Mass Gathering Outbreaks: Assessment of Frequency, Policy and Communication Strategies

U.S. Department of Health and Human Services Form Approved OMB Control No. 0920-0879

Centers for Disease Control and Prevention Expiration Date: 03/31/2018

Attachment D - Data Collection Instrument: MS Word version

[Introductory screen – by clicking on link]

Mass Gathering Outbreak Information Collection Form (word version)

Due to concerns about the possible impact of pandemic influenza, SARS-like viruses, and MERS, the Council of State and Territorial Epidemiologists (CSTE) and the National Association of County and City Health Officials (NACCHO) are collaborating with U.S. Centers for Disease Control and Prevention (CDC) to conduct an assessment of mass gathering-related respiratory disease outbreaks reported in your jurisdiction from January 2009 through December 2014.

For the purpose of this assessment, a mass gathering is considered the congregation (planned or unplanned) of ≥ 1000 persons in either an indoor or outdoor venue for a common purpose (e.g., sporting event, conference, and a state fair). An outbreak is one or more cases of an infectious respiratory disease associated with a mass gathering (transmission linked to a point source, animal, or another person at the mass gathering). We are only interested in aggregate, de-identified information about outbreaks and the mass gatherings with which they were associated that were not previously reported to CDC’s Notification of Outbreak Reporting System (NORS).

There are two parts of the collection form: 1) information on mass gathering-related respiratory disease outbreaks reported in your jurisdiction, and 2) information on relevant intervention and communication strategies implemented at mass gatherings. You are able to report up to 10 mass gathering-related outbreaks. You can start and save your responses and then complete at a later time. Just remember to submit after finalizing. The assessment can be completed in 30 minutes. Neither your name nor the name of your jurisdiction will be included in any report resulting from this assessment. Data will be collected and analyzed by CDC.

Please provide the following contact information. This is used for recording purposes only.

Please check the jurisdiction you are currently representing: State □ City or County □

Position title:	Time with jurisdiction:
If State, which one (drop-down menu):	If City or County, which one (drop-down menu):

PART 1. MASS GATHERING OUTBREAK
Please provide the following information about each mass gathering-related respiratory disease outbreak reported in your jurisdiction between January 2009 and December 2014 (not previously reported to NORS).
Were there any mass gathering- related respiratory disease outbreaks in your jurisdiction between January 2009 and December 2014? Yes □ go to next question No □ go to Part 2.
What was the name of the mass gathering (if not known, please briefly describe)?
Location (city, state):		Annual event: Yes □ No □ Unknown: □
Month/Year of mass gathering (enter starting month if covering more than one month): MM/YYYY Estimated duration of mass gathering (in days): XX (if unknown, leave blank)
For the mass gathering reported above, please provide the information below
Type: Sporting event: □ Religious event: □ Professional conference: □ Trade show: □ Music event/concert: □ Fair (county or state): □ Festival (e.g., cultural/neighborhood): □ Camp □ Political event (e. g., DNC/RNC): □ Other: □ (describe) _______________________________
Size of gathering: ___ ___ ___ ___ ___ ___ (numeric estimate – e.g., 5000)	Venue: Indoor □ Outdoor □ Both □ Unknown □

In the next two screens, please provide information on the type and size of the outbreak that occurred at the above mass gathering
Approximate date of index case (first case identified): mm/dd/yyyy (If not known, leave blank)
Mode of transmission for respiratory outbreak: Person to person (e.g., SARS): □ Animal-borne (e.g., H3N2v): □ Point source (e.g., Legionella): □ Unknown: □
Etiology: list agent(s) of illnesses if known: Viral □ Bacterial □ Other □_________________________ Unknown □ If known, name of agent: ________________________________
Total number of cases (probable and confirmed): ___ ___ ___ Number of confirmed cases (if known is a subset of total number of cases): ___ ___ ___
Age of cases: (check all that apply) < 2 years: □ 2-17 years: □ 18-64 years: □ ≥ 65 years: □ Unknown: □
Geographic spread (check all that apply): Local □ State-wide □ National □ Unknown □

Do you have any additional mass gathering-related outbreaks to report in this assessment?

Yes □ (go back to report next mass gathering related outbreak)

No □ (go to Part 2 or the assessment tool)

PART 2. POLICY AND COMMUNICATION

In this part, please briefly describe the last time since January 2009 your jurisdiction implemented (supported with human or financial resources) the following during a mass gathering:

1. Conducted on-site infectious disease surveillance (data collection/monitoring of disease events) or any kind?

Yes: □ No: □ [if no, go to question 2]

Type of Mass Gathering: _________________________ (e.g., sporting event) [drop down menu]

When: ______________________________ (month/year) [drop down menu]

For what type of infections [check all that apply]:

Respiratory: □

Gastrointestinal: □

Vector-borne: □

Other: □

Why: ___________________________________________________________ (open ended)

________________________________________________________________________________________________________

2. Implemented a nonpharmaceutical intervention (e.g., hand washing stations, provision of tissues for appropriate cough etiquette, social distancing)?

Yes: □ No: □ [if no, go to question 3]

Type of Mass Gathering: _________________________ (e.g., sporting event) [drop down menu]

When: ______________________________ (month/year) [drop down menu]

Which type of non-pharmaceutical interventions [click on all that apply]

Increased number of hand washing stations: □

Distribution of hand sanitizer: □

Distribution of tissues: □

Increased of spacing of attendees (e.g. seating arrangements) – social distancing: □

Why: ___________________________________________________________ (open ended)

3) Conducted any public health messaging (e.g., radio/TV announcements, posters, twitter feeds):

Yes: □ No: □ [if no, go to question 4]

Type of Mass Gathering: ___________________________ (e.g., sporting event) [drop down menu]

When: ______________________________ (month/year) [drop down menu]

Which type of messaging: [click all that apply]

Posters: □

Fact sheets: □

Guidance: □

Planning checklists: □

Traditional media (TV/Radio): □

Web links (or widgets): □

Social media messages: □

Mobile phone text messages and apps: □

Other: □ _________________

Why: ___________________________________________________________ (open ended)

___________________________________________________________________________________________

4) Other:

Yes: □ No: □ [if no, go to next question]

Type of Mass Gathering: ___________________________ (e.g., sporting event) [drop down menu]

When: ______________________________ (month/year) [drop down menu]

Describe other activity: ____________________________________ (open ended)

Why: ___________________________________________________________ (open ended)

What can CDC do to help improve our communication with you about non-pharmaceutical interventions and/or mass gatherings? (Please provide any comments or suggestions in the space provided below): [open ended]

_______________________________________________________________________________________________

You are able to review and change any of your responses by clicking on [XXXXX]. If you are ready to submit your responses, please click on the [Submit] icon below.

We greatly appreciate your time in completing this assessment. We will work with CSTE and NACCHO to provide you a report of our findings.

SUBMIT

Public reporting burden of this collection of information is estimated to average 30 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-74, Atlanta, Georgia 30333; ATTN: PRA 0920-XXXX.