Form NAHMS FORM - 57 NAHMS FORM - 57 National Animal Health (NAHRS) Monthly Report

National Animal Health Reporting System (NAHRS) Monthly Report Form

(2009)

 	OMB Number 0579-0299 Exp. Date: USDA:APHIS:VS:CEAH Fort Collins, CO 80526-8117

Instructions

These instructions refer to completion of the National Animal Health Reporting System (NAHRS) form by the State Veterinarian’s office or representative.

For each month, please report disease presence or absence for the entire month. Monthly reports are due by the 20th of the following month. If you receive reports on out-of-state submissions, REPORT ONLY CASES THAT OCCURRED IN YOUR OWN STATE. Be sure to indicate the State and month for which you are reporting. If there are questions on reporting, consult the NAHRS disease reporting criteria. The NAHRS Operational Manual and Uniform Methods and Rules can be located on the NAHRS Homepage, http://www.aphis.usda.gov/vs/ceah/ncahs/nahrs.

If you received a report of a case which fits the NAHRS criteria, check ‘YES’ under PRESENT. If you received a report of a case which does not fit the NAHRS criteria, but you have additional evidence to support the presence of confirmed disease, check ‘YES’ under PRESENT. If you received no reports in the investigation of a suspected confirmed disease which fit the NAHRS criteria and you have no further supporting evidence of the presence of confirmed disease, check ‘NO’ under PRESENT (e.g., all investigations for a given disease were negative.) A ‘NO’ report, in relation to an endemic disease, indicates that from information available there were no reports of confirmed disease occurrence, and does not infer the endemic disease does not occur in the State.

Most endemic diseases include both a presumptive and definitive level of confirmation. If a case meets the NAHRS definitive criteria for presence of disease, record it as present. If a case does not meet the NAHRS definitive criteria, but meets presumptive criteria—report the case if it is considered a probable case and ‘presumptive’ can be indicated in the comment section. The disease reporting criteria are minimum standards and additional information can be utilized to report i.e. epidemiological link, or other non-listed laboratory tests.

Add any additional information which you feel may be of value or pertinent in the COMMENTS column e.g. level of lab diagnosis; presumptive vs. definitive; environment disease occurrence located in – backyard, feral, etc; and any other clarifying information needed.

If a report of a case is received after the report has been sent or edits to the report are required, notify the NAHRS administrator to update the information.

NOTE: Diseases below that are indicated as FAD (foreign animal disease) are those diseases that are considered foreign to the United States or are managed as FADs. To report the presence of an FAD or occurrence, mark ‘yes’ for the disease after State-Federal coordination.

NAHRS Report for:

STATE:

MONTH:

YEAR:

Person Completing the Report:

NAME:	TELEPHONE:
ADDRESS:	E-MAIL ADDRESS:
CITY, STATE, ZIP:

Disease Occurrence Information:

OIE NUMBER - DISEASE NAME	PRESENT		COMMENTS
BOVINE	YES	NO
A010-A018 Foot and mouth disease (all FMD, Viruses O, A, C, SAT 1, SAT 2, SAT 3, Asia 1)		FAD
A020-A023 Vesicular stomatitis (VS, Viruses Indiana, New Jersey, or not typed)		FAD
A040 Rinderpest		FAD
A060 Contagious bovine pleuropneumonia (Mycoplasma mycoides mycoides)		FAD
A070 Lumpy skin disease		FAD
A080 Rift valley fever		FAD
N001 Crimean Congo hemorrhagic fever		FAD
A090 Bluetongue
B051 Anthrax (Bacillus anthracis)
B052 Aujesky’s disease (Pseudorabies)
B053 Echinococcosis / Hydatidosis
B055 Heartwater (Cowdria ruminantium)		FAD
B056 Leptospirosis
B057 Q fever (Coxiella burnetti)
B058 Rabies
B059 Paratuberculosis (Johne’s Disease, Mycobacterium avium paratuberculosis)
B060-B061 New and Old World screwworm (Cochliomyia (Callitroga) hominivorax, Chrysomya bezziana)		FAD
B101 Anaplasmosis (Anaplasma marginale, A. centrale)
B102 Babesiosis (Babesia bovis, B. bigemina)		FAD
N103 Bovine brucellosis (Brucella abortus)
N152 Brucellosis (Brucella melitensis)		FAD
N253 Brucellosis (Brucella suis)
B104 Bovine genital campylobacteriosis (Campylobacter fetus venerealis)
B105 Bovine tuberculosis (Mycobacterium bovis)
N117 Bovine viral diarrhea (BVD)
B108 Enzootic bovine leukosis (BLV)
B109 Hemorrhagic septicemia (Pasteurella multocida, B/Asian or E/African serotypes)
B110 Infectious bovine rhinotracheitis/ infectious pustular vulvovaginitis (IBR/IPV)
B111 Theileriasis (Theileria annulata, T. parva)		FAD
B112 Trichomoniasis (Tritrichomonas (Trichomonas) foetus)
B113 Trypanosomiasis (Trypanosoma congolense, T. vivax, T. brucei brucei, T. evansi)		FAD
B114 Malignant catarrhal fever			Indicate if Sheep or Wildebeest related form/ or other (Wildebeest-FAD)
B115 Bovine spongiform encephalopathy		FAD
N158 Epizootic hemorrhagic disease (EHD)
CAPRINE AND OVINE	YES	NO
A010-A018 Foot and mouth disease (FMD, Viruses O, A, C, SAT 1, SAT 2, SAT 3, Asia 1, or not typed)		FAD
A020-A023 Vesicular stomatitis (VS, Viruses Indiana, New Jersey, or not typed)		FAD
A040 Rinderpest		FAD
A050 Peste des petits ruminants		FAD
A080 Rift Valley fever		FAD
A090 Bluetongue
N001 Crimean Congo hemorrhagic fever		FAD
A100 Sheep pox and goat pox		FAD
B051 Anthrax (Bacillus anthracis)
B052 Aujesky’s disease (Pseudorabies)
B053 Echinococcosis / Hydatidosis
B055 Heartwater (Cowdira ruminantium)		FAD
B056 Leptospirosis
B057 Q fever (Coxiella burnetti)
B058 Rabies
B059 Paratuberculosis (Johne’s Disease, Mycobacterium paratuberculosis)
B060-B061 New and Old World screwworm (Cochliomyia (Callitroga) hominivorax, Chrysomya bezziana)		FAD
B151 Ovine epididymitis (Brucella ovis infection)
N152 Caprine and ovine brucellosis- (B. melitensis) (all others except B. ovis)
B153 Caprine arthritis / encephalitis (CAE)
B154 Contagious agalactia (Mycoplasma agalactiae, M. capricolum capricolum, M. putrefaciens, M. mycoides mycoides, M. mycoides mycoides LC)
B155 Contagious caprine pleuropneumonia (Mycoplasma capricolum capripneumoniae)		FAD
B156 Enzootic abortion of ewes (Ovine Psittacosis, Chlamydia psittaci)
B158 Nairobi sheep disease		FAD
B159 Salmonellosis (Salmonella abortus ovis)
B160 Scrapie
B161 Maedi-visna / ovine progressive pneumonia
B352 Tularemia (Francisella tularensis)
N002 West Nile fever / encephalitis
EQUINE	YES	NO
A020-A023 Vesicular stomatitis (VS, viruses Indiana, New Jersey, or not typed)		FAD
A110 African horse sickness		FAD
B051 Anthrax (Bacillus anthracis)
B056 Leptospirosis
B058 Rabies
B060-B061 New and Old World screwworm (Cochliomyia (Callitroga) hominivorax, Chrysomya bezziana)		FAD
B062 Trichinellosis (Trichinela spiralis)
B201 Contagious equine metritis (Taylorella equigenitalis)		FAD
B202 Dourine (Trypanosoma equiperadum)		FAD
N220 Eastern equine encephalomyelitis (EEE)
N221 Western equine encephalomyelitis (WEE)
B205 Equine infectious anemia (EIA)			Report additional EIA testing information below
B206 Equine influenza (virus type A)
B207 Equine piroplasmosis (Babesiosis, Babesia (Piroplasma) equi, B. caballi)		FAD
B208 Equine rhinopneumonitis (EHV 1 and 4)
B208a Equine herpesvirus myeloencephalopathy (EHV1 – EHM)
B209 Glanders (Pseudomonas mallei)		FAD
B211 Equine viral arteritis (EVA)
B212 Japanese encephalitis		FAD
B215 Surra (Trypanosoma evansi)		FAD
B216 Venezuelan equine encephalomyelitis		FAD
N352 Tularemia (Francisella tularensis)
N002 West Nile Fever / encephalitis
PORCINE	YES	NO
A010-A018 Foot and mouth disease (FMD-O, A, C, SAT 1, SAT 2, SAT 3, Asia 1, or not typed)		FAD
A020-A023 Vesicular stomatitis (VS, Viruses Indiana, New Jersey, or not typed)		FAD
A030 Swine vesicular disease		FAD
A040 Rinderpest		FAD
A120 African swine fever		FAD
A130 Classical swine fever (hog cholera)		FAD
N258 Nipah virus encephalitis		FAD
B051 Anthrax (Bacillus anthracis)
B052 Aujesky’s disease (Pseudorabies)
B053 Echinococcosis / Hydatidosis
B056 Leptospirosis
B058 Rabies
B060-B061 New and Old World screwworm (Cochliomyia (Callitroga) hominivorax, Chrysomya bezziana)		FAD
B062 Trichinellosis (Trichinela spiralis)
B252 Cysticercosis (Cysticercus cellulosae metacestode stage of Taenia solium)
N253 Porcine brucellosis (Brucella suis)
B254 Transmissible gastroenteritis (TGE)
B257 Porcine reproductive and respiratory syndrome (PRRS)
B212 Japanese encephalitis		FAD
B352 Tularemia (Francisella tularensis)
POULTRY	YES	NO
A150 Highly pathogenic avian influenza (fowl plague)		FAD
A160 Newcastle disease (exotic)		FAD
N150i Low pathogenic avian influenza (H5 or H7 subtypes) poultry
1008 Turkey rhinotracheitis
B301 Avian infectious bronchitis
B302 Avian infectious laryngotracheitis
B304 Duck viral hepatitis		FAD
B306 Fowl cholera (Pasteurella multocida)
B308 Fowl typhoid (Salmonella gallinarum)		FAD
B309 Infectious Bursal Disease (Gumboro Disease)
B310 Marek’s Disease
B311 Mycoplasmosis (Mycoplasma gallisepticum)
1009 Mycoplasmosis (Mycoplasma synoviae)
B312 Avian Chlamydiosis (Psittacosis and Ornithosis, Chlamydia psittaci)
B313 Pullorum Disease (Salmonella pullorum)
AQUACULTURE	YES	NO
FISH
B401 Viral hemorrhagic septicemia (VHS)
B404 Spring viremia of carp (SVC)
B405 Infectious hematopoietic necrosis (IHN)
B413 Epizootic hematopoietic necrosis		FAD
N416 Infectious salmon anemia (ISA)		FAD
N417 Epizootic ulcerative syndrome
N418 Gyrodactylosis (Gyrodactylus salaries)		FAD
N419 Red sea brea iridoviral disease		FAD
N420 Koi herpesvirus disease
MOLLUSC
Infection with Bonamia ostreae		FAD
Infection with Bonamia exitiosa		FAD
Infection with Marteilia refringens		FAD
Infection with Perkinsus marinus
Infection with Perkinsus olseni		FAD
Infection with Xenohaliotis californiensis		FAD
Abalone viral mortality		FAD
CRUSTACEAN
Taura syndrome		FAD
White spot disease		FAD
Yellowhead disease		FAD
Tetrahedral baculovirosis (Baculovirus penaei)		FAD
Spherical baculovirosis (Penaeus monodon-type baculovirus)		FAD
Infectious hypodermal and haematopoietic necrosis		FAD
Crayfish plague (Aphanomyces astaci)		FAD
Infectious myonecrosis		FAD
White tail disease		FAD

Additional Equine Infectious Anemia Testing Information:

1. Number of EIA tests performed in reporting month:
2. Number of horses tested in reporting month (leave blank if unavailable):
3. Number of horses tested positive in reporting month:
4. Number of premises (epidemiological units) with positive(s) in reporting month (If premises previously reported in calendar year do not report, and if no other positive premises indicate -- 0):
5. Number of total horses quarantined in State for positive EIA test:

Instructions for Additional Equine Infectious Anemia Questions:

1. Number of EIA tests performed in reporting month: Report the total number of EIA tests performed the reporting month for horses that reside in your State. This includes all tests on resident horses conducted both at in-state and out-of-state labs.
   
   

2. Number of horses tested in reporting month (if unavailable leave blank): Report the number of horses tested for EIA for the reporting month. Do not include repeat EIA tests on the same horse in the calendar year. If this information is unavailable, leave this blank.
   
   

3. Number of horses tested positive in reporting month: Report the total number of newly identified horses tested positive for EIA in the reporting month. Do not include repeat testing of an already identified positive horse.
   
   

4. Number of premises (epidemiological units) with positive(s) in reporting month (If premise previously reported in calendar year do not report, and if no other positive premises indicate -- 0): Identify the number of premises (epidemiological units) with positive EIA horses for the calendar year. If a premise has been reported as positive in a previous monthly report, do not include in number of premises positive in reporting month. If the only positive premises is a premises identified on a previous monthly report for the calendar year, report ‘0’. Example: if a premise has one positive horse in June and additional testing in July identifies 3 additional positive horses on the same premises – for July indicate 3 positive horses and ‘0’ for number of premises.
   
   

5. Number of total horses quarantined in State for positive EIA test: This is the total number of EIA quarantined horses at the end of the previous month with the addition of newly identified EIA positive horses and minus any EIA quarantined animals that were destroyed or died in the reporting month.

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0579-0299. The time required to complete this information collection is estimated to average 4 hours 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.

OMB Number 05729-02997

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NAHMS FORM – 57

NAHRS Monthly Report Form

This form (5/09) replaces all previous forms