0920-0004 Influenza Virus PHLIS (Oct-May) electronic

Please fax report to 1-888-232-1322 (No cover sheet is needed)

1

WHO COLLABORATING CENTER FOR INFLUENZA

INFLUENZA VIRUS SURVEILLANCE (2006-07 Season)

Lab ID Number

Concord

NH

L aboratory / Report for week ending ____/____/____

(City) (State) Mo. Day Yr.

Patient's age in years	<1	1-4	5-24	25-44	45-64	65	Unk
No. of specimens tested for respiratory viruses

No. influenza A(H1N1) isolates
No. influenza A(H3N2) isolates
No. influenza A, subtype unknown*
No. influenza B*

* Isolates or antigen detection. Rapid tests may be counted as long as the testing method identifies both type A and type B influenza and distinguishes the two.

• If you have no isolates to report for a week, please fax a form listing the laboratory name and week ending date, but leave the rest of the form blank.

• If you wish to revise a previous report (such as if you report isolates as “influenza A, subtype unknown” and subsequently subtype the isolates), please indicate the changes on a copy of the form on which the isolates were initially reported, listing the original week ending date. Clearly mark the copy as a revised report and fax it to us.

P lease call us about unusual isolates: (404-639-3591)

C omments:

Between October and May, a weekly updated influenza activity report is available by facsimile 24 hours a day from the CDC Fax Information Service at 888-CDC-FAXX (888-232-3299, request doc. #361100) or by Internet at www.cdc.gov/flu/weekly/fluactivity.htm.

Public reporting burden of this collection of information is estimated to average 10 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, Reports Clearance Officer, 1600 Clifton Rd., MS D-74, Atlanta, GA 30333, ATTN: PRA (0920-0666).

CDC 55.31 REV 9/06

Please fax report to 1-888-232-1322 (No cover sheet is needed)

1

WHO COLLABORATING CENTER FOR INFLUENZA

INFLUENZA VIRUS SURVEILLANCE (2006-07 Season)

Lab ID Number

Concord

NH

L aboratory / Report for week ending ____/____/____

(City) (State) Mo. Day Yr.

Patient's age in years	<1	1-4	5-24	25-44	45-64	65	Unk
No. of specimens tested for respiratory viruses

No. influenza A(H1N1) isolates
No. influenza A(H3N2) isolates
No. influenza A, subtype unknown*
No. influenza B*

* Isolates or antigen detection. Rapid tests may be counted as long as the testing method identifies both type A and type B influenza and distinguishes the two.

• If you have no isolates to report for a week, please fax a form listing the laboratory name and week ending date, but leave the rest of the form blank.

• If you wish to revise a previous report (such as if you report isolates as “influenza A, subtype unknown” and subsequently subtype the isolates), please indicate the changes on a copy of the form on which the isolates were initially reported, listing the original week ending date. Clearly mark the copy as a revised report and fax it to us.

P lease call us about unusual isolates: (404-639-3591)

C omments:

Between October and May, a weekly updated influenza activity report is available by facsimile 24 hours a day from the CDC Fax Information Service at 888-CDC-FAXX (888-232-3299, request doc. #361100) or by Internet at www.cdc.gov/flu/weekly/fluactivity.htm.

Public reporting burden of this collection of information is estimated to average 10 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, Reports Clearance Officer, 1600 Clifton Rd., MS D-74, Atlanta, GA 30333, ATTN: PRA (0920-0004).

CDC 55.31 REV 9/06