cells per microliter of blood, or develop certain illnesses, sometimes called opportunistic infections.
  • Opportunistic Infections | HIV.gov

• Specimens that meet HIV infection laboratory criteria AND,
• CD4+ cell count of less than 200 cells per microliter of blood

• Detection of A. phagocytophilum DNA in a clinical specimen via amplification of a specific target by polymerase chain reaction (PCR) assay, nucleic acid amplification tests (NAAT), or other molecular testing, OR
• Serological evidence of elevated IgG antibody reactive with A. phagocytophilum antigen by indirect immunofluorescence assay (IFA) at a titer ≥1:128, OR
• Microscopic identification of intracytoplasmic morulae in leukocytes, OR
• Demonstration of anaplasmal antigen in a biopsy or autopsy sample by immunohistochemical (IHC) methods, OR
• Isolation of A. phagocytophilum from a clinical specimen in cell culture with molecular confirmation (e.g., PCR, sequencing)

• Isolation of virus from, or demonstration of specific viral antigen or nucleic acid in, tissue, blood, CSF, or other body fluid, OR
• Virus-specific IgM antibodies in serum with confirmatory virus-specific neutralizing antibodies in the same or a later specimen, OR
• Virus-specific IgM antibodies in CSF or serum.

• Isolation of virus from, or demonstration of specific viral antigen or nucleic acid in, tissue, blood, CSF, or other body fluid, OR
• Virus-specific IgM antibodies in serum with confirmatory virus-specific neutralizing antibodies in the same or a later specimen, OR
• Virus-specific IgM antibodies in CSF and a negative result for other IgM antibodies in CSF for arboviruses endemic to the region where exposure occurred, OR
• Virus-specific IgM antibodies in CSF or serum.

• Isolation of virus from, or demonstration of specific viral antigen or nucleic acid in, tissue, blood, CSF, or other body fluid, OR
• Virus-specific IgM antibodies in serum with confirmatory virus-specific neutralizing antibodies in the same or a later specimen, OR
• Virus-specific IgM antibodies in CSF and a negative result for other IgM antibodies in CSF for arboviruses endemic to the region where exposure occurred, OR
• Virus-specific IgM antibodies in CSF or serum.

• Isolation of virus from, or demonstration of specific viral antigen or nucleic acid in, tissue, blood, CSF, or other body fluid, OR
• Virus-specific IgM antibodies in serum with confirmatory virus-specific neutralizing antibodies in the same or a later specimen, OR
• Virus-specific IgM antibodies in CSF and a negative result for other IgM antibodies in CSF for arboviruses endemic to the region where exposure occurred, OR
• Virus-specific IgM antibodies in CSF or serum.

• Isolation of virus from, or demonstration of specific viral antigen or nucleic acid in, tissue, blood, CSF, or other body fluid, OR
• Virus-specific IgM antibodies in serum with confirmatory virus-specific neutralizing antibodies in the same or a later specimen, OR
• Virus-specific IgM antibodies in CSF and a negative result for other IgM antibodies in CSF for arboviruses endemic to the region where exposure occurred. OR
• Virus-specific IgM antibodies in CSF or serum.

• To assist with clinical diagnosis and informing the public health investigation, providers may be able to submit specimens to the PHL.
• Providers must consult with the Epidemiologist-on-Call (405) 426-8710 for testing approval and instructions on what specimens need to be collected for testing.
• PHL Test Menu: Vector Borne and Zoonotic Diseases

• Clinical Description Resource (CDC): Brucellosis

• The Epidemiologist-on-Call is available for consultation 24/7/365 at (405) 426–8710 when brucellosis is suspected. If the brucellosis infection is suspected to be associated with bioterrorism, it should be reported immediately upon suspicion.

• Culture and identification of a presumptive Brucella spp. from clinical specimens, OR
• Detection of Brucella IgG antibodies by ELISA in a sample.

• All suspect Brucella species samples must be sent to the PHL.
• PHL Test Menu: Highly Hazardous /Suspect Biothreat Organism
• Call the 24/7 PHL Hotline at (405) 406–3511 to notify PHL staff prior to submission.

• Isolation of any Campylobacter spp. by culture in a clinical specimen from any source, OR

• Detection of any Campylobacter spp. using a culture-independent diagnostic testing (CIDT [e.g., polymerase chain reaction (PCR), nucleic acid amplification tests (NAATs), and immunoassays]) in a clinical specimen from any source.

• To assist with outbreak response, laboratories may be requested to forward clinical specimens or isolates to the PHL for testing. This testing would be directed and approved by the Epidemiologist-on-Call (405) 426-8710 prior to submission to the PHL.
• PHL Test Menu Enteric Pathogen, Isolate Identification

• Isolation of virus from, or demonstration of specific viral antigen or nucleic acid in, tissue, blood, CSF, or other body fluid; OR
• Virus-specific IgM antibodies in serum with confirmatory virus-specific neutralizing antibodies in the same or a later specimen; OR
• Virus-specific IgM antibodies in CSF or serum.

• Clinical Description Resource (CDC): Rubella

• Any infant diagnosed by a physician as having congenital rubella syndrome.

• Isolation of rubella virus, OR
• Detecting of rubella-specific immunoglobulin (IgM)antibody, OR
• A specimen that is PCR positive for rubella virus

• Evidence of Cryptosporidium organisms or DNA in stool, intestinal fluid, tissue samples, biopsy specimens, or other biological sample by certain laboratory methods with a high positive predictive value (PPV), e.g.,
  • Direct fluorescent antibody [DFA] test, OR
  • Polymerase chain reaction [PCR], OR
  • Enzyme immunoassay [EIA], OR
  • Light microscopy of stained specimen.

OR

• The detection of Cryptosporidium antigen by a screening test method, such as immunochromatographic card/rapid card test; or a laboratory test of unknown method.

• The detection of Cyclospora organisms or DNA in stool, intestinal fluid/aspirate, or intestinal biopsy specimens.

• To assist with outbreak response, laboratories may be requested to forward clinical specimens or isolates to the PHL for testing at CDC. This testing would be directed and approved by the Epidemiologist-on-Call (405) 426-8710 prior to submission to the PHL.

• Detection of dengue virus (e.g., growth in cell culture), viral antigen (e.g., NS1 antigen capture ELISA, immunohistochemistry), or viral RNA (e.g., PCR) in a serum, plasma, blood, cerebral spinal fluid (CSF), or tissue specimen, OR
• Detection of anti-DENV IgM or neutralizing antibodies in a serum or CSF specimen.

• Isolation of E. coli O157:H7 from a clinical specimen, OR
• Isolation of E. coli from a clinical specimen with detection of Shiga toxin or Shiga toxin genes, OR
• Isolation of E. coli O157 from a clinical specimen without confirmation of H antigen, detection of Shiga toxin, or detection of Shiga toxin genes, OR
• Identification of IgM or IgG antibody titer against a known Shiga toxin-producing serogroup of E. coli, OR
• Detection of Shiga toxin or Shiga toxin genes in a clinical specimen using a culture-independent diagnostic test (CIDT; e.g. polymerase chain reaction (PCR), nucleic acid amplification tests (NAATs) and immunoassays)) and no known isolation of Shigella from a clinical specimen, OR
• Detection of E. coli O157 or STEC/ Enterohemorrhagic E. coli (EHEC) in a clinical specimen using a CIDT.

• Laboratories should attempt to reflex culture positive STEC CIDT samples. If unable to perform reflex culture, submitters shall submit positive STEC CIDT stool samples in modified Cary Blair transport media to the OSDH PHL ideally within 48-96 hours of collection. Specimens received > 96 hours (> 4 days) from time of collection will be tested for surveillance purposes only (results not reported to submitter).
• All STEC isolates must be sent to the PHL.
• PHL Test Menu: Enteric Pathogen, Isolate Identification or Enteric Pathogens, Isolation and Identification

• Detection of Ehrlichia spp. DNA in a clinical specimen via amplification of a specific target by polymerase chain reaction (PCR) assay, nucleic acid amplification tests (NAAT), or other molecular testing, OR
• Serological evidence of elevated IgG antibody reactive with Ehrlichia spp. antigen by indirect immunofluorescence assay (IFA) at a titer ≥1:128, OR
• Microscopic identification of intracytoplasmic morulae in leukocytes, OR
• Demonstration of ehrlichial antigen in a biopsy or autopsy sample by immunohistochemical methods, OR
• Isolation of Ehrlichia spp. from a clinical specimen in cell culture with molecular confirmation (e.g., NAAT, PCR, sequencing).

• Detection of Haemophilus influenzae type b antigen in cerebrospinal fluid, OR
• Detection of Haemophilus influenzae-specific nucleic acid in a specimen obtained from a normally sterile body site (e.g., CSF, blood, joint fluid, pleural fluid, pericardial fluid), using a validated polymerase chain reaction (PCR) assay, OR
• Isolation of Haemophilus influenzae from a normally sterile body site (e.g., CSF, blood, joint fluid, pleural fluid, pericardial fluid).

• All sterile site Haemophilus influenzae must be sent to the PHL.
• PHL Test Menu: Bacterial (Non-Enteric) Pathogen, Isolate Identification

• Clinical Description Resource (CDC):
  • Hantavirus without pulmonary syndrome | Hantavirus | CDC
  • Hantavirus Pulmonary Syndrome | Hantavirus | CDC

The Epidemiologist-on-Call is available for consultation 24/7/365 at (405) 426–8710 when a hantavirus infection is suspected.

• Detection of hantavirus-specific IgM or titers of hantavirus-specific IgG, OR
• Detection of hantavirus-specific ribonucleic acid in clinical specimens, OR
• Detection of hantavirus antigen by immunohistochemistry in lung biopsy or autopsy tissues.

• To assist with clinical diagnosis and informing the public health investigation, providers may be requested to submit specimens to the PHL.
• Providers must consult with the Epidemiologist-on-Call (405) 426-8710 for testing approval and instructions on what specimens need to be collected for testing.
• PHL Test Menu: Vector Borne and Zoonotic Diseases

• Anemia (acute onset) with microangiopathic changes (i.e., schistocytes, burr cells, or helmet cells) on peripheral blood smear,

AND

• Renal injury (acute onset) evidenced by either hematuria, proteinuria, or elevated creatinine level (i.e., greater than or equal to 1.0 mg/dL in a child aged less than 13 years or greater than or equal to 1.5 mg/dL in a person aged greater than or equal to 13 years, or greater than or equal to 50% increase over baseline).

• Immunoglobulin M (IgM) antibody to hepatitis A virus (anti-HAV) positive, OR
• Nucleic acid amplification test (e.g., NAAT, PCR, genotyping) for hepatitis A virus RNA positive.

• Clinical Description Resource (CDC): Hepatitis B
  • Hepatitis B is a vaccine-preventable liver infection. HBV is transmitted when blood, semen, or another body fluid from a person infected with the virus enters the body of someone who is uninfected. HBV can be either acute or chronic, and many people infected with hepatitis B virus won’t experience symptoms.

• CDC now recommends use of the triple panel test, which includes testing for:
  • HBsAg
  • Anti-HBs
  • Total antibody to hepatitis B core antigen (total anti-HBc)
• Any periodic follow-up testing can use tests as appropriate based on the results of the triple panel.
• For all pregnant patients who are HBsAg-positive, clinicians should test for HBV DNA.
• Clinical Testing and Diagnosis for Hepatitis B
• Clinical Guidance for Perinatal Hepatitis B Testing

• If any of the HBsAg+, anti-HBc-IgM+, HBeAg+, or HBV DNA+ are positive, then all test results on the hepatitis panel must be reported.
• For infants ≤18 months, all hepatitis B related tests ordered, regardless of test result, must be reported.

• Clinical Description Resource (CDC): Hepatitis C
  • Hepatitis C is transmitted through exposure to infectious blood.
  • Most people with hepatitis C virus (HCV) infection do not have symptoms.

Clinical Screening and Diagnosis for Hepatitis C

In persons having jaundice or ALT ≥ 200 with laboratory confirmation:

• Hepatitis C EIA is confirmed by NAT for HCV RNA, OR
• Anti-HCV s/co ratio or index is predictive of a true positive
• Positive HCV RNA are reportable by both laboratories and providers.
• Negative HCV RNA are reportable by laboratories only. 

• Clinical Description Resource (CDC): HIV

• All HIV tests must be reported regardless of result, including HIV nucleotide sequences. (by laboratory only).
• All tests indicative of HIV infection are reportable by laboratories and providers:    
• Reactive on an initial laboratory-based antigen/antibody immunoassay to detect HIV-1 and HIV-2 antibodies and HIV-1 p24 antigen (HIV-1/HIV-2 Ag/Ab combination assay). Followed by a reactive on laboratory-based supplemental antibody immunoassay that differentiates HIV-1 antibodies from HIV-2 antibodies, OR
• HIV nucleic acid (DNA or RNA) detection (e.g., DNA polymerase chain reaction [PCR] or plasma HIV-1 RNA), OR
• HIV isolation (viral culture)
• For infants ≤ 18 months, all HIV tests ordered, regardless of test result, must be reported.

• Clinically compatible illness that was confirmed to be influenza by an appropriate laboratory or rapid diagnostic test AND
  • Hospitalized AND/OR
  • Died

Evidence of a positive influenza test by at least one of the following methods:

• Positive viral culture for influenza; OR
• Positive immunofluorescence antibody staining (Direct [DFA] or indirect [IFA]) for influenza; OR
• Reverse transcriptase polymerase chain reaction (RT-PCR) positive for influenza; OR
• Serologic testing positive for influenza; OR
• A positive, unspecified influenza test noted in the medical chart (e.g., a written note in the admission H&P or discharge summary); OR
• A positive commercially available rapid diagnostic test for influenza.

• Isolation of any Legionella organism from lower respiratory secretions, lung tissue, pleural fluid, or extrapulmonary site; OR
• Detection of any Legionella species from lower respiratory secretions, lung tissue, pleural fluid, or extrapulmonary site by a validated nucleic acid amplification test; OR
• Detection of Legionella pneumophila serogroup 1 antigen in urine using validated reagents; OR
• Detection of specific Legionella antigen or staining of the organism in lower respiratory secretions, lung tissue, pleural fluid, or extrapulmonary site associated with clinical disease by direct fluorescent antibody (DFA) staining, immunohistochemistry (IHC), or other similar method, using validated reagents.

• Isolation of Leptospira from a clinical specimen; OR
• Demonstration of Leptospira in tissue by direct immunofluorescence; OR
• Leptospira agglutination titer of ≥800 by Microscopic Agglutination Test (MAT) in one or more serum specimens; OR
• Detection of pathogenic (P1 clade) or intermediate (P2 clade) Leptospira DNA (e.g., by PCR) from a clinical specimen; OR
• Leptospira agglutination titer of ≥200 but < 800 by Microscopic Agglutination Test (MAT) in one or more serum specimens; OR
• Demonstration of anti-Leptospira antibodies in a clinical specimen by indirect immunofluorescence (IFA); OR
• Demonstration of Leptospira in a clinical specimen by darkfield microscopy; OR
• Detection of IgM antibodies against Leptospira in an acute phase serum specimen.

• Any person with L. monocytogenes isolated or detected from a normally sterile site, reflective of an invasive infection, by culture or CIDT (e.g. polymerase chain reaction (PCR), nucleic acid amplification tests (NAATs) and immunoassays); OR
• Any person with L. monocytogenes isolated or detected in a specimen from products of conception (e.g., placenta, amniotic fluid, umbilical cord blood) by culture or CIDT at the time of delivery; OR
• Any person with L. monocytogenes isolated or detected from a non-sterile neonatal site (e.g., meconium, tracheal aspirate) by culture or CIDT collected within 48 hours of delivery; OR
• Any person with L. monocytogenes isolated from a non-invasive clinical specimen (e.g., stool, urine, wound) other than those specified for maternal and neonatal specimens; OR
• Any person with isolation of Listeria species other than L. monocytogenes (such as L. ivanovii and L. grayi) from a normally sterile site that reflects invasive disease.

• All Listeria monocytogenes isolates must be sent to the PHL.
• PHL Test Menu: Enteric Pathogen, Isolate Identification

• Clinical Description Resource (CDC): Lyme
  • Hallmark symptom: Erythema migrans rash

• Isolation of B. burgdorferi or B. mayonii in culture, OR
• Detection of B. burgdorferi or B. mayonii in a clinical specimen by a B. burgdorferi group-specific NAAT assay, OR
• Detection of B. burgdorferi group-specific antigens by immunohistochemical assay on biopsy or autopsy tissues, OR
• Antibody to B. burgdorferi detected by EIA or IFA, OR
• An immunoblot test positive for B. burgdorferi-specific IgM or IgG

• Detection of circulating malaria-specific antigens using rapid diagnostic test (RDT), OR
• Detection of species specific parasite DNA in a sample of peripheral blood using a Polymerase Chain Reaction test. (Note: Laboratory-developed malaria PCR tests must fulfill CLIA requirements, including validation studies), OR
• Detection of malaria parasites in thick or thin peripheral blood films, determining the species by morphologic criteria, and calculating the percentage of red blood cells infected by asexual malaria parasites (parasitemia).

• All EDTA whole blood in which Plasmodium spp.  is suspected, must be sent to the PHL for confirmation and speciation. 
• PHL Test Menu: Vector Borne and Zoonotic Diseases

• Clinical Description Resource (CDC): Mumps

• The Epidemiologist-on-Call is available for consultation 24/7/365 at (405) 426–8710 when mumps is suspected.
• In the absence of a more likely alternative diagnosis:
  • An acute illness characterized by parotitis (i.e., acute onset of unilateral or bilateral tender, self-limited swelling of the parotid) or swelling of other (non-parotid) salivary gland(s), OR
  • An acute illness characterized by at least one of the following mumps-associated complication(s): orchitis, oophoritis, aseptic meningitis, encephalitis, hearing loss, mastitis, or pancreatitis.

• Person reporting international travel in the 30 days prior to symptom onset
• Person without history of vaccination reporting direct contact to a confirmed case.

• Positive reverse transcriptase polymerase chain reaction (RT-PCR) for mumps-specific nucleic acid; OR
• Isolation of mumps virus; OR
• Positive test for serum mumps immunoglobulin M (IgM) antibody

• To assist with clinical diagnosis and informing the public health investigation, providers may be able to submit specimens to the PHL.
• Providers must consult with the Epidemiologist-on-Call (405) 426-8710 for testing approval and instructions on what specimens need to be collected for testing.

• Clinical Description Resource (CDC): Pertussis

• The Epidemiologist-on-Call is available for consultation 24/7/365 at (405) 426–8710 when pertussis is suspected.
• In the absence of a more likely diagnosis, a cough illness of any duration, with at least one of the following signs or symptoms:
  • Paroxysms of coughing; OR
  • Inspiratory whoop; OR
  • Post-tussive vomiting; OR
  • Apnea (with or without cyanosis).

• Isolation of B. pertussis from a clinical specimen
• Polymerase Chain Reaction (PCR) positive for B. pertussis

• Isolation of Chlamydophila psittaci from respiratory specimens (e.g., sputum, pleural fluid or tissue) or blood, OR
• Detection of antibody (IgG) against C. psittaci by complement fixation (CF) or microimmunofluorescence (MIF) in serum specimens, OR
• Detection of antibody (IgM) against C. psittaci by CF or MIF in serum specimen, OR
• Detection of C. psittaci DNA in a respiratory specimen (e.g., sputum, pleural fluid or tissue) via amplification of a specific target by PCR assay. 

• Clinical Description Resource (CDC): Q Fever

• The Epidemiologist-on-Call is available for consultation 24/7/365 at (405) 426–8710 when Q fever is suspected. If the Q fever infection is suspected to be associated with bioterrorism, it should be reported immediately upon suspicion.

• Serological evidence of immunoglobulin G (IgG)- specific antibody titer to C. burnetii phase II antigen by indirect immunofluorescence assay (IFA), OR
• Detection of C. burnetii DNA in a clinical specimen via amplification of a specific target by polymerase chain reaction (PCR) assay, OR
• Demonstration of C. burnetii antigen in a clinical specimen by immunohistochemical methods (IHC), OR
• Isolation of C. burnetii from a clinical specimen by culture, OR
• Single IFA IgG titer of ≥1:128 to phase II antigen, OR
• Serologic evidence of elevated IgG or IgM antibody reactive with C. burnetii antigen by enzyme-linked immunosorbent assay (ELISA), OR
• Serologic evidence of elevated IgG or IgM antibody reactive with C. burnetii antigen by dot-ELISA, OR
• Serologic evidence of elevated IgG or IgM antibody reactive with C. burnetii antigen by latex agglutination

• Clinical Description Resource (CDC): Rubella

• The Epidemiologist-on-Call is available for consultation 24/7/365 at (405) 426–8710 when rubella is suspected. 

• Gave birth to an infant with confirmed congenital rubella, OR
• International travel prior to rash onset in an individual without history of vaccination, OR
• Recent contact with a laboratory-confirmed rubella or congenital rubella case.

• Detection of rubella virus (e.g., RT-PCR, culture, next generation sequencing [NGS]), OR
• Positive serologic rubella IgM antibody AND low IgG avidity, OR
• Positive serologic rubella IgM antibody.

• Detection of Salmonella spp. in a clinical specimen using a culture-independent diagnostic testing (CIDT [e.g., polymerase chain reaction (PCR), nucleic acid amplification tests (NAATs), and immunoassays]), OR
• Isolation of Salmonella spp. from a clinical specimen.

• Laboratories should attempt to reflex culture positive Salmonella CIDT samples. If unable to perform reflex culture, submitters shall submit positive CIDT stool samples in modified Cary Blair transport media to the OSDH PHL ideally within 48-96 hours of collection. Specimens received > 96 hours (> 4 days) from time of collection will be tested for surveillance purposes only (results not reported to submitter).
• All Salmonella isolates (or specimens if no isolate is available) must be sent to the PHL.
• PHL Test Menu: Enteric Pathogen, Isolate Identification or Enteric Pathogens, Isolation and Identification

• Detection of SARS-CoV-2 nucleic acid in a clinical or post-mortem specimen using a diagnostic molecular test (e.g., NAAT) performed by a CLIA-certified provider, OR
• Detection of SARS-CoV-2 RNA in a clinical or post-mortem specimen by genomic sequencing, OR
• Detection of SARS-CoV-2 specific antigen by diagnostic immunocytochemistry staining performed by a CLIA-certified provider, OR
• Detection of SARS-CoV-2 specific antigen in a clinical or post-mortem specimen using a diagnostic test performed by a CLIA-certified provider

• PHL Test Menu: SARS-CoV-2 Virus Surveillance

• Detection of Shigella spp. or Shigella/enteroinvasive E. coli (EIEC) in a clinical specimen using a culture-independent diagnostic testing (CIDT [e.g., polymerase chain reaction (PCR), nucleic acid amplification tests (NAATs), and immunoassays]), OR
• Isolation of Shigella spp. from a clinical specimen.

• Any patient with laboratory evidence of Spotted Fever Rickettsiosis (SFR) (including RMSF) including any of the following:
  • Detection of SFGR nucleic acid in a clinical specimen via amplification of a Rickettsia genus- or species-specific target by polymerase chain reaction (PCR) assays, OR
  • Elevated IgG antibody titer in one or more serology samples reactive with SFGR antigen by IFA, OR
  • Demonstration of SFGR antigen in a biopsy or autopsy specimen by IHC, OR
  • Isolation of SFGR from a clinical specimen in cell culture and molecular confirmation (e.g., PCR or sequence).

• Isolation of group A Streptococcus (Streptococcus pyogenes) by culture from a normally sterile site (e.g., blood or cerebrospinal fluid, or, less commonly, joint, pleural, or pericardial fluid)

• Isolation of S. pneumoniae from a normally sterile site (e.g., blood, cerebrospinal fluid, or, less commonly, joint, pleural, or pericardial fluid)
• Identification of S. pneumoniae by culture-independent diagnostic test (CIDT [e.g. PCR, antigen based tests]) from a normally sterile body site

• Clinical Description Resource (CDC): Syphilis
  • Syphilis is a sexually transmitted infection that develops in stages, with each stage having different signs and symptoms. Common symptoms include chancres (sores), rashes (often on the palms of the hands and bottom of the feet), swollen lymph nodes, patchy hair loss, condyloma lata as well as other general symptoms such as fever and fatigue.

• Demonstration of T. pallidum by darkfield microscopy, direct fluorescent antibody (DFA-TP), or equivalent methods in clinical specimens from lesions, placenta, umbilical cord, or autopsy material, OR
• All reactive serologic tests on a nontreponemal test (Venereal Disease Research Laboratory [VDRL] or Rapid Plasma Reagin [RPR]), OR
• All reactive serologic tests on a on a treponemal test (Fluorescent Treponemal Antibody Absorbed [FTA-ABS] or Microhemagglutination Assay for antibody to T. pallidum [MHA-TP], or equivalent Treponema pallidum particle agglutination [TPPA], OR
• Reactive VDRL in cerebrospinal fluid (CSF), OR
• For infants ≤ 18 months, all syphilis related tests ordered, regardless of test result, must be reported.

Note: If any syphilis test is positive, then all syphilis test results on the panel must be reported.

• Clinical Description Resource (CDC): Tetanus

• The Epidemiologist-on-Call is available for consultation 24/7/365 at (405) 426–8710 when tetanus is suspected. Tetanus is reported based on clinical suspicion only. There is no laboratory testing available.
• In the absence of a more likely diagnosis, an acute illness with:
  • Muscle spasms or hypertonia, AND
  • Diagnosis of tetanus by a health care provider

• Demonstration of Trichinella larvae in tissue obtained by biopsy, OR
• Positive serologic test for Trichinella, OR
• Demonstration of Trichinella larvae in the food item.

• Clinical Description: Tuberculosis (TB) | Tuberculosis (TB) | CDC

• Isolation of M. tuberculosis from a clinical specimen (Use of rapid identification techniques for M. tuberculosis e.g., DNA probes and mycolic acids high-pressure liquid chromatography performed on a culture from a clinical specimen are acceptable under this criterion), OR
• Demonstration of M. tuberculosis from a clinical specimen by Polymerase Chain Reaction (PCR), a molecular diagnostic technique that amplifies and detects specific DNA sequences of Mycobacterium tuberculosis, the bacterium responsible for tuberculosis

• Any AFB smear or culture positive for M. tuberculosis is required to be sent to the Oklahoma State Department of Health Public Health Laboratory (PHL). Please refer to Mycobacteria in the PHL Laboratory Testing page for the proper procedures to send in isolates or specimens. A copy of the OSDH PHL Test Requisition Form or a printout of the submitted web-based PHL Lab Test Requisition Form must accompany each isolate. A copy of the form and instructions to submit an electronic laboratory requisition is located in the PHL Section of this manual.

• Clinical Description Resource (CDC): Tularemia

• The Epidemiologist-on-Call is available for consultation 24/7/365 at (405) 426–8710 when tularemia is suspected. If the tularemia infection is suspected to be associated with bioterrorism, it should be reported immediately upon suspicion.

• Positive result on F. tularensis serum antibody assay, OR
• Isolation or detection of F. tularensis in a clinical or autopsy specimen by fluorescent assay or polymerase chain reaction (PCR).

• All suspect Francisella tularensis isolates must be sent to the PHL.
• PHL Test Menu: Highly Hazardous/Suspect Biothreat Organisms
• Call the 24/7 PHL Hotline at (405) 406–3511 to notify PHL staff prior to submission.

• Physicians, Infection Preventionists, laboratories, and other healthcare providers should report any unusual disease or syndrome. "Unusual disease or syndrome" means a case of an uncommon, possibly infectious disease of known or unknown etiology, even if laboratory testing may be pending or inconclusive, or if testing for common etiologies is negative. Such cases of disease may not normally be endemic to Oklahoma, may be an emerging or re-emerging disease, and/or represent diseases for which a public health intervention may be needed. Examples of such unusual diseases or syndromes include but are not limited to, unexplained adult respiratory distress syndrome, rash illness with atypical presentation, or an illness occurring along with an unusual pattern of illness or death among animals.
• Unusual diseases or syndromes must be reported to the Epidemiologist-on-Call by telephone (405-426-8710) or electronically via the secure web-based PHIDDO system using “Unusual Syndrome or Uncommon Disease – non-urgent” or “Unusual Syndrome or Uncommon Disease – Urgent” as the disease/condition. Healthcare providers should use “Unusual Syndrome or Uncommon Disease – Urgent” as the disease/condition if immediate consultation and investigation is needed based on the severity of the disease or unusual pattern of illness.

• Consult with the Epidemiologist-on-Call for instructions on what specimens need to be collected for testing.

• Cholera
  • Isolation of toxigenic (i.e., cholera toxin-producing) Vibrio cholerae O1 or O139 by culture from stool or vomitus, OR
  • Serologic evidence of recent infection
• Vibriosis (Non-O1 or O139 cholerae)
  • Detection of a species of the family Vibrionaceae (other than toxigenic Vibrio cholerae O1 or O139, which are reportable as cholera) from a clinical specimen using a culture-independent diagnostic test, OR
  • Isolation of a species of the family Vibrionaceae (other than toxigenic Vibrio cholerae O1 or O139, which are reportable as cholera) from a clinical specimen.

• Vibrio species isolates (V cholera, V vulnificus, V parahaemolyticus) must be sent to the PHL.  
• PHL Test Menu: Enteric Pathogen, Isolate Identification

• Isolation of virus from, or demonstration of specific viral antigen or nucleic acid in, tissue, blood, CSF, or other body fluid, OR
• Virus-specific IgM antibodies in serum with confirmatory virus-specific neutralizing antibodies in the same or a later specimen, OR
• Virus-specific IgM antibodies in CSF and a negative result for other IgM antibodies in CSF for arboviruses endemic to the region where exposure occurred, OR
• Virus-specific IgM antibodies in CSF or serum.

• Isolation of yellow fever virus from, or demonstration of yellow fever viral antigen or nucleic acid in, tissue, blood, CSF, or other body fluid; OR
• Yellow fever virus-specific IgM antibodies in CSF or serum with confirmatory virus-specific neutralizing antibodies in the same or a later specimen; OR
• Yellow fever virus-specific IgM antibodies in CSF or serum, and negative IgM results for other arboviruses endemic to the region where exposure occurred.

• To assist with clinical diagnosis and informing the public health investigation, providers may be able to submit specimens to the PHL.
• Providers must consult with the Epidemiologist-on-Call (405) 426-8710 for testing approval and instructions on what specimens need to be collected for testing.

• Detection of Zika virus, viral antigen, or viral RNA in any body fluid or tissue (e.g., blood, CSF, amniotic fluid, placenta, umbilical cord, cord blood, postmortem tissue); OR
• Detection of Zika virus IgM antibodies in adult or infant blood or CSF

Clinical Care of HIV | HIV Nexus | CDC

• A CD4 count is a blood test that measures the number of CD4 cells, which are a type of white blood cell crucial for the immune system.
• It helps assess the impact of HIV on the immune system and monitor the effectiveness of antiretroviral therapy (ART). 

• All CD4 cell count with cell count % must be reported.
• A normal CD4 count typically ranges from 500 to 1,500 cells per cubic millimeter of blood; lower counts indicate a weakened immune system and a higher risk of opportunistic infections.

About Chlamydia | Chlamydia | CDC

• Isolation of C. trachomatis by culture, OR
• Demonstration of C. trachomatis in a clinical specimen by detection of antigen or nucleic acid.

• Clinical Description Resource (CDC): LGV
• Report as Chlamydia and designate as LGV

• Isolation of C. trachomatis, serotype L1, L2, or L3, from clinical specimen, OR
• Demonstration by immunofluorescence of inclusion bodies in leukocytes of an inguinal lymph node (bubo) aspirate, OR
• Positive microimmunofluorescent serologic test for a lymphogranuloma venereum strain of C. trachomatis (in a clinically compatible case)

• Positive RT-QuIC in cerebrospinal fluid (CSF) or other tissues, OR
• Positive histopathology, immunohistochemistry, Western blot, or prion analysis of autopsy or biopsy tissue for CJD, OR
• Presence of CJD protein marker 14-3-3 in cerebral spinal fluid (CSF).

About Gonorrhea

• Isolation of typical gram-negative, oxidase-positive diplococci (presumptive Neisseria gonorrhoeae) from a clinical specimen, OR
• Demonstration of N. gonorrhoeae in a clinical specimen by detection of antigen or nucleic acid, OR
• Observation of gram-negative intracellular diplococci in a urethral smear obtained from a male.

• If there is concern for a drug-resistant gonorrhea, contact the Sexual Health and Harm Reduction Service (405) 426-8400.

Clinical Care of HIV | HIV Nexus | CDC

• HIV RNA (viral load) is a surrogate marker of antiretroviral therapy (ART) responses and HIV disease progression that is used to manage and monitor HIV infection.
• High viral load is generally considered to be above 100,000 copies/mL, while an undetectable viral load is defined as less than 20 copies/mL
• Undetectable = Untransmittable/Treatment as Prevention

• All HIV viral load tests (detectable and undetectable) must be reported.
• HIV viral load is measured in copies of HIV RNA per milliliter of blood, indicating the number of HIV RNA copies present in a milliliter.