0920-0004 Suspected Viral Gastroenteritis (AKA Calicivirus Surveillance)

OB ________
CDC Use Only

REPORT OF OUTBREAK OF
SUSPECTED VIRAL GASTROENTERITIS
Viral Gastroenteritis Section
DASH Unit 75
Centers for Disease Control and Prevention
1600 Clifton Road, N.E., Mailstop G-04
Atlanta, GA 30333

Telephone

(404) 639-3577 or
(404) 639-3607
(404) 639-3645
[email protected]

Facsimile
E-Mail

Date _____/_____/_____

Primary contact for epidemiologic investigation

mm

dd

yyyy

Name ______________________________________________________ Telephone___________________________
Agency _____________________________________________________ Facsimile ___________________________
Address_____________________________________________________ E-mail ______________________________
_____________________________________________________
Outbreak Information
State Outbreak ID __________
Date of first case

EFORS code __________
(if known)

_____/_____/_____
mm

dd

Date health department notified _____/_____/_____
mm

Date of last case

yyyy

Location(s) of outbreak: State______City

dd

yyyy

_____/_____/_____
mm

dd

yyyy

County (list if several) _________________________

If multistate, list other states_______________________________________________________________________
Suspected mode of transmission (can check more than one)
Person-to-person

Foodborne

Waterborne

Unknown

Other______________________

If food or waterborne
Implicated food or water source _____________________ Foodhandler implicated?
(can check more than one)

Setting
Nursing home
Community
Work Place

Assisted Living
Prison

Restaurant / Deli / Cafeteria

Ship

Private Home

Religious Facility

Hotel

Hospital

Yes: epidemiologic evidence
Yes: laboratory evidence
Yes: suspected, but no evidence
No
School

Daycare

Private event

Camp

Catered Event

Other ____________________ Date of event (if applicable) _____/_____/_____
mm

Illness Characteristics

dd

yyyy

Number of persons exposed _____ Number of persons ill _____
Number visiting health care provider _____ Number hospitalized______Number deaths_____
(Categories NOT mutually exclusive)

Symptoms: Number of persons with information _________
No. with abdominal cramps ____

No. with fever____

No. with diarrhea ____

No. with vomiting ____

Median incubation period (hours) ____ range_____
Median duration of illness (hours) ____ range_____

No. with other symptom(s) _______________________________________________________________________
Comments_______________________________________________________________________________________
_________________________________________________________________________________________________

Part II
Specimen Collection
Contact person for specimen handling

___________________________________________________________

Telephone

Facsimile ___________________ E-Mail _________________________
Number of vomitus specimens submitted __________

Number of stool specimens submitted
Tested for bacteria?

Yes

No

Results (if known) ________________________

Tested for ova and parasites?

Yes

No

Results (if known) _________________________

Stool and vomitus specimens collected from ill persons should be stored in watertight containers (e.g., stool collection cups) and
refrigerated (not frozen), and shipped on frozen refrigerant packs (not on wet ice) accompanied by CDC form 50.34 (DASH
Form).

Number of acute serum specimens collected from:

ill persons _____ control persons _____

Anticipated date for collection of convalescent sera

______/______/______

mm
dd
yyyy
Matching acute and convalescent serologic specimens should be stored and shipped frozen in plastic (transportable) aliquot
tubes, accompanied by CDC form 50.34 (DASH Form). Acute sera should be collected within 7 days of onset of symptoms and
convalescent sera should be collected 3 weeks after the collection of acute sera.

Other specimens collected?

Yes

No

Type ___________________ Date Collected _____/_____/_____
mm

dd

yyyy

Date specimens shipped to CDC

_____/_____/_____

Specimen type _______________________

Date specimens shipped to CDC

_____/_____/_____

Specimen type _______________________

mm

mm

dd

yyyy

dd

yyyy

Tracking Number (FedEx, UPS, USPS, etc): ____________________________________________________
List of unique identifiers and specimen type for samples submitted to CDC for testing
Unique ID

Specimen Type1

Date of Collection (mm/dd/yyyy)

Additional Information2

1

e.g. Bulk stool, vomitus, serum, rectal swab, environmental specimen
e.g. Foodhandler / ship crew

2

THANK YOU

RESET

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Revised 11/03

EXPORT DATA

MMWR, Vol. 50, No. RR-9, Page 11
RECOMMENDATIONS REGARDING SPECIMEN COLLECTION FOR DIAGNOSIS OF NLVs*
Clinical Specimens
Stool
Timing. Specimen collection for viral testing should begin on day 1 of the epidemiologic investigation. Any
delays to await testing results for bacterial or parasitic agents could preclude establishing a viral diagnosis.
Ideally, specimens should be obtained during the acute phase of illness (i.e., within 48--72 hours after onset)
while the stools are still liquid or semisolid because the level of viral excretion is greatest then. With the
development of sensitive molecular assays, the ability to detect viruses in specimens collected later in the
illness has been improved. In specific cases, specimens might be collected later during the illness (i.e., 7--10
days after onset), if the testing is necessary for either determining the etiology of the outbreak or for
epidemiologic purposes (e.g., a specimen obtained from an ill foodhandler who might be the source of
infection). If specimens are collected late in the illness, the utility of viral diagnosis and interpretation of the
results should be discussed with laboratory personnel before tests are conducted.
Number and Quantity. Ideally, specimens from >10 ill persons should be obtained during the acute phase of
illness. Bulk samples (i.e., 10--50 ml of stool placed in a stool cup or urine container) are preferred, as are
acute diarrhea specimens that are loose enough to assume the shape of their containers. Serial specimens
from persons with acute, frequent, high-volume diarrhea are useful as reference material for the development
of assays. The smaller the specimen and the more formed the stool, the lower the diagnostic yield. Rectal
swabs are of limited or no value because they contain insufficient quantity of nucleic acid for amplification.
Storage and Transport. Because freezing can destroy the characteristic viral morphology that permits a
diagnosis by EM, specimens should be kept refrigerated at 4 C. At this temperature, specimens can be stored
without compromising diagnostic yield for 2--3 weeks, during which time testing for other pathogens can be
completed. If the specimens have to be transported to a laboratory for testing, they should be bagged and
sealed and kept on ice or frozen refrigerant packs in an insulated, waterproof container. If facilities for testing
specimens within 2--3 weeks are not available, specimens can be frozen for antigen or PCR testing.
Vomitus
Vomiting is the predominant symptom among children, and specimens of vomitus can be collected to
supplement the diagnostic yield from stool specimens during an investigation. Recommendations for collection,
storage, and shipment of vomitus specimens are the same as those for stool specimens.
Serum
Timing. If feasible, acute- and convalescent-phase serum specimens should be obtained to test for a
diagnostic >4-fold rise in IgG titer to NLVs. Acute-phase specimens should be obtained during the first 5 days
of symptoms, and the convalescent-phase specimen should be collected from the third to sixth week after
resolution of symptoms.
Number and Quantity. Ideally, 10 pairs of specimens from ill persons (i.e., the same persons submitting stool
specimens) and 10 pairs from well persons (controls) should be obtained. Adults should provide 5--7 ml of
blood, and children should provide 3--4 ml.
Storage. Specimens should be collected in tubes containing no anticoagulant, and the sera should be spun off
and frozen. If a centrifuge is not available, a clot should be allowed to form, and the serum should be decanted
and frozen. If this step cannot be accomplished, the whole blood should be refrigerated but not frozen.
Environmental Specimens
NLVs cannot be detected routinely in water, food, or environmental specimens. Nevertheless, during recent
outbreaks (33--36), NLVs have been detected successfully in vehicles epidemiologically implicated as the
source of infection. If a food or water item is strongly suspected as the source of an outbreak, then a sample
should be obtained as early as possible and stored at 4 C. If the epidemiologic investigation confirms the link, a
laboratory with the capacity to test these specimens should be contacted for further testing. If drinking water is
suspected, special filtration (45) of large volumes (i.e., 5--100 liters) of water can concentrate virus to facilitate
its detection.