Transport of samples

1 Legal provisions

Biological samples are considered “dangerous substances” whose transport is subject to strict regulation based on the United Nations “Recommendations on the Transport of Dangerous Goods”.1

The International Air Transport Association (IATA) has incorporated these recommendations into its “Dangerous Goods Regulations,” to which many airlines are subject, including express transporters like DHL. These regulations are updated annually.

International air transport regulations (IATA) are the most restrictive.
Whatever the type of transport – national or international, road, rail, maritime, or air – all MSF shipments of potentially infectious samples must comply with those regulations.

According to the “Recommendations on the Transport of Dangerous Goods”, all biological samples fall into the “6.2-Infectious Substances” risk class.

1 UN Library, 2019. Recommendations on the Transport of Dangerous Goods: Model Regulations. https://doi.org/10.18356/7c03b465-en

2 Sample classification

Infectious substances are divided into three categories according to risk

Infectious substance, Category A Classification UN2814An infectious substance that is transported in a form that, when exposure to it occurs, is capable of causing permanent disability, life-threatening or fatal disease in otherwise healthy humans or animals
Biological substance, Category B Classification UN3373

A biological substance that does not meet the criteria for Category A, but which contains pathogens capable of infecting humans or animals, with no risk of death or permanent disability.

Samples that contain pathogens not classified as UN2814 or not included in the exemptions (slides or dried blood spots (DBS)) should be considered as UN3373.

ExemptionsSome biological products do not fit into Category A or B for a variety of reasons and hence are exempt; the IATA regulations do not apply.

Information regarding the danger category for each of the pathogens described in the MSF guideline 'Collection, storage and transport of samples from field to reference laboratory', chapter 2. A table of all Category A infectious substances – UN2814 can be found in Section 6.1.

A declaration is also required when using dry ice as a cooling agent, because it is a dangerous substance. The following must be added to the packages in question: UN1845 “Carbon dioxide, solid” (+ specific hazard label). The following must also appear on the Air Waybill (AWB): UN1845 “Carbon dioxide, solid”, the number of packages, and the net quantity of dry ice added per package. This must also appear on the Dangerous Goods Declaration, if it accompanies UN2814 infectious substances.

Every type of international transport has specific documents and conditions regarding:

  • The packing instruction
  • Marking and labelling
  • Transport mode
  • Administrative documentation

It is therefore necessary to:

  • Assign the dangerous substance to be transported to one of the three categories (UN2814, UN3373, or exemptions). It is up to the medical staff to determine which categories the samples in question belong to.
  • Know the recommended transport temperature: ambient temperature or cold chain (positive or negative).
  • If there is any doubt or question, consult the laboratory advisor.

2.1 Special case of dried blood spot (DBS) shipments

According to the IATA, DBS shipments are exempt.2

The completely dry DBS should be placed in its own bag with desiccant, and the bag placed in an envelope and shipped by a rapid transporter with shipment tracking (e.g., DHL, UPS, or FedEx).

DBS samples shipped via transporter must meet the following criteria:

  • Triple packaged, with two waterproof inner packagings (individual bags and then a zip-lock bag).
  • A third (outer) packaging (envelope or cardboard box) measuring at least 10 x 10 cm.
  • “Exempt Human Specimen” appears on the package (outer packaging) and on the Air Waybill.

The transporter may ask for documentation proving that the samples are exempt.3 Check with the laboratory advisor.