NDR Manual

Notifiable Disease Report (NDR) Manual

Third Edition (2007) Disease Control and Prevention Branch, Alberta Health and Wellness Printed November 2006. Resource Number: NCN1217 (2005/March). For additional copies see: www.health-sites.ab.ca

http://www.health-sites.ab.ca/

Notifiable Disease Report (NDR) Manual (3rd Edition). January 2007. i Alberta Health and Wellness, Disease Control & Prevention

Notifiable Disease Report (NDR) Manual Third Edition (2007)

TABLE OF CONTENTS

INTRODUCTION .............................................................................................................................................................................. 1 CHANGES................................................................................................................................................................................... 1 PURPOSE ................................................................................................................................................................................... 1 ORGANIZATION ......................................................................................................................................................................... 2

REPORTING RESPONSIBILITIES .................................................................................................................................................. 3 FASTEST MEANS POSSIBLE (FMP) AND NON-FMP NOTIFIABLE DISEASE REPORTING ................................................... 3 REPORTER’S RESPONSIBILITIES............................................................................................................................................ 4 ALBERTA HEALTH AND WELLNESS (AHW) RESPONSIBILITIES ........................................................................................... 5 OTHER REPORTING RESPONSIBILITIES ................................................................................................................................ 6

PART 1: PERSONAL IDENTIFIERS................................................................................................................................................ 8 UNABLE TO CONTACT/LOST TO FOLLOW-UP........................................................................................................................ 9 LIVES ON RESERVE .................................................................................................................................................................. 9 IDENTIFIER CODE ................................................................................................................................................................... 10 PHN/OTHER IDENTIFIER......................................................................................................................................................... 10 BIRTH DATE ............................................................................................................................................................................. 11 GENDER ................................................................................................................................................................................... 11 ETHNICITY................................................................................................................................................................................ 12 PATIENT NAME ........................................................................................................................................................................ 13 ALIAS ........................................................................................................................................................................................ 13 PREGNANT............................................................................................................................................................................... 14 HOME ADDRESS...................................................................................................................................................................... 15

PART 2: DISEASE DESCRIPTORS AND LABORATORY TEST DETAILS ................................................................................ 16 DISEASE NAME........................................................................................................................................................................ 17 ICD9 CODE ............................................................................................................................................................................... 17 DIAGNOSIS (AS PER CASE DEFINITION) ....................................................................................................................................... 19 CASE/CARRIER........................................................................................................................................................................ 19 ONSET DATE............................................................................................................................................................................ 20 DIAGNOSIS DATE .................................................................................................................................................................... 20 LAB DIAGNOSIS ....................................................................................................................................................................... 21 SPECIMEN COLLECTION DATE.............................................................................................................................................. 21 SEROTYPE/SEROGROUP....................................................................................................................................................... 22 TYPE OF SPECIMEN................................................................................................................................................................ 22 HOSPITALIZED......................................................................................................................................................................... 23 FATAL /DATE OF DEATH ......................................................................................................................................................... 23 EPI LINKED ............................................................................................................................................................................... 24 OUTBREAK ASSOCIATED....................................................................................................................................................... 24 EI# (EXPOSURE INVESTIGATION).......................................................................................................................................... 25

PART 3: IMMIGRATION AND TRAVEL DETAILS........................................................................................................................ 26 A. WAS ILLNESS LIKELY ACQUIRED WHILE RESIDING OUTSIDE OF CANADA? .............................................................. 28 B. WAS ILLNESS LIKELY ACQUIRED DURING TRAVEL OUTSIDE OF ALBERTA?.............................................................. 29

PART 4: ENTERICS....................................................................................................................................................................... 30 A. WHERE WAS DISEASE LIKELY ACQUIRED....................................................................................................................... 31 B. HOW WAS DISEASE LIKELY ACQUIRED?......................................................................................................................... 33

PART 5: NON-ENTERICS.............................................................................................................................................................. 35

TABLE OF CONTENTS

Notifiable Disease Report (NDR) Manual (3rd Edition). January 2007. Alberta Health and Wellness, Disease Control & Prevention ii

MANIFESTATION OR SITE....................................................................................................................................................... 37 RISK FACTORS/SUSCEPTIBILITY FOR ACQUIRING DISEASE ............................................................................................ 38 WHERE WAS DISEASE LIKELY ACQUIRED? ......................................................................................................................... 39 HOW WAS DISEASE LIKELY ACQUIRED? (FOR BLOOD BORNE PATHOGENS ONLY) ................................................................. 40

PART 6: RELEVANT IMMUNOBIOLOGICAL/CHEMOPROPHYLAXIS DETAILS/OTHER......................................................... 41 RELEVANT IMMUNIZATION STATUS FOR AGE/ELIGIBILITY................................................................................................ 42 VACCINE CODE........................................................................................................................................................................ 44 ANTIGEN COUNT ..................................................................................................................................................................... 46 IMMUNIZATION DATE.............................................................................................................................................................. 46 PRIOR TO SYMPTOM ONSET WAS THIS PERSON ON POST EXPOSURE PROPHYLAXIS (PEP)? ................................... 47 AGENT RECEIVED ................................................................................................................................................................... 47 CHEMOPROPHYLAXIS............................................................................................................................................................ 48 IMMUNE GLOBULINS AND ANTITOXINS................................................................................................................................ 48

PART 7: REPORTING SECTION.................................................................................................................................................. 49 COMMENTS.............................................................................................................................................................................. 50 RHA PUBLIC HEALTH STAFF .................................................................................................................................................. 50 TELEPHONE NUMBER............................................................................................................................................................. 50 RHA REPORTING..................................................................................................................................................................... 51 DATE REPORTED TO AHW ..................................................................................................................................................... 51

REFERENCE LIST......................................................................................................................................................................... 52

APPENDIX A: NOTIFIABLE DISEASE REPORT (NDR) FORM.................................................................................................. 53 NOTIFIABLE DISEASE REPORT (NDR) FORM ....................................................................................................................... 53 AMENDMENT TO NOTIFIABLE DISEASE REPORT (NDR) FORM ......................................................................................... 54

APPENDIX B: NOTIFIABLE DISEASE REPORTING REQUIREMENTS ..................................................................................... 55 MANDATORY FIELDS .............................................................................................................................................................. 55

APPENDIX C: PROTOCOL FOR REPORTING NOTIFIABLE DISEASE INVOLVING FIRST NATIONS AND INUIT HEALTH BRANCH (FNIHB) .......................................................................................................................................................................... 58

APPENDIX D: ENHANCED SURVEILLANCE FORMS ............................................................................................................... 63 HANTAVIRUS ENHANCED SURVEILLANCE REPORT........................................................................................................... 63 SARS ENHANCED SURVEILLANCE REPORT........................................................................................................................ 67 WEST NILE VIRUS ENHANCED SURVEILLANCE REPORT................................................................................................... 70

APPENDIX E: OUTBREAK REPORTING FORMS ....................................................................................................................... 74 ENTERIC OUTBREAK REPORT FORM (EORF) ...................................................................................................................... 74 NON-ENTERIC OUTBREAK REPORT FORM (NEORF) .......................................................................................................... 79

APPENDIX F: EXAMPLES OF COMPLETED NDR FORMS........................................................................................................ 84 ENTERIC................................................................................................................................................................................... 84 NON-ENTERIC.......................................................................................................................................................................... 86

APPENDIX G: CONTINENT AND COUNTRY CODES ................................................................................................................ 89

APPENDIX H: ENTERIC AND NON-ENTERIC DISEASE LISTS ................................................................................................. 92 ENTERIC LIST FOR NDR FORM .............................................................................................................................................. 92 NON-ENTERIC LIST FOR NDR FORM..................................................................................................................................... 93

APPENDIX I: IMMUNOBIOLOGICAL LISTS................................................................................................................................. 94 CHEMOPROPHYLAXIS............................................................................................................................................................ 94 IMMUNE GLOBULINS AND ANTITOXINS................................................................................................................................ 94 VACCINE AND IMMUNE GLOBULIN CODES .......................................................................................................................... 95

INTRODUCTION

Notifiable Disease Report (NDR) Manual (3rd Edition). January 2007. 1 Alberta Health and Wellness, Disease Control & Prevention

INTRODUCTION This is the third edition of the Notifiable Disease Report (NDR) Manual. It has been revised to reflect changes made to the NDR form (Appendix A: Notifiable Disease Report Form). The NDR form is intended to be a surveillance tool that collects meaningful disease information in Alberta in a manner that allows it to be easily analyzed, interpreted, and disseminated. The information required on the NDR form is not intended to be a comprehensive case management recording system. The information will enable Alberta Health & Wellness (AHW) to respond and advise Regional Health Authorities (RHAs) on reported communicable diseases, and to capture the information needed to report to Albertans, and nationally to the Public Health Agency of Canada (PHAC). CHANGES Changes to the NDR manual include:

• A copy of the updated NDR form (Appendix A: Notifiable Disease Report Form). • A description of the reporting requirements for each field (box) on the form incorporating

the changes and additions that have been made to the NDR form: Part 1: Personal Identifiers:

o Unable to contact and lost to follow-up category added. o Lives on reserve category added.

Part 3: Immigration and Travel Details: o Enhances surveillance and consistency of information collected on immigration and

travel. Part 4: Enterics:

o This section has been re-formatted to collect information for enteric diseases separately from non-enterics for ease and consistency in data collection.

Part 5: Non-Enterics o This section has been re-formatted to collect information for non-enteric diseases

separately from enterics for ease and consistency in data collection. PURPOSE The purpose of the NDR Manual is to:

• Describe the roles and responsibilities of public health reporters (regional public health professionals).

• Describe the roles and responsibilities of AHW in the systematic collection, analysis, interpretation, and dissemination of data to appropriate stakeholders.

• Provide guidance for the completion of the NDR form to maintain consistency in gathering information and interpretation of the fields.

INTRODUCTION


ORGANIZATION The NDR manual follows the NDR form and is divided into seven parts:

Part 1. Personal Identifiers Part 2. Disease Descriptors and Laboratory Test Details Part 3. Immigration and Travel Details Part 4. Enterics Part 5. Non-Enterics Part 6. Relevant Immunological/Chemoprophylaxis Details/Other Part 7. Reporting Section

The following appendices are included in the NDR manual:

Appendix A: Notifiable Disease Report Form Appendix B: Notifiable Disease Reporting Requirements Appendix C: Protocol for Reporting Notifiable Disease Involving First Nations and Inuit Health

Branch Appendix D: Enhanced Surveillance Forms Appendix E: Outbreak Reporting Forms Appendix F: Examples of Completed NDR Forms Appendix G: Continent and Country Codes Appendix H: Enteric and Non-enteric Disease Lists Appendix I: Immunobiological Lists

Each part of the NDR Manual has specific information about how to complete the NDR form:

• Field Name (box): Name of the box as it appears on the form e.g., Birth date (see Table of Contents for a list of specific fields). Field names are bolded throughout the manual.

• Description: Describes the information to be entered e.g., identifies the province that issued the Personal Health Number such as Alberta (AB).

• Reporting Requirement: Mandatory: The data for the field must be reported. Conditional: The data must be reported under certain situations.

See also Appendix B: Notifiable Disease Reporting Requirements for a complete list of mandatory fields for all diseases.

• Instructions: Guidelines for completing the field e.g., “Enter the code ‘AB’ for Alberta, or the code for another province”.

• Code: The code/information if applicable is entered in the box. • Definitions: Provides explanation for choices under Field Name (box). • Note: Additional information to provide further clarification.

REPORTING RESPONSIBILITIES


REPORTING RESPONSIBILITIES FASTEST MEANS POSSIBLE (FMP) AND NON-FMP NOTIFIABLE DISEASE REPORTING

1. Labs include Insurance Companies, Regional laboratories and the Provincial Laboratory of Public Health. 2. Communicable Diseases Regulation - Section 22(1). 3. Voice mail, mail, fax and electronic transfer (e-mail) are not acceptable. 4. Exception confirmed/probable/possible Creutzfeldt-Jakob Disease – Classic and Variant. CMOH notification within 48 hours via

phone, fax, or electronic. 5. Exception Group A Streptococcal Disease, Invasive with manifestation of Toxic Shock Syndrome or Necrotizing Fasciitis or disease

resulting in death. Immediate notification to CMOH via direct voice communication. 6. Exception Hepatitis C reporting. Final report within 6 weeks.

To the Medical Officer of Health (MOH) To the Chief MOH (CMOH)

Lab1 Physician2 Other e.g., daycare

Out-of-region notification

/report Lab MOH

Out-of-

province notification

/report

Time Immediate Immediate Immediate Immediate Immediate Immediate Immediate

Method3 Direct voice communication

Direct voice communication






Lab Hard Copy

By fax, electronic or mail when available

NA NA

RHA first notified

forwards copy by fax to MOH (or designate)

where the client resides


NA

RHA first notified

forwards copy by fax to the CMOH (or designate)

Prelim. Report within 7 days

FMP

NDR Hard Copy NA NA NA NA NA

Final Report within 2 weeks

NA

Time Within 48 hours

Within 48 hours

Within 48 hours

Within 48 hours

Within 48 hours NA4,5 Within

48 hours

Method Mail, fax, electronic

Phone, fax, electronic



Mail, fax, electronic NA5 Phone, fax,

electronic

Lab Hard Copy


NA NA

RHA first notified

forwards copy by fax to MOH (or designate)

where the client resides


NA

RHA first notified

forwards copy by fax to the CMOH (or designate)

Prelim. Report within 2 weeks

Non-

FMP

NDR Hard Copy NA NA NA NA NA

Final Report within 4 weeks6

NA



REPORTER’S RESPONSIBILITIES RHA Public Health staff have a number of responsibilities for reporting notifiable diseases. The timeliness of reporting notifiable diseases is critical to ensure the health and safety of all Albertans. The NDR form is to be completed and sent to AHW, Disease Control and Prevention, within the timelines for specific diseases and level of urgency according to the Public Health Act and Communicable Diseases Regulation. See page 3 for FMP and Non-FMP Notifiable Disease Reporting. These requirements must be diligently followed. FMP Diseases which are to be reported by the fastest means possible:

• Cases are brought to the attention of the CMOH or designate by direct voice communication within 24 hours. This timeline requires that the CMOH be made aware of cases no later than the next working day. If you wish to report immediately, over a weekend or holiday, contact the CMOH or designate through the pager number (780) 419-9339.

• The NDR form must be forwarded to AHW within 7 days. Non-FMP All other notifiable diseases:

• NDR form must be forwarded to AHW within 14 days.

Out of Region Reports The MOH or designate first notified shall notify the MOH (or designate) where the client resides by mail, fax, or electronic transfer and fax a copy of the positive laboratory report within 48 hours (two days). Out of Province and Out of Country Reports For out of province and out of country reports, the following information should be forwarded to the CMOH (or designate) by phone, fax or electronic transfer within 48 hours (two days) including:

• name • date of birth • out of province health care number • out of province address and phone number • attending physician (locally and out of province) • positive laboratory report (faxed)

For NDRs involving FNIHB See Appendix C: Protocol for Reporting Notifiable Disease Involving First Nations and Inuit Health Branch (FNIHB).



ALBERTA HEALTH AND WELLNESS (AHW) RESPONSIBILITIES AHW uses the notifiable disease data captured through the Communicable Disease Reporting System (CDRS) for surveillance purposes. Surveillance and how the data is used is best defined by the Centers for Disease Control and Prevention (CDC):

Public health surveillance is the ongoing, systematic collection, analysis, interpretation, and dissemination of data about a health-related event for use in public health action to reduce morbidity and mortality and to improve health. Surveillance serves at least eight public health functions. These include supporting case detection and public health interventions, estimating the impact of a disease or injury, portraying the natural history of a health condition, determining the distribution and spread of illness, generating hypotheses and stimulating research, evaluating prevention and control measures, and facilitating planning. Another important public health function of surveillance is outbreak detection (i.e., identifying an increase in frequency of disease above the background occurrence of the disease) (2001).

Data entered into CDRS is used by AHW to achieve the following objectives for Disease Control and Prevention and Health Surveillance:

1. To uniquely count incidents of notifiable disease. 2. To identify, in a timely fashion, any cases of disease that may require immediate public health

intervention measures. 3. To alert health personnel and other relevant professionals to any changes in disease activity in

their area. 4. To identify changes in disease patterns or trends that may require more detailed investigation. 5. To assist in the identification of outbreaks and support their effective management. 6. To monitor and report disease incidence by epidemiological dimensions of: person, place,

and time. 7. To assess disease impact and help set priorities for prevention and control activities. 8. To evaluate the effectiveness of prevention and control activities (e.g., monitor the impact of

an immunization strategy on reducing incidence of disease). 9. To identify risk factors for disease to support the development of effective and targeted

prevention measures. 10. To assess population health status and enable epidemiological analysis by identifying: who,

what, when, where, and why. 11. To allow linkages with related data to assess population health status (e.g., linkage to hospital

admissions database). 12. To provide data and/or information about communicable diseases in Alberta to health

professionals, researchers, the media, and the general public. 13. To fulfill national reporting requirements.



OTHER REPORTING RESPONSIBILITIES Reporting Amendments to Previously Reported Cases The Amendment to Notifiable Disease Report Form has mandatory fields which are shaded to assist in identifying the case and in reporting only the information that is new or has changed. (See Appendix A: Amendment to Notifiable Disease Report Form).

• Amendment NDR Report # is the original NDR number • PHN/other identifier • Birth date • Gender • Patient name • Disease name • ICD9 code • RHA public health staff • Telephone number of the RHA staff reporting • RHA reporting • Date reported to AHW

It is not necessary to submit an Amendment Form to report a lab confirmed serotype/serogroup (subtype, phagetype, PFGE, etc.) that is confirmed by Provincial Laboratory of Public Health (PLPH) AHW receives reports from PLPH to confirm this information. Other Disease-Specific Reports

1. Diseases Under Enhanced Surveillance

In addition to submitting the NDR form, diseases designated for enhanced surveillance require the completion of a disease-specific form (Appendix D: Enhanced Surveillance Forms).

• Hantavirus Infection • Severe Acute Respiratory Syndrome (SARS) • West Nile Virus (WNv) Infections

2. Outbreak Reporting

In accordance with the Communicable Diseases Regulation/Public Health Act, in any disease outbreak, a form is required to be completed and reported to AHW. A sample Enteric Outbreak Reporting Form (EORF) and Non-Enteric Outbreak Reporting Form (NEORF) is provided (Appendix E: Outbreak Reporting Forms).



NDR Form Descriptions Unique Number Every NDR form has a unique number assigned at the time of printing. This unique identifier in no way discloses information specific to the client’s identity. The purpose of this numerical assignment is for case tracking and to correspond any additional amendments to the original case. Note: An original NDR form must be completed for each case. Photocopies of an NDR form are

not to be used, as each case requires a unique identifier.

PERSONAL IDENTIFIERS


PART 1: PERSONAL IDENTIFIERS Personal Identifiers provides nominal data for the case being reported. It is used in determining the demographics of a notifiable disease and prevents duplication.

• Unable to contact/Lost to follow-up • Lives on reserve • Identifier code • PHN/other identifier • Birth date • Gender • Ethnicity • Patient name • Alias • Pregnant • Home address • City/town • Province • Country • Postal code

Note: For examples of completed NDR forms see Appendix F: Examples of Completed NDR Forms.



FIELD NAME UNABLE TO CONTACT/LOST TO FOLLOW-UP Description: The Unable to contact/Lost to follow-up field indicates no contact or insufficient

contact has been made to complete the NDR form. Reporting Requirement: Conditional Instructions: 1. Place an ‘X’ in the appropriate box as applicable. Definitions:

Unable to contact Indicates there were attempts to contact the case, however, no direct contact was made.

Lost to follow-up Indicates an initial contact was made and subsequently lost to follow-up. FIELD NAME LIVES ON RESERVE Description: The Lives on reserve field indicates whether a client lives on or off a reserve. This

field identifies clients who fall under the First Nations Inuit Health Branch (FNIHB) mandate and to determine where disease was acquired.

Reporting Requirement: Mandatory Instructions: 1. Place an ‘X’ in the appropriate box. Definitions:

No Case does not live on reserve.

Yes Case’s residence (home address) is on reserve on the Diagnosis date.



FIELD NAME IDENTIFIER CODE Description: The Identifier code field identifies the issuer (e.g., province/territory/organization)

of the Personal Health Number (PHN) or other health identifier of the case. Reporting Requirement: Mandatory Instructions: 1. Enter the code that represents the Identifier Code in this field:

e.g., ‘AB’ for Alberta resident, ‘RC’ for RCMP.

FIELD NAME PHN/OTHER IDENTIFIER

Description: The PHN/other identifier field is the health number or other identifying number

issued to the case. It presumes eligibility for basic health services.

Reporting Requirement: Mandatory if the Identifier code is ‘AB’. This field must contain a valid Alberta PHN.

Instructions: 1. Enter the appropriate PHN/other identifier in this field. 2. If the Identifier code is ‘NR’ or ‘UO’ then this field must be left blank. 3. For all other Identifier codes include the number if available.

Identifier Codes AB Alberta resident with a PHN NR Non-Registered Albertan BC British Columbia OOP Health Number UO Unable to Obtain (case does not know PHN) MB Manitoba OOP Health Number TP Temporary Payee Number NB New Brunswick OOP Health Number FP Federal Penitentiary Inmate NF Newfoundland OOP Health Number TN Treaty NT Northwest Territories Health Number OC Out-Of-Country NS Nova Scotia OOP Health Number AF Armed Forces NU Nunavut OOP Health Number RC RCMP ON Ontario OOP Health Number PE Prince Edward Island OOP Health Number QC Quebec OOP Health Number SK Saskatchewan OOP Health Number YT Yukon Territory OOP Health Number *OOP = Out of Province



FIELD NAME BIRTH DATE Description: The Birth date field is the date the case was born. Reporting Requirement: Mandatory Instructions: 1. Enter the date of birth. 2. If the year of birth is known, but not the month and day, enter the first day of the first

month, i.e., YYYY/01/01. 3. If the year and month of birth are known, but not the day, enter the day as the first day of the

month, i.e., YYYY/MM/01. FIELD NAME GENDER Description: The Gender field indicates the biological sex of the case. Reporting Requirement: Mandatory Instructions: 1. Place an ‘X’ in the appropriate box. Definitions:

Male As reported by client or review of history.

Female As reported by client or review of history.

Unk To be used in circumstances where there is no way of determining gender (e.g., no contact made, no gender reported on the lab report, etc.).

Other Refers to cases where the biological gender does not fit the terms ‘male’ or ‘female’. This includes individuals who have undergone surgical/chemical gender changes and hermaphrodites.



FIELD NAME ETHNICITY Description: The Ethnicity field provides key information related to the ethnic background of the

case. It refers to the social group characterized by distinctive social and cultural tradition with whom the case belongs. This is usually a common history, origin, or a sense of identification with the group. These are distinctive features in lifestyle and often a common genetic heritage in which these features may be reflected in their experience of health and disease. This is the ethnic group that the case most identifies with.

Reporting Requirement: Mandatory for the following diseases:

• Acute Flaccid Paralysis • Chickenpox (Varicella) - Spring 2007 • Congenital Cytomegalovirus • Congenital Rubella Infection • Congenital Rubella Syndrome • Congenital Toxoplasmosis • Creutzfeldt-Jakob Disease - Classic • Creutzfeldt-Jakob Disease - Variant • Group A Streptococcal Disease,

Invasive • Hepatitis A • Hepatitis B

• Hepatitis C • Hepatitis, (other, viral) • Leprosy • Measles • Mumps • Pneumococcal Disease, Invasive • Poliomyelitis • Rubella • Severe Acute Respiratory Syndrome • Subacute Sclerosing Panencephalitis

Instructions: 1. Place an ‘X’ in the appropriate box. 2. When the Ethnicity field is not mandatory, leave the field blank. Definitions:

Caucasian As reported by client.

Black As reported by client.

Oriental This includes individuals from Cambodia, China, Indonesia, Japan, Laos, Korea, Malaysia, Philippines, Thailand, and Vietnam.

Other Asian This includes individuals from India, Pakistan, Singapore, Sri Lanka, South Asia and West Asia who are not included in ‘Oriental’.

First Nation As reported by client – includes both Treaty/Status and Non-Status.

Métis As reported by client.

Inuit As reported by client.

Unk Ethnicity is unknown.

Other, specify Specify ethnicity if other than the choices provided. Note: For mandatory fields for a specific disease See Appendix B: Notifiable Disease Reporting

Requirements.



FIELD NAME PATIENT NAME Description: The Patient name field identifies the legal name of the case. Reporting Requirement: Mandatory First and Last name Conditional Middle name Instructions: 1. Complete the first and last name of the case for all notifiable disease incidents and middle

name if available. Definitions:

Last name The surname of the case

First name The given name of the case.

Middle name The middle name of the case.

FIELD NAME ALIAS Description: The Alias field identifies alternate names, AKA’s, such as nick names used by the

case. This field helps to prevent duplication. Reporting Requirement: Conditional Instructions: 1. Complete this field when the case goes by a name other than the legal name.

Definitions:

Last name If the alias is two names.

First name If the alias is one name.



FIELD NAME PREGNANT Description: The Pregnant field indicates whether the individual was pregnant on the Onset date.

If the NDR is for a carrier, indicate if the individual was pregnant at the time of reporting.


• Chickenpox (Varicella) - Spring 2007 • Diphtheria • Hepatitis B • Hepatitis C • Hepatitis (other, viral) • Listeriosis • Malaria • Measles • Psittacosis • Rubella • Severe Acute Respiratory Syndrome • Smallpox • Subacute Sclerosing Panencephalitis • Western Equine Encephalitis • West Nile Virus Asymptomatic Infection • West Nile Virus Neurological Syndrome • West Nile Virus Non-Neurological Syndrome

Instructions: 1. Place an ‘X’ in the appropriate box. 2. When the Pregnant field is not pertinent, leave the field blank. Notes: 1. ‘Unk’ indicates the woman does not know if she is pregnant. 2. For mandatory fields for a specific disease see Appendix B: Notifiable Disease Reporting

Requirements.



FIELD NAME HOME ADDRESS Definition: The Home address field refers to the street address (or legal land description), postal

box number, city, town, or village, province, country where the case physically resided on the Diagnosis date.

Reporting Requirement: Mandatory: Address (street or legal land description), city/town,

province, and postal code. Conditional: Country

Instructions: 1. Complete the address by filling in the street address or postal box number, city, town, or

village, province, country and postal code. List the legal land description rather than the street address if applicable.

2. If the PHN/Other Identifier field is blank then the postal code must be entered. 3. If the postal code is not known, then the general delivery postal code for the area where the

case resided at the time of diagnosis must be entered. 4. If the case is from out-of-province, the City/town and Province fields must be completed

but all other address fields are optional. 5. If the case is from out-of-country the Country field must be completed but all other address

fields are optional.

Note: For information regarding out of country codes See Appendix G: Continent and Country Codes.

Province and Territory Codes AB Alberta BC British Columbia MB Manitoba NB New Brunswick NF Newfoundland NS Nova Scotia NT Northwest Territories NU Nunavut ON Ontario PE Prince Edward Island QC Quebec SK Saskatchewan YT Yukon

DISEASE DESCRIPTORS AND LABORATORY TEST DETAILS


PART 2: DISEASE DESCRIPTORS AND LABORATORY TEST DETAILS Disease Descriptors and Laboratory Test Details identifies disease-specific parameters and characteristics of the disease being reported. This section includes the following:

• Disease name • ICD9 code • Diagnosis (as per case definition) • Case/Carrier • Onset date • Diagnosis date • Lab diagnosis • Specimen collection date • Serotype/Serogroup • Type of specimen • Hospitalized • Fatal/Date of death • EPI linked • Outbreak associated • EI# (Exposure Investigation Number)




FIELD NAME DISEASE NAME Description: The Disease name field identifies the name of the disease reportable by the Public

Health Act Communicable Diseases Regulation. Reporting Requirement: Mandatory Instructions: 1. For the disease being reported, enter the Disease name in this field. See Disease name list

on page 18. 2. Complete a separate NDR form for each notifiable disease when more than one notifiable

disease has been diagnosed in the same case at the same time. ICD9 CODE Description: The ICD9 code field identifies the disease code as per the International Classification

of Disease (ICD) code. Reporting Requirement: Mandatory Instructions: 1. For the disease being reported, enter the ICD9 code in this field. See ICD9 code list on

page 18. 2. Complete a separate NDR form for each notifiable disease when more than one notifiable

disease has been diagnosed in the same case at the same time.



Disease Name ICD9

Code Disease Name ICD9

Code Acute Flaccid Paralysis (AFP) 0459 Marburg Haemorrhagic Fever 078.3 Amoebiasis 006 Measles/Rubeola 055 Anthrax 022 Meningococcal Disease, Invasive (IMD) 036 Botulism 0051 Mumps 072 Brucellosis 023 Neonatal Herpes Simplex Infection 054 Campylobacteriosis 0084 Paratyphoid Fever 0029 Chickenpox (Varicella) Spring 2007 052 Pertussis 033 Cholera (01 and 0139) 001 Plague 020 Congenital Cytomegalovirus (CMV) 7711 Pneumococcal Disease, Invasive (IPD) 3201 Congenital Rubella Infection 7710 Poliomyelitis 045 Congenital Rubella Syndrome (CRS) 7710 Powassan Encephalitis 0638 Congenital Toxoplasmosis 7712 Psittacosis 073 Creutzfeldt-Jakob Disease - Classic (CJD) 0461 Q Fever 083 Creutzfeldt-Jakob Disease - Variant (vCJD) 0461.1 Rabies 071 Crimean Congo Haemorrhagic Fever 065.0 Rocky Mountain Spotted Fever 082 Cryptosporidiosis 0078 Rubella 056 Cyclosporiasis 0079 St. Louis Encephalitis 0623 Dengue Fever 061 Salmonellosis 003 Diphtheria 032 Severe Acute Respiratory Syndrome (SARS) 480.8 Eastern Equine Encephalitis (EEE) 0622 Shigellosis 004 Ebola Haemorrhagic Fever 078.1 Smallpox 050 E. coli O157:H7 0080 Subacute Sclerosing Panencephalitis (SSPE) 0462 Giardiasis 007 Tetanus 037 Group A Streptococcal Disease, Invasive (iGAS)

034 Toxic Shock Syndrome (non-group A strep) 7855

Haemophilus Influenzae , Invasive - type b (HIB)

3200 Trichinosis 124

Haemolytic Uremic Syndrome (HUS) 2831 Tularemia 021 Hantavirus Pulmonary Syndrome (HPS) 0786 Typhoid Fever 0020 Hepatitis A (HAV) 0700 Typhus – Louseborne 080 Hepatitis B (HBV) 0702 Typhus – Murine 081.0 Hepatitis C (HCV) 0708 Typhus – Scrub 081.2 Hepatitis (other, viral) 0709 Varicella Zoster, Shingles 053 Lassa Fever 078.2 Vibrio Parahaemolyticus 0054 Legionellosis 4828 Vibrio Cholerae, non O1, non O139 0019 Leprosy 030 Western Equine Encephalitis (WEE) 0621 Leptospirosis 100 West Nile Virus Asymptomatic Infections (WNAI) 0663.2 Listeriosis 027 West Nile Virus Neurological Syndrome (WNNS) 0663 Lyme Disease 087 West Nile Virus Non-Neurological Syndrome

(WNNon-NS) 0663.1

Malaria 084 Yellow Fever 060 Yersiniosis 0091



FIELD NAME DIAGNOSIS (AS PER CASE DEFINITION) Description: The Diagnosis (as per case definition) field indicates the diagnosis for the

notifiable disease at time of reporting. Reporting Requirement: Mandatory Instructions: 1. Place an ‘X’ in the appropriate box. Note: For disease case definitions see Alberta Case Definitions Manual. FIELD NAME CASE/CARRIER Description: The Case/Carrier field indicates if the case is an acute case or a carrier of the

reportable disease. Reporting Requirement: Mandatory for the following diseases:

• Diphtheria • Hepatitis B • Paratyphoid Fever • Typhoid Fever

Instructions: 1. Place an ‘X’ in the appropriate box. 2. When it is not mandatory to complete the Case/Carrier field, leave the field blank. Note: For mandatory fields for a specific disease see Appendix B: Notifiable Disease Reporting

Requirements.



FIELD NAME ONSET DATE Description: The Onset date field is the date the disease or symptoms are reported to have first

appeared. Reporting Requirement: Mandatory Instructions: 1. Enter the Onset date. 2. If only the year, month and week of onset are known, but not the specific day, enter the first

day of the week. (The first day of the week is defined as Monday for NDR form purpose). 3. If the year and month of onset are known, but not the week or day, enter the first day of the

month. 4. If the Onset date is completely unknown, enter the Diagnosis date. Use this for cases that

are asymptomatic. 5. If the Diagnosis date is unknown, enter the Specimen collection date. 6. If the Specimen collection date is unknown, enter the date of lab reporting. Note: The Onset date must be prior to, or the same as, the Diagnosis date. FIELD NAME DIAGNOSIS DATE Description: The Diagnosis date field is the date the notifiable disease was diagnosed by

laboratory confirmation or by a physician’s clinical diagnosis.

Reporting Requirement: Mandatory Instructions: 1. Enter the Diagnosis date in this field. 2. When there is a laboratory diagnosis enter the date the specimen was collected. 3. When there is a clinical diagnosis made by a physician enter the date the diagnosis was made. Notes: 1. If the date of the clinical diagnosis is unavailable, enter the date the case was seen by the

physician. 2. The Diagnosis date must be later or the same as the Onset date.



FIELD NAME LAB DIAGNOSIS Definition: The Lab diagnosis field indicates if a laboratory test has been requested to confirm

the diagnosis of the notifiable disease. Reporting Requirement: Mandatory Instructions: 1. Place an ‘X’ in the appropriate box. Definitions:

No No lab specimen was collected. Diagnosis is based on clinical symptoms.

Yes Appropriate lab specimen has been collected and is used to confirm diagnosis.

Pending Appropriate lab specimen has been collected and clinical diagnosis has been made. Awaiting lab results to confirm diagnosis.

FIELD NAME SPECIMEN COLLECTION DATE Description: The Specimen collection date field identifies the date the specimen was taken. Reporting Requirement: Mandatory if there has been a specimen collected to confirm diagnosis. Instructions: 1. Enter the date the specimen was collected. 2. If Specimen collection date is unavailable, enter the date the specimen was received by the

lab.



FIELD NAME SEROTYPE/SEROGROUP Description: The Serotype/Serogroup field indicates the strain differentiation. It includes all

forms of differentiation (e.g., serotype/serogroup, subtype, phagetype, PFGE, etc.). Reporting Requirement: Conditional Instructions: 1. Enter the actual Serotype/Serogroup as reported on the lab report. 2. The Serotype/Serogroup is only required if reported by the lab at time of NDR submission. Notes: 1. The serotype must be valid for the reported disease. 2. It is not necessary to submit an Amendment Form to report a lab confirmed

serotype/serogroup that has been confirmed by PLPH. AHW receives reports from PLPH to confirm this information.

FIELD NAME TYPE OF SPECIMEN Description: The Type of specimen field identifies the specimen collected to confirm the

diagnosis of the disease case. Reporting Requirement: Mandatory if there has been a specimen collected. Instructions: 1. Place an ‘X’ in the appropriate box. 2. If Type of specimen is Other, additional details must be reported in the space provided.



FIELD NAME HOSPITALIZED Description: The Hospitalized field indicates if the case was hospitalized as a result of the

notifiable disease. Reporting Requirement: Conditional Instructions: 1. Place an ‘X’ in the appropriate box. Definitions:

No Not admitted or only seen in the emergency room.

Yes Case admitted to hospital overnight.

Unk Unknown if case was hospitalized. FIELD NAME FATAL /DATE OF DEATH Description: The Fatal/Date of death field identifies if the case died and the date of death. Reporting Requirement: Conditional Instructions: 1. Place an ‘X’ in the appropriate box. 2. The date of death must be entered. Definitions:

Died from disease The case died from the notifiable disease being reported.

Died from other causes The case died from causes unrelated to the notifiable disease being reported.



FIELD NAME EPI LINKED Description: The EPI Linked field identifies cases that are epidemiologically linked to a lab-

confirmed case for the same disease. This field assists with identifying the scope of the disease/outbreak within a region and the province.

Reporting Requirement: Mandatory when the case is epi linked to a confirmed case.

Instructions: 1. Place an ‘X’ in the appropriate box. 2. If EPI Linked indicator equals Yes, report the NDR number of the FIRST

LABORATORY CONFIRMED CASE. Definitions:

No Not known to be epidemiologically linked to a lab-confirmed case for the same disease.

Yes Epidemiologically linked to a lab-confirmed case for the same disease. FIELD NAME OUTBREAK ASSOCIATED Description: The Outbreak associated field indicates whether a disease event is associated with an

outbreak. This field assists in identifying the scope of the disease/outbreak within the region and the province.

Reporting Requirement: Mandatory when the case is part of an outbreak. Instructions: 1. Place an ‘X’ in the appropriate box. Definition: Outbreak A distribution of cases of a communicable disease that is unusual in terms

of time, place or persons affected as per Communicable Diseases Regulation (2006, p.3).

Outbreak Involving Enteric Infections

Two or more individuals who are epidemiologically and/or laboratory linked and who do not live in a common household (private dwelling), exclusive of an institutional event. (Alberta Health and Wellness, September 2002, p.2).



FIELD NAME EI# (EXPOSURE INVESTIGATION) Description: The EI# field identifies the number assigned by the PLPH, at the request of the

MOH, when investigating a possible outbreak or cluster. Reporting Requirement: Mandatory when an EI# has been assigned to a notifiable disease

outbreak or cluster. Instructions: 1. Enter the assigned EI number in the field provided.

IMMIGRATION AND TRAVEL DETAILS


PART 3: IMMIGRATION AND TRAVEL DETAILS Immigration and Travel Details identifies when a notifiable disease is acquired outside of Alberta as a result of travelling or previous country of residence.

• Was illness likely acquired while residing outside of Canada? • Was illness likely acquired during travel outside of Alberta?

Note: For examples of completed NDR forms see Appendix F: Examples of Completed NDR Forms. Enteric diseases for the purposes of the NDR form include:

• Amoebiasis • Botulism - if foodborne (Wound Botulism - refer to Part 5 - Non-enteric) • Brucellosis • Campylobacteriosis • Cholera (O1 and O139) • Cryptosporidiosis • Cyclosporiasis • E. coli O157:H7 • Giardiasis • Haemolytic Uremic Syndrome • Hantavirus Pulmonary Syndrome • Hepatitis A • Hepatitis (other, viral) - Hepatitis E only (Hepatitis D and Hepatitis G - refer to Part 5 -

Non-enteric) • Leptospirosis • Listeriosis • Paratyphoid Fever • Psittacosis • Q Fever • Salmonellosis • Shigellosis • Trichinosis • Typhoid Fever • Vibrio Parahaemolyticus • Vibrio Cholerae, non O1, non O139 • Yersiniosis



Non-enteric diseases for the purposes of the NDR form include:

• Acute Flaccid Paralysis • Anthrax • Botulism - if Wound Botulism

(Foodborne - refer to Part 4 - Enteric)

• Chickenpox (Varicella) - Spring 2007 • Congenital Cytomegalovirus • Congenital Rubella Infection • Congenital Rubella Syndrome • Congenital Toxoplasmosis • Creutzfeldt-Jakob Disease - Classic • Creutzfeldt-Jakob Disease - Variant • Crimean Congo Haemorrhagic Fever • Dengue Fever • Diphtheria • Eastern Equine Encephalitis • Ebola Haemorrhagic Fever • Group A Streptococcal Disease,

Invasive • Haemophilus Influenzae, Invasive - type b • Hepatitis B • Hepatitis C • Hepatitis (other, viral) - Hepatitis D

and Hepatitis G (Hepatitis E - refer to Part 4 - Enterics)

• Lassa Fever • Legionellosis • Leprosy • Lyme Disease • Malaria • Marburg Haemorrhagic Fever • Measles/Rubeola

• Meningococcal Disease, Invasive • Mumps • Neonatal Herpes Simplex Infection • Pertussis • Plague • Pneumococcal Disease, Invasive • Poliomyelitis • Powassan Encephalitis • Rabies • Rocky Mountain Spotted Fever • Rubella • St. Louis Encephalitis • Severe Acute Respiratory Syndrome • Smallpox • Subacute Sclerosing Panencephalitis • Tetanus • Toxic Shock Syndrome (non-group A

strep) • Tularemia • Typhus - Louseborne • Typhus - Murine • Typhus - Scrub • Varicella Zoster, Shingles • Western Equine Encephalitis • West Nile Virus Asymptomatic

Infections • West Nile Virus Neurological

Syndrome • West Nile Virus Fever Non-

Neurological Syndrome • Yellow Fever



FIELD NAME A. WAS ILLNESS LIKELY ACQUIRED WHILE RESIDING OUTSIDE OF CANADA? Description: The Was illness likely acquired while residing outside of Canada? field identifies

whether the case acquired disease prior to immigration to Canada. This field assists in identifying changes in disease epidemiology due to immigration.

Reporting Requirement: Mandatory Instructions: 1. Place an ‘X’ in the appropriate box. 2. If No, proceed to Part 3 B of the Immigration and Travel Details section. 3. If Yes, enter the Country of source and the Date of arrival in Canada.

• Enterics – proceed to Part 6 – Relevant Immunobiological/Chemoprophylaxis Details/Other.

• Non-Enterics – proceed to Part 5 - Non-Enterics. Definitions:

Country of source The country where disease was most likely acquired given the incubation period of the disease being reported.



FIELD NAME B. WAS ILLNESS LIKELY ACQUIRED DURING TRAVEL OUTSIDE OF ALBERTA? Description: The Was illness likely acquired during travel outside of Alberta? field identifies

whether the case acquired disease during travel outside of Alberta. This is travel outside of Alberta that is not associated with immigration to Canada and includes individuals working or studying outside of Alberta.

Reporting Requirement: Mandatory if the response is No to A. Was illness likely acquired

while residing outside of Canada? Instructions: 1. Place an ‘X’ in the appropriate box. 2. If No:

• Enterics – proceed to Part 4 – Enterics. • Non-Enterics - proceed to Part 5 – Non-Enterics.

3. If Yes, place an ‘X’ next to Domestic or Foreign as appropriate. Indicate the most likely location disease was acquired in Travel location field. • Enter the Dates of travel indicating Departure from Alberta date and Return to Alberta

date. • Enterics – proceed to Part 6 – Relevant Immunobiological/Chemoprophylaxis

Details/Other • Non-Enterics – proceed to Part 5 Non-Enterics.

Definitions: Domestic Travel outside Alberta but within Canada. Foreign Travel outside of Canada.

ENTERICS


PART 4: ENTERICS Enterics identifies information required specifically related to enteric diseases.

• Where was disease likely acquired? • How was disease likely acquired?

Note: For examples of completed NDR forms see Appendix F: Examples of Completed NDR Forms pp 84,85. Enteric diseases for the purposes of the NDR form include:

• Amoebiasis • Botulism - if foodborne (Wound

Botulism - refer to Part 5 - Non-enteric)

• Brucellosis • Campylobacteriosis • Cholera (O1 and O139) • Cryptosporidiosis • Cyclosporiasis • E. coli O157:H7 • Giardiasis • Haemolytic Uremic Syndrome • Hantavirus Pulmonary Syndrome • Hepatitis A

• Hepatitis (other, viral) - Hepatitis E only (Hepatitis D and Hepatitis G - refer to Part 5 - Non-enteric)

• Leptospirosis • Listeriosis • Paratyphoid Fever • Psittacosis • Q Fever • Salmonellosis • Shigellosis • Trichinosis • Typhoid Fever • Vibrio Parahaemolyticus • Vibrio Cholerae, non O1, non O139 • Yersiniosis

See Appendix H: Enteric and Non-enteric Disease Lists.

ENTERICS


FIELD NAME A. WHERE WAS DISEASE LIKELY ACQUIRED Description: The Where was disease likely acquired? field indicates where the case most likely

acquired disease.

Reporting Requirement: Mandatory for enteric diseases acquired in Alberta. See list on page 30. Instructions: 1. Place an ‘X’ in the most appropriate box. Definitions:

Community organization function

Events or functions open to the general public where foods served have been prepared at home and/or in a non-permitted facility by volunteers (e.g., wild game dinners, community sports events, fundraising dinners, etc.). Note: This box should only be selected when illness is associated

with the food or water served at the event. If the suspected source of the illness is something other than the food or water, then select the next most appropriate acquisition source in this column.

Restricted function Events or functions not open to the general public where foods served have been prepared at home and/or in a non-permitted facility by volunteers. Attendance at these functions is by personal invitation only and for the purposes of disease reporting includes potlucks and bake sales (e.g., family reunions, retreats, etc.). Note: This box should only be selected when illness is associated

with the food or water served at the event. If the suspected source of the illness is something other than the food or water, then select the next most appropriate acquisition source in this column.

Permitted food establishment

A food establishment listed on a valid Food Handling Permit issued under Part 1 of the Public Health Act Food Regulation and for the purpose of disease reporting includes temporary food establishments operating at special events and catered events as defined in the Public Health Act Food Regulation.

Animal facility Animal Facility – Select the most appropriate facility type. Farm Agricultural facilities where livestock or fur-bearing animals are

raised on agricultural lands.

Intensive Livestock Operation

Facilities where livestock are confined for the purpose of growing, sustaining, finishing or breeding and are fed by means other than grazing. This does not include equestrian stables, auction markets, race tracks or exhibition grounds.

Petting Zoo

Facilities that feature a combination of domestic animals and some wild species that are docile enough to touch and feed.

ENTERICS


Other An animal facility that does not fit one of the above animal facility categories (e.g., zoo, equestrian stables, auction markets, race tracks, exhibition grounds).

Child care facility This includes day care centres, preschools, out of school care, and family day homes. For the purposes of disease reporting, secure youth facilities are not included in this category.

Health care facility Any health care facility including hospitals, long term care facilities, and seniors lodges.

Private dwelling A separate set of living quarters with a private entrance, including private dwellings used as group homes and foster homes.

Unk It is not possible to determine where the disease was likely acquired.

Other The type of facility or location must be specified (e.g., camps, secure youth facilities, homeless shelters).

Note: The selection of Where was disease likely acquired? should answer the question “Where

would legislation or education most appropriately be directed to prevent similar transmission?”

ENTERICS


FIELD NAME B. HOW WAS DISEASE LIKELY ACQUIRED? Description: The How was disease likely acquired? field indicates how the case most likely

acquired disease.

Reporting Requirement: Mandatory for enteric diseases acquired in Alberta. See Enteric list on page 30.

Instructions: 1. Place an ‘X’ in the most appropriate box. Definitions:

Food Any substance, including ice, intended for use in whole or in part for human consumption, but does not include a drug, medication or a regulated health related product and, for the purpose of disease reporting, does not include water.

Animal or animal manure contact

Select the most appropriate animal category. In the event that both apply, choose Livestock. Please specify the suspect animal type(s).

Domestic pet, specify animal(s)

Contact with an animal that is kept for amusement or companionship, and that would typically live in the home. Contact with manure from an animal(s) in this sub-category, for example at a dog kennel.

Livestock, specify animal(s)

Contact with poultry, horses, cattle, sheep, swine, goats, bison, fur-bearing animals raised in captivity and domestic cervids (e.g., deer, elk, etc.). Contact with manure from an animal(s) listed in this sub-category, for example at a livestock truck washing station.

Other Contact with an animal or that animal’s manure that does not fit one of the above animal or animal manure categories (e.g., wild animals such as elephants, zebras, etc.).

Drinking water Water typically intended for human consumption, including private systems such as wells and cisterns, and treated municipal water. Does not include ice.

Other water Recreational water usage and contact with, or consumption of, water not typically intended for human consumption, including water from swimming pools, lakes/ponds or rivers/streams (e.g., beach, pool, river, etc.).

Sexual contact Deep kissing, sexual intercourse (vaginal, oral or anal) or any other sexual activities that expose an individual to the body fluids of another person.

Person to person Non-sexual contact with an infected individual.

Unk It is not possible to determine how the disease was likely acquired.

Other Specify how the disease was transmitted.

ENTERICS


Notes: 1. See Appendix H: Enteric and Non-Enteric Disease Lists. 2. For mandatory fields for a specific disease see Appendix B: Notifiable Disease Reporting

Requirements.

NON-ENTERICS


PART 5: NON-ENTERICS

Non-enterics identifies information required specifically related to non-enteric diseases. • Manifestation or site • Risk factors/Susceptibility for acquiring disease • Where was disease likely acquired? • How was disease likely acquired? (for Blood Borne Pathogens only)

Note: For examples of completed NDR forms see Appendix F: Examples of Completed NDR Forms pp 86, 87, 88.

NON-ENTERICS


Non-enteric diseases for the purposes of the NDR form include:

• Acute Flaccid Paralysis • Anthrax • Botulism - if Wound Botulism

(Foodborne - refer to Part 4 - Enteric)

• Chickenpox (Varicella) - Spring 2007 • Congenital Cytomegalovirus • Congenital Rubella Infection • Congenital Rubella Syndrome • Congenital Toxoplasmosis • Creutzfeldt-Jakob Disease - Classic • Creutzfeldt-Jakob Disease - Variant • Crimean Congo Haemorrhagic Fever • Dengue Fever • Diphtheria • Eastern Equine Encephalitis • Ebola Haemorrhagic Fever • Group A Streptococcal Disease,

Invasive • Haemophilus Influenzae, Invasive - type b • Hepatitis B • Hepatitis C • Hepatitis (other, viral) - Hepatitis D

and Hepatitis G (Hepatitis E - refer to Part 4 - Enterics)



strep) • Tularemia • Typhus - Louseborne • Typhus - Murine • Typhus - Scrub • Varicella Zoster, Shingles • Western Equine Encephalitis • West Nile Virus Asymptomatic

Infections • West Nile Virus Neurological

Syndrome • West Nile Virus Fever Non-

Neurological Syndrome • Yellow Fever

See also Appendix H: Enteric and Non-enteric Disease Lists.

NON-ENTERICS


FIELD NAME MANIFESTATION OR SITE Description: The Manifestation or Site field identifies the primary symptom presentation of the

disease. This field assists with monitoring the epidemiology of the disease. Reporting Requirement: Mandatory for the following non-enteric diseases:

• Anthrax • Eastern Equine Encephalitis • Group A Streptococcal Disease, Invasive • Haemophilus Influenzae, Invasive - type b • Legionellosis • Lyme Disease • Meningococcal Disease, Invasive • Plague • Pneumococcal Disease, Invasive • Powassan Encephalitis • St. Louis Encephalitis • Western Equine Encephalitis

Instructions: 1. Place an ‘X’ in the appropriate box. Definitions:

Cellulitis Inflammation of the cellular or connective tissue (close to the skin).

Epiglottitis Inflammation of the epiglottis.

Joint Includes septic arthritis, bursitis, joint fluid/aspirate, and synovial fluid.

Meningitis Inflammation of the membranes of the spinal cord or brain.

Necrotizing Fasciitis Death of membranes surrounded by healthy parts supporting and separating the muscle.

Osteomyelitis Inflammation of the bone marrow and adjacent bone.

Pericarditis Inflammation of the pericardium.

Peritonitis Inflammation of the peritoneum (membranous coat of the abdominal cavity).

Pneumonia Inflammation of the lungs. This includes pleural fluid specimens.

Septicemia/Bacteremia If sample is blood with no other focus.

Soft Tissue Infection Includes abscesses, lymph node, etc.

Toxic Shock Syndrome As diagnosed by specific symptoms outlined in case definition.

Other Any other normally sterile site (e.g., myositis). Note: For a complete list of mandatory fields for all diseases see Appendix B: Notifiable Disease

Reporting Requirements.

NON-ENTERICS


FIELD NAME RISK FACTORS/SUSCEPTIBILITY FOR ACQUIRING DISEASE Description: The Risk factors/Susceptibility for acquiring disease field identifies relevant risk

factors, susceptibility, and underlying conditions pertinent or contributing to the disease event. Identifies those lifestyle behaviours or factors identified as possibly contributing to disease acquisition. May assist with identifying emerging trends occurring in Alberta.

Reporting Requirement: Mandatory for all non-enteric diseases. See non-enteric list on page 36. Instructions: 1. Place an ‘X’ in the appropriate box. Definitions:

Alcohol Abuse As reported by client or review of history.

Chronic disease As reported by client or review of history.

Diabetes As reported by client or review of history.

Hepatitis C As reported by client or review of history.

HIV As reported by client or review of history.

Homelessness At the time of diagnosis the case did not have an address or home (e.g., apartment, townhouse, etc.). This would include people staying in shelters, cars, etc.

Illicit drug use As reported by client or review of history.

Immunocompromised This includes asplenia, cancer; immunodeficiency diseases, or immunosuppressive therapy e.g., carcinoma or sarcoma corticosteroids, leukemia, lymphoma, transplant recipient.

Postpartum Defined as ≤28 days after delivery.

Wound - surgical As reported by client or review of history.

Wound - non-surgical As reported by client or review of history.

None identified No risk factors or susceptibility identified.

Unk Unknown if case has any risk factors or susceptibilities.

Other If other is selected, additional details must be reported. Note: For a complete list of mandatory fields for all diseases see Appendix B: Notifiable Disease


NON-ENTERICS


FIELD NAME WHERE WAS DISEASE LIKELY ACQUIRED? Description: The Where was disease likely acquired? field identifies the suspected type of

setting where the notifiable disease was likely acquired. This field assists in identifying settings that may require public health intervention.

Reporting Requirement: Mandatory for all non-enteric diseases. See list on page 36. Instructions: 1. Place an ‘X’ in the appropriate box. 2. If other is checked off, additional details must be reported. Definitions:

Acute care facility Facility designated as acute care (e.g., active treatment hospital).

Child care facility This includes day care centres, preschools, out of school care, and family day homes.

Long term care Facilities that provide care for clients who require assistance with daily living activities. Includes seniors lodges and assisted living facilities.

School Primary or post secondary educational institutions. Includes private our public educational institutions.

Private dwelling A separate set of living quarters with a private entrance, including private dwellings used as group homes and foster homes.

Unk Location is unknown.

Other The type of facility/location must be specified (e.g., camps, homeless shelters, correctional facilities, secure youth facilities, community settings such as bingo halls).

Note: For a complete list of mandatory fields for all diseases see Appendix B: Notifiable Disease


NON-ENTERICS


FIELD NAME HOW WAS DISEASE LIKELY ACQUIRED? (FOR BLOOD BORNE PATHOGENS ONLY) Description: The How was disease likely acquired field identifies how the disease was likely

transmitted and acquired. Assists in identifying emerging trends in Alberta and populations that may require further public health intervention.

Reporting Requirement: Mandatory for Blood Borne Pathogen diseases which include:

• Creutzfeldt-Jakob Disease - Classic • Creutzfeldt-Jakob Disease - Variant • Crimean Congo Haemorrhagic Fever • Ebola Haemorrhagic Fever • Hepatitis B • Hepatitis C • Hepatitis (other, viral)- Hepatitis D or Hepatitis G (Hepatitis E - refer to Part 4 -

Enterics) • Lassa Fever • Marburg Haemorrhagic Fever • West Nile Virus Asymptomatic Infections • West Nile Virus Neurological Syndrome • West Nile Virus Fever Non- Neurological Syndrome

Instructions: 1. Place an ‘X’ in the appropriate box. 2. If other is selected, additional details must be reported. Definitions:

Injection/intravenous drug use

As reported by client or review of history.

Sexual contact Deep kissing, sexual intercourse (vaginal, oral or anal) or any other sexual activities that expose an individual to the body fluids of another person.

Vertical Mother to infant in utero or in immediate postpartum period.

Blood/blood product Blood or blood product transfusion.

Breast milk Transmission through breast milk.

Unk Transmission unknown.

Other If other is selected, additional details must be reported e.g., needlestick injury; sharing personal items such as toothbrushes, razors, or nail clippers; electrolysis, acupuncture, tattooing, or skin piercing with inappropriately sterilized or unsterilized equipment; or household contact (household contact applies to Hepatitis B only).



RELEVANT IMMUNOBIOLOGICAL/CHEMOPROPHYLAXIS DETAILS


PART 6: RELEVANT IMMUNOBIOLOGICAL/CHEMOPROPHYLAXIS DETAILS/OTHER

Relevant Immunobiological/Chemoprophylaxis Details/Other identifies immunization and prophylaxis information on the case as it relates to the notifiable disease.

• Relevant immunization status for age/eligibility • Vaccine code • Antigen count • Immunization date • Prior to symptom onset was this person on Post Exposure Prophylaxis (PEP)? • Agent received

See Appendix I: Immunobiological Lists. Note: For examples of completed NDR forms see Appendix F: Examples of Completed NDR Forms.



FIELD NAME RELEVANT IMMUNIZATION STATUS FOR AGE/ELIGIBILITY Description: The Relevant immunization status for age/eligibility field is used to record the

immunization status for age/risk group of vaccine-preventable diseases specific to the notifiable disease. This field identifies individuals who develop diseases despite having received vaccine.


• Acute Flaccid Paralysis - Polio immunization

• Anthrax • Chickenpox (Varicella) - Spring

2007 • Cholera (O1 and O139) • Diphtheria • Hepatitis A • Hepatitis B • Measles • Meningococcal Disease, Invasive • Mumps • Pertussis

• Pneumococcal Disease, Invasive • Poliomyelitis • Rabies • Rubella • Smallpox • Subacute Sclerosing

Panencephalitis - Measles immunization

• Tetanus • Typhoid Fever • Varicella Zoster (Shingles) • Yellow Fever

Instructions: 1. Place an ‘X’ in the appropriate box. 2. Only Relevant immunization status for age/eligibility details related to the disease case

need to be reported. For example, when reporting a measles case, report vaccines that contain measles such as ‘MMR’, not ‘DTaP/Hib/IPV’ immunization history. Also include all antigens in the vaccine. For example, when reporting a case of pertussis, include DTaP-IPV-Hib or DTaP-IPV.





Definitions for Immunization Status:

Complete Complete immunization for current age/risk group/eligibility. Follow the current Alberta Immunization Manual and policy updates.

Incomplete Incomplete immunization for age/risk group/eligibility. A series that is not complete because of the age of the case or other circumstances (e.g., an 8-month old child who had two doses of DTaP-IPV-Hib is incomplete). Complete for age would be three doses of DTaP-IPV-Hib. Comment is required.

Not eligible A client is considered “Not eligible” for immunization because of age (e.g., too young), medical contraindication, or other reason that the client has not been immunized. A clarifying comment is required.

No documentation (and eligible)

Client is eligible for vaccine but the immunization status cannot be verified with documentation/immunization record. A comment is required (e.g., inability to obtain an immunization record).

None (and eligible) Client is eligible and it is clear via immunization record and client history vaccine has not been received. A comment is required (e.g., unable to contact client OR client’s parents do not consent to immunizations). This field should not be confused with the Not eligible field.

Unk Immunization status is unknown because case is lost to follow-up, unable to contact case, or unable to assess for vaccine eligibility.



FIELD NAME VACCINE CODE Description: The Vaccine code field identifies the vaccine the case received prior to the date of

diagnosis. Reporting Requirement: Mandatory when the Relevant immunization status for age/eligibility

details indicate Complete or Incomplete. Instructions: 1. Record the immunization agent specific to the notifiable disease using the valid vaccine codes

as listed on page 45. Note: For examples of completed NDR forms see Appendix F: Examples of Completed NDR forms pp

85, 86, 87.



Vaccine Code Table VACCINE CODE

VACCINE NAME/DESCRIPTION START >= END <=

aP Acellular Pertussis 1997/07/01 2001/10/31 BCG Bacillus Calmette Guerin (TB) 1956/01/01 CHI Cholera – Injectable 1970/01/01 1999/01/01 CHO Cholera – Oral 1997/01/01 D Diphtheria Toxoid (fluid) 1954/04/01 1994/08/01 DD Diphtheria Toxoid (fluid-diluted) 1954/04/01 1994/08/01 DPT Diphtheria/whole cell Pertussis/ Tetanus 1948/01/01 1997/06/30 DPTP Diphtheria/whole cell Pertussis/ Tetanus/ IPV (QUAD) 1994/08/02 1997/06/30 DPTPHib Diphtheria/whole cell Pertussis/ Tetanus/ IPV/Hib (Penta) 1994/08/02 1997/06/30 DRT Diphtheria Reaction Test 1923/01/01 1996/01/01 DT Diphtheria/Tetanus toxoids (pediatric) 1948/01/01 1998/12/31 DTaP Diphtheria/Tetanus/Acellular Pertussis (Tripacel) 1997/07/01 1999/01/01 dTap Diphtheria/Tetanus/Acellular Pertussis (Adacel) 2004/02/01 DTaP-IPV Diphtheria/Tetanus/Acellular Pertussis/IPV (Quadracel) 1997/07/01 DTaP-IPV-Hib Diphtheria/Tetanus/Acellular Pertussis/IPV/Hib (Pentacel) 1997/07/01 DT-IPV Diphtheria/Tetanus/IPV (pediatric) 1996/07/01 2005/10/31 EZM E/Z Measles 1969/01/01 1971/01/01 FLU Influenza 1939/01/01 HABV Hepatitis A and B 1997/01/01 HAV Hepatitis A 1994/01/01 HbOC Haemophilus influenza b (Lederle-Praxis) 1992/05/19 1993/02/01 HBV Hepatitis B 1983/01/01 HBVD Hepatitis B for Dialysis 1983/01/01 Hib Haemophilus influenza b (Connaught) (PRPT) 1993/02/01 IPV Inactivated Polio (Salk) 1956/01/01 JEV Japanese Encephalitis 1990/01/01 KMEA Killed red measles 1963/01/01 1970/12/31 MEA Measles (Red) 1971/01/01 1998/12/31 MenACs Meningococcal, polysaccharide, bivalent (A, C) (single dose) 2001/01/01 2002/03/01 MenconC Meningococcal, conjugate, monovalent (C) 2001/06/15 MeninAC Meningococcal, polysaccharide, bivalent (A, C) (multidose) 2001/01/01 2002/03/01 MENING Meningococcal, polysaccharide, quadrivalent (A, C, Y, W-135) (single dose) 1983/05/04 MENOTET Meningococcal, polysaccharide, quadrivalent (A, C, Y, W-135) (multidose) 1983/05/04 2000/11/01 MMR Measles/Mumps/Rubella 1982/01/01 MONM Measles (Red) (multidose) 1997/04/01 1998/06/30 MR Measles/Rubella 1997/01/01 1999/12/31 MU Mumps 1982/01/01 OMP Haemophilus influenza b (Merck Frosst) 1990/01/01 1994/08/02 OPV Oral Polio (Sabin) 1962/01/01 1994/07/31 P Whole Cell Pertussis 1939/01/01 1997/06/30 PNEUMO-P Pneumococcal (23 – polysaccharide) 1997/04/29 POL1 Polio 1994/08/02 1998/12/31 PPD Purified Protein Derivative 5TU (Mantoux – TB Test) 1960/01/05 PNEU-C Pneumococcal (7 – conjugate) 2001/01/06 PRPD Haemophilus influenza b (Connaught) 1988/03/16 1992/05/18 RAB Rabies (HDCV) 1980/01/01 RUB Rubella 1971/01/01 1998/10/01 TBEV Tick-Borne Encephalitis Virus 1995/06/01 Td Tetanus/Diphtheria toxoids (adult) 1980/07/09 TdP Tetanus/Diphtheria/IPV (adult) 1984/01/10 TP Tetanus Polio 1959/01/01 1994/08/01 TT Tetanus Toxoid 1947/01/01 2001/05/31 TYO Typhoid Ty21a – Oral 1992/01/01 TYVI Typhim VI – Injectable 1993/11/01 VZ Varicella Zoster 1998/12/01 YF Yellow Fever 1935/01/01

1 POL is a combination vaccine code used only for mixed OPV / IPV records to assess dose count.

Updated July 2006.



FIELD NAME ANTIGEN COUNT Description: The Antigen count field identifies the number of doses of antigen administered to

the case prior to the date of diagnosis. Reporting Requirement: Mandatory if a Vaccine code is reported. Instructions: 1. Enter the number of doses administered next to the Vaccine code. Include all doses of vaccine. FIELD NAME IMMUNIZATION DATE Description: The Immunization date field is the date the case received the immunization. Reporting Requirement: Mandatory if a Vaccine code is reported Instructions: 1. Enter the date the vaccine was given. 2. If only the year is known but not the month and day, enter the first day of the first month. 3. If the year and month are known but not the day, enter the first day of the month.



FIELD NAME PRIOR TO SYMPTOM ONSET WAS THIS PERSON ON POST EXPOSURE PROPHYLAXIS (PEP)? Description: The Post Exposure Prophylaxis (PEP) field identifies details about the vaccine or

antibiotic medication prescribed for the case in order to prevent the disease or reduce the severity of the disease prior to onset of symptoms.


• Botulism - Wound Botulism • Chickenpox (Varicella) - Spring

2007 • Group A Streptococcal Disease,

Invasive • Haemophilus Influenzae, Invasive -

type b • Hepatitis A • Hepatitis B

• Leprosy • Malaria • Measles • Meningococcal Disease, Invasive • Pertussis • Plague • Rabies • Tetanus

Instructions: 1. Place an ‘X’ in the appropriate box. 2. If Yes: Complete the date the case started the chemoprophylaxis or received the immune

globulin/antitoxin. Definitions:

No Case did not receive prophylaxis prior to onset of symptoms to prevent or reduce the severity of the disease.

Yes Case did receive prophylaxis prior to onset of symptoms to prevent or reduce the severity of the disease.

AGENT RECEIVED Description: The Agent received field identifies the vaccine or antibiotic medication prescribed

for the case. Reporting Requirement: Mandatory if yes is marked in the Post Exposure Prophylaxis (PEP)

field. Instructions: 1. Complete agent received. See chemoprophylaxis, immune globulin, and antitoxin codes on

page 48.



CHEMOPROPHYLAXIS

CODE DESCRIPTION AZ Bact BIA Ceph

Azithromycin Bactrim Biaxin Cephalosporins (e.g., Cephalexion)

Clari Erythro FL

Clarithromycin Erythromycin Flagyl

MAL Malaria Prophylaxis Pen Penicillins Rif Sep

Rifampin Septra

Tet ZI

Tetracyclines Zithromax

IMMUNE GLOBULINS AND ANTITOXINS CODE DESCRIPTION Bot-Anti

Botulism antitoxin

Diph-Anti Diphtheria antitoxin HBIG Hepatitis B Immune Globulin IG Immune Serum Globulin (Human – IM) RIG Rabies Immune Globulin TIG Tetanus Immune Globulin VZIG Varicella Zoster Immune Globulin

REPORTING SECTION


PART 7: REPORTING SECTION

Reporting Section provides allowance for additional comments, identifies the reporter, telephone number, and date that the NDR was completed by RHA public health staff.

• Comments • RHA public health staff • Telephone number • RHA reporting • Date reported to AHW


REPORTING SECTION


FIELD NAME COMMENTS Description: The Comments field allows for any significant additional notes related to the case

that are relevant to the notifiable disease and have not been reported elsewhere on the form.

Reporting Requirement: Conditional Instructions: 1. Complete this field only if there is additional information that is not captured elsewhere on

the form. FIELD NAME RHA PUBLIC HEALTH STAFF Description: The RHA public health staff field identifies the name of the regional public health

staff member who has completed the follow-up and is reporting the notifiable disease case to AHW.

Reporting Requirement: Mandatory Instructions: 1. Print the name of the public health staff person reporting the case to AHW. Ensure that the

first and last names are legible. FIELD NAME TELEPHONE NUMBER Description: The Telephone number field identifies the telephone number of the RHA public

health staff. This may be an office, cellular, or pager number. Reporting Requirement: Mandatory Instructions: 1. Enter the telephone number where the reporter can be contacted. This may be an office,

cellular, or pager number.

REPORTING SECTION


FIELD NAME RHA REPORTING Description: The RHA reporting field is the name of the RHA reporting the notifiable disease

case to AHW. Reporting Requirement: Mandatory Instructions: 1. Print the legal name and the number of the region reporting to AHW. FIELD NAME DATE REPORTED TO AHW Description: The Date reported to AHW is the date the notifiable disease report is submitted to

AHW by regional public health staff. Reporting Requirement: Mandatory Instructions: 1. Enter the date the NDR form is submitted to AHW.

REFERENCE LIST


REFERENCE LIST Alberta Health & Wellness. Alberta Immunization Manual. Alberta Health & Wellness (June 2003). Alberta Case Definitions Manual. Alberta Health & Wellness (September 2002). Outbreak Roles and Responsibilities. Centres for Disease Control and Prevention (CDC) (2001). Updated Guidelines for Evaluating Public Health Surveillance Systems. Retrieved November 10, 2006 http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5013a1htm. Province of Alberta (2006). Public Health Act Communicable Diseases Regulation (Alberta Regulation 238/85). Alberta, Canada: Alberta Queen’s Printer. Province of Alberta (2006). Public Health Act Food Regulation (31/2006). Alberta, Canada: Alberta Queen’s Printer.

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5013a1htm

APPENDIX A


APPENDIX A: NOTIFIABLE DISEASE REPORT (NDR) FORM NOTIFIABLE DISEASE REPORT (NDR) FORM

APPENDIX A


AMENDMENT TO NOTIFIABLE DISEASE REPORT (NDR) FORM

APPENDIX B


APPENDIX B: NOTIFIABLE DISEASE REPORTING REQUIREMENTS MANDATORY FIELDS The following fields are mandatory for ALL diseases as indicated by the shading on the NDR form:

Part 1: Personal Identifiers • Lives on reserve • Identifier code • PHN/other identifier • Birth date • Gender • Patient Name • Home address • City/town • Province • Postal Code

Part 2: Disease Descriptors and Laboratory Test Details

• Disease Name • ICD9 code • Diagnosis (as per case definition) • Onset date • Diagnosis date • Lab diagnosis • Hospitalized • Fatal • Epi linked • Outbreak associated • EI#

Part 3: Immigration and Travel Details

• A. Was illness likely acquired while residing outside of Canada? • If No to Question A – then B. Was illness likely acquired during travel

outside of Alberta? is mandatory.

Part 7: Reporting Section • RHA public health staff • Telephone number • RHA reporting • Date reported to AHW

APPENDIX B


The following are disease specific mandatory fields:

Diseases reportable by fastest means possible. *Bioterrorisim Agents

Part 4: Enterics

Part 5: Non - Enterics DISEASE/AGENT

ICD-

9 Cod

e

Ethn

icity

Preg

nant

Labo

rato

ry D

iagno

sis1

Ent

erics

– A

& B2

Mani

fest

atio

n or

Si

te

Risk

Fac

tors

/ Su

scep

tibilit

y

Whe

re w

as

dise

ase l

ikely

acqu

ired?

Ho

w wa

s dise

ase

likely

acqu

ired

?

Relev

ant

Imm

unob

iolo

gica

l/ Ch

emop

roph

ylaxis

Acute Flaccid Paralysis (AFP) 0459 M M M M Amoebiasis 006 M M *Anthrax 022 M M M M M *Botulism 0051 M M M M Brucellosis 023 M M Campylobacteriosis 0084 M M Chickenpox (Varicella) – Spring 2007 052 M M M M M M Cholera (O1 and O139) 001 M M M Congenital Cytomegalovirus (CMV) 7711 M M M M Congenital Rubella Infection 7710 M M M M Congenital Rubella Syndrome (CRS) 7710 M M M M Congenital Toxoplasmosis 7712 M M M M Creutzfeldt-Jakob Disease - Classic (CJD) 0461 M M M M M Creutzfeldt-Jakob Disease – Variant (vCJD) 0461.1 M M M M M Crimean Congo Haemorrhagic Fever 065.0 M M M M Cryptosporidiosis 0078 M M Cyclosporiasis 0079 M M Dengue Fever 061 M M M Diphtheria 032 M M M M M Eastern Equine Encephalitis (EEE) 0622 M M M M *Ebola Haemorrhagic Fever 078.1 M M M M E. coli O157:H7 0080 M M Giardiasis 007 M M Group A Streptococcal Disease, Invasive (iGAS) 034 M M M M M M Haemophilus Influenzae, Invasive - type b (HIB) 3200 M M M M M Haemolytic Uremic Syndrome (HUS) 2831 M Hantavirus Pulmonary Syndrome (HPS) 0786 M M Hepatitis A (HAV) 0700 M M M M Hepatitis B (HBV) 0702 M M M M M M M Hepatitis C (HCV) 0708 M M M M M M Hepatitis (other, viral) 0709 M M M Hep E M M Hep D & G *Lassa Fever 078.2 M M M M Legionellosis 4828 M M M M Leprosy 030 M M M M M Leptospirosis 100 M M Listeriosis 027 M M M Lyme Disease 087 M M M M Malaria 084 M M M M M *Marburg Haemorrhagic Fever 078.3 M M M M Measles/Rubeola 055 M M M M M M

APPENDIX B


Part 4: Enterics

Part 5: Non - Enterics DISEASE/AGENT

ICD-

9 Cod

e

Ethn

icity

Preg

nant

Labo

rato

ry D

iagno

sis1

Ent

erics

– A

& B2

Mani

fest

atio

n or

Si

te

Risk

Fac

tors

/ Su

scep

tibilit

y

Whe

re w

as

dise

ase l

ikely

acqu

ired?

Ho

w wa

s dise

ase

likely

acqu

ired

?

Relev

ant

Imm

unob

iolo

gica

l/ Ch

emop

roph

ylaxis

Meningococcal Disease, Invasive (IMD) 036 M M M M M Mumps 072 M M M M M Neonatal Herpes Simplex Infection 054 M M M Paratyphoid Fever 0029 M M Pertussis 033 M M M M *Plague 020 M M M M M Pneumococcal Disease, Invasive (IPD) 3201 M M M M M M Poliomyelitis 045 M M M M M Powassan Encephalitis 0638 M M M M Psittacosis 073 M M M Q Fever 083 M M Rabies 071 M M M M Rocky Mountain Spotted Fever 082 M M M M Rubella 056 M M M M M M St. Louis Encephalitis 0623 M M M M Salmonellosis 003 M M Severe Acute Respiratory Syndrome (SARS) 480.8 M M M M M Shigellosis 004 M M *Smallpox 050 M M M M M Subacute Sclerosing Panencephalitis (SSPE) 0462 M M M M Tetanus 037 M M M Toxic Shock Syndrome (non-group A strep) 7855 M M M Trichinosis 124 M M *Tularemia 021 M M M Typhoid Fever 0020 M M M Typhus – Louseborne 080 M M M Typhus – Murine 081.0 M M M Typhus – Scrub 081.2 M M M Varicella Zoster, Shingles 053 M M M Vibrio Parahaemolyticus 0054 M M Vibrio Cholerae, non O1, non O139 0019 M M Western Equine Encephalitis (WEE) 0621 M M M M M West Nile Virus Asymptomatic Infections (WNAI) 0663.2 M M M M M West Nile Virus Neurological Syndrome (WNNS) 0663 M M M M M West Nile Virus Non-Neurological Syndrome (WNNon-NS)

0663.1 M M M M M

Yellow Fever 060 M M M M Yersiniosis 0091 M M

1Laboratory Diagnosis – if Yes, then the laboratory details including Specimen collection date and Type of specimen are mandatory for the diseases as indicated by ‘M’. 2Part 4: Enterics – Mandatory for disease acquired within Alberta.

APPENDIX C


APPENDIX C: PROTOCOL FOR REPORTING NOTIFIABLE DISEASE INVOLVING FIRST NATIONS AND INUIT HEALTH BRANCH (FNIHB) All laboratory reports should be sent to the RHA of residence of the notifiable disease case. If the address of the case is not available, the laboratory requisition should be sent to the RHA of the requesting physician (based on the physician’s office address). RHA staff should determine the residence of the case. Forward the laboratory report to the appropriate First Nations Community Health Centre and a copy to the MOH/designate of FNIHB within one working day. In case of FMP notifiable diseases, the RHA should phone the MOH/designate of FNIHB, as well as the nurse at the appropriate First Nations community health centre as soon as possible. The following flowcharts describe four possible scenarios involving FNIHB. Definitions applicable to scenarios: Host RHA: The RHA in which the First Nations Community is located (where the case resides). Another RHA: Any RHA other than the Host RHA NDR: Notifiable Disease Report Distributed to RHAs and FNIHB by AHW October 2000 Evaluation by AHW shared May 2002 Reviewed Oct. 2006

APPENDIX C


Scenario 1: Provincial Laboratory Reports sent to the Host RHA Situation: The Provincial Laboratory sends a positive laboratory report to AHW and the Host RHA. Procedure: The Host RHA identifies whether the notifiable disease case is a resident of a First Nations community. If so, the laboratory report is forwarded or faxed to the appropriate First Nations Community Health Centre and a copy is sent to the MOH/designate of FNIHB. The Host RHA should retain a copy of the laboratory report to facilitate inquiries. The First Nations Community Health Centre staff will do the necessary case management of the notifiable disease cases and will complete the NDR form. When completed the First Nations Community Health Centre staff will forward the completed NDR form to the MOH/designate of FNIHB who will then send the original NDR form to AHW. FNIHB will send a quarterly and annual line listing for all NDRs submitted to the appropriate RHA.

Provincial Lab

Alberta Health & Wellness

Host RHA(fax FN Health Centre, FNIHB MOH)

First Nations Community Health Centre

(NDR to)

First Nations & Inuit Health Branch


(Original)

Host RHA(information for surveillance)

Scenario 1

APPENDIX C


Scenario 2: Provincial Laboratory Reports sent to Another RHA Situation: The Provincial Laboratory sends a positive laboratory report to AHW and to a RHA other than where the notifiable disease case resides (“Another RHA”). Procedure: The RHA staff will forward (fax) the laboratory report to the appropriate RHA. The RHA identifies whether the notifiable disease case is a resident of a First Nations community. If so, the laboratory report is forwarded or faxed to the appropriate First Nations Community Health Centre and a copy is sent to the MOH/designate of FNIHB. “Another RHA” should also retain a copy of the laboratory report to facilitate inquiries. The First Nations Community Health Centre staff will do the necessary case management of the ND cases and complete the NDR form. When completed, the First Nations Community Health Centre staff will forward the completed NDR form to the MOH/designate of FNIHB. FNIHB will then send the original NDR form to AHW. FNIHB will send a quarterly and annual line listing for all NDRs submitted to the appropriate RHA.

Provincial Lab


Another RHA(fax FN Health Centre, FNIHB MOH)

(copy to Host RHA)


(NDR to)



(Original)


Host RHA(retain copy)

Scenario 2

APPENDIX C


Scenario 3: Regional Laboratory Reports sent to the Host RHA Situation: The regional laboratory sends a positive laboratory report to the Host RHA. Procedure: The Host RHA identifies whether the notifiable disease case is a resident of a First Nations community. If so, the laboratory report is forwarded or faxed to the appropriate First Nations Community Health Centre and a copy is sent to the MOH/designate of FNIHB. The Host RHA should retain a copy of the laboratory report to facilitate inquiries. The First Nations Community Health Centre staff will do the necessary case management of the notifiable disease cases and will complete the NDR form. When completed the First Nations Community Health Centre staff will forward the completed NDR form to the MOH/designate of FNIHB who will then send the original NDR form to AHW. FNIHB will send a quarterly and annual line listing for all NDRs submitted to the appropriate RHA.

Regional Labs

Host RHA(fax FN Health Centre, FNIHB MOH)


(NDR to)



(Original)


Scenario 3

APPENDIX C


Scenario 4: Regional Laboratory Reports sent to another RHA Situation: The regional laboratory sends a positive laboratory report to a RHA other than where the notifiable disease case resides (“Another RHA”). Procedure: The RHA staff will forward the laboratory report to the appropriate RHA. The RHA identifies whether the notifiable disease case is a resident of a First Nations community. If so, the laboratory report is forwarded or faxed to the appropriate First Nations Community Health Centre and a copy is sent to the MOH/designate of FNIHB. “Another RHA” should also retain a copy of the laboratory report to facilitate inquiries. The First Nations Community Health Centre staff will do the necessary case management of the ND cases and complete the NDR form. When completed, the First Nations Community Health Centre staff will forward the completed NDR form to the MOH/designate of FNIHB. FNIHB will then send the original NDR form to AHW. FNIHB will send a quarterly and annual line listing for all NDRs submitted to the appropriate RHA.

Regional Lab

Another RHA(fax FN Health Centre, FNIHB MOH)

(copy to Host RHA)


(NDR to)



(Original)


Host RHA(retain copy)

Scenario 4

APPENDIX D


APPENDIX D: ENHANCED SURVEILLANCE FORMS HANTAVIRUS ENHANCED SURVEILLANCE REPORT

APPENDIX D


APPENDIX D


APPENDIX D


APPENDIX D


SARS ENHANCED SURVEILLANCE REPORT

APPENDIX D


APPENDIX D


APPENDIX D


WEST NILE VIRUS ENHANCED SURVEILLANCE REPORT

APPENDIX D


APPENDIX D


APPENDIX D


APPENDIX E


APPENDIX E: OUTBREAK REPORTING FORMS ENTERIC OUTBREAK REPORT FORM (EORF)

APPENDIX E


Enteric Outbreak Reporting Form (EORF)

Definitions The following definitions are not intended to have legal interpretations; instead they provide a quick understanding of terms to maximize consistency with data entry when completing the form. The entire form is to be completed by the RHA. Section 1 – Initial Summary/Contact Information EI# - Exposure investigation Number

• Unique exposure investigation number assigned by the Provincial Laboratory of Public Health (ProvLab) to each reported outbreak.

Provincial Lab Contact

• Lab point person identified by the ProvLab. Date Investigation Opened

• Date the outbreak is identified by the RHA. Date of Onset

• Date symptoms first appeared in the index case. Date Reported to AHW

• Date that Sections 1 and 2 are submitted to Alberta Health and Wellness (AHW). RHA Reporting

• Name of the RHA reporting the outbreak to AHW. RHA Primary Investigator

• Primary RHA contact for the outbreak. Section 2 – Investigation Details Suspected Organism

• Organism suspected of causing the outbreak. Location of Outbreak Select one of the following options:

• Acute Care: Any acute care facility in the province, may be a wing of a hospital or an entire hospital facility.

• Child Care Facility: Daycare centre, family day home or similar social care facility in which care is provided for children, other than a group home or a foster home.

• Community: Outbreaks that appear to be related to no specific event or location. • Food Service Establishment: Premises that serves, offers for sale, displays, processes,

packages, stores or handles food that is intended for public consumption (includes work camps).

• Long Term Care Facility: Residential facility in which accommodation, meals, necessary nursing services, the ability to access routine and emergency drugs as well as life enrichment services are offered. May be a wing/area of an acute care facility.

• Post Secondary Institution: College, university etc. • Private Dwelling: Housing accommodation, including a private residence, a rental

accommodation, a group home and a foster home.

APPENDIX E


• School: Private or public educational institution (K – 12). • Seniors Lodge: Home for senior citizens who are not capable of maintaining or do not

desire to maintain their own home but does not include the provision of advanced nursing services. May also be referred to as assisted living.

• Swimming Pool: Pool other than a swimming pool at a private dwelling. • Travel: Domestic or foreign travel. Location must be specified. • Other: Outbreaks related to locations or events not identified on this list.

Name of Facility

• Facility name in which the outbreak is occurring or is suspected to have been associated with.

Town/City

• Town or city in which the outbreak is occurring.

Number of People Ill • (a) Total number of clients/residents experiencing symptoms associated with the

suspected organism/outbreak. • (b) Total number of staff experiencing symptoms associated with the suspected

organism/outbreak. • (c) Sum total of (a) plus (b).

Population at People at Risk

• (a) Total number of clients/residents at risk of becoming infected. Do not include individuals already considered cases.

• (b) Total number of staff, if the outbreak is occurring in a public facility, which are at risk of becoming infected. Do not include individuals already considered cases.

• (c) The sum total of (a) plus (b). Cases in more than one RHA

• Indicate if there are cases in other RHAs. Section 3 – Final Summary Organism Identified

• Indicate the type of organism identified in a clinical specimen (e.g., Salmonella). • If more than one organism is found, identify the most likely primary causative agent in the

drop down boxes and list all secondary organisms in the Comments (Section 4). • Drop down fields A-S and S-Z provide the most common organisms in alphabetical order.

Lab Confirmed in Staff

• If staff members are ill indicate if a clinical specimen contains the organism identified. If no staff are ill select N/A (not applicable).

Lab Confirmed in Residents/Clients

• Indicate if clients/residents have a clinical specimen which contains the organism identified. If no clients/residents are ill select N/A (not applicable).

Number of People Ill

• (a) Total number of ill with specimen samples that were found to contain the Organism Identified.

• (b) Total number of ill without specimen samples that were found to contain the Organism Identified.

• (c) Sum total of (a) plus (b).

APPENDIX E


Probable Vehicle • The most specific person, place or food involved in transmitting the illness, if unknown

indicate “unknown”. Samples Submitted

• Indicate if environmental samples (e.g., food or water) were tested. Lab Confirmed

• Indicate if the environmental samples contain the Organism Identified. • In the event more than one organism is found, list them in the Comments (Section 4).

Date Investigation Closed • Date the RHA completed their investigation.

Date Reported to AHW

• Date that Section 3 and 4 are submitted to AHW. Section 4 – Comments

• Provide any additional comments that may be relevant to the investigation of the outbreak.

APPENDIX E


Suspected Organism

None Enterovirus Unknown Giardia lamblia Aeromonas Hepatitis A Bacillus cereus Histoplasma Brucella Listeria monocytogenes Campylobacter Norovirus Clostridium perfringens Rotavirus Clostridium difficile Salmonella Cryptosporidium Shigella Cyclospora Staphylococcus E. coli 0157:H7 Vibrio Yersinia entercolitica

Organisms Identified

A-R S-Z None Salmonella Aeromonas Salmonella enteritidis Bacillus cereus Salmonella hadar Brucella Salmonella heidelberg Campylobacter Salmonella infantis Clostridium difficile Salmonella java Clostridium perfringens Salmonella meleagridis Cryptosporidium Salmonella muenchen Cyclospora Salmonella schwarzengrund E. Coli 0157:H7 Salmonella thompson Enterovirus Salmonella typhimurium Giardia lamblia Shigella Hepatitis A Shigella flexneri Histoplasma Shigella sonnei Listeria monocytogenes Staphylococcus aureus Norovirus Vibrio None Vibrio cholerae Other, specify Vibrio parahemolyticus Rotavirus Yersinia entercolitica

APPENDIX E


NON-ENTERIC OUTBREAK REPORT FORM (NEORF)

APPENDIX E


Non - Enteric Outbreak Reporting Process Introduction The information required on the Non-Enteric Outbreak Reporting Form (NEORF) will assist Regional Health Authorities (RHAs) and Alberta Health and Wellness (AHW) in the surveillance of disease outbreaks or potential disease outbreaks and is not intended to replace the use of the Notifiable Disease Report (NDR). AHW is responsible provincially for disease surveillance. AHW also has a responsibility to communicate to all RHAs when outbreaks are occurring in selected RHAs for the purpose of case finding in RHAs not yet affected (the meningococcal, pertussis, and MRSA outbreaks are examples). Purpose The purpose of the NEORF is to:

• Provide a tool for communication between RHAs and AHW. • Provide RHAs with a process to report non-enteric outbreaks to AHW in a more consistent

manner. • Mitigate public health risks that are broader than one RHA. • Assist with case finding if the outbreak crosses RHA boundaries.

This form is to be used to report all non-enteric disease outbreaks (except influenza) as well as unidentified clusters of illness. RHA Responsibilities To complete when:

• An Exposure Investigation Number (EI#) is opened. • There is an outbreak with no EI# assigned. • There is a distribution of illness that is unusual in terms of time, place or persons affected

(unidentified organism). The NEORF is to be completed and sent to AHW, Disease Control and Prevention. AHW Responsibilities AHW uses the information captured on the NEORF for surveillance purposes and to enhance the dissemination of outbreak related information to the RHAs. The NEORF is used by AHW to achieve the following objectives for Disease Control and Prevention and Health Surveillance:

1. To identify, in a timely fashion, outbreaks or potential outbreaks occurring in RHAs. 2. To provide assistance and support to RHAs as needed. 3. To ensure that information is made available to other RHAs in a timely manner.

Non-Enteric Organism Outbreak Reporting Timelines: New Reporting:

Electronic or fax to AHW within 2 working days of onset of the outbreak investigation (may be adjusted dependent on disease).

Final Summary: Electronic or fax to AHW within 2 weeks of closure of outbreak investigation.

APPENDIX E


Non – Enteric Outbreak Reporting Form (NEORF) Definitions

Section 1 – Initial Summary/Contact Information The following definitions are not intended to have legal interpretations; instead they provide a quick understanding of terms and to maximize consistency with data entry when completing the form. The entire form is to be completed by the RHA.

Facility Name • Facility name in which the outbreak is occurring or is suspected to have been

associated with. Town/City

• Town or city in which the outbreak is occurring. RHA Reporting

• Name of the RHA reporting the outbreak to AHW. RHA Contact

• Primary RHA contact for the outbreak. Telephone Number

• Phone number for primary RHA contact. EI# - Exposure Investigation Number

• Unique exposure investigation number assigned by the Provincial Public Health Laboratory (ProvLab) to each reported outbreak.

Provincial Lab Contact

• Lab point person identified by the ProvLab.

Date Investigation Opened • Date the outbreak is identified by the RHA.

Date of Onset • Date symptoms first appeared in the index case.

Date Reported to AHW

• Date that Sections 1 and 2 are submitted to Alberta Health and Wellness (AHW). Location of Outbreak Select one of the following options:

• Acute Care Facility: Any acute care facility in the province, may be a wing of a hospital or an entire hospital facility

• Child Care Facility: Day cares, day homes, preschool or playschool • Community Settings: Includes locations such as malls, arena, swimming pool, shelter

and bingo • Correctional Facility: Facilities for incarceration (e.g., Prisons, Remand Centre) • Long Term Care Facility: Long term care facilities are for people who need

assistance with daily living activities such as dressing, toileting, transferring and eating. They have staff hired to perform these duties (Nursing attendant, licensed practical

APPENDIX E


nurse) and a registered nurse per x number of beds to give meds, to do assessments, and supervise care.

• Personal Services: Includes personal service locations/delivery; for example, tattooing, piercing, electrolysis, esthetics, foot care, massage therapy, spas, and beauty salons.

• Post Secondary Institution: College, university, etc. • Private Dwelling: Housing accommodations, including a private residence, a rental

accommodation, a group home and a foster home (e.g., condo, apartment, cabin etc). • Seniors Lodge/ Assisted Living Facilities:

o Seniors Lodge is for people who can care for themselves. If they need assistance with activities of daily living home care will sometimes go in and provide. Meals are often served in a dining room, and housekeeping assistance available.

o Assisted Living Facilities are for clients who do not require 24 hour care as in a long term care facility and are not independent enough for a seniors’ Lodge.

• School: Private or public educational institution (K – 12) • Travel: Domestic or foreign travel. Location must be specified. • Other: Outbreaks related to locations or events not identified on this list.

Section 2 – Investigation Details

1. Suspected Organism or Primary Symptoms: • Organism suspected of causing the outbreak, if unknown provide the primary

symptoms exhibited.

2. Number of People ill/Infected • (a) Total number of clients/residents experiencing symptoms associated with the

suspected organism/outbreak. • (b) Total number of staff experiencing symptoms associated with the suspected

organism/outbreak. • (c) Sum total of (a) plus (b).

3. Number of People Colonized (for MRSA only)

• (a) Total number of clients/residents who have been identified as carriers of the organism and have no symptoms.

• (b) Total number of staff who have been identified as carriers of the organism and have no symptoms.

• (c) Sum total of (a) plus (b). 4. Population at risk

• (a) Total number of clients/residents at risk of becoming infected/colonized. Do not include individuals already considered cases.

• (b) Total number of staff, if outbreak is occurring in a public facility, which are at risk of becoming infected/colonized. Do not include individuals already considered cases.

• (c) Sum total of (a) plus (b).

APPENDIX E


Section 3 – Final Summary

1. Confirmed Organism • Indicate the type of organism identified in a clinical/screening specimen. Will include

Pertussis, Rubella, RSV, Chicken pox (when it becomes reportable), MRSA etc. Any ARO or non-enteric disease.

• If more than one organism is found, identify the most likely primary causative agent and list all secondary organisms in Comments (Section 4).

2. Cases in more than one RHA

• Indicate if there are cases in other RHAs.

3. Lab Confirmed in Clients/Residents • Indicate if clients/residents have a clinical/screening specimen which contains the

organism identified. If no clients/residents are ill/colonized select N/A (not applicable).

4. Lab Confirmed in Staff • Indicate if staff have a clinical/screening specimen which contains the organism

identified. If no staff are ill/colonized select N/A (not applicable).

5. Number of Cases • (a) Total number of lab confirmed cases • (b) Total number of probable cases • (c) Sum total of (a) plus (b) • (d) Number of people hospitalized as a result of the outbreak • (e) Number of deaths as a result of the outbreak.

6. Outbreak Interventions • Indicate the public health/infection prevention and control actions taken to help control

the outbreak (e.g., Treatment of cases/contacts, immunization of cases/contacts, post exposure prophylaxis of cases/contacts, exclusion of cases/contacts, enhanced cleaning protocols),

7. Date Investigation Closed

• Date the RHA completed their investigation.

8. Date Reported to AHW • Date that sections 3 and 4 are submitted to AHW.

Section 4 – Comments

• Provide any additional comments that may be relevant to the investigation of the outbreak.

APPENDIX F


APPENDIX F: EXAMPLES OF COMPLETED NDR FORMS ENTERIC

APPENDIX F


APPENDIX F


NON-ENTERIC

APPENDIX F


APPENDIX F


APPENDIX G


APPENDIX G: CONTINENT AND COUNTRY CODES

ABW ARUBA COM COMOROS AFG AFGHANISTAN COG CONGO ALB ALBANIA COK COOK ISLANDS DZA ALGERIA CRI COSTA RICA ASM AMERICAN SAMOA CIV COTE D'IVOIRE AND ANDORRA HRV CROATIA (LOCAL NAME: HRVATSKA) AGO ANGOLA CUB CUBA AIA ANGUILLA CYP CYPRUS ATA ANTARCTICA CZE CZECH REPUBLIC ATG ANTIGUA AND BARBUDA DNK DENMARK ARG ARGENTINA DJI DJIBOUTI ARM ARMENIA DMA DOMINICA AUS AUSTRALIA DOM DOMINICAN REPUBLIC AUT AUSTRIA TMP EAST TIMOR AZE AZERBAIJAN ECU ECUADOR BHS BAHAMAS EGY EGYPT BHR BAHRAIN SLV EL SALVADOR BGD BANGLADESH GNQ EQUATORIAL GUINEA BRB BARBADOS EST ESTONIA BLR BELARUS ETH ETHIOPIA BEL BELGIUM FLK FALKLAND ISLANDS (MALVINAS) BLZ BELIZE FRO FAROE ISLANDS BEN BENIN FJI FIJI BMU BERMUDA FIN FINLAND BTN BHUTAN FRA FRANCE BOL BOLIVIA FXX FRANCE, METROPOLITAN BIH BOSNIA AND HERZEGOWINA GUF FRENCH GUIANA

BWA BOTSWANA PYF FRENCH POLYNESIA BVT BOUVET ISLAND ATF FRENCH SOUTHERN TERRITORIES BRA BRAZIL GAB GABON IOT BRITISH INDIAN OCEAN TERRITORY GMB GAMBIA BRN BRUNEI DARUSSALAM GEO GEORGIA BGR BULGARIA DEU GERMANY BFA BURKINA FASO GHA GHANA BDI BURUNDI GIB GIBRALTAR

KHM CAMBODIA GRC GREECE CMR CAMEROON GRL GREENLAND CAN CANADA GRD GRENADA CPV CAPE VERDE GLP GUADELOUPE CYM CAYMAN ISLANDS GUM GUAM CAF CENTRAL AFRICAN REPUBLIC GTM GUATEMALA TCD CHAD GIN GUINEA CHL CHILE GNB GUINEA-BISSAU CHN CHINA GUY GUYANA CXR CHRISTMAS ISLAND HTI HAITI CCK COCOS (KEELING) ISLANDS HMD HEARD AND MC DONALD ISLANDS

APPENDIX G


COL COLOMBIA HND HONDURAS HKG HONG KONG MAR MOROCCO HUN HUNGARY MOZ MOZAMBIQUE ISL ICELAND MMR MYANMAR IND INDIA NAM NAMIBIA IDN INDONESIA NRU NAURU IRN IRAN (ISLAMIC REPUBLIC OF) NPL NEPAL IRQ IRAQ NLD NETHERLANDS IRL IRELAND ANT NETHERLANDS ANTILLES ISR ISRAEL NCL NEW CALEDONIA ITA ITALY NZL NEW ZEALAND JAM JAMAICA NIC NICARAGUA JPN JAPAN NER NIGER JOR JORDAN NGA NIGERIA KAZ KAZAKHSTAN NIU NIUE KEN KENYA NFK NORFOLK ISLAND KIR KIRIBATI MNP NORTHERN MARIANA ISLANDS PRK KOREA, DEMOCRATIC PEOPLE'S REPUBLIC NOR NORWAY KOR KOREA, REPUBLIC OF OMN OMAN KWT KUWAIT OTH OTHER KGZ KYRGYZSTAN PAK PAKISTAN LAO LAO PEOPLE'S DEMOCRATIC REPUBLIC PLW PALAU LVA LATVIA PAN PANAMA LBN LEBANON PNG PAPUA NEW GUINEA LSO LESOTHO PRY PARAGUAY LBR LIBERIA PER PERU LBY LIBYAN ARAB JAMAHIRIYA PHL PHILIPPINES LIE LIECHTENSTEIN PCN PITCAIRN LTU LITHUANIA POL POLAND LUX LUXEMBOURG PRT PORTUGAL MAC MACAU PRI PUERTO RICO MKD MACEDONIA, FORMER YUGOSLAV REP. QAT QATAR MDG MADAGASCAR REU REUNION MWI MALAWI ROM ROMANIA MYS MALAYSIA RUS RUSSIAN FEDERATION MDV MALDIVES RWA RWANDA MLI MALI KNA SAINT KITTS AND NEVIS MLT MALTA LCA SAINT LUCIA MHL MARSHALL ISLANDS VCT SAINT VINCENT AND THE GRENADINES MTQ MARTINIQUE WSM SAMOA MRT MAURITANIA SMR SAN MARINO MUS MAURITIUS STP SAO TOME AND PRINCIPE MYT MAYOTTE SAU SAUDI ARABIA MEX MEXICO SEN SENEGAL FSM MICRONESIA, FEDERATED STATES OF SYC SEYCHELLES MDA MOLDOVA, REPUBLIC OF SLE SIERRA LEONE MCO MONACO SGP SINGAPORE MNG MONGOLIA SVK SLOVAKIA (SLOVAK REPUBLIC) MSR MONTSERRAT SVN SLOVENIA

APPENDIX G


SLB SOLOMON ISLANDS TKM TURKMENISTAN SOM SOMALIA TCA TURKS AND CAICOS ISLANDS ZAF SOUTH AFRICA TUV TUVALU SGS

SOUTH GEORGIA AND THE SOUTH SANDWICH ISL UGA UGANDA

ESP SPAIN UKR UKRAINE LKA SRI LANKA ARE UNITED ARAB EMIRATES SHN ST. HELENA GBR UNITED KINGDOM SPM ST. PIERRE AND MIQUELON USA UNITED STATES SDN SUDAN UMI UNITED STATES MINOR OUTLYING ISLANDS SUR SURINAME UNK UNKNOWN SJM SVALBARD AND JAN MAYEN ISLANDS URY URUGUAY SWZ SWAZILAND UZB UZBEKISTAN SWE SWEDEN VUT VANUATU CHE SWITZERLAND VAT VATICAN CITY STATE (HOLY SEE) SYR SYRIAN ARAB REPUBLIC VEN VENEZUELA TWN TAIWAN, PROVINCE OF CHINA VNM VIET NAM TJK TAJIKISTAN VGB VIRGIN ISLANDS (BRITISH) TZA TANZANIA, UNITED REPUBLIC OF VIR VIRGIN ISLANDS (U.S.) THA THAILAND WLF WALLIS AND FUTUNA ISLANDS TGO TOGO ESH WESTERN SAHARA TKL TOKELAU YEM YEMEN TON TONGA YUG YUGOSLAVIA TTO TRINIDAD AND TOBAGO ZAR ZAIRE TUN TUNISIA ZMB ZAMBIA TUR TURKEY ZWE ZIMBABWE

Source: International Organization for Standardization ISO 3166-1:1997

APPENDIX H


APPENDIX H: ENTERIC AND NON-ENTERIC DISEASE LISTS ENTERIC LIST FOR NDR FORM • Amoebiasis • Botulism - if foodborne (Wound Botulism - refer to Part 5 - Non-enteric) • Brucellosis • Campylobacteriosis • Cholera (O1 and O139) • Cryptosporidiosis • Cyclosporiasis • E. coli O157:H7 • Giardiasis • Haemolytic Uremic Syndrome • Hantavirus Pulmonary Syndrome • Hepatitis A • Hepatitis (other, viral) - Hepatitis E only (Hepatitis D and Hepatitis G - refer to Part 5 - Non-

Enteric) • Leptospirosis • Listeriosis • Paratyphoid Fever • Psittacosis • Q Fever • Salmonellosis • Shigellosis • Trichinosis • Typhoid Fever • Vibrio Parahaemolyticus • Vibrio Cholerae, non O1, non O139 • Yersiniosis

APPENDIX H


NON-ENTERIC LIST FOR NDR FORM • Acute Flaccid Paralysis • Anthrax • Botulism - if Wound Botulism

(Foodborne - refer to Part 4 - Enteric) • Chickenpox (Varicella) - Spring 2007 • Congenital Cytomegalovirus • Congenital Rubella Infection • Congenital Rubella Syndrome • Congenital Toxoplasmosis • Creutzfeldt-Jakob Disease - Classic • Creutzfeldt-Jakob Disease - Variant • Crimean Congo Haemorrhagic Fever • Dengue Fever • Diphtheria • Eastern Equine Encephalitis • Ebola Haemorrhagic Fever • Group A Streptococcal Disease, Invasive • Haemophilus Influenzae , Invasive - type b • Hepatitis B • Hepatitis C • Hepatitis (other, viral) - Hepatitis D and

Hepatitis G (Hepatitis E - refer to Part 4 – Enterics)



strep) • Tularemia • Typhus - Louseborne • Typhus - Murine • Typhus - Scrub • Varicella Zoster, Shingles • Western Equine Encephalitis • West Nile Virus Asymptomatic Infections • West Nile Virus Neurological Syndrome • West Nile Virus Fever Non- Neurological

Syndrome • Yellow Fever

APPENDIX I


APPENDIX I: IMMUNOBIOLOGICAL LISTS

CHEMOPROPHYLAXIS

CODE DESCRIPTION AZ Bact BIA Ceph

Azithromycin Bactrim Biaxin Cephalosporins (e.g., Cephalexion)

Clari Erythro

Clarithromycin Erythromycin

MAL Malaria Prophylaxis Pen Penicillins Rif Sep

Rifampin Septra

Tet ZI

Tetracyclines Zithromax

IMMUNE GLOBULINS AND ANTITOXINS CODE DESCRIPTION Bot-Anti

Botulism antitoxin

Diph-Anti Diphtheria antitoxin HBIG Hepatitis B Immune Globulin IG Immune Serum Globulin (Human – IM) RIG Rabies Immune Globulin TIG Tetanus Immune Globulin VZIG Varicella Zoster Immune Globulin

APPENDIX I


VACCINE AND IMMUNE GLOBULIN CODES

VACCINE CODE 1

TYPE 2 VACCINE NAME/DESCRIPTION ACTIVE 3 START >= END <=

aP A Acellular Pertussis N 1997/07/01 2001/10/31 BA P Botulism Antitoxin Y 1962/06/12 BCG A Bacillus Calmette Guerin (TB) Y 1956/01/01 CHI A Cholera - Injectable N 1970/01/01 1999/01/01 CHO A Cholera – Oral Y 1997/01/01 D A Diphtheria Toxoid (fluid) N 1954/04/01 1994/08/01 DA P Diphtheria Antitoxin Y 1895/01/01 DD A Diphtheria Toxoid (fluid-diluted) N 1954/04/01 1994/08/01 DPT A Diphtheria/whole cell Pertussis/

Tetanus N 1948/01/01 1997/06/30

DPTP A Diphtheria/whole cell Pertussis/ Tetanus/ IPV (QUAD)

N 1994/08/02 1997/06/30

DPTPHib A Diphtheria/whole cell Pertussis/ Tetanus/ IPV/Hib (Penta)

N 1994/08/02 1997/06/30

DRT CP Diphtheria Reaction Test N 1923/01/01 1996/01/01 DT A Diphtheria/Tetanus toxoids (pediatric) N 1948/01/01 1998/12/31 DTaP A Diphtheria/Tetanus/Acellular

Pertussis (Tripacel) N 1997/07/01 1999/01/01

dTap A Diphtheria/Tetanus/Acellular Pertussis (Adacel)

Y 2004/02/01

DTaP-IPV A Diphtheria/Tetanus/Acellular Pertussis/IPV (Quadracel)

Y 1997/07/01

DTaP-IPV-Hib A Diphtheria/Tetanus/Acellular Pertussis/IPV/Hib (Pentacel)

Y 1997/07/01

DT-IPV A Diphtheria/Tetanus/IPV (pediatric) Y 1996/07/01 2005/10/31 EZM A E/Z Measles N 1969/01/01 1971/01/01 FLU A Influenza Y 1939/01/01 HABV A Hepatitis A and B Y 1997/01/01 HAV A Hepatitis A Y 1994/01/01 HBIG P Hepatitis B Immune Globulin Y 1971/01/01 HbOC A Haemophilus influenza b

(Lederle-Praxis) N 1992/05/19 1993/02/01

HBV A Hepatitis B Y 1983/01/01 HBVD A Hepatitis B for Dialysis Y 1983/01/01 Hib A Haemophilus influenza b (Connaught)

(PRPT) Y 1993/02/01

IG P Immune Globulin (human, intramuscular)

Y 1987/02/18

IPV A Inactivated Polio (Salk) Y 1956/01/01 JEV A Japanese Encephalitis Y 1990/01/01 KMEA A Killed red measles N 1963/01/01 1970/12/31 MEA A Measles (Red) Y 1971/01/01 1998/12/31 MenACs A Meningococcal, polysaccharide,

bivalent (A, C) (single dose) Y 2001/01/01 2002/03/01

MenconC A Meningococcal, conjugate, monovalent (C)

Y 2001/06/15

MeninAC A Meningococcal, polysaccharide, bivalent (A, C) (multidose)

Y 2001/01/01 2002/03/01

APPENDIX I


VACCINE CODE 1

TYPE 2 VACCINE NAME/DESCRIPTION ACTIVE 3 START >= END <=

MENING A Meningococcal, polysaccharide, quadrivalent (A, C, Y, W-135) (single dose)

Y 1983/05/04

MENOTET A Meningococcal, polysaccharide, quadrivalent (A, C, Y, W-135) (multidose)

Y 1983/05/04 2000/11/01

MMR A Measles/Mumps/Rubella Y 1982/01/01 MONM A Measles (Red) (multidose) N 1997/04/01 1998/06/30 MR A Measles/Rubella Y 1997/01/01 1999/12/31 MU A Mumps Y 1982/01/01 OMP A Haemophilus influenza b

(Merck Frosst) N 1990/01/01 1994/08/02

OPV A Oral Polio (Sabin) N 1962/01/01 1994/07/31 P A Whole Cell Pertussis N 1939/01/01 1997/06/30 PNEUMO-P A Pneumococcal (23 - polysaccharide) Y 1983/01/01 POL 4 A Polio N 1994/08/02 1998/12/31 PPD CP Purified Protein Derivative 5TU

(Mantoux - TB Test) Y 1960/01/05

PNEU-C A Pneumococcal (7 - conjugate) Y 2001/01/06 PRPD A Haemophilus influenza b (Connaught) N 1988/03/16 1992/05/18 RAB A Rabies (HDCV) Y 1980/01/01 RIG P Rabies Immune Globulin Y 1983/09/16 RUB A Rubella N 1971/01/01 1998/10/01 SNAKE P Snakebite antivenin Y 1980/01/01 TBEV A Tick-Borne Encephalitis Virus Y 1995/06/01 Td A Tetanus/Diphtheria toxoids (adult) Y 1980/07/09 TdP A Tetanus/Diphtheria/IPV (adult) Y 1984/01/10 TIG P Tetanus Immune Globulin Y 1963/12/09 TP A Tetanus Polio N 1959/01/01 1994/08/01 TT A Tetanus Toxoid N 1947/01/01 2001/05/31 TYO A Typhoid Ty21a - Oral Y 1992/01/01 TYVI A Typhim VI - Injectable Y 1993/11/01 VZ A Varicella Zoster Y 1998/12/01 VZIG P Varicella Zoster Immune Globulin Y 1985/01/01 YF A Yellow Fever Y 1935/01/01 1 The Vaccine Code column identifies the vaccine or other immunobiological agent. 2 The Type column identifies the type of immunobiological agent (A = active immunization; P = passive

immunization; CP = chemoprophylaxis or test) 3 The Active column identifies whether or not the immunobiological agent is currently in use (Y = immunobiological

agent in current use; N = historic immunobiological agent not in current use) 4 POL is a combination vaccine code used only for mixed OPV / IPV records to assess dose count

Updated July 2006

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NDR Manual