0920-0004 National Enterovirus Surveillance Report 55.9

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Overview

REPORT FORM
ENTEROVIRUS CODE LIST
STATE FIPS CODE LIST

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Sheet 1: REPORT FORM

National Enterovirus Surveillance System Report Form

Form Approved OMB No. 0920-0004

Reporting Lab :

Report Date:

Positive Test Results

Age (# Only)

Age Type (Days, Weeks, Months or Years)

Sex (M/F/U)

State of Residence (see codes--3rd sheet)

Number of Enteroviruses detected from patient

Enterovirus (see codes--2nd sheet)

Source Specimen (see legend--far right)

Specimen Date (mm/dd/yyyy)

Enterovirus 2

Source Specimen 2

Specimen Date 2

Enterovirus 3

Source Specimen3

Specimen Date 3

Specimen Legend

1

CSF

2

Stool/Rectal Swab

3

Throat/NP Swab

4

Tissue Culture

5

Other

9

Unknown

Date of Report

Reporting Official

Title

Public reporting burden of this collection of information is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-24, Atlanta, Georgia 30333; ATTN: PRA (0920-0004).

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Sheet 2: ENTEROVIRUS CODE LIST

AGENT	SEROTYPE
201	Coxsackievirus A1
202	Coxsackievirus A2
203	Coxsackievirus A3
204	Coxsackievirus A4
205	Coxsackievirus A5
206	Coxsackievirus A6
207	Coxsackievirus A7
208	Coxsackievirus A8
209	Coxsackievirus A9
210	Coxsackievirus A10
211	Coxsackievirus A11
212	Coxsackievirus A12
213	Coxsackievirus A13
214	Coxsackievirus A14
215	Coxsackievirus A15
216	Coxsackievirus A16
217	Coxsackievirus A17
218	Coxsackievirus A18
219	Coxsackievirus A19
220	Coxsackievirus A20
221	Coxsackievirus A21
222	Coxsackievirus A22
224	Coxsackievirus A24
224	Echovirus 34
299	Coxsackievirus A Type Unknown
301	Coxsackievirus B1
302	Coxsackievirus B2
303	Coxsackievirus B3
304	Coxsackievirus B4
305	Coxsackievirus B5
306	Coxsackievirus B6
399	Coxsackievirus B Type Unknown
401	Echovirus 1
401	Echovirus 8
402	Echovirus 2
403	Echovirus 3
404	Echovirus 4
405	Echovirus 5
406	Echovirus 6
407	Echovirus 7
409	Echovirus 9
411	Echovirus 11
412	Echovirus 12
413	Echovirus 13
414	Echovirus 14
415	Echovirus 15
416	Echovirus 16
417	Echovirus 17
418	Echovirus 18
419	Echovirus 19
420	Echovirus 20
421	Echovirus 21
422	Echovirus 22
422	Parechovirus 1
423	Echovirus 23
423	Parechovirus 2
424	Echovirus 24
425	Echovirus 25
426	Echovirus 26
427	Echovirus 27
429	Echovirus 29
430	Echovirus 30
431	Echovirus 31
432	Echovirus 32
433	Echovirus 33
499	Echovirus Type Unknown
501	Enterovirus 68
502	Enterovirus 69
503	Enterovirus 70
504	Enterovirus 71
505	Enterovirus 73
599	Enterovirus 70/71
601	Poliovirus 1
602	Poliovirus 2
603	Poliovirus 3
699	Poliovirus Type Unknown
999	Enterovirus Type Unknown

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Sheet 3: STATE FIPS CODE LIST

CODE	ABBR	STATENAME
1	AL	ALABAMA
2	AK	ALASKA
4	AZ	ARIZONA
5	AR	ARKANSAS
6	CA	CALIFORNIA
8	CO	COLORADO
9	CT	CONNECTICUT
10	DE	DELAWARE
11	DC	DISTRICT OF COLUMBIA
12	FL	FLORIDA
13	GA	GEORGIA
15	HI	HAWAII
16	ID	IDAHO
17	IL	ILLINOIS
18	IN	INDIANA
19	IA	IOWA
20	KS	KANSAS
21	KY	KENTUCKY
22	LA	LOUISIANA
23	ME	MAINE
24	MD	MARYLAND
25	MA	MASSACHUSETTS
26	MI	MICHIGAN
27	MN	MINNESOTA
28	MS	MISSISSIPPI
29	MO	MISSOURI
30	MT	MONTANA
31	NE	NEBRASKA
32	NV	NEVADA
33	NH	NEW HAMPSHIRE
34	NJ	NEW JERSEY
35	NM	NEW MEXICO
36	NY	NEW YORK
37	NC	NORTH CAROLINA
38	ND	NORTH DAKOTA
39	OH	OHIO
40	OK	OKLAHOMA
41	OR	OREGON
42	PA	PENNSYLVANIA
44	RI	RHODE ISLAND
45	SC	SOUTH CAROLINA
46	SD	SOUTH DAKOTA
47	TN	TENNESSEE
48	TX	TEXAS
49	UT	UTAH
50	VT	VERMONT
51	VA	VIRGINIA
53	WA	WASHINGTON
54	WV	WEST VIRGINIA
55	WI	WISCONSIN
56	WY	WYOMING
60	AS	AMERICAN SAMOA
64	FM	FEDERATED STATES OF MICRONESIA
66	GU	GUAM
69	MP	NORTHERN MARIANA ISLANDS
70	PW	PALAU
72	PR	PUERTO RICO
74	UM	U.S. MINOR OUTLYING ISLANDS
78	VI	VIRGIN ISLANDS
99	UNK	UNKNOWN