If you do not see an answer for your specific question, please contact Dr. Scott Lindquist, State Epidemiologist for Communicable Diseases, at scott.lindquist@doh.wa.gov or 206-418-5406 for additional guidance.
General Reporting Questions
Borderline, Indeterminate and Equivocal Results
Notifications to Public Health - What to Include
Condition-Specific Reporting Questions
Borderline, Indeterminate and Equivocal Results
Q: Are borderline, indeterminate and equivocal results notifiable to public health?
A: Yes, borderline, indeterminate and equivocal results are valuable for public health investigations and considered notifiable in Washington State.
IgG Results
Q: Should laboratories report any IgG results?
A: In Washington State, IgG results are notifiable to public health for the following agents/conditions:
- Arboviruses (West Nile virus, eastern and western equine encephalitis, dengue, St. Louis encephalitis, La Crosse encephalitis, Japanese encephalitis, Powassan, California serogroup, Chikungunya, Zika)
- Borrelia burgdorferi (Lyme disease)
- Brucella species (Brucellosis)
- Burkholderia mallei and pseudomallei
- Chlamydophila psittaci (Psittacosis)
- Coxiella burnetii (Q fever)
- Cryptosporidium (Cryptosporidiosis)
- Francisella tularensis (Tularemia)
- Hantavirus
- Leptospira species (Leptospirosis)
- SARS-associated coronavirus
- Variola virus (smallpox)
- Arenaviruses, bunyaviruses, filoviruses, flaviviruses (Viral hemorrhagic fever)
- Yellow fever virus
- Yersinia pestis (Plague)
Notifications to Public Health - What to Include
Q: What should be included in notifiable condition reports to public health?
A: There are specific data element requirements for 1) notifiable condition result notifications to public health and 2) specimen submissions sent to reference labs, as listed below.
| Required Data Element | Notifiable Condition Result Notifications to Public Health WAC 246-101-225(1) |
Specimen Submissions to Reference Labs WAC 246-101-205(3) |
|---|---|---|
| Patient Name | (j) Name of patient | (a) Patient name |
| Patient Address | (m) Full address of patient, or patient zip code at a minimum, when available in laboratory data base |
(b) Full address of patient, or patient zip code at a minimum, when available in laboratory data base |
| Patient DOB or Age | (l) Date of birth or age of patient, when available in laboratory data base |
(c) Date of birth or age of patient, when available in laboratory data base |
| Patient Sex | (k) Sex of patient, when available in laboratory data base |
(d) Sex of patient, when available in laboratory data base |
| Provider Name | (f) Requesting health care provider's name |
(e) Name of the principal health care provider |
| Provider Phone Number | (g) Requesting health care provider's phone number |
(f) Telephone number of the principal health care provider |
| Provider Address | (h) Requesting health care provider's address, when available |
(g) Address of the principal health care provider, when available |
| Test | (i) Test result | (h) Type of test requested |
| Specimen Type | (a) Type of specimen tested | (i) Type of specimen |
| Specimen Collection Date | (d) Date of specimen collection | (j) Date of specimen collection |
| Reporting Laboratory Name | (b) Name of reporting laboratory | |
| Reporting Laboratory Phone Number |
(c) Telephone number of reporting laboratory |
|
| Date Specimen Received by Reporting Laboratory |
(e) Date specimen received by reporting laboratory |
Please confirm your lab is reporting all required data elements in direct notifications to public health and with specimen submissions to reference labs.
Reference Lab Results
Q: Should labs report notifiable results performed at reference labs?
A: The Department of Health strongly prefers that original ordering labs and performing reference labs both report notifiable results. Why both? In general, performing reference labs send notifications to public health sooner and original ordering labs send notifications to public health with more complete patient and provider demographic information. Receiving results sooner is important for mitigating potential disease outbreaks. Receiving results with complete patient and provider demographic information is important for ensuring patients receive appropriate care and follow up. Each notification plays a valuable part in our ability to create a safer and healthier Washington State.
Please refer to the Notifiable Conditions Reporting letter for more information about what data is required to be included in direct notifications to public health and with specimen submissions to reference labs.
Antibiotic Resistant Organisms
Q: Which antibiotic resistant organisms are reportable to public health and requested for submission to the Washington State Public Health Laboratory?
A: Effective January 2017, Washington State Department of Health and Public Health Laboratories have expanded surveillance for antibiotic resistant organisms. Please refer to the Antibiotic Resistant Organisms Elaborations newsletter article for detailed information about this increased surveillance.
Please note, there are some requests that were in place prior to 2017 for all Washington labs and those requests continue. The additional requests, added in January 2017, apply only to sentinel laboratories. Select sentinel labs will be contacted directly by the Washington State Department of Health to work in partnership to expand our understanding of the organisms circulating in our state.
All Washington laboratories are requested to continue reporting or submitting specimens for the following, as listed on the Lab Reporting Poster:
| Request | Category | Family/Genus | Criteria (including CLSI breakpoints) |
|---|---|---|---|
| SUBMIT SPECIMEN to Washington State Public Health Lab | Carbapenem-resistant Enterobacteriaceae (CRE) | Enterobacteriaceae:
E. coli
Klebsiella spp. Enterobacter spp. |
Resistant to ≥ 1 carbapenem**:
|
| REPORT results to patient's local health jurisdiction within 24 hours | Carbapenem-producing CRE | Enterobacteriaceae:
E. coli
Klebsiella spp. Enterobacter spp. |
Suspected of producing carbapenemase* |
*Reporting of Carbapenem-producing enterobacteriaceae began in 2014
**Reporting of Carbapenem-resistant enterobacteriaceae began in 2012
Sentinel laboratories only are requested to submit specimens for the following:
| Request | Category | Family/Genus | Criteria (including CLSI breakpoints) |
|---|---|---|---|
| SUBMIT SPECIMEN to Washington State Public Health Lab | Expanded Multidrug-Resistant Organism (MDRO) Surveillance | Enterobacteriaceae:
E. coli
Klebsiella spp. Enterobacter spp. |
Resistant to colistin:
|
| Pseudomonas spp. | Resistant to ≥ 1 carbapenem:
|
||
| Suspected of producing carbapenemase | |||
Resistant to colistincolistin:
|
|||
| Acinetobacter spp. | Resistant to ≥ 1 carbapenem:
|
||
| Suspected of producing carbapenemase | |||
Resistant to colistin:
|
|||
Unusual Candida species:
|
Any of those specified or unidentified species |
***If labs experience a high volume of C. glabrata isolates and cannot send them all, every third or fifth isolate is acceptable. The Washington State Public Health Lab will work with you to find the optimal surveillance strategy for your lab.
Additional considerations:
- Please refer to the PHL Microbiology Laboratory Test Menu for detailed submission and testing information for each organism.
- Local health departments may have additional requests for antibiotic resistant organism reporting (as allowed per WAC 246-101-201).
Blood Lead
Q: What blood lead results are notifiable to public health?
A: All blood lead results are required to be reported to the Washington State Department of Health under the state notifiable conditions rule. Refer to the Blood Lead Reporting page for more information.
Carbapenem-resistant Enterobacteriaceae (CRE)
Q: Are Carbapenem-resistant Enterobacteriaceae results notifiable to public health?
A: Carbapenemase-producing CRE results are reportable to the patient's local health jurisdiction and CRE specimens are requested for submission to the Washington State Public Health Lab.
| Request | Category | Family/Genus | Criteria (including CLSI breakpoints) |
|---|---|---|---|
| SUBMIT SPECIMEN to Washington State Public Health Lab | Carbapenem-resistant Enterobacteriaceae (CRE) | Enterobacteriaceae:
E. coli
Klebsiella spp. Enterobacter spp. |
Resistant to ≥ 1 carbapenem**:
|
| REPORT results to patient's local health jurisdiction within 24 hours | Carbapenem-producing CRE | Enterobacteriaceae:
E. coli
Klebsiella spp. Enterobacter spp. |
Suspected of producing carbapenemase* |
Please note: Local health officers and departments may have additional reporting requests for CRE results. For more information about the Washington State Department of Health's CRE surveillance, please refer to the Communication Archive.
For additional information go to the following articles: Antibiotic Resistant Organisms (2016), CRE: Updated Case Definition article (2015), Changes to CRE Surveillance article (2014), and CRE & VRSA: Reporting and Specimen Submission document (2012).
Coccidioides
Q: Are Coccidioides Ab, IgG and Coccidioides Ab, IgM results notifiable?
A: Yes, both results are notifiable to public health, along with IgG results by any other method, such as immunodiffusion, complement fixation, latex agglutination. Isolate submission to the Washington State Public Health Laboratory (PHL) is also requested. Refer to Coccidioidomycosis Reporting Changes email and Coccidioidomycosis Reporting in Washington 9-08-14 attachment for more information.
Coronavirus
Q: Which coronaviruses are reportable to public health?
A: Labs are required to immediately notify the local health jurisdiction where the patient resides of positive Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV) results. Positive Middle East Respiratory Syndrome Coronavirus (MERS-CoV) results are also currently requested for reporting.
| Coronaviruses | Notifiable by Labs to Public Health |
|---|---|
| 229E | No |
| NL63 | No |
| OC43 | No |
| HKU1 | No |
| SARS-CoV | Yes |
| MERS-CoV | Yes |
| SARS-CoV-2 | Yes* |
Please submit any SARS-CoV postive and MERS-CoV positive specimens to the Washington State Public Health Lab.
* All SARS-CoV-2 testing results (negative and positive and inconclusive) are reportable. Specimens associated with a positive result must be submitted upon request.
Hepatitis
Q: Are HAV Ab, Total [IgG and IgM] results notifiable to public health?
A: No, Hepatitis A IgM positive results are reportable separately, but not in combination with IgG results.
Q: Are Anti-HBc EIA results notifiable to public health?
A: Yes, Anti-HBc IgM results are reportable to public health. Total Anti-HBc EIA results are not reportable to public health.
HIV
Q: HIV diagnostic testing practices have changed since the Washington Administrative Code (WAC) was updated in 2011. What HIV results should we report to public health?
A: In June 2014, CDC published updated recommendations for laboratory HIV testing (see Laboratory Testing for the Diagnosis of HIV Infection - Updated Recommendations). A positive HIV-1/HIV-2 screening result requires two or more confirmatory tests, as shown in this CDC recommended algorithm.
Using this algorithm, the HIV Surveillance Program requests that all of the following results be reported to Washington State Department of Health (non-King County residents) and Public Health - Seattle & King County (for King County residents):
- Positive initial screening results (HIV-1/2 antigen/antibody combination immunoassay)
- All, both positive and negative, confirmatory results. HIV-1/HIV-2 antibody differentiation immunoassay and HIV-1 NAT Immunoassay results notifiable to public health.
Q: Recombigen: Are HIV 1 and 2 Trinity Bio Tech Uni-Gold
A: Yes, these results help to determine a confirmed case of HIV.
Q: Are these tests notifiable to public health: HIV 1/2 Differentiation, HIV 1 Ab Multispot, HIV 2 Ab Multispot, HIV Interp?
A: Yes, these confirmatory tests are used to determine a case of HIV.
Influenza
Q: Are rapid flu test results notifiable to public health?
A: No, rapid flu tests do not pick up novel or unsubtypable influenza strains, which are the only notifiable influenza results. Therefore, rapid flu test results are not reportable to public health.
Malaria
Q: Are malaria speciation results notifiable to public health?
A: Positive malaria results are notifiable to public health. While Plasmodium speciation results are not reportable, the Department of Health strongly prefers to receive these results as well.
MRSA
Q: Is MRSA a notifiable condition?
A: No, MRSA is not a notifiable condition in Washington State.
Syphilis
Q: What results are notifiable in a syphilis serology panel?
A: Notify public health of any positive, reactive or titer results from a syphilis serology panel.
Tuberculosis
Q: Which tuberculosis results are reportable to public health?
A: Positive results for Mycobacterium tuberculosis complex (MTBC) culture, nucleic acid amplification (NAT or NAAT), and drug susceptibilities (molecular and culture based) are notifiable to the Department of Health (DOH) within 2 business days via approved electronic laboratory reporting or fax 206-364-1060. Specimen submission is required for MTBC positive isolate (earliest available isolate for the patient) to the DOH Public Health Lab within 2 business days.
Specimen submission to the Washington State Public Health Laboratory (WAPHL) is required for all acid-fast bacilli (AFB) cultures with a Mycobacterium tuberculosis positive result.
Vancomycin-resistant Staphylococcus aureus (VRSA)
Q: Are Vancomycin-resistant Staphylococcus aureus (VRSA) results notifiable to public health?
A: Yes. The Department of Health requests that labs notify the patient's local health jurisdictions within 24 hours when multidrug-resistant organisms, including Vancomycin-resistant Staphylococcus aureus, are identified. Isolate submission to the Washington State Public Health Laboratory (PHL) is also requested. Refer to CRE & VRSA: Reporting and Specimen Submission document for additional information.
Yersiniosis
Q: Which Yersinia species are notifiable to public health?
A: Yersinia enterocolitica and Y. pseudotuberculosis are the only two species reportable to public health when it is a confirmed culture. When using non-culture based laboratory methods (CIDT), laboratories are requested to report any non-plague Yersinia species.
Zika
Q: What Zika results are notifiable to public health?
A: Laboratories are requested to send positive and equivocal results of testing for Zika, with the exception of PRNT tests which are reportable for both positive and negative results. Refer to the Zika Reporting letter for additional information.
Please note: Blood banks, performing Zika testing for the sole purpose of screening the general blood supply, are only required to report positive Zika results.