Form NAHMS-57 NAHRS Monthly State Report Form

National Animal Health
(NAHRS) Monthly Report

Reporting System
Form

USDA:APHIS:VS:CEAH
2150 Centre Ave, Bldg B
Fort Collins, CO 80526-8117

OMB Number 0579-0299
Exp. Date:

Person completing the report:

Name:
Address:
Telephone:
FAX:
E-mail address
These instructions refer to completion of this form by the State Veterinarian’s office or representative. The level of
disease (presumptive versus definitive) reported to your office by laboratories should be taken into account and
combined with other available information to determine whether the data fit the National Animal Health Reporting
System (NAHRS) reporting criteria.
For each month, please report for the entire month. The report for each month is generally due by the 20th of the
following month. If you receive reports on out-of-state submissions, REPORT ONLY FOR YOUR OWN
STATE. Be sure to indicate the State and month for which you are reporting in the spaces provided on the top of
each page of the form.
Complete the following confirmed disease report after consulting the NAHRS disease reporting criteria for each
disease. If a case meets the NAHRS criteria for presence of disease, record it as present. If a case does not strictly
meet the NAHRS criteria, you may use additional information to decide if you want to report the presence of
confirmed disease for the given month. 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. NOTE: For those
diseases considered to be foreign to the United States (FAD), the default response is ‘NO’. To report the presence
of an FAD, change the ‘NO’ to ‘YES’.
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. In the COMMENTS column, please indicate the highest level of
diagnostic criteria used in confirming a clinical case. If a report of a case is received after the report has been sent,
notify the NAHRS administrator to update the information.
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. If the disease is considered reportable in your State (you would
expect to receive a report if found), but you received no report which fits the NAHRS criteria, check ‘NO’ under
PRESENT.
Add any additional information which you feel may be of value in the COMMENTS column e.g. level of lab
diagnosis, presumptive vs definitive, clarification if needed.

NAHMS FORM - 57
NAHRS Reporting Form - This form (1/06) replaces all previous forms.

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STATE:
OIE NUMBER - DISEASE NAME
BOVINE
A010-A018 Foot and Mouth Disease (FMD,
Viruses O, A, C, SAT 1, SAT 2, SAT 3, Asia 1, or
not typed)
A020-A023 Vesicular Stomatitis (VS, Viruses
Indiana, New Jersey, or not typed)
A040 Rinderpest
A060 Contagious Bovine Pleuropneumonia
(Mycoplasma mycoides mycoides)
A070 Lumpy Skin Disease
A080 Rift Valley Fever
N001 Crimean Congo Hemorrhagic Fever

MONTH:

YEAR:

PRESENT
YES

COMMENTS

NO

X
X
X
X
X
X
X

A090 Bluetongue
B051 Anthrax (Bacillus anthracis)
B052 Aujesky’s Disease (Pseudorabies)
B053 Echinococcosis/Hydatidosis
B055 Heartwater (Cowdria ruminantium)

X

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)
B101 Anaplasmosis (Anaplasma marginale, A.
centrale)
B102 Babesiosis (Babesia bovis, B. bigemina)

X

X

N103 Bovine Brucellosis (Brucella abortus)
N152 Brucellosis (Brucella melitensis)
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)
B112 Trichomoniasis (Tritrichomonas
(Trichomonas) foetus)
B113 Trypanosomiasis (Trypanosoma
congolense, T. vivax, T. brucei brucei)
B114 Malignant Catarrhal Fever (Bovine
Malignant Catarrh, Wildebeest associated)
B115 Bovine Spongiform Encephalopathy

X

X
Indicate if Sheep or Wildebeest related form/ or
other

X

NAHRS Reporting Form - This form (1/06) replaces all previous forms.

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CAPRINE AND OVINE

YES

A010-A018 Foot and Mouth Disease (FMD,
Viruses O, A, C, SAT 1, SAT 2, SAT 3, Asia 1, or
not typed)
A020-A023 Vesicular Stomatitis (VS, Viruses
Indiana, New Jersey, or not typed)
A040 Rinderpest

NO

X
X
X
X
X

A050 Peste des Petits Ruminants
A080 Rift Valley Fever
A090 Bluetongue
N001 Crimean Congo Hemorrhagic Fever

X
X

A100 Sheep Pox and Goat Pox
B051 Anthrax (Bacillus anthracis)
B052 Aujesky’s Disease (Pseudorabies)
B053 Echinococcosis/Hydatidosis
B055 Heartwater (Cowdira ruminantium)

X

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)
B151 Ovine Epididymitis (Brucella ovis
infection)
N152 Caprine and Ovine Brucellosis- (B.
melitensis) (all others except B. ovis)
B153 Caprine Arthritis/Encephalitis (CAE)

X

B154 Contagious Agalactia (Mycoplasma
agalactiae, M. capricolum capricolum, M.
putrefaciens, M. mycoides mycoides, M.
mycoides mycoides LC)
B155 Contagious Caprine Pleuropneumonia
(Mycoplasma capricolum capripneumoniae)
B156 Enzootic Abortion of Ewes (Ovine
Psittacosis, Chlamydia psittaci)
B158 Nairobi Sheep Disease

X

X

B159 Salmonellosis (Salmonella abortus ovis)
B160 Scrapie
B161 Maedi-Visna/Ovine Progressive
Pneumonia
B352 Tularemia (Francisella tularensis)
N002 West Nile fever/encephalitis

EQUINE
A020-A023 Vesicular Stomatitis (VS, Viruses
Indiana, New Jersey, or not typed)
A110 African Horse Sickness

YES

NO

X

B051 Anthrax (Bacillus anthracis)
B056 Leptospirosis
B058 Rabies
B060-B061 New and Old World Screwworm
(Cochliomyia (Callitroga) hominivorax,

X

NAHRS Reporting Form - This form (1/06) replaces all previous forms.

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Chrysomya bezziana)
B062 Trichinellosis (Trichinela spiralis)
B201 Contagious Equine Metritis (Taylorella
equigenitalis)
B202 Dourine (Trypanosoma equiperadum)

X

N220 Eastern Equine Encephalomyelitis (EEE)
N221 Western Equine Encephalomyelitis (WEE)
B205 Equine Infectious Anemia (EIA)
B206 Equine Influenza (Virus Type A)
B207 Equine Piroplasmosis (Babesiosis,
Babesia (Piroplasma) equi, B. caballi)
B208 Equine Rhinopneumonitis (EHV 1 and 4)

X

B208a Equine herpesvirus
myeloencephalopathy (EHV1 – EHM)
B209 Glanders (Pseudomonas mallei)

X

B211 Equine Viral Arteritis (EVA)
B212 Japanese Encephalitis

X
X
X

B215 Surra (Trypanosoma evansi)
B216 Venezuelan Equine Encephalomyelitis
N103 Brucellosis (Brucella abortus)
N253 Brucellosis (Brucella suis)
N352 Tularemia (Francisella tularensis)
N002 West Nile Fever/encephalitis

PORCINE
A010-A018 Foot and Mouth Disease (FMD,
Viruses O, A, C, SAT 1, SAT 2, SAT 3, Asia 1, or
not typed)
A020-A023 Vesicular Stomatitis (VS, Viruses
Indiana, New Jersey, or not typed)
A030 Swine Vesicular Disease
A040 Rinderpest
A120 African Swine Fever
A130 Classical Swine Fever (Hog Cholera)
N258 Nipah Virus Encephalitis

YES

NO

X

X
X
X
X
X

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)
B062 Trichinellosis (Trichinela spiralis)

X

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
NAHRS Reporting Form - This form (1/06) replaces all previous forms.

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B352 Tularemia (Francisella tularensis)

POULTRY

YES

A150 Fowl Plague (Highly Pathogenic Avian
Influenza)
A160 Newcastle Disease (Exotic)

NO

X
X

N150i Low Pathogenic Avian Influenza (H5 or
H7 subtypes) poultry
1008 Turkey Rhinotracheitis

X

B301 Avian Infectious Bronchitis
B302 Avian Infectious Laryngotracheitis
B304 Duck Viral Hepatitis
B306 Fowl Cholera (Pasteurella multocida)
B308 Fowl Typhoid (Salmonella gallinarum)
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)

AQUCULTURE

YES

NO

COMMENTS

B401 Viral Hemorrhagic Septicemia
B404 Spring Viremia of Carp
B405 Infectious Hematopoietic Necrosis
B413 Epizootic Hematopoietic Necrosis
B415 Onchorynchus Masou Virus Disease

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.

NAHRS Reporting Form - This form (1/06) replaces all previous forms.

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