Form CDC 55.90 CDC 55.90 Enterovirus Surveillance System Report Form

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Overview

REPORT FORM
ENTEROVIRUS CODE LIST
SPECIMEN CODE LIST

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Sheet 1: REPORT FORM

National Enterovirus Surveillance System

Report Form

Form Approved OMB No. 0920-0004

Reporting Lab :

Report Date:

Positive Test Results

Enterovirus 1

Enterovirus 2

Enterovirus 3

Age

Age Type

Sex

State of Residence

Illness Outcome

Number of Enteroviruses Detected

Enterovirus

Nucleic Acid Extract?

Source Specimen

Specimen Date

Enterovirus

Nucleic Acid Extract?

Source Specimen

Specimen Date

Enterovirus

Nucleic Acid Extract?

Source Specimen

Specimen Date

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).

CDC 55.9 Rev.01/2014

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Sheet 2: ENTEROVIRUS CODE LIST

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

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Sheet 3: SPECIMEN CODE LIST

CODE	SPECIMENTYPE
1	CSF
6	Lesion swab/scraping
7	Plasma
8	Serum
2	Stool/Rectal Swab
3	Throat/NP Swab
10	Tissue (biopsy)
11	Tissue (post mortem)
4	Tissue Culture
12	Urine
13	Whole blood
5	Other (specify)
9	Unknown