Form 0920-0900 Influenza Outbreak Enhanced Data Collection Form – Marit

OMB Approved

Control No. 0920-0900

Exp. XX/XX/20XX

Influenza Outbreak Enhanced Data Collection

Ship: (entered by MA) _______­­­­­­­­­­­­_________ Voyage #: (entered by MA)__________

Pre-Embarkation: Were persons with ARI* allowed to board while symptomatic?
Isolation Practices†: Were persons diagnosed with test-positive influenza isolated† appropriately?
Case Ascertainment, Treatment‡, & Subtyping: Of the persons with ARI that tested positive for influenza, how many were considered high-risk?	Crew high-risk cases
	Passenger high-risk cases
Of the persons with ARI that tested positive for influenza, how many were treated with influenza antiviral medication?	High-risk cases treated‡:
	Non-high risk cases treated:
Of the persons with ARI that tested positive for influenza, how many subtypes were identified (e.g., “Influenza A”, “Influenza B”, “Influenza A/B”)?	Influenza A:
	Influenza B:
	Influenza A/B: (i.e., not subtyped)
Contact Identification§ & Post-exposure Prophylaxis (PEP)¥: How many total influenza contacts§ were identified (for the number of test-positive influenza cases listed above)?	Total contacts:
Of that total contact count, how many contacts were high-risk?	High-risk contacts§:
Of that total contact count, how many contacts were not high-risk?	Non-high risk contacts :
How many asymptomatic influenza contacts were provided with antiviral medication as post-exposure chemoprophylaxis (PEP)?	PEP to high-risk contacts ¥:
	PEP to non-high risk contacts:
Notifications: Were influenza notifications sent out to crew/passengers?	Crew: Passengers:
Prevention: What percentage of your crew members are vaccinated with this season’s influenza vaccine?			%
Federal Assistance: Do you need CDC assistance in managing this influenza outbreak?

* An illness of presumed viral etiology with at least two or more of the following symptoms: fever/feverishness, cough, runny nose, nasal congestion, or sore throat AND excluding: confirmed acute respiratory disease diagnoses other than COVID-19, influenza, or RSV; diagnoses of bacterial pneumonia (clinical or test-positive); non-infectious conditions as determined by the ship’s physician.

† Persons with influenza should remain isolated in their cabins or quarters until at least 24 hours after resolution of fever (temperature 100.4 °F [38 °C]) without the use of fever-reducing medications AND improving symptoms. If afebrile, persons with influenza should remain isolated for at least 24 hours AND improving symptoms.

‡ Early antiviral treatment with neuraminidase inhibitors (oral oseltamivir, inhaled zanamivir or IV peramivir) is recommended for persons with suspected or confirmed influenza who have severe illness or who are at high risk for influenza complications, including persons with asthma, diabetes, and heart disease. Treatment also can be considered, on the basis of clinical judgment, for outpatients with uncomplicated, suspected, or confirmed influenza who are not known to be at increased risk for developing severe or complicated illness if antiviral treatment can be initiated within 48 hours of illness onset, and treatment of these cases may be particularly advisable in an outbreak setting on a cruise ship. In addition, antiviral chemoprophylaxis could be considered for prevention of infection in exposed persons who are at high risk for complications or could be given to all contacts on a cruise ship when the outbreak threshold is met or exceeded.

§ ILI contacts on a cruise ship are considered to be any passengers or crew members who were in close proximity (within 6 feet) with an infected person or enclosed environment for a prolonged period of time, such as: sharing a cabin, family members, travel group members, crew working in shifts at the same space and having cared for or had direct contact with respiratory secretions or body fluids of an active influenza-like illness case. High-risk contacts are defined here and, in general, include all adults older than 65 years of age, children younger than 5 years old, and pregnant women and persons with chronic conditions including asthma, diabetes, and heart disease.

^¥ Antiviral chemoprophylaxis can be considered for prevention of infection in exposed persons who are at high risk for complications or for controlling influenza outbreaks on cruise ships when large numbers of persons at higher risk for influenza complications are onboard.

Public reporting burden of this collection of information is estimated to average 10 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 H21-8, Atlanta, Georgia 30333; ATTN: PRA 0920-0900.