Form VS 12-10 VS 12-10 NLRAD NAHRS Monthly Report Form

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it
displays a valid OMB control number. The valid OMB control number for this information collection is 0579-0299 and 0579-XXXX. The time required to complete this information
collection is estimated to average 8 hours 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.

UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
VETERINARY SERVICES

OMB Approved
0579-0299 and
0579-XXXX

NATIONAL LIST OF REPORTABLE ANIMAL DISEASES (NLRAD)
NATIONAL ANIMAL HEALTH REPORTING SYSTEM (NAHRS)
MONTHLY REPORT FORM
INSTRUCTIONS

These instructions refer to completion of the NLRAD NAHRS form by the State Animal Health Officials (SAHO) or representatives. NLRAD NAHRS
reporting is completed through the NAHRS web reporting form https://dis.aphis.usda.gov. This document reflects the reporting required in the
NAHRS web reporting form and can be utilized to assist in completing reports or as a guide for reporting requirements. Additional information on the
NLRAD NAHRS, reporting criteria, and utilizing the NAHRS web reporting form can be found at
https://www.aphis.usda.gov/aphis/ourfocus/animalhealth/monitoringand-surveillance/sa_disease_reporting/ct_info_for_participants
For each month, please report disease presence or absence for the entire month. Monthly reports are requested by the 20th of the following month.
If you receive reports on out-of-state submissions, REPORT ONLY CASES THAT OCCURRED IN YOUR OWN STATE.
If you received a report of a case which fits the NAHRS criteria, check ‘YES’ under PRESENT. If you received a report of a case which does not fit
the NAHRS criteria, but you have additional evidence to support the presence of confirmed disease, check ‘YES’ under PRESENT. If you received
no reports in the investigation of a suspected disease which fit the NAHRS criteria and you have no further supporting evidence of the presence of
confirmed disease, check ‘NO’ under PRESENT (e.g., all investigations for a given disease were negative.) A ‘NO’ report, in relation to an endemic
disease, indicates that from information available there were no reports of confirmed disease occurrence, and does not infer the endemic disease
does not occur in the State.
Most endemic diseases include both a presumptive and definitive level of confirmation. If a case meets the NAHRS confirmed (definitive) criteria for
presence of disease, record it as present. If a case does not meet the NAHRS confirmed (definitive) criteria, but meets presumptive criteria -- report
the case if it is considered a probable case and ‘presumptive’ can be indicated in the comment section. The disease reporting criteria are minimum
standards and additional information can be utilized to report i.e. epidemiological link, or other non-listed laboratory tests.
Add any additional information which you feel may be of value or pertinent in the COMMENTS column e.g. level of lab diagnosis; presumptive vs.
confirmed; environment disease occurrence located in – backyard, feral, etc.; and any other clarifying information needed.
If a report of a case is received after the report has been sent or edits to the report are required, notify the NAHRS coordinator at
[email protected] to update the information.

VS FORM 12-10
FEB 2020

(This form replaces SDA-1.)

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SECTION I - NAHRS REPORT FOR:
State:

Month:

Year:

NOTE: Diseases below that are indicated as Foreign Animal Disease (FAD) are those diseases that are considered foreign to the United
States. Reporting the presence of a FAD occurrence is made after State-Federal coordination.
SECTION II – DISEASE OCCURRENCE INFORMATION:
WORLD ORGANIZATION FOR ANIMAL HEALTH (OIE)
NUMBER - DISEASE NAME

PRESENT

MULTIPLE SPECIES

YES

COMMENTS

NO

Akabane

Indicate species

Anthrax (Bacillus anthracis)

Indicate species

Bluetongue (all serotypes other than 8)

Indicate species

Bluetongue (serotype 8)

Indicate species

Bovine tuberculosis (Mycobacterium bovis)

Indicate species

Brucellosis (Brucellosis abortus)

Indicate species

Brucellosis (Brucellosis melitensis)

Indicate species

Brucellosis (Brucellosis suis)

Indicate species

Crimean-Congo hemorrhagic fever

Indicate species

Eastern equine encephalomyelitis

Indicate species

Echinococcosis (Echinococcus granulosus or E. multilocularis)

Indicate species

Foot-and-mouth disease

Indicate species

Glanders (Burkholderia mallei)

Indicate species

Heartwater (Cowdria ruminantium)

Indicate species

Epizootic hemorrhagic disease

Indicate species

Japanese encephalitis

Indicate species

Melioidosis (Burkholderia pseudomallei)

Indicate species

New World screwworm (Cochliomyia hominivorax)

Indicate species

Old World screwworm (Chrysomya bezziana)

Indicate species

Paratuberculosis / Johne’s Disease (Mycobacterium avium
paratuberculosis)

Indicate species

Pseudorabies / Aujesky’s disease

Indicate species

Q fever (Coxiella burnetii)

Indicate species

Rabies

Indicate species

Rift Valley fever

Indicate species

Rinderpest

Indicate species

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(This form replaces SDA-1.)

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Surra (Trypanosoma evansi)

Indicate species

Trichinellosis (Trichinella spp.)

Indicate species

Tularemia (Francisella tularensis)

Indicate species

Venezuelan equine encephalomyelitis

Indicate species

Vesicular stomatitis

Indicate species

West Nile virus

Indicate species

Western equine encephalomyelitis

Indicate species

Other diseases (occurrence of non-listed diseases/events of significance, enter in

Indicate species

comments)

AVIAN

YES

NO

COMMENTS

YES

NO

COMMENTS

Avian chlamydiosis / psittacosis (Chlamydophila psittaci)
Avian infectious bronchitis
Avian infectious laryngotracheitis
Duck viral hepatitis (Duck hepatitis A virus)
Fowl typhoid (Salmonella enterica serovar gallinarum)
Infectious bursal disease
Highly pathogenic avian influenza (reporting of occurrence in all
birds)
Low pathogenicity avian influenza (H5 or H7 subtypes) poultry
Mycoplasmosis (Mycoplasma gallisepticum)
Mycoplasmosis (Mycoplasma synoviae)
Pullorum disease (Salmonella enterica serovar pullorum)
Turkey rhinotracheitis (avian metapneumovirus)
Virulent Newcastle disease
Other diseases (occurrence of non-listed diseases/events of significance, enter in
comments)

BEE (Apiary)
Acarapisosis (Acarapis woodi)
American foulbrood (Paenibacillus larvae)
European foulbrood (Melissococcus plutonius)
Small hive beetle infestation (Aethina tumida)
Tropilaelaps mites (Tropilaelaps spp.)
Varroa mites (Varroa spp.)
VS FORM 12-10
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(This form replaces SDA-1.)

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Other diseases (occurrence of non-listed diseases/events of significance, enter in
comments)

BOVINE

YES

NO

COMMENTS

Anaplasmosis (Anaplasma marginale, A. centrale)
Babesiosis (Babesia bovis, B. bigemina)
Bovine genital campylobacteriosis (Campylobacter fetus
venerealis)
Contagious bovine pleuropneumonia (Mycoplasma mycoides
mycoides)
Enzootic bovine leukosis
Bovine spongiform encephalopathy
Bovine viral diarrhea
Hemorrhagic septicemia (Pasteurella multocida, B/Asian or
E/African serotypes)
Infectious bovine rhinotracheitis/ infectious pustular vulvovaginitis
(Bovine herpesvirus 1)
Lumpy skin disease
Malignant catarrhal fever (Ovine herpesvirus-2 or alcelaphine
herpesvirus-1)

Indicate if Sheep- or Wildebeest-related form, or other

Theileriasis (Theileria annulata, T. parva)
Trichomoniasis (Tritrichomonas foetus)
Trypanosomiasis (tsetse-transmitted)
(Trypanosoma congolense, T. vivax, T. brucei brucei)
Other diseases (occurrence of non-listed diseases/events of significance, enter in
comments)

CAPRINE AND OVINE

YES

NO

COMMENTS

Brucellosis / ovine epididymitis (Brucella ovis)
Caprine arthritis and encephalitis
Contagious caprine pleuropneumonia (Mycoplasma capricolum
capripneumoniae)
Contagious agalactia (Mycoplasma agalactiae, M.
capricolum capricolum, M. putrefaciens, M. mycoides capri)
Enzootic abortion of ewes (Chlamydia abortus)
Maedi-visna / ovine progressive pneumonia
Mange-Sarcoptes scabiei var ovis, Chorioptes bovis, Psoroptes
ovis, Psoroptes cuniculi, Psorergates ovis
Nairobi sheep disease
Peste des petits ruminants
Salmonellosis (Salmonella abortus ovis)

VS FORM 12-10
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(This form replaces SDA-1.)

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Scrapie
Sheeppox (Sheeppox or goatpox virus)
Other diseases (occurrence of non-listed diseases/events of significance, enter in
comments)

FARMED CERVIDS

YES

NO

COMMENTS

YES

NO

COMMENTS

YES

NO

COMMENTS

YES

NO

COMMENTS

Chronic wasting disease
Other diseases (occurrence of non-listed diseases/events of significance, enter in
comments)

EQUINE
African horse sickness
Contagious equine metritis (Taylorella equigenitalis)
Dourine (Trypanosoma equiperdum)
Equine rhinopneumonitis / Equine herpesvirus-1
myeloencephalopathy (EHV1 – EHM)
Equine infectious anemia
Equine influenza
Equine piroplasmosis (Theileria equi, Babesia. caballi)
Equine rhinopneumonitis (non-EHM)(equine herpesvirus-1)
Equine viral arteritis (EVA)
Hendra virus
Pigeon fever / ulcerative lymphangitis (Corynebacterium
pseudotuberculosis)
Strangles (Steptococcus equi equi)
Other diseases (occurrence of non-listed diseases/events of significance, enter in
comments)

LAGOMORPH (Rabbits and Hares)
Myxomatosis (Myxoma virus)
Rabbit hemorrhagic disease
Other diseases (occurrence of non-listed diseases/events of significance, enter in
comments)

PORCINE
African swine fever
Classical swine fever
Cysticercosis (Taenia sagnata, T. solium)
Nipah virus
Porcine reproductive and respiratory syndrome
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Swine vesicular disease
Transmissible gastroenteritis
Other diseases (occurrence of non-listed diseases/events of significance, enter in
comments)

OTHER TERRESTRIAL DISEASES

YES

NO

COMMENTS

AQUACULTURE

YES

NO

COMMENTS

AMPHIBIAN DISEASES

YES

NO

COMMENTS

YES

NO

COMMENTS

YES

NO

COMMENTS

Camelpox
Leishmaniosis
Other diseases (occurrence of non-listed diseases/events of significance, enter in
comments)

Batrachochytrium dendrobatidis
Batrachochytrium salamandrivorans
Ranavirus (Ranavirus spp.)
Other diseases (occurrence of non-listed diseases/events of significance, enter in
comments)

CRUSTACEAN
Acute hepatopancreatic necrosis disease (Vibrio
parahemolyticus-pVA-1 plasmid)
Crayfish plague (Aphanomyces astaci)
Infectious hypodermal and hematopoietic necrosis
Infectious myonecrosis
Necrotising hepatopancreatitis / early mortality syndrome
(Hepatobacter penaei)
Taura syndrome
White spot disease (white spot syndrome virus)
White tail disease (Macrobrachium rosenbergii nodavirus)
Yellowhead disease (Yellowhead virus genotype 1)
FISH
Epizootic hematopoietic necrosis
Epizootic ulcerative syndrome (Aphanomyces invadans)
Gyrodactylosis (Gyrodactylus salaris)
Infectious hematopoietic necrosis
Infectious salmon anemia (HPR0)
Infectious salmon anemia (HPR-deleted)
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(This form replaces SDA-1.)

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Koi herpesvirus disease
Red sea bream iridoviral disease
Salmonid alphavirus
Spring viremia of carp
Tilapia lake virus
Viral hemorrhagic septicemia
Other diseases (occurrence of non-listed diseases/events of significance, enter in
comments)

MOLLUSC

YES

NO

COMMENTS

Abalone herpesvirus
Bonamia exitiosa
Bonamia ostreae
Marteilia refringens
Perkinsus marinus
Perkinsus olseni
Xenohaliotis californiensis
Other diseases (occurrence of non-listed diseases/events of significance, enter in
comments)

SECTION III – ADDITIONAL EQUINE INFECTIOUS ANEMIA TESTING INFORMATION:
1. Number of EIA tests performed in a reporting month:
2. Number of horses tested in reporting month (leave blank if unavailable):
3. Number of horses tested positive in reporting month:
4. Number of premises (epidemiological units) with positive(s) in reporting month (if premises previously reported in calendar year do not report, and if not other positive
premises indicate – 0):
5. Number of total horses quarantined in State for positive EIA test:
Instructions for Additional Equine Infectious Anemia Questions:
1. Number of EIA tests performed in reporting month: Report the total number of EIA tests performed the reporting month for horses that
reside in your State. This includes all tests on resident horses conducted both at in-state and out-of-state labs.
2. Number of horses tested in reporting month (if unavailable leave blank): Report the number of horses tested for EIA for the reporting
month. Do not include repeat EIA tests on the same horse in the calendar year. If this information is unavailable, leave this blank.
3. Number of horses tested positive in reporting month: Report the total number of newly identified horses tested positive for EIA in the
reporting month. Do not include repeat testing of an already identified positive horse.
4. Number of premises (epidemiological units) with positive(s) in reporting month (If premise previously reported in calendar year do not
report, and if no other positive premises indicate -- 0): Identify the number of premises (epidemiological units) with positive EIA horses for the
calendar year. If a premise has been reported as positive in a previous monthly report, do not include in number of premises positive in reporting
month. If the only positive premises is a premises identified on a previous monthly report for the calendar year, report ‘0’. Example: if a premise
has one positive horse in June and additional testing in July identifies 3 additional positive horses on the same premises – for July indicate 3
positive horses and ‘0’ for number of premises.
5. Number of total horses quarantined in State for positive EIA test: This is the total number of EIA quarantined horses at the end of the
previous month with the addition of newly identified EIA positive horses and minus any EIA quarantined animals that were destroyed or died in the
reporting month.
VS FORM 12-10
FEB 2020

(This form replaces SDA-1.)

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