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pdf8/23/2016
CDC survey of county-level surveillance records of Aedes aegypti and Aedes albopictus from 1960 to present
CDC survey of countylevel surveillance records of
Aedes aegypti and Aedes albopictus from 1960 to
present
Form Approved
OMB Control No. 0920XXXX
Exp. Date: XX/XX/XXXX
******************************
In response to the ongoing Zika virus outbreak, the Centers for Disease Control and Prevention is
implementing a survey to collect county level records for Aedes aegypti and Ae. albopictus, the vectors of
dengue, yellow fever, chikungunya, and Zika viruses. This information will be used to update species
distribution maps for the contiguous United States and to develop a model aimed at identifying where
these vectors can survive and reproduce. The resulting maps and models will:
•
•
•
Inform the public and policy makers of the known distribution of these vectors
Identify gaps in vector surveillance
Target allocation of surveillance and prevention resources
To aid in this public health effort, we would be grateful for your voluntary contribution to this knowledge
base. If you have colleagues who might have additional records to share, please forward the link so they
are invited to participate as well.
In the interest of timely development of this map, we ask that you complete your survey by October 31,
2016.
This survey is designed to collect records at the county level. If you have surveillance records for more
than one county, please fill out one survey for each county.
If you have any questions, you may contact [email protected].
Thank you for your participation.
*****************************************************************************************************
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 D74, Atlanta, Georgia 30333; ATTN:
PRA 0920XXXX
* Required
Submitter's Contact Information
Please include contact information for the person submitting the surveillance records and the agency or
organization to which these records should be attributed. This information will be used to follow up with
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you to confirm accuracy of your entries prior to finalizing the end report.
If you have already submitted a surveillance record, you do not need to include your phone number and
mailing address for subsequent entries.
1. Submitter's First Name *
2. Submitter's Last Name *
3. Phone Number
Please use format: XXXXXXXXXX
4. Email *
5. Affiliation *
Please list the agency or organization to which
these collection records should be attributed.
6. Street
7. City
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8. State
Mark only one oval.
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
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Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
9. Zip code
Previous Ae. aegypti or Ae. albopictus records
10. In this survey we are seeking records for Ae. aegypti or Ae. albopictus from 1960 to present.
The previous U.S. Stegomyia survey focused on 2000spring 2016. Do you have new records
to submit that were not previously submitted to CDC? *
For example, in the U.S. Stegomyia survey in Spring 2016, through an ELC cooperative agreement,
or via ArboNET?
Mark only one oval.
Yes
No
Skip to question 11.
Skip to question 13.
I am not sure.
Skip to question 13.
Previous Ae. aegypti or Ae. albopictus records
11. If you have submitted records previously, where did you submit these records? *
Check all that apply.
U.S. Stegomyia survey Spring 2016
ELC cooperative agreement
ArboNET
Other:
12. Do you have new records to submit that were not previously submitted to CDC? *
Mark only one oval.
Yes
Skip to question 13.
No
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13. Which state would you like to submit surveillance records for? *
Mark only one oval.
Alabama
Skip to question 14.
Alaska
Skip to question 15.
Arizona
Skip to question 16.
Arkansas
Skip to question 17.
California
Skip to question 18.
Colorado
Skip to question 19.
Connecticut
Skip to question 20.
Delaware
Skip to question 21.
Florida
Skip to question 22.
Georgia
Skip to question 23.
Hawaii
Skip to question 24.
Idaho
Skip to question 25.
Illinois
Skip to question 26.
Indiana
Iowa
Skip to question 27.
Skip to question 28.
Kansas
Skip to question 29.
Kentucky
Skip to question 30.
Louisiana
Skip to question 31.
Maine
Skip to question 32.
Maryland
Skip to question 33.
Massachusetts
Michigan
Skip to question 34.
Skip to question 35.
Minnesota
Skip to question 36.
Mississippi
Skip to question 37.
Missouri
Skip to question 38.
Montana
Skip to question 39.
Nebraska
Skip to question 40.
Nevada
Skip to question 41.
New Hampshire
Skip to question 42.
New Jersey
Skip to question 43.
New Mexico
Skip to question 44.
New York
Skip to question 45.
North Carolina
North Dakota
Ohio
Skip to question 47.
Skip to question 48.
Oklahoma
Oregon
Skip to question 46.
Skip to question 49.
Skip to question 50.
Pennsylvania
Skip to question 51.
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Rhode Island
Skip to question 52.
South Carolina
South Dakota
Tennessee
Texas
Utah
Skip to question 54.
Skip to question 55.
Skip to question 56.
Skip to question 57.
Vermont
Virginia
Skip to question 58.
Skip to question 59.
Washington
West Virginia
Wisconsin
Wyoming
Skip to question 53.
Skip to question 60.
Skip to question 61.
Skip to question 62.
Skip to question 63.
District of Columbia
Skip to question 64.
Alabama
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14. Which county would you like to submit surveillance records for? *
This survey is designed to collect records at the county level. If you have surveillance records for
more than one county, please fill out one survey for each county.
Mark only one oval.
Autauga County 01001
Baldwin County 01003
Barbour County 01005
Bibb County 01007
Blount County 01009
Bullock County 01011
Butler County 01013
Calhoun County 01015
Chambers County 01017
Cherokee County 01019
Chilton County 01021
Choctaw County 01023
Clarke County 01025
Clay County 01027
Cleburne County 01029
Coffee County 01031
Colbert County 01033
Conecuh County 01035
Coosa County 01037
Covington County 01039
Crenshaw County 01041
Cullman County 01043
Dale County 01045
Dallas County 01047
DeKalb County 01049
Elmore County 01051
Escambia County 01053
Etowah County 01055
Fayette County 01057
Franklin County 01059
Geneva County 01061
Greene County 01063
Hale County 01065
Henry County 01067
Houston County 01069
Jackson County 01071
Jefferson County 01073
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Lamar County 01075
Lauderdale County 01077
Lawrence County 01079
Lee County 01081
Limestone County 01083
Lowndes County 01085
Macon County 01087
Madison County 01089
Marengo County 01091
Marion County 01093
Marshall County 01095
Mobile County 01097
Monroe County 01099
Montgomery County 01101
Morgan County 01103
Perry County 01105
Pickens County 01107
Pike County 01109
Randolph County 01111
Russell County 01113
Shelby County 01117
St. Clair County 01115
Sumter County 01119
Talladega County 01121
Tallapoosa County 01123
Tuscaloosa County 01125
Walker County 01127
Washington County 01129
Wilcox County 01131
Winston County 01133
Skip to question 65.
Alaska
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63. Which county would you like to submit surveillance records for? *
This survey is designed to collect records at the county level. If you have surveillance records for
more than one county, please fill out one survey for each county.
Mark only one oval.
Albany County 56001
Big Horn County 56003
Campbell County 56005
Carbon County 56007
Converse County 56009
Crook County 56011
Fremont County 56013
Goshen County 56015
Hot Springs County 56017
Johnson County 56019
Laramie County 56021
Lincoln County 56023
Natrona County 56025
Niobrara County 56027
Park County 56029
Platte County 56031
Sheridan County 56033
Sublette County 56035
Sweetwater County 56037
Teton County 56039
Uinta County 56041
Washakie County 56043
Weston County 56045
Skip to question 65.
District of Columbia
64. Which county would you like to submit surveillance records for? *
This survey is designed to collect records at the county level. If you have surveillance records for
more than one county, please fill out one survey for each county.
Mark only one oval.
District of Columbia County 11001
Skip to question 65.
Surveillance records
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65. In which years were at least one Aedes aegypti (any life stage) collected in this county? *
Please check all years that apply.
Check all that apply.
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
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1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
No Aedes aegypti were collected in this county between 1960 and 2016.
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66. In which years were at least one Aedes albopictus (any life stage) collected in this county? *
Please check all years that apply.
Check all that apply.
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
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1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
No Aedes albopictus were collected in this county between 1960 and 2016.
67. If you have any additional information or comments you would like to share regarding these
records, please include them here.
68. Do you have Aedes aegypti or Aedes albopictus records from additional counties? *
Mark only one oval.
Yes
No
Stop filling out this form.
Click submit to finish.
Thank you for your time sharing your surveillance records. If you have surveillance records from
additional counties, please submit these by filling out the survey again.
For information about Aedes aegypti and Aedes albopictus and the ongoing Zika virus outbreak, please
visit: http://www.cdc.gov/zika/
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| File Type | application/pdf |
| Author | Micah Hahn |
| File Modified | 2016-09-14 |
| File Created | 2016-08-23 |