Form CDC 55.90 CDC 55.90 Enterovirus Surveillance System Report Form

[NCIRD] National Disease Surveillance Program - II. Disease Summaries

Attachment V National Enterovirus Surveillance System (NESS) Report (CDC 55.9) (electronic).xlsx

National Enterovirus Surveillance Report 55.9

OMB: 0920-0004

Document [xlsx]
Download: xlsx | pdf

Overview

REPORT FORM
CODES


Sheet 1: REPORT FORM

National Enterovirus Surveillance System
Report Form
















Form Approved
OMB No. 0920-0004

Reporting Lab:

Lab ID:

Report Date (m/d/y):






















Positive Test Results






Enterovirus 1 Enterovirus 2 Enterovirus 3
Age Age Type Sex State/Territory of Residence Illness Outcome Number of Enteroviruses Detected Enterovirus Nucleic Acid Extract? Source Specimen Specimen Date (m/d/y) Enterovirus Nucleic Acid Extract? Source Specimen Specimen Date (m/d/y) Enterovirus Nucleic Acid Extract? Source Specimen Specimen Date (m/d/y)

















































































































































































































































































































































































































































































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


















Sheet 2: CODES

CODES FOR DATA ENTRY






























AGE

AGE TYPE


STATE OR TERRITORY


ENTEROVIRUS

NUCLEIC ACID EXTRACT SPECIMEN
CODE AGE
CODE ABBR Type
CODE ABBR State
AGENT SEROTYPE
CODE Nucleic Acid Extract?
0 0
0 D Days
1 AL Alabama
299 Coxsackievirus A Type Unknown
0 No
1 1
1 M Months
2 AK Alaska
201 Coxsackievirus A1
1 Yes
2 2
2 Y Years
4 AZ Arizona
210 Coxsackievirus A10
9 Unknown
3 3
9 U Unknown
5 AR Arkansas
211 Coxsackievirus A11


4 4




6 CA California
212 Coxsackievirus A12
SPECIMEN TYPE
5 5
SEX


8 CO Colorado
213 Coxsackievirus A13
CODE SPECIMENTYPE
6 6
CODE ABBR SEX
9 CT Connecticut
214 Coxsackievirus A14
1 CSF
7 7
1 F Female
10 DE Delaware
215 Coxsackievirus A15
6 Lesion swab/scraping
8 8
0 M Male
11 DC District of Columbia
216 Coxsackievirus A16
5 Other (specify)
9 9
9 U Unknown
12 FL Florida
217 Coxsackievirus A17
7 Plasma
10 10




13 GA Georgia
218 Coxsackievirus A18
8 Serum
11 11
ILLNESS OUTCOME


15 HI Hawaii
219 Coxsackievirus A19
2 Stool/Rectal Swab
12 12
CODE IllnessOutcome

16 ID Idaho
202 Coxsackievirus A2
3 Throat/NP Swab
13 13
1 Living

17 IL Illinois
220 Coxsackievirus A20
10 Tissue (biopsy)
14 14
2 Deceased

18 IN Indiana
221 Coxsackievirus A21
11 Tissue (post mortem)
15 15
9 Unknown

19 IA Iowa
222 Coxsackievirus A22
4 Tissue Culture
16 16




20 KS Kansas
224 Coxsackievirus A24
9 Unknown
17 17




21 KY Kentucky
203 Coxsackievirus A3
12 Urine
18 18




22 LA Louisiana
204 Coxsackievirus A4
13 Whole blood
19 19




23 ME Maine
205 Coxsackievirus A5


20 20




24 MD Maryland
206 Coxsackievirus A6


21 21




25 MA Massachusetts
207 Coxsackievirus A7


22 22




26 MI Michigan
208 Coxsackievirus A8


23 23




27 MN Minnesota
209 Coxsackievirus A9


24 24




28 MS Mississippi
399 Coxsackievirus B Type Unknown


25 25




29 MO Missouri
301 Coxsackievirus B1


26 26




30 MT Montana
302 Coxsackievirus B2


27 27




31 NE Nebraska
303 Coxsackievirus B3


28 28




32 NV Nevada
304 Coxsackievirus B4


29 29




33 NH New Hampshire
305 Coxsackievirus B5


30 30




34 NJ New Jersey
306 Coxsackievirus B6


31 31




35 NM New Mexico
401 Echovirus 1


32 32




36 NY New York
411 Echovirus 11


33 33




37 NC North Carolina
412 Echovirus 12


34 34




38 ND North Dakota
413 Echovirus 13


35 35




39 OH Ohio
414 Echovirus 14


36 36




40 OK Oklahoma
415 Echovirus 15


37 37




41 OR Oregon
416 Echovirus 16


38 38




42 PA Pennsylvania
417 Echovirus 17


39 39




44 RI Rhode Island
418 Echovirus 18


40 40




45 SC South Carolina
419 Echovirus 19


41 41




46 SD South Dakota
402 Echovirus 2


42 42




47 TN Tennessee
420 Echovirus 20


43 43




48 TX Texas
421 Echovirus 21


44 44




49 UT Utah
422 Echovirus 22


45 45




50 VT Vermont
423 Echovirus 23


46 46




51 VA Virginia
424 Echovirus 24


47 47




53 WA Washington
425 Echovirus 25


48 48




54 WV West Virginia
426 Echovirus 26


49 49




55 WI Wisconsin
427 Echovirus 27


50 50




56 WY Wyoming
429 Echovirus 29


51 51




60 AS American Samoa
403 Echovirus 3


52 52




64 FM Federated States of Micronesia
430 Echovirus 30


53 53




66 GU Guam
431 Echovirus 31


54 54




69 MP Northern Mariana Islands
432 Echovirus 32


55 55




70 PW Palau
433 Echovirus 33


56 56




72 PR Puerto Rico
224 Echovirus 34


57 57




74 UM U.S. Minor Outlying Islands
404 Echovirus 4


58 58




78 VI Virgin Islands
405 Echovirus 5


59 59




99 UNK Unknown
406 Echovirus 6


60 60








407 Echovirus 7


61 61








401 Echovirus 8


62 62








409 Echovirus 9


63 63








499 Echovirus Type Unknown


64 64








501 Enterovirus 68


65 65








502 Enterovirus 69


66 66








503 Enterovirus 70


67 67








599 Enterovirus 70/71


68 68








504 Enterovirus 71


69 69








505 Enterovirus 73


70 70








999 Enterovirus Type Unknown


71 71








400 Parechovirus Type Unknown


72 72








422 Parechovirus 1


73 73








423 Parechovirus 2


74 74








434 Parechovirus 3


75 75








435 Parechovirus 4


76 76








436 Parechovirus 5


77 77








437 Parechovirus 6


78 78








601 Poliovirus 1


79 79








602 Poliovirus 2


80 80








603 Poliovirus 3


81 81








699 Poliovirus Type Unknown


82 82













83 83













84 84













85 85













86 86













87 87













88 88













89 89













90 90













91 91













92 92













93 93













94 94













95 95













96 96













97 97













98 98













99 99













100 100













101 101













102 102













103 103













104 104













105 105













106 106













107 107













108 108













109 109













999 Unknown













File Typeapplication/vnd.openxmlformats-officedocument.spreadsheetml.sheet
File Modified0000-00-00
File Created0000-00-00

© 2024 OMB.report | Privacy Policy