What's New?

Changing Methodology for Syphilis Testing 

The Michigan Department of Health & Human Services, Bureau of Laboratories (MDHHS/BOL) will be changing methodology for syphilis testing beginning May 14, 2018. MDHHS/BOL has been using the forward algorithm for syphilis where the initial screening is a non-treponemal test followed by a treponemal test. In effort to better serve our submitters, we will be switching to the reverse algorithm, where the initial screen will be a treponemal test followed by a non-treponemal test, if needed. When syphilis testing is ordered, we will perform Bio-Rad’s Total IgG/IgM Multiflow Immunoassay (MIA) on the BioPlex® 2200 instrument. If MIA results are nonreactive, no further testing will be performed. If MIA results are reactive or equivocal, testing will reflex to the Unheated Serum Reagin (USR) assay. If the USR result is nonreactive, the Treponema pallidum Particle Agglutination (TP-PA) assay will be performed as a supplemental treponemal assay (see algorithm here). 

The validation studies at BOL showed a 98% accuracy rate when comparing the BioPlex® 2200 Total IgG/IgM MIA with the  TP-PA method. Sensitivity/specificity rates were 99%/100% respectively. Currently MDHHS is using Bio-Rad’s IgG MIA platform. When switching to the new algorithm using Bio-Rad’s Total MIA assay, we will be capable of screening for both IgG and IgM antibodies, enabling us to detect earlier infection. This technology relies on the detection of IgG/IgM antibodies bound to beads coated with T. pallidum fusion protein (rTP47/rTP17), with the amount of antibody captured by the antigen measured as an antibody index (A.I.). Since testing is qualitative, possible results will be reported as NONREACTIVE, REACTIVE, EQUIVOCAL or INDETERMINATE. TP-PA testing will be run on all EQUIVOCAL and INDETERMINATE MIA samples with additional USR testing if required.   An interpretation guide (below) will be included on all reports.

Non-Treponemal (USR)/Treponemal Test Result Interpretation Guide
Nonreactive Treponemal (only) or
Nonreactive USR /Nonreactive Treponemal
No serologic evidence of syphilis infection.
Recommend additional testing consistent with clinical history findings*.
Reactive USR/Reactive Treponemal Presumptive evidence of syphilis infection.
Nonreactive USR/Reactive Treponemal Primary or latent infection, or previously treated or untreated syphilis.
Recommend additional testing consistent with clinical history findings*.
Reactive USR/Nonreactive Treponemal
(For special requests or forward algorithm testing)
Syphilis infection unlikely; biological false positive likely.
Recommend additional testing consistent with clinical history findings*.
Reactive MIA Total (IgG/IgM)/Nonreactive USR/Indeterminate or Atypical TP-PA (supplemental) Primary or latent infection, or previously treated or untreated syphilis.
Recommend additional testing consistent with clinical history findings*.
Equivocal MIA Total (IgG/IgM)/Nonreactive or Reactive USR/Indeterminate or Atypical TP-PA (supplemental) Indeterminate for syphilis infection; potentially early infection or false positive.
Recommend additional testing consistent with clinical history findings*.
Equivocal or Reactive MIA Total (IgG/IgM)/
Nonreactive USR/Nonreactive TP-PA (supplemental)
No serologic evidence of syphilis infection.
Recommend additional testing consistent with clinical history findings*.
Equivocal MIA Total (IgG/IgM)/Reactive USR/Nonreactive TP-PA (supplemental) Indeterminate for syphilis infection; potentially early infection or false positive.
Recommend additional testing consistent with clinical history findings*.

*Specimen may have been collected before the production of detectable antibody.   
If recent infection is suspected, submit a convalescent specimen in 2-4 weeks (or one week if patient is pregnant).   
The predictive value of a reactive USR test in the serologic diagnosis of syphilis is increased when combined with a reactive treponemal test. Interpretation of results must be used in conjunction with the clinical signs and symptoms, medical history and other clinical/laboratory findings.

For ordering testing, continue using the DCH-0583 test requisition form. Once requisition forms are updated, there will be an option to choose “SYPHILIS PANEL”. Until then, reverse algorithm testing will be performed on all syphilis USR requests.

For submitters currently using the using the forward algorithm or for those using the syphilis reverse algorithm at their institutions wanting only the TP-PA to confirm, submitters may request the syphilis TP-PA as a single test. In those cases, we will perform only the TP-PA.

 
If you have any questions please feel free to call or email using the contact information below.  

Kristine W. Smith, MT (ASCP)
Unit Manager/Bacterial & Viral Serology/Infectious Disease Division
Bureau of Laboratories/Michigan Department of Health & Human Services
3350 N. Martin Luther King Blvd.
Lansing, MI  48906
(517)-335-8100
Smithk8@michigan.gov

Diana Riner, PhD, MS
Virology Section Chief
Bureau of Laboratories/Michigan Department of Health & Human Services
3350 North Martin Luther King Jr Blvd
Lansing, Michigan  48906
517-335-8099
rinerd@michigan.gov

Updated 05/09/2018


Discontinuation of Zika Virus Screening 

Since May, 2016 the Michigan Department of Health & Human Services Bureau of Laboratories (MDHHS BOL) has offered screening for Zika virus antibodies and viral RNA due to the public health emergence of Zika virus. This testing also included Dengue virus and Chikungunya virus serology and molecular testing as part of an Emerging Arbovirus panel.

Due to budget constraints, as of March 20, 2018 the Bureau of Laboratories (BOL) will no longer be able to offer screening services for Zika virus testing. Several commercial laboratories now routinely offer Zika serology and PCR testing to offset the need for testing at MDHHS BOL. BOL will continue to serve as the Zika virus confirmatory testing center for Michigan residents who have had positive screening testing performed at another laboratory. Healthcare providers can also request Zika, Chikungunya, or Dengue virus testing at BOL by special arrangement by first contacting Epidemiology for pre-approval at 517-335-8165. 

Sample criteria for specimens approved for Zika virus testing at BOL will continue to include urine and serum from either pregnant women (symptomatic or asymptomatic) or symptomatic non-pregnant individuals with exposure through travel to a Zika virus endemic area, or unprotected sex with a partner who traveled, within 12 weeks of sample collection. Babies born with findings consistent with Zika virus infection may also be tested by arrangement.

As of March 20, 2018 all requests for Zika Virus testing at BOL must be approved through the Bureau of Epidemiology and Population Health at 517-335-8165.

Added 02/12/2018


Call for laboratory specimens positive for Hepatitis A IgM from SE Michigan due to ongoing outbreak

MDHHS is requesting that laboratories in Southeast Michigan submit all positive hepatitis A IgM serum specimens to the state laboratory in Lansing. MDHHS will forward these specimens to the Centers for Disease Control and Prevention (CDC) for genotyping.
Please see the notice here for further information.

Added 11/08/2017


MDHHS to screen newborns for two Lysosomal Storage Diseases (LSD) beginning August 7, 2017

The MDHHS Newborn Screening Laboratory begins screening for Lysosomal Storage Diseases -  Pompe disease and Mucopolysaccharidosis I (MPS I) - August 7, 2017.

Further Information for providers and the public can be found at www.michigan.gov/newbornscreening  under ‘Announcements’.

Added 08/07/2017


Laboratory System Podcasts

As a part of the May, 2013, Laboratory System Advisory Group meeting, a series of podcasts were developed on the value of the Michigan Laboratory System.   These podcasts can be viewed in either QuickTime or RealPlayer.

Your Public Health Laboratory System - Michigan
The Value of the State Public Health Laboratory
The Hospital Laboratory Role in the Public Health Laboratory System
The County Health Department's Role in the Public Health Laboratory System
State Public Health Role in Emergency Response
Epidemiology-Laboratory Collaboration.

added 08/29/2013


Blood Lead Testing Collection Videos

Filter Paper Collection Video- This video provides a step-by-step demonstration of proper specimen collection using filter paper.  It can be viewed at http://youtu.be/WAKcq3N3mow. 

Capillary Draw Collection Video- This video provides a step-by-step demonstration of proper specimen collection using a capillary vacutainer.  It can be viewed at http://youtu.be/TkYGbJI2VY4.

updated 7/17/13


Virtual Tour Available

Have you ever wanted to tour the State Public Health Laboratory?  Take a virtual tour now by viewing our new video.

updated 8/24/2011

 

 Rev. 03/20/2018