Appendix A - Proposed Amendments

APPENDIX A
Proposed Amendments to form CDC 54.1 (Malaria Case Surveillance Report)
***Changes are in Bold font
Current Form (Field Names)	Current Value Set	Proposed Form (Field Names)	Proposed Value Set	Justification
DASH No.		CSID No.		DASH changed to CSID (CDC Specimen Identifier ) to conform to the new changes in laboratory specimen identification system in place
County		County		Field placement has been moved underneath "State/territory reporting this case"
Age/ (yrs)(mos)		Age/ yrs. mos. wks. days (circle units)		Change to account for various reporting age units
Lab results	Smear positive, smear negative, No smear taken	Positive lab test result (check all that apply)	Smear, PCR, RDT, No test done/unknown	Change to capture PCR and RDT positive test results
Species (check all that apply)	Vivax, Falciparum, Malariae, Ovale, Not determined	Species (check all that apply)	Vivax, Falciparum, Malariae, Ovale, Not determined, Other (specify)	Change to capture other plasmodium species
NEW FIELD		Parasitemia (%)		Added to capture parasetemia data if available
Patient admitted to hospital	Yes, No	Patient admitted to hospital	Yes, No, Unknown	Added unknown as a possible value to collect more accurate data
Specimen being sent to CDC	Yes, No	Specimen being sent to CDC	Yes, No, Unknown	Added unknown as a possible value to collect more accurate data
Has patient traveled or lived outside the US during the past 4 year?	Yes, No	Has patient traveled or lived outside the US during the past 2 year?	Yes, No	Change to 2 years sufficiently captures travel history
Duration of stay in foreign country (days)		Duration in country/ yrs. mos. wks. days (circle units)		Reworded Change to account for various reporting duration/time units
Did patient reside in US prior to most recent travel?	Yes, for ≥12 months, Yes, for <12 months, No (specify country), Unknown	Did patient reside in US prior to most recent travel?	Yes, No (specify country), Unknown	Simplified value set to capture the same data; Added unknown as a possible value to collect accurate data
Principal reason for travel from/to US for most recent trip	Tourism, Military, Business, Peace Corps, Visiting friends/relatives, Airline/ship crew, Missionary or dependent, Refugee/immigrant, Student/teacher, Other	Principal reason for travel from/to US for most recent trip	Tourism, Military, Business, Peace Corps, Visiting friends/relatives, Airline/ship crew, Missionary or dependent, Refugee/immigrant, Student/teacher, Other, Unknown	Added unknown as a possible value to collect more accurate data
Was malaria chemoprophylaxis taken	Yes, No	Was malaria chemoprophylaxis taken	Yes, No, Unknown	Added unknown as a possible value to collect more accurate data
If yes, which drugs were taken	Chloroquine, Mefloquine, Doxycycline, Primaquine, Malarone, Other	If yes, which drugs were taken	Chloroquine, Mefloquine, Doxycycline, Primaquine, Atovaquone/proguanil, Other, Unknown	Used chemical name of Malarone; Added unknown as a possible value to collect more accurate data
Were all pills taken as prescribed	Yes missed no doses, No missed one to a few doses, No missed more than a few but <half of the doses, No missed doses but not sure how many, Don't know	Were all pills taken as prescribed	Yes missed no doses, No missed doses, Unknown	Simplified value set to capture the same data
If doses were missed, what was the reason	Forgot, Didn’t think needed, Had a side affect (specify), Was advised by others to stop, Prematurely stopped taking once home, Other (specify)	If doses were missed, what was the reason	Forgot, Didn’t think needed, Had a side affect (specify), Was advised by others to stop, Prematurely stopped taking once home, Other (specify), Unknown	Added unknown as a possible value to collect more accurate data
History of malaria in last 12 months (prior to this report)	Yes, No	History of malaria in last 12 months (prior to this report)	Yes, No, Unknown	Added unknown as a possible value to collect more accurate data
If yes, species (check all that apply)	Vivax, Falciparum, Malariae, Ovale, Not determined	If yes, species (check all that apply)	Vivax, Falciparum, Malariae, Ovale, Not determined, Other (specify)	Change to capture other plasmodium species
Blood transfusion/organ transplant within last 12 months	Yes, No	Blood transfusion/organ transplant within last 12 months	Yes, No, Unknown	Added unknown as a possible value to collect more accurate data
Clinical Complications	Cerebral malaria, Renal Failure, ARDS, Anemia (Hb<11, Hct<33), None, Other	Clinical Complications	Cerebral malaria, Renal Failure, ARDS, Severe anemia (Hb<7), None, Other	Changed Anemia value to better identify associated clinical complications
Was illness fatal	Yes, No	Was illness fatal	Yes, No, Unknown	Added unknown as a possible value to collect more accurate data
Therapy for this attack (check all that apply)	Chloroquine, Tetracycline/Doxycycline, Mefloquine, Exchange transfusion, Unknown, Primaquine, Quinine/quinidine, Pyrimethamine-sulfadoxine, Malarone, Other (specify)	Therapy for this attack (check all that apply)	Chloroquine, Tetracycline, Doxycycline, Mefloquine, Exchange transfusion, Unknown, Primaquine, Quinine, Quinidine, Clindamyacin, Atovaquone/proguanil, Artesunate, Other (specify)	Used chemical name of Malarone; Updated value set to capture drugs available for treatment
Date		Date Submitted		Change to clarify date description