National Enterovirus Surveillance System Report Form | ||||||||||||||||
Form Approved OMB No. 0920-0004 |
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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). |
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 |
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 |
File Type | application/vnd.ms-excel |
Author | AHL4 |
Last Modified By | Ashley LaMonte |
File Modified | 2003-03-25 |
File Created | 2001-09-28 |