Anthrax
Laboratory confirmation requires at least one of the following:

• isolation of Bacillus anthracis from a clinical specimen
• demonstration of B. anthracis in a clinical specimen by immunofluorescence
• significant antibody titres developing in an appropriate clinical case

Congenital Rubella Syndrome
Laboratory confirmation requires at least one of the following:

• demonstration of rubella-specific IgM antibody
• infant rubella antibody level that persists at a higher level and for a longer period than expected from passive transfer of maternal antibody (that is, rubella titre that does not drop at the expected rate of a twofold dilution per month)
• isolation of rubella virus by culture
• detection of rubella virus nucleic acid.

Cronobacter Species Invasive Disease
Laboratory confirmation requires isolation of the organism from a normally sterile site eg. blood, cerebrospinal fluid, or aspirated urine.

All invasive isolates of Cronobacter spp. or yellow-pigmented Enterobacter species (if unable to further speciate) from neonates or infants should be referred to the Enteric Reference Laboratory at ESR for confirmation.

Cysticercosis
Laboratory confirmation requires:

• a microscopic or histological identification of cysticerci in tissue
• a reactive serology on serum or CSF in the context of suggestive radiological features on CT/MRI.

Diphtheria
Laboratory confirmation requires isolation of diphtheria toxin-producing corynebacteria from a clinical specimen such as nose, throat and skin swabs.

Hydatid Disease
Laboratory confirmation requires histopathological or other demonstration of live E. granulosus cysts or radiological or other organ imaging evidence of characteristic cystic disease with a positive serological test.

Leprosy
A clinically compatible syndrome with acid fast bacilli in biopsy or slit-skin smear OR a biopsy with characteristic pathological changes.

Murine Typhus
Laboratory confirmation by serology for Rickettsia typhi.

Novel Coronavirus
The Novel Coronavirus form is no longer in use. If notifying COVID-19, please use the COVID-19 case report form in EpiSurv.

Plague
Laboratory confirmation requires isolation of Y. pestis OR four-fold or greater rise in antibody to Y. pestis

Poliomyelitis
Laboratory confirmation requires isolation of poliovirus OR detection of poliovirus nucleic acid from a clinical specimen.

Accepted clinical specimens and reference laboratory information can be found on the Ministry of Health Communicable Disease Control Manual.

Primary Amoebic Meningoencephalitis
Laboratory confirmation requires demonstration in cerebrospinal fluid of the causative organism – usually Naegleria fowleri.

Q Fever
Laboratory definitive evidence for acute Q fever requires at least one of the following:

• detection of C. burnetii nucleic acid
• seroconversion or ≥4-fold increase in antibody level to phase II antigen in paired sera tested in parallel in the absence of recent Q fever vaccination.

Detection of C. burnetii nucleic acid by NAAT with negative serology results confirms acute Q fever; however, serial serological testing is required to monitor for chronic infection.

Laboratory suggestive evidence for acute Q fever requires at least one of the following:

• presence of IgM antibody to phase II antigen
• single raised convalescent IgG antibody to phase II antigen.

It is important to know the date on which the person became unwell. A serological response to Q fever vaccination is transient, but if the person has been vaccinated, the date of vaccination should be provided.

Rabies
Laboratory confirmation requires at least one of the following:

• isolation of rabies virus from skin snips, saliva, cerebrospinal fluid (CSF) or neural tissue
• detection of viral antigen in tissue
• detection of rabies neutralising antibody at a titre of at least 1:5 in serum or CSF (provided the patient is not immunised).

Rickettsial Disease
Laboratory confirmation requires seroconversion or significant or increase in IgG antibody titres between acute and convalescent sera OR detection of rickettsial nucleic acid

Severe acute respiratory syndrome (SARS)
Laboratory confirmation requires at least one of the following:

• detection of diagnostic levels of serum antibody to SARS-CoV
• isolation (for example, in cell culture) of SARS-CoV from a clinical specimen
• detection of SARS-CoV nucleic acid in two clinical specimens either collected from different sources or collected from the same source on different days.

Taeniasis
Laboratory confirmation requires microscopic identification of proglottids or eggs in the faeces or in the perianal region (eggs may not develop for up to 3 months).

Tetanus
A clinically compatible illness, as diagnosed by a medical practitioner.

Trichinellosis
Laboratory confirmation requires a demonstration of Trichinella larvae in tissue obtained by muscle biopsy OR positive serologic test for Trichinella.

MERS-CoV
Laboratory confirmation requires molecular diagnostic testing, including either a positive PCR on at least two specific genomic targets or a single positive target with sequencing on a second.

While PCR testing for MERS-CoV may be undertaken in any PC2 laboratory, positive samples should be sent to Institute of Environmental Science and Research (ESR) for confirmatory testing.