Specimen Collection Form

Zika Virus
Collection and submission of fetal tissues for Zika virus testing

Form Approved
OMB Control No: 0920-XXXX
Exp. Date: XX/XX/XXXX

General information
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Interim Guidelines for the Evaluation and Testing of Infants with Possible Congenital Zika Virus Infection — United
States, 2016 are available at http://www.cdc.gov/mmwr/volumes/65/wr/mm6503e3.htm.
Please make sure that your state or local health department and CDC have been notified and approved receipt of all
specimens before they are collected and shipped.
CDC Form 50.34 is required to be submitted with all specimens. For test order name, enter “Zika virus”. The form is
available at http://www.cdc.gov/laboratory/specimen-submission/pdf/form-50-34.pdf.
Please direct questions to pathology@cdc.gov.

Collection of fetal or infant tissues
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Before sending specimens to CDC
o Obtain appropriate consent to collect and send the specimens for Zika virus testing.
o Ensure that a portion of the tissue or products of conception is collected and routed for routine evaluation or
cytogenetics, as needed.
To optimize evaluation of possible Zika virus infection on fetal tissues, please provide both formalin fixed and frozen
tissues. If it is not possible to provide both types of tissue, prioritize formalin fixed tissues.
The type of tissues available for evaluation will depend on the gestational age of the fetus and the procedure that is
performed. Effort should be made to maintain the tissue architecture, and to minimize any dissection or disruption of the
tissues.
Collection tissue is most important to evaluate for possible Zika virus infection. Maintaining the structure of the brain
architecture is particularly important to help evaluate viral neuropathology.
Placenta should be sampled extensively (or submitted intact if early gestation); recommend several full thickness pieces of
the placental disk, membranes, umbilical cord, and any pathologic lesions.
If individual organs or tissue types can be easily identified at autopsy, please provide a 0.5-1.0 cm sample from each
major organ, including heart, lungs, liver, kidneys, skeletal muscle, and bone marrow. Sampling of eyes is highly
recommended.
For situations where individual organs or tissue types cannot be identified, please provide any available tissue with
minimal disruption.

Formalin fixed tissues
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Histopathology, immunohistochemical staining, and reverse transcription-polymerase chain reaction (RT-PCR) will be
performed on fixed tissues, as needed.
Tissues should be placed into one or more sterile containers containing adequate formalin.
Fixed tissues should be stored and shipped at room temperature.
Fixed tissues should be shipped to the:

Infectious Diseases Pathology Branch
Centers for Disease Control and Prevention
1600 Clifton Rd NE, MS G-32
Atlanta, Georgia 30329-4027
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More information about collecting, handling, and shipping formalin fixed tissues is available at
http://www.cdc.gov/ncezid/dhcpp/idpb/specimen-submission/index.html.
Additional questions should be directed to pathology@cdc.gov or 404-639-3133.

Public reporting burden of this collection of information is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing
data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a
person is not required to respond to a collection of information unless it displays a currently valid OMB Control Number. Send comments regarding this burden estimate
or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road NE,
MS D-74, Atlanta, Georgia 30333; ATTN: PRA 0920-XXXX

National Center for Emerging and Zoonotic Infectious Diseases
Division of Vector-Borne Diseases

Zika Virus
Frozen tissues
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RT-PCR can be performed on frozen tissues.
Fresh tissue should be placed into one or more sterile containers.
If samples are taken from individual organs, please provide at least a 0.25 cm square from each organ.
Frozen tissues should be stored at -70o Centigrade and shipped on dry ice. If dry ice is not available, tissues can be
shipped on wet ice but is not optimal.
Fixed tissues should be shipped to the:

Arboviral Diseases Branch Diagnostic Laboratory
Centers for Disease Control and Prevention
3156 Rampart Road
Fort Collins, Colorado 80521
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More information about collecting, handling, and shipping frozen tissues is available at
http://www.cdc.gov/ncezid/dvbd/specimensub/arboviral-shipping.html.
Additional questions should be directed to the Arboviral Diseases Branch at 970-221-6400.

Reporting of results
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Test results will be reported to the state health department and the submitting healthcare provider.
Turnaround time will vary and depend on testing volume.

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