Table 3. National Recommendations from the WHO-CC for Research and Training on Viral Zoonoses, Thailand, Concerning Biological Samples Collected for Diagnosis of Human Rabies.

Intra-Vitam Diagnosis of Human Rabies
Samples	Sensitivity Considering the Clinical Evolution of the Patient (in Days following the Onset of Symptoms)		Commentsa	Storage	Technique (Reference)
	0–8 Days	>8 Days
Saliva (1 mL or saliva swabs)	High	High	Collected once daily. Repeat testing if result is negative.Liquid saliva is preferable to saliva swabs.	−20°C/−80°C	NASBA [11], [18]; TaqMan RT-PCR [43]
Urine (at least 2 mL)	Average	Average	Collected once daily. Repeat testing if result is negative.Fresh urine is preferable to stored samples.	−20°C/−80°C	NASBA [11], [18]; TaqMan RT-PCR [43]
Extracted hair (at least 20 follicles)	Average	Average	Collected once daily. Repeat testing if result is negative.	−20°C/−80°C	NASBA [11], [18]; TaqMan RT-PCR [43]
CSF (1 mL)	Average	Average	Collected once daily. Repeat testing if result is negative.	−20°C/−80°C	NASBA [11], [18]; TaqMan RT-PCR [43]

^aSamples from all sources should be examined simultaneously due to the intermittent shedding of virus. If not possible, at least thrree of four less-invasive samples—saliva, extracted hair follicles, and urine—should be collected. Repeat testing if the first result is negative and test for other etiologic agent(s). RNA detection may be less sensitive on patient with paralytic rabies. Detection of rabies antibody is not sensitive in serum (approximately 25%) and CSF (none was found positive even 3 weeks after onset) in Asian dog related cases. Therefore, antibody detection-based assays are not recommended in this protocol. All specimens should be transported immediately (on ice) and if not possible, should be stored at +4°C for no longer than 24 h or at −20°C or −80°C (preferable) if storage time is longer.

FAT, fluorescent antibody test; NASBA, nucleic acid sequence-based amplification; RT-PCR, reverse transcription polymerase chain reaction.