003-GA Burden Memo

Burden Memo for the Generic Clearance of Emergency Epidemic Investigation Data Collections

(0920-1011)

GenIC No.:	2014003-XXX
EPI AID No. (if applicable):	NA
Requesting entity (e.g., jurisdiction):	Georgia Department of Public Health
Title of Investigation:	Contact Investigation of Travelers Potentially Exposed to Middle East Respiratory Syndrome Coronavirus (MERS-CoV) during Air Travel 
Purpose of Investigation: (Use as much space as necessary)	Middle East Respiratory Syndrome (MERS) is viral respiratory illness first reported in Saudi Arabia in 2012. It is caused by a coronavirus called MERS-CoV. Most people who have been confirmed to have MERS-CoV infection developed severe acute respiratory illness. They had fever, cough, and shortness of breath. About 30% of these people died. A second imported case of MERS in the United States, identified in a traveler, was reported to CDC by the Florida Department of Health on May 11, 2014, and confirmed by CDC on May 11. On May 1, the patient traveled by commercial airline from Saudi Arabia to the UK, then UK to Boston, Massachusetts; then Boston to Atlanta, Georgia; and then Atlanta to Orlando, Florida. The traveler was a health-care provider in Saudi Arabia and traveled while symptomatic and potentially contagious. Little is known about the modes of transmission of MERS-CoV and the risks of acquiring infection from contact with an infected person, either in the community or household setting or on conveyances such as planes, buses or trains. Many of the contacts on the Boston to Atlanta leg of the journey ended their travel in Georgia. The Georgia Department of Health has requested CDC assistance in doing a contact investigation to identify those passengers and notify them about the possible exposure. This will include collecting information about any symptoms related to MERS-CoV infection and collection of appropriate biological specimen to test for MERS-CoV.
Duration of Data Collection:
Date Began:	5/23/2014
Date Ended:	7/29/2014
Lead Investigator
Name:	Nicki Pesik
CIO/Division/Branch:	NCEZID/DGMQ/Quarantine and Border Health Services Branch

Complete the following for each instrument used during the investigation.

Data Collection Instrument 1

Name of Data Collection Instrument:

MERS-CoV_Questionnaire for Passengers and Crew

Type of Respondent

General public Healthcare staff Laboratory staff Patients Restaurant staff

Other: (describe) Airline passengers and staff

Data Collection Methods (check all that apply)

Epidemiologic Study (indicate which type(s) below)

Descriptive Study (describe): Describe the occurrence and extent of transmission of MERS-CoV related to the exposure of passengers or crew on air or land conveyances or community, household or community contacts in order to assess factors related to transmission. Contact investigation data analyzed to determine the occurrence and extent of MERS-CoV transmission among case contacts, to identify risk factors for transmission, and to implement immediate control measures for any new infectious cases identified. Characterization of MERS-CoV transmission also used to inform public health prevention and control recommendations for travel restriction among persons with symptoms consistent with MERS-CoV. 

Cross-sectional Study (describe):

Cohort Study (describe):

Case-Control Study (describe):

Other (describe):

Environmental Assessment (describe):

Laboratory Testing (describe): Blood for acute- and convalescent-phase sera among all contacts and possibly for PCR among asymptomatic persons. Oral and nasopharyngeal swabs and other appropriate samples for MERS-CoV testing among symptomatic contacts.

Other (describe):

Data Collection Mode (check all that apply)

Survey Mode (indicate which mode(s) below):

Face-to-face Interview (describe):

Telephone Interview (describe): Identified contacts interviewed by telephone to assess information about flight/travel, travel companions, and health status.

Self-administered Paper-and-

Pencil Questionnaire (describe):

Self-administered Internet

Questionnaire (describe):

Other (describe):

Medical Record Abstraction (describe):      

Biological Specimen Sample

Environmental Sample

Other (describe):

Response Rate (if applicable)

Total No. Responded (A):	101
Total No. Sampled/Eligible to Respond (B):	186
Response Rate (A/B):	54%

Data Collection Instrument 2

Name of Data Collection Instrument:

MERS-CoV_Serology Assent Form     

Type of Respondent

General public Healthcare staff Laboratory staff Patients Restaurant staff

Other: (describe) Airline passengers and staff

Data Collection Methods (check all that apply)

Epidemiologic Study (indicate which type(s) below)

Descriptive Study (describe):

Cross-sectional Study (describe):

Cohort Study (describe):

Case-Control Study (describe):

Other (describe):

Environmental Assessment (describe):

Laboratory Testing (describe): Blood for acute- and convalescent-phase sera among all contacts

 Other (describe):

Data Collection Mode (check all that apply)

Survey Mode (indicate which mode(s) below):

Face-to-face Interview (describe):

Telephone Interview (describe):

Self-administered Paper-and-

Pencil Questionnaire (describe):

Self-administered Internet

Questionnaire (describe):

Other (describe):

Medical Record Abstraction (describe):

Biological Specimen Sample

Environmental Sample

Other (describe):

Response Rate (if applicable)

Total No. Responded (A):	33
Total No. Sampled/Eligible to Respond (B):	101
Response Rate (A/B):	33%

Complete the following burden table. Each data collection instrument should be included as a separate row.

Burden Table (insert rows for additional respondent types if needed)

Data Collection Instrument Name	Type of Respondent	No. Respondents (A)	No. Responses per Respondent (B)	Burden per Response in Minutes (C)	Total Burden in Hours (A x B x C)/60*
MERS-CoV_Questionnaire for Passengers and Crew	General Public, Airline Passengers and Staff	101	1	20	34
MERS-CoV_Serology Assent Form	General Public, Airline Passengers and Staff	33	1	5	3

Return completed form and a blank copy of each final data collection instrument within 5 business days of data collection completion to the EEI Information Collection Request Liaison, Danice Eaton ([email protected]).

EEI Information Collection Request Liaison:

Danice Eaton, PhD, MPH

EIS Program Staff Epidemiologist

Epidemiology Workforce Branch

Division of Scientific Education and Professional Development

Centers for Disease Control and Prevention

2400 Century Center, MS E-92

Office: 404.498.6389
[email protected]

Page 4 of 4 Form Updated: 5/29/2014