Oral fluid kit tests for patients

Surveillance testing for vaccine preventable infections  

UK Health Security Agency (UKHSA) undertake routine surveillance testing of many infections and often this is through samples already collected for clinical purposes being sent on to the reference laboratories, however, for a small number of infections, test kits called Oral Fluid Kits (OFKs), are sent out following a clinical notification in order to collect new samples for analysis.  These tests support our ongoing robust surveillance testing, which in turn support work toward reducing the burden of infection and aim to eliminate infections such as rubella and measles.  This relies on high uptake of the testing from patients and your support as clinicians is vital to help this work. 

Who receives tests? 

Currently test kits are sent to patients with suspected measles, mumps, rubella and some pertussis infections. In some specific situations they may also be sent for other infections such as to the household contacts of patients with Hepatitis A where the source of infection is unclear.  All individuals who have been notified to the HPT by primary or secondary care with suspected measles, mumps or rubella infections will receive a postal test kit.  This will also include individuals with these infections who have already been tested locally even if these local results were found to be positive. This is to ensure a sample is sent to the reference lab for further detailed analysis.  Individuals with suspected pertussis/whooping cough will also be sent a kit but only if they are aged between two and 17 years and have not received a pertussis vaccine in the last 12 months, therefore you may be asked by the HPT for vaccination dates to confirm if they are eligible for a kit. 

What should your patients expect? 

After you have notified a suspected case of measles, mumps, rubella or pertussis who is eligible for testing, these individuals will be sent an oral fluid kit through the post.  The kit will arrive a few days later in a box that fits through their letter box.  It contains instructions on how to use the kit including labelling the forms and sample tube, advice on how to swab the gum line for two minutes; and the samples also come with a free post envelope to return the sample through the post.  Results often take a couple weeks to come back and will be sent to the patient’s GP. 

Why are the kits sent? 

Surveillance is a key remit of UKHSA and in particular strengthening surveillance for measles and rubella is part of the UK elimination strategy.  These tests are different to tests you may take for clinical investigations to guide treatment plans, as the tests often take a couple weeks to process and return results for.  If more urgent testing is required for clinical management you may need to speak with your local laboratory to discuss the options available.  If urgent testing is required for public health purposes the HPT will arrange more rapid testing; for example this would be undertaken for a patient with suspected measles infection where high risk contacts that may require immunoglobulin are identified.   The routine surveillance testing depends on the suspected infection but can include disease specific immunoglobulins (such as measles IgG, IgM), RNA (such as measles via PCR if the sample was taken within seven days of onset of suspected measles rash), genotyping (such as for measles to provide distinction between wild type and post vaccine rash) and sometimes additional testing for differential infections is undertaken including scarlet fever, flu, and chickenpox. 

How are results reported? 

The patient’s registered GP should receive the results from an oral fluid kit a few weeks after the case was notified to the HPT.  The results are also received by the HPT who will follow up on any public health actions such as arranging post exposure prophylaxis for close contacts of measles or managing outbreaks. 

Why is your help needed and how you can you support this surveillance? 

Robust surveillance of infections is vital to reduce the burden of disease and this relies on support from frontline clinicians to notify infections and encourage uptake of testing.  The testing helps the HPT to identify pockets of disease early to take public health actions including targeting immunisation services around areas of concern. 

When you are seeing patients with suspected measles, mumps, rubella or pertussis (in those aged two to 17 years), please ensure that you notify your local HPT of the case and also let the patient (or their parent) know that an OFKs will be sent to their home address and request that they complete the kits, so that we can better understand how these infections are spreading locally and across the country.  Translated materials are available so please include on the notification to the HPT if materials in languages other than English would be helpful for the patient.  The patients will not directly receive the results and may call their GP to get their results. 

Where can you find out more? 

• Instruction video for the kits: https://www.youtube.com/watch?v=zR0dankzUJ4 

• Resources for pertussis testing: https://www.gov.uk/government/publications/pertussis-whooping-cough-oral-fluid-laboratory-request-form-and-instructions 
• Resources for MMR testing: https://www.gov.uk/government/publications/measles-mumps-and-rubella-mmr-letter-for-parents-and-form-for-oral-fluid-swab