(MAVEN HELP DESK VERSION)

Transcription

1 Office of Integrated Surveillance and Informatics Services (ISIS) Standard Operating Procedures GUIDE TO EVENT CLASSIFICATION AND LABORATORY INTERPRETATION (MAVEN HELP DESK VERSION)

2 SURVEILLANCE GUIDE TO EVENT CLASSIFICATION AND LABORATORY INTERPRETATION Common Terms: confirmed event: clinical and/or laboratory evidence fulfills all criteria required for a true case probable event: available clinical and/or laboratory evidence meets most, but not all, of the criteria required for a confirmed of case suspect event: available clinical and/or laboratory evidence meets some, but not all, of the criteria required for a definitive classification of the case revoked event: available clinical and/or laboratory evidence is sufficient to indicate the case is not actually a true case antibody: an immune system protein created by the body in response to an invading microorganism antigen screen: a test designed to detect a specific piece of a particular organism assay: a test performed to determine the presence of a substance and/or the amount of that substance biopsy: the removal of a sample of tissue for examination under a microscope (sometimes in an attempt to demonstrate a particular microorganism) - examination of a biopsy sample often involves the use of stains clinical : refers to a human (as opposed to a not specified as clinical, which could be an animal or inanimate ) clinically compatible case: a clinical syndrome generally compatible with the disease, as described in the clinical description culture: a test intended to isolate (or grow) a particular microorganism in order to identify it event time period: the length of time during which a person should NOT be reentered into the database for the same disease/infection (event time periods take into account a variety of disease-specific information, including acquired immunity and course of disease) Example: The event time period for all enteric events is 1 year. If you receive a lab regarding John Smith s Giardiasis on 2/11/02 and another lab on 11/15/02 DO NOT ENTER AS A NEW EVENT! Update Smith s existing Giardiasis record with any new information from the most recent report.

3 epidemiologically linked event: a event in which both a) the patient has had contact with one or more persons who either have/had the disease or have been exposed to a point source of infection b) transmission of the agent is plausible note: Per CDC, a event may be considered epidemiologically linked to a laboratory-confirmed event if at least one event in the chain of transmission is laboratory confirmed fluorescence: a substance used to make an organism visible microorganism: any bacterium, parasite, virus, yeast or fungi ova and parasite: a type of slide smear test intended to make visible the eggs (ova) of a particular parasite or the parasite itself PCR: a type of test used to amplify selected sections of the DNA of a microorganism serology: a test using blood or blood components (such as serum or plasmid) to determine the presence of antibodies (such as IgG or IgM) to a particular microorganism serotype: a further subdivision of a species e.g. Shigella flexneri 2A slide test: a test in which a is placed on a slide in order to make it visible under a microscope smear test: a slide test, usually involving stains, designed to make a microorganism visible under a microscope species: smallest category of classification for living organisms- usually the second of the two Latin names cited for an organism e.g. Shigella flexneri sterile site: an area of the body normally free of microorganisms from which laboratory s may be taken, such as blood, pleural fluid, pericardial fluid, joint fluid, peritoneal fluid, CSF (cerebral spinal fluid); organisms identified in sputum or throat cultures are not considered to be from a sterile sites; organisms identified from wounds or other sources should be reviewed with an Epidemiologist prior to entry of the event toxin: a chemical, which can be harmful or deadly, excreted by some microorganisms

4 Common Acronyms/Abbreviations Ig: Immunoglobulin IgM: Immunoglobulin M IgG: Immunoglobulin G CRF: Case Report Forms CSF: Cerebral Spinal Fluid Epi: Epidemiologist Common Lab Tests DFA: direct fluorescent antibody EIA: enzyme immunoassay ELISA: enzyme-linked immunosorbent assay EITB: electrophoretic immunotransblot IFA: immunofluorescent assay MIF: micro immunofluorescence O & P : ova and parasite PCR: polymerase chain reaction PFGE: pulsed-field gel electrophoresis RIBA: recombinant immunoblot assay RT- PCR: reverse transcriptase polymerase chain reaction SIA: strip immunoblot assay WB: western blot ** throughout this text, bolded event names indicate a nationally notifiable disease as of ** throughout this text, grayed events indicate that the event definition is in draft form and/or pending final review IMMEDIATE DISEASE PROTOCOL: 1. Laboratory report is entered into MAVEN immediately. 2. Fax to Local Board of Health. 3. Select and date LBOH notified in Administrative QP. AIDS/HIV REPORTS Aids/HIV lab reports (including CD4 counts) should be placed in an interoffice envelope to AIDS surveillance. SEXUALLY TRANSMITTED DISEASE (STD) STD lab reports should be placed in an interoffice envelope to STD surveillance.

5 AMEBIASIS NON-IMMEDIATE NOTIFICATION EPIDEMIOLOGY PROGRAM Event Name: Event Time Period: Clinical Description (CDC 1990): AMEB 1 year Infection of the large intestine by Entamoeba histolytica may result in an illness of variable severity ranging from mild, chronic diarrhea to fulminant dysentery. Infection also may be asymptomatic. Extraintestinal infection also can occur (e.g., hepatic abscess). CDC Event Classification (1990): Confirmed A clinically compatible illness with laboratory confirmation (O&P or serology) by: 1. Demonstration of cysts or trophozoites of Entamoeba histolytica in stool; 2. Demonstration of trophozoites of E. histolytica in extra intestinal tissue, tissue biopsy or ulcer scrapings (by culture or histopathology); OR 3. antibody tests (ELISA or indirect hemaglutination) for E. histolytica Massachusetts Event Classification: Confirmed Probable Revoked clinically compatible illness with at least one of the following laboratory results: 1. Entamoeba dispar/histolytica by EIA, 2. Entamoeba histolytica by EIA, or 3. Entamoeba dispar/histolytica trophs or cysts seen Entamoeba histolytica by EIA, Entamoeba dispar/histolytica by EIA or Entamoeba dispar/histolytica trophs or cysts seen and no clinical information is available Case report form clearly states case was asymptomatic with: 1. Entamoeba dispar/histolytica by EIA, 2. Entamoeba histolytica by EIA, or 3. Entamoeba dispar/histolytica trophs or cysts seen

6 AMEBIASIS (continued) Report Type Test Type Source Result Stain Stain Clinical Specimen Clinical Specimen Entamoeba histolytica/dispar Entamoeba histolytica cyst or trophozoites Select: Microscopy:Prld:Pt xxx:m: xxx stain O&P Stool Entamoeba histolytica cyst or trophozoites Select: Microscopy: PrId: Pt: xxx: m: Ova and parasite preparation ELISA Blood Positive for Indirect Entamoeba histolytica hemaglutination Select: Entamoeba histolytica Ab: ACnc: Pt: Ser: Ord: Select (IgM specific): Entamoeba histolytica Ab.IgM: ACnc: Pt: Ser: Qn: EIA Antibody Clinical Specimen Select: Entamoeba histolytica Ab: ACnc: Pt: Ser: Ord: Select (IgM specific): Entamoeba histolytica Ab: IgM ACnc: Pt: Ser: Qn DNA Clinical Specimen : Morbidity Report Case Report Form Entamoeba histolytica cyst or trophozoites or beyond PROBABLE PROBABLE PROBABLE PROBABLE Positive for E. histolytica PROBABLE Same Event Select: Entamoeba histolytica DNA: ACnc Pt xxx: Ord: Probe.Amp Tar Lab Status based on epi review lab Call to get lab

7 HUMAN GRANULOCYTIC ANAPLASMOSIS NON-IMMEDIATE NOTIFICATION EPIDEMIOLOGY PROGRAM NOTE: Enter results for all tickborne diseases (positive and negative) in lab screen when at least one positive result is available (Lyme, Babesiosis, Tularemia, Rocky Mountain Spotted Fever, Ehrlichiosis). Event Name: Event Time Period: Clinical Description (CDC 2008) CDC Event Classification (2008): HGA 1 year Human Granulocytic Anaplasmosis is characterized by fever and one or more of the following: headache, myalgia, anemia, leucopenia, thrombocytopenia, or any hepatic transaminase elevation.. Confirmed clinically compatible and meets one of the following laboratory criteria: 1. Serological evidence of a four-fold or greater change in IgG specific antibody titer to Anaplasma phagocytophila by IFA in paired serum samples (one taken in first week of illness and a second 2-4 weeks later), OR 2. identification of A. phagocytophila by PCR, OR 3. demonstration of anaplasmal antigen in a biopsy/autopsy sample by IHC, OR Massachusetts Event Classification: 4. isolation of A. phagocytophilum from a clinical in culture Probable clinically compatible and meets one of the following laboratory criteria: 1. serological evidence of elevated IgG or IgM antibody reactive with A. phagocytophilum antigen by IFA, ELISA, dot-elisa, or assays in other formats, OR 2. identification of morulae in the cytoplasm of neutrophils or eosinophils by microscopic examination Suspect A case with laboratory evidence of past or present infection, but no clinical information available follows the CDC event classification

8 HUMAN GRANULOCYTIC ANAPLASMOSIS (continued) NOTE: Enter results for all tickborne diseases (positive and negative) in lab screen when at least one positive result is available (Lyme, Babesiosis, Tularemia, Rocky Mountain Spotted Fever, Ehrlichiosis). Anaplasma phagocytophila is also called Ehrlichia phagocytophila. or beyond Report Type Test Type Source Result Laboratory Report OR Laboratory Report OR Culture Clinical Ehrlichia phagocytophila OR Anaplasma phagocytophila Select: Microorganism : PrId : Pt : xxx : m : Culture IFA Clinical Positive for Anaplasma phagocytophila OR Human granulocytic ehrlichiosis Select: Human granulocytic ehrlichiosis Ab : Titr : Pt : Ser : Qn : IF Select (IgG-specific): Human granulocytic ehrlichiosis Ab.IgG : Titr : Pt : Ser : Qn : IF Select (IgM-specific): Human granulocytic ehrlichiosis Ab.IgM : Titr : Pt : Ser : Qn : IF Laboratory Report OR EIA Clinical Positive for Anaplasma phagocytophila or Specimen human granulocytic ehrlichiosis Select (IgG-specific): Human granulocytic ehrlichiosis IgG: ACnc: Pt: Ser: Ord: EIA Select (IgM-specific): Human granulocytic ehrlichiosis IgM: ACnc: Pt: Ser: Ord: EIA Laboratory Report OR EIA Clinical Positive for Anaplasma phagocytophila OR Human granulocytic ehrlichiosis Laboratory Report OR Select: Ehrlichia phagocytophila Ab : ACnc : Pt : Ser : Ord : EIA PCR Clinical Positive for Anaplasma phagocytophila OR Human granulocytic ehrlichiosis Select: Ehrlichia phagocytophila DNA : ACnc : Pt : Bld : Ord : Probe.Amp.Tar Laboratory Report OR RIBA Clinical Positive for Anaplasma phagocytophila OR Human granulocytic ehrlichiosis Select (IgG-specific): Human granulocytic ehrlichiosis Ab.IgG : ACnc : Pt : xxx : Ord : IB Select (IgM-specific): Human granulocytic ehrlichiosis Ab.IgM : ACnc : Pt : xxx : Ord : IB Laboratory Report OR Smear Clinical Select: Microscopy : PrId : Pt : xxx : m : xxx stain Positive WBC inclusions/morulae found (granulocytes found)

9 HUMAN GRANULOCYTIC ANAPLASMOSIS (continued) Report Type Test Type Source Result or beyond Morbidity card

10 ANTHRAX IMMEDIATE NOTIFICATION EPIDEMIOLOGY PROGRAM Event Name: Event Time Period: Clinical Description (CDC 2010): ANTH 1 year Cutaneous Anthrax: An acute illness, or post-mortem examination revealing a painless skin lesion developing over 2 to 6 days from a papular through a vesicular stage into a depressed black eschar with surrounding edema. Fever, malaise and lymphadenopathy may accompany the lesion. Inhalation Anthrax: An acute illness, or post-mortem examination revealing a prodrome resembling a viral respiratory illness, followed by hypoxia, dyspnea or acute respiratory distress with resulting cyanosis and shock. Radiological evidence of mediastinal widening or pleural effusion is common. Gastrointestinal Anthrax: An acute illness, or post-mortem examination revealing severe abdominal pain and tenderness, nausea, vomiting, hematemesis, bloody diarrhea, anorexia, fever, abdominal swelling and septicemia. Oropharyngeal Anthrax: An acute illness, or post-mortem examination revealing a painless mucosal lesion in the oral cavity or oropharynx, with cervical adenopathy, edema, pharyngitis, fever, and possibly septicemia. CDC Event Classification (2010): Meningeal Anthrax: An acute illness, or post-mortem examination revealing fever, convulsions, coma, or meningeal signs. Signs of another form will likely be evident as this syndrome is usually secondary to the above syndromes. Confirmed A clinically compatible illness with one of the following: 1. Culture and identification of B. anthracis from clinical s by the Laboratory Response Network (LRN); 2. Demonstration of B. anthracis antigens in tissues by immunohistochemical staining using both B. anthracis cell wall and capsule monoclonal antibodies; 3. Evidence of a four-fold rise in antibodies to protective antigen between acute and convalescent sera or a fourfold change in antibodies to protective antigen in paired convalescent sera using Centers for Disease Control and Prevention (CDC) quantitative anti-pa IgG ELISA testing; 4. Documented anthrax environmental exposure AND evidence of B. anthracis DNA (for example, by LRN-validated polymerase chain reaction) in clinical s collected from a normally sterile site (such as blood or CSF) or lesion of other affected tissue (skin, pulmonary, reticuloendothelial, or gastrointestinal).

11 ANTHRAX (continued Probable A clinically compatible illness that does not meet the confirmed case definition, but with one of the following: Epidemiological link to a documented anthrax environmental exposure; Evidence of B. anthracis DNA (for example, by LRN-validated polymerase chain reaction) in clinical s collected from a normally sterile site (such as blood or CSF) or lesion of other affected tissue (skin, pulmonary, reticuloendothelial, or gastrointestinal); Positive result on testing of clinical serum s using the Quick ELISA Anthrax-PA kit; Detection of Lethal Factor (LF) in clinical serum s by LF mass spectrometry Positive result on testing of culture from clinical s with the RedLine Alert test. Massachusetts Event Classification Suspect An illness suggestive of one of the known anthrax clinical forms. definitive, presumptive, or suggestive laboratory evidence of B. anthracis, or epidemiologic evidence relating it to anthrax. Follows CDC event classification

12 ANTHRAX (continued) Report Type Test Type Source Result Culture Clinical Specimen Bacillus anthracis Select: Microorganism: Pt: xxx: m: Culture IFA Clinical Bacillus anthracis Specimen Select: Bacillus anthracis Ag: ACnc: Pt: xxx: Ord: IF Quick ELISA Clinical Positive Anthrax PA OR Specimen Anti-PA antibodies Select: Bacillus anthracis anti-pa Ab: Titr: Pt: Ser: Qn: ELISA Lethal Factor Serum Positive Select: Bacillus anthracis lethal factor: ACnc: Pt: xxx: Qn: Mass Spectrometry Stain Clinical Gram positive rod Select: Microscopy: Prld: Pt: xxx: m: xxx stain Malachite green Clinical Positive Stain Select: Spore identification: Prld: Pt: xxx: m: Malachite green stain PCR Clinical Positive Select: Bacillus anthracis DNA: ACnc: Pt: xxx: Ord: Probe.amp.tar RedLine Alert Test Clinical Positive Select: Bacillus anthracis Ag: ACnc: Pt: xxx: Ord: IF or beyond

13 ANTHRAX (continued) Report Type Test Type Source Result Morbidity Report (non- Boston) Anthrax EITB Reaction Serum Positive or beyond DO NOT ENTER DO NOT ENTER; give to liaison

14 ARBOVIRAL INFECTIONS NON-IMMEDIATE NOTIFICATION EPIDEMIOLOGY PROGRAM Event Name: EEE WNE WNI ARBO VEE Event Time Period: 60 days Clinical Description Cases of arboviral disease are classified either as neuroinvasive or non-neuroinvasive, according to the following criteria: (CDC 2004): 1. Neuroinvasive disease requires the presence of fever and at least one of the following, as documented by a physician and in the absence of a more likely clinical explanation: Acutely altered mental status (e.g., disorientation, obtundation, stupor, or coma), or Other acute signs of central or peripheral neurologic dysfunction (e.g., paresis or paralysis, nerve palsies, sensory deficits, abnormal reflexes, generalized convulsions, or abnormal movements), or Pleocytosis (increased white blood cell concentration in cerebrospinal fluid [CSF]) associated with illness clinically compatible with meningitis (e.g., headache or stiff neck). 2. n-neuroinvasive disease requires, at minimum, the presence of documented fever, as measured by the patient or clinician, the absence of neuroinvasive disease (above), and the absence of a more likely clinical explanation for the illness. Involvement of non-neurological organs (e.g., heart, pancreas, liver) should be documented using standard clinical and laboratory criteria. CDC Event Confirmed A clinically compatible case with laboratory confirmation (culture or serology) by: Classification (2004): 1. Four-fold or greater change in virus-specific serum antibody titer, or 2. Isolation of virus from or demonstration of specific viral antigen or genomic sequences in tissue, blood, CSF, or other body fluid, or 3. Virus-specific immunoglobulin M (IgM) antibodies demonstrated in CSF by antibody-capture enzyme immunoassay (EIA), or 4. Virus-specific IgM antibodies demonstrated in serum by antibody-capture EIA and confirmed by demonstration of virus-specific serum immunoglobulin G (IgG) antibodies in the same or a later by another serologic assay (e.g., neutralization or hemagglutination inhibition). Probable A clinically compatible case and meets one of the following laboratory criteria: 1. Stable (less than or equal to a two-fold change) but elevated titer of virus-specific serum antibodies, or 2. Virus-specific serum IgM antibodies detected by antibody-capture EIA but with no available results of a confirmatory test for virus-specific serum IgG antibodies in the same or a later. Massachusetts Event Follows the CDC event classification Classification:

15 ARBOVIRAL INFECTIONS (continued) Report Type Laboratory report OR Boston Reporting Card Laboratory report OR Boston Reporting Card Test Type Culture Source Clinical Specimen Result Eastern equine encephalomyelitis virus OR Jamestown Canyon virus OR La Crosse virus OR Powassan virus OR Saint Louis encephalitis virus OR Venezuelan equine encephalomyelitis virus OR Western equine encephalomyelitis virus OR West Nile virus Select: Virus identified: PrId: Pt: xxx: m: Virus culture EIA or CSF or West Nile Virus IFA Serum Select(IgM specific): West Nile virus Ab.IgM: ACnc: Pt: xxx: Ord: EIA Select (IgGspecific): West Nile virus Ab.IgG: ACnc: Pt: xxx: Ord: EIA Laboratory report EIA or CSF or Eastern equine encephalomyelitis virus OR Boston IFA Serum Reporting Card Select(IgM specific): Eastern equine encephalitis virus Ab.IgM: ACnc: Pt: Ser: Ord: EIA Select(IgG specific): Eastern equine encephalitis virus Ab.IgG: ACnc: Pt: xxx: Ord: EIA Laboratory report EIA or Serum or OR Boston IFA CSF Reporting Card Select(IgM specific): Arbovirus Ab.IgM: ACnc: Pt: xxx: Ord: EIA Select(IgG specific): Arbovirus Ab.IgG: ACnc: Pt: xxx: Ord: EIA Laboratory report IFA Clinical LA crosse virus OR Boston Specimen Reporting Card Select(IgM specific): LA crosse virus Ab. IgM Titr Pt Ser Qn IF Select(IgG specific): LA crosse virus Ab. IgG Titr Pt Ser Qn IF Jamestown Canyon virus OR La Crosse virus OR Powassan virus OR Saint Louis encephalitis virus OR Venezuelan equine encephalomyelitis virus OR Western equine encephalomyelitis virus or beyond

16 ARBOVIRAL INFECTIONS (continued) Report Type Laboratory report OR Boston Reporting Card Test Type IFA Source Clinical Specimen Result Saint Louis encephalitis Select(IgM specific): Saint Louis encephalitis virus Ab. IgM: Titr: Pt: Ser: Qn: IF Select(IgG specific): Saint Louis encephalitis virus Ab. IgG: Titr: Pt: Ser: Qn: IF Laboratory report Viral Clinical Postitive or numeric combination value OR Boston Sequence Specimen Reporting Card Select: Viral Seq: Prld: Pt: ser: m: Amp/Seq Laboratory report PRNT Serum or West Nile virus OR Boston (Plaque CSF Reporting Card Neutraliz ation Test) Select: West Nile virus Ab: Titr: Pt: xxx: Qn: Neut Laboratory report OR Boston Reporting Card Laboratory report OR Boston Reporting Card PRNT (Plaque Neutraliz ation Test) Serum or CSF Eastern equine encephalomyelitis virus Select: Eastern equine encephalitis virus Ab: ACnc: Pt: Ser: Ord: Neut PRNT Serum or Jamestown Canyon virus OR La Crosse (Plaque CSF virus OR Powassan virus OR Saint Louis Neutraliz encephalitis virus OR Venezuelan equine ation encephalomyelitis virus OR Western Test) or beyond equine encephalomyelitis virus Select: Arbovirus Ab: Titr: Pt: xxx: Qn: Neut - only when accompanied by other lab results or initial value is High - only when accompanied by other lab results or initial value is High - only when accompanied by other lab results or initial value is High

17 ARBOVIRAL INFECTIONS (continued) Report Type Laboratory report OR Boston Reporting Card Test Type Nucleic acid test (RNA) Source Clinical Result Eastern equine encephalomyelitis virus Select: Eastern equine encephalitis virus RNA: ACnc: Pt: Bld: Ord: Probe.Amp.Tar Laboratory report Nucleic Clinical West Nile Virus OR Boston acid test Reporting Card (RNA) Select: West Nile virus RNA: ACnc: Pt: xxx: Ord: Probe.Amp.Tar Laboratory report Nucleic Clinical Jamestown Canyon virus OR La Crosse OR Boston acid test virus OR Powassan virus OR Saint Louis Reporting Card (specific encephalitis virus OR Venezuelan equine arbovirus encephalomyelitis virus OR Western RNA) equine encephalomyelitis virus Select: Arbovirus RNA: ACnc: Pt: xxx: Ord: Probe.Amp.Tar Laboratory report OR Boston Reporting Card IFA Serum or CSF Western Equine Encephalitis Select (IgG specific): Western equine encephalitis virus Ab.IgG: Titr: Pt: Ser: Qn: IF Select (IgM pecific): Western equine encephalitis virus Ab.IgM: Titr: Pt: Ser: Qn: IF or beyond

18 AVIAN INFLUENZA IMMEDIATE NOTIFICATION IMMUNIZATION PROGRAM Event Name: Clinical Description Case Time Period: WHO Case Classification (2006): Massachusetts Case Classification: A/FLU 180 days (6 months) Confirmed A person meeting the criteria for a suspected or probable case AND a. Isolation of an H5N1 virus; b. Positive H5 PCR results from tests using two different PCR targets, e.g. primers specific for influenza A and H5 HA; c. A fourfold or greater rise in neutralization antibody titer for H5N1 based on testing of an acute serum (collected 7 days or less after symptom onset) and a convalescent serum. The convalescent neutralizing antibody titer must also be 1:80 or higher; d. A microneutralization antibody titer for H5N1 of 1:80 or greater in a single serum collected at day 14 or later after symptom onset and a positive result using a different serological assay, for example, a horse red blood cells haemagglutination inhibition titer of 1:160 or greater or an H5-specific western blot positive result. Probable A person meeting the criteria for a suspected case AND a. infiltrates or evidence of an acute pneumonia on chest radiograph plus evidence of respiratory failure (hypozemia, severe tachypnea) OR b. positive laboratory confirmation on an influenza A infection but insufficient laboratory evidence for H5N1 infection. Definition 2: A person dying of an unexplained acute respiratory illness who is considered to be epidemiologically linked by time, place, and exposure to a probable or confirmed H5N1 case. Suspect A person presenting with unexplained acute lower respiratory illness with fever (>38º C) and cough, shortness of breath or difficulty breathing AND a. close contact (within 1 meter) with a person (e.g. caring for, speaking with, or touching) who is a suspected, probable, or confirmed H5N1 case; b. Exposure (e.g. handling, slaughtering, defeathering, butchering, preparation for consumption) to poultry or wild birds or their remains or to environments contaminated by their feces in an area where H5N1 infections in animals or humans have been suspected or confirmed in the last month; c. Consumption of raw or undercooked poultry products in an area where H5N1 infections in animals or humans have been suspected or confirmed in the last month; d. Close contact with a confirmed H5N1 infected animal other than poultry or wild birds (e.g. cat or pig); e. Handling samples (animal or human) suspected of containing H5N1 virus in a laboratory or other setting. Follows WHO classification

19 AVIAN INFLUENZA (continued) Report Type Test Type Source Result or beyond Laboratory Report Culture Influenza virus isolated Select (subtype-specified): Virus identified: PrId: Pt: xxx: m: Virus culture Laboratory Report PCR Influenza virus Select (PCR for Influenza A): Influenza virus A RNA: Acnc: Pt: xxx: Ord: Probe.Amp.Tar Laboratory Report Antigen CSF or Serum Select(A antigen): Influenza virus A Ag: ACnc: Pt: xxx: Ord: Morbidity Card Do not enter

20 BABESIOSIS NON-IMMEDIATE NOTIFICATION EPIDEMIOLOGY PROGRAM Event Name: Event Time Period: Clinical Description (CDC <year>): CDC Event Classification (<year>): Massachusetts Event Classification: BAB 1 year Most babesia infections are asymptomatic. When disease occurs it is a febrile illness characterized by generalized weakness, headache, myalgia, arthralgia, gastrointestinal symptoms, and weight loss. Less common symptoms may include hyperesthesia, sore throat, photophobia, abdominal pain and a nonproductive cough. Severe illness, often characterized by hemolytic anemia and possibly resulting in death, can occur and are more common in individuals over 40, and patients with asplenia or immunocompromise. Confirmed A clinically compatible and meets one of the following laboratory criteria: 1. Identification of intraerythrocytic Babesia parasites by light microscopy in a peripheral blood smear; or 2. Isolation of the parasite from a whole blood by animal inoculation. Probable A clinically compatible case with Babesia-specific antibody titer of at least 1:256 with an indirect fluorescent antibody (IFA) test for total Ig or IgG. Confirmed A clinically compatible case that meets the following laboratory criteria: 1. Identification of intraerythrocytic Babesia parasites by light microscopy in a peripheral blood smear, OR 2. Isolation (culture) of the parasite from a whole blood by animal inoculation, OR 3. Identification of the parasite by PCR; OR 4. Four-fold change in paired, Babesia-specific antibody titers with an indirect fluorescent antibody (IFA) test for total Ig or IgG. Probable A clinically compatible case with a single Babesia-specific antibody titer of at least 1:256 with an indirect fluorescent antibody (IFA) test for total Ig or IgG. Suspect Any of the previously mentioned laboratory tests without corresponding clinical information.

21 BABESIOSIS (continued) NOTE: Enter results for all tickborne diseases (positive and negative) in lab screen when at least one positive result is available (Erlichiosis, Lyme, Rocky Mountain, Spotted Fever, Tularemia). or beyond Report type Test Type Source Result Laboratory Report OR Culture Clinical Babesia species identified Select: Microorganism: Prld: Pt: xxx: m: Culture Laboratory Report OR Microscopy Whole Babesia species isolated Smear blood Laboratory Report OR Select: Microscopy: PrId: Pt: xxx: m: xxx stain IgG or IgM (method not specified) Clinical Babesia species or Positive Select (IgG-specific): Babesia Microti Ab IgG: Acnc: Pt: Ser: Ord: Select (IgM-specific): Babesia Microti Ab IgM: Acnc: Pt: Ser: Ord: Laboratory Report OR EIA IgG Clinical Babesia species or Positive Select: Babesia Microti Ab IgG: Acnc: Pt: Ser: Ord: EIA Laboratory Report OR PCR Clinical Babesia species or Positive Select: Babesia microti DNA: ACnc: Pt: Bld: Ord: Probe.Amp.Tar Laboratory Report OR IFA IgG or Serum Positive IgM Select (IgG-specific): Babesia sp Ab.IgG: Titr: Pt: Ser: Qn: IF Select (IgM-specific): Babesia sp Ab.IgM: Titr: Pt: Ser Qn: IF Laboratory Report OR RIBA IgG or IgM Positive Select (IgG-specific): Babesia sp Ab.IgG: Titr: Pt: Ser: Qn: IB Select (IgM-specific): Babesia sp Ab.IgM: Titr: Pt: Ser: Qn: IB

22 BABESIOSIS (continued) Report type Test Type Source Result Morbidity Report or beyond

23 INVASIVE BACTERIAL INFECTION - OTHER NON-IMMEDIATE NOTIFICATION EPIDEMIOLOGY PROGRAM Event Name: Event Code: Case Time Period: Invasive Bacterial Infection (other) BACT 30 days (create a new event for each different type of bacteria identified) Report Type Test Type Source Result or beyond Laboratory report Culture CSF, Blood bacteria that is NOT H. influenzae, N. meningitidis, S. pyogenes (GAS), S. agalactiae (GBS), L. monocytogenes, S. pneumoniae, or an STD Select: Microorganism : PrId : Pt : xxx : m : Culture Select: Bacteria, Unspecified as result and type in the bacteria identified in the lab notes section CONFIRMED

24 BOTULISM IMMEDIATE NOTIFICATION EPIDEMIOLOGY PROGRAM Event Name: Event Time Period: Clinical Description (CDC 1996): CDC Event Classification (1996): Massachusetts Event Classification: BOT 60 days Ingestion of botulinum toxin results in an illness of variable severity. Common symptoms are diplopia, blurred vision, and bulbar weakness. Symmetric paralysis may progress rapidly. Foodborne Confirmed Clinically compatible case that is laboratory confirmed or that occurs among persons who ate the same food as persons who have laboratoryconfirmed botulism Probable Clinically compatible case with an epidemiologic link (e.g., ingestion of a home-canned food within the previous 48 hours) Infant Confirmed clinically compatible case that is laboratory-confirmed, occurring in a child aged less than 1 year Wound Confirmed Clinically compatible case that is laboratory confirmed in a patient who has no suspected exposure to contaminated food and who has a history of a fresh, contaminated wound during the 2 weeks before onset of symptoms Other Confirmed Clinically compatible case that is laboratory confirmed in a patient aged greater than or equal to 1 year who has no history of ingestion of suspect food and has no wounds Follows CDC event classification

25 BOTULISM (continued) Report Type Test Type Source Result or beyond Mouse bioassay Food, Clinical Botulinum toxin present, select specific type if identified Select: Clostridium botulinum toxin : ACnc : Pt : xxx : Ord : Select (Toxin A): Clostridium botulinum toxin A : ACnc : Pt : xxx : Ord : Select (Toxin B): Clostridium botulinum toxin B : ACnc : Pt : xxx : Ord : Select (Toxin E): Clostridium botulinum toxin E : ACnc : Pt : xxx : Ord : Select (Toxin F): Clostridium botulinum toxin F : ACnc : Pt : xxx : Ord : Culture Stool, Wound, Clinical Clostridium botulinum Select (where subtype is not specified): Microorganism : PrId : Pt : xxx : m : Culture Select (where subtype is specified): Microorganism : PrId : Pt : Islt : m : Bacterial subtyping Morbidity Report

26 BRUCELLOSIS NON- IMMEDIATE NOTIFICATION EPIDEMIOLOGY PROGRAM Event Name: BRU Event Time Period: 1 year Clinical Description (CDC 2010): An illness characterized by acute or insidious onset of fever and one or more of the following: night sweats, arthralgia, headache, fatigue, anorexia, myalgia, weight loss, arthritis/spondylitis, meningitis, or focal organ involvement (endocarditis, orchitis/epididymitis, hepatomegaly, splenomegaly). CDC Event Classification (2010): Confirmed A clinically compatible case with laboratory confirmation by: 1. Culture and identification of Brucella spp. from clinical s; OR 2. Evidence of a fourfold or greater rise in Brucella antibody titer between acute- and convalescentphase serum s obtained greater than or equal to 2 weeks apart Probable Clinically compatible case that is epidemiologically linked to a confirmed human or animal case or that has presumptive laboratory test results: 1. Brucella total antibody titer of greater than or equal to 160 by standard tube agglutination test (SAT) or Brucella microagglutination test (BMAT) in one or more serum s obtained after onset of symptoms 2. Detection of Brucella DNA in a clinical by PCR assay Suspect Laboratory confirmation without a CRF Massachusetts Event Classification: Follows the CDC event classification

27 BRUCELLOSIS (continued) Laboratory Report OR Report Type Test Type Source Result Culture Clinical Brucella species Select for general culture: Microorganism : PrId : Pt : xxx : m : Culture Select for culture with sub-types: Microorganism : PrId : Pt : Islt : m : Bacterial subtyping Laboratory Report OR EIA IgG or IgM Serum Positive Select (IgM-specific): Brucella sp Ab.IgM : ACnc : Pt : Ser : Ord : EIA Select (IgG-specific): Brucella sp Ab.IgG : ACnc : Pt : Ser : Ord : EIA Laboratory Report OR DNA Serum Positive Laboratory Report OR Laboratory Report OR Select: Brucella sp DNA : ACnc : Pt : XXX : Ord : Probe.amp.tar Serum Serum Positive agglutination test Select: Brucella sp Ab : Titr : Pt : Ser : Qn : Aggl IgM, method not Clinical Positive specified Specimen Select: Brucella sp Ab.IgM : ACnc : Pt : Ser : Qn or beyond

28 CALICIVIRUS / NOROVIRUS NON-IMMEDIATE NOTIFICATION EPIDEMIOLOGY PROGRAM Event Name: Event Time Period: Clinical Description: CDC Event Classification: Massachusetts Event Classification: CALI 60 days N/A N/A Confirmed Probable Positive laboratory confirmation (Electron Microscopy, EIA, RT-PCR or serology) by isolation of species from any clinical stool or serum Clinically compatible case that is epidemiologically linked to a confirmed case Report Type Test Type Source Result or beyond Electron microscopy Blood, Stool or Vomit Positive Select: Microscopy: PrId: Pt: xxx: m: Microscopy.Electron Antigen Test Blood, Stool Positive or Vomit Select: rwalkvirus 1Ag: PrId:Pt: Stl: m: Antigen Test Stool Positive Select: Select: Select: Select: rovirus Ag: ACnc: Pt: Ord: Stool Antigen Test Blood, Stool Positive or Vomit rovirus 2 Ag: Prld: Pt: Stl:m PCR Blood, Stool Positive or Vomit Calicivirus RNA: Acnc: Pt: xxx: Ord: Probe.Amp.Tar PCR Blood, Stool Positive or Vomit rovirus 2 RNA: ACnc:Pt: Stool Ord: Probe.Amp.Tar CONFIRMED CONFIRMED CONFIRMED CONFIRMED CONFIRMED CONFIRMED

29 CALICIVIRUS / NOROVIRUS (Continued) Report Type Test Type Source Result or beyond Morbidity Report Select: PCR Blood, Stool Positive or Vomit rwalk Virus RNA: Acnc: Pt: Stl: Ord: Probe: Amp.Tar CONFIRMED

30 CAMPYLOBACTERIOSIS NON-IMMEDIATE NOTIFICATION EPIDEMIOLOGY PROGRAM Event Name: Event Time Period: Clinical Description (CDC 1990) CDC Event Classification (1990): Massachusetts Event Classification: CAMP 1 year An infection that may result in diarrheal illness of variable severity Confirmed isolation of Campylobacter species from any clinical Probable clinically compatible case that is epidemiologically linked to a confirmed case Follows CDC event classification Report Type Test Type Source Result or beyond Culture Clinical Campylobacter sp. Select (no species specified): Microorganism : PrId : Pt : xxx : m : Culture Select (sub-species specified): Microorganism : PrId : Pt : Islt : m : Bacterial subtyping Morbidity Report Gram stain Clinical Campylobacter sp. Select: Microscopy : PrId : Pt : xxx : m : xxx stain PCR Clinical Campylobacter sp. Or Positive Select: Campylobacter sp rrna : ACnc : Pt : xxx : Ord : Probe Antigen Clinical Positive Select: Campylobacter species Ag: ACnc: Pt: XXX: Ord CONFIRMED CONFIRMED CONFIRMED CONFIRMED

31 CHAGAS DISEASE (Trypanosoma cruzi) NON-IMMEDIATE NOTIFICATION EPIDEMIOLOGY PROGRAM Event Name: Event Time Period: Clinical Description (WHO, 2003): Massachusetts Event Classification (based on WHO classification): CHAGAS Lifelong immunity The acute phase of disease is often asymptomatic. When symptoms are present they may include fever, anorexia, lymphadenopathy, heptosplenomegaly and rarely, myocarditis or encephalitis. Unilateral palpebral or periocular swelling, known as Romana s sign, or a chagoma may be present depending on the site of inoculation. If untreated, an acute case will usually resolve into an asymptomatic chronic infection. Approximately 30% of chronic cases will eventually develop signs and symptoms that may include cardiac conduction abnormalities, decreased ejection fraction, palpitations, syncope, dysphagia, constipation and other signs related to cardiomyopathy, megaesophagus and megacolon. Appropriate epidemiological risk history includes: Mother emigrated from an endemic country Recipient of blood transfusion and/or organ or tissue transplant from an infected donor Travel to, or residence in, an endemic area Laboratory exposure to the parasite Confirmed A clinically compatible, possibly asymptomatic, case with appropriate epidemiological history and laboratory confirmation by: visualization of parasites in blood smears or buffy coat, OR identification of the agent in blood through an in vivo or in vitro diagnostic technique, OR identification of the organism via PCR, OR positive serology for antibodies to the agent from two separate tests which may include IFA, ELISA or RIPA. Probable A clinically compatible, possibly asymptomatic, case with appropriate epidemiological history and positive serology for antibodies to the agent from a single test which may include IFA, ELISA or RIPA

32 CHAGAS DISEASE (continued) Report Type Test Type Source Result or beyond Culture Clinical Trypanosoma species or Trypanosoma cruzi Select (no species specified): Microorganism: PrId: Pt: xxx: m: Culture Select (sub-species specified): Microorganism: PrId: Pt: Islt: m: Bacterial subtyping Giemsa stain Clinical Trypanasoma species or Trypanosoma cruzi Select: Microscopy: PrId: Pt: xxx: m: Giemsa stain PCR Clinical Positive Select: Trypanosoma cruzi DNA: ACnc: Pt: Bld: Ord: Probe.amp.tar EIA Clinical IgM Positive IgM Select: Trypanosoma cruzi Ab.IgM: ACnc: Pt: Ser: Qn: EIA EIA IgG Clinical IgG Positive Select: Trypanosoma cruzi Ab.IgG: ACnc: Pt: Ser: Qn: EIA RIBA or Clinical IgG Positive Western blot IgG Select: Trypanosoma cruzi Ab.IgG: ACnc: Pt: Ser: Qn: IB RIBA or Western blot IgM Clinical IgM Positive Select: Trypanosoma cruzi Ab.IgM: ACnc: Pt: Ser: Qn: IB

33 CHAGAS DISEASE (continued) Morbidity Report Report Type Test Type Source Result or beyond

34 CLOSTRIDIUM PERFRINGENS NON-IMMEDIATE NOTIFICATION EPIDEMIOLOGY PROGRAM Event Name: CPERF Event Time Period: 60 days Clinical Description: N/A CDC Event Classification: N/A Massachusetts Event Classification: Confirmed Clinically compatible case with laboratory confirmation, based on epidemiologist review Report Type Test Type Source Result or beyond Culture Stool Clostridium perfringens Select (no species specified): Microorganism : PrId : Pt : xxx : m : Culture Select (sub-species specified): Microorganism : PrId : Pt : Islt : m : Bacterial subtyping Morbidity Report Enterotoxin Stool Positive Select: C perfringens Enterotoxin: Prld : Pt : xxx : m : xxx CONFIRMED CONFIRMED

35 CREUTZFELDT-JAKOB DISEASE IMMEDIATE NOTIFICATION EPIDEMIOLOGY PROGRAM Event Name: CJD Event Time Period: Lifelong immunity Clinical Description: N/A CDC Event Classification: N/A Massachusetts Event Classification: Confirmed Clinically compatible case with laboratory confirmation, based on epidemiologist review

36 CREUTZFELDT-JAKOB DISEASE (Continued) Report Type Test Type Source Result? Genotyping Clinical Specimen Postive Select: Prion Gene: Prld: Pt: CSF: m: Genotyping protein Clinical Specimen Positive Select: Protein: MCnc: Pt: CSF: Qn Tau protein Clinical Specimen Positive Select: Tau protein: MCnc: Pt: CSF: Qn PrP SC or PrP Clinical Specimen Select: PrPSC: Prld: Pt: Tiss: m: IF PrP SC or Clinical Specimen PrP Select: PrPSC: Prld: Pt: Tiss: m: IF 3F4 OR anti- Clinical Specimen PRP3F4 OR mab 3F4 Select: 3F4 Ab: ACnc: Pt: xxx: Qn: IB Morbidity Report 3F4 OR anti- PRP3F4 OR mab 3F4 Clinical Specimen Select: 3F4 Ab: ACnc: Pt: xxx: Qn: IB Positive Negative or Equivocal Positive Negative or Equivocal DO NOT CREATE NEW EVENT - SHRED enter all results regardless of result in existing event DO NOT CREATE NEW EVENT - SHRED enter all results regardless of result in existing event

37 CRYPTOCOCCUS NEOFORMANS NON-IMMEDIATE NOTIFICATION EPIDEMIOLOGY PROGRAM Event Name: Event Time Period: CDC Event Classification: Massachusetts Event Classification: CNEO 1 year N/A N/A

38 CRYPTOCOCCUS NEOFORMANS (continued) Report Type Test Type Source Result Culture CSF Cryptococcus neoformans Select (general culture): Microorganism: PrId: Pt: xxx: m: Culture Select (when var is specified): Microorganism: PrId: Pt: Islt: m: Bacterial subtyping PCR CSF Cryptococcus neoformans Select: Cryptococcus neoformans rrna: ACnc: Pt: xxx: Ord: Probe Morbidity Report Stain CSF Cryptococcus neoformans Select: Microscopy: PrId: Pt: Tiss: m: xxx stain Antigen CSF Positive Latex Agglutination Select: Cryptococcus neoformans Ag: ACnc: Pt: xxx: Ord: Antigen CSF Positive EIA Select: Cryptococcus sp Ag: ACnc Pt: CSF: Ord: EIA or beyond Same Event

39 CRYPTOSPORIDIOSIS NON-IMMEDIATE NOTIFICATION EPIDEMIOLOGY PROGRAM Event Name: Event Time Period: Clinical Description (CDC 2009): CDC Event Classification (2009): CRYPT 1 year An illness characterized by watery diarrhea, abdominal cramps, loss of appetite, low-grade fever, nausea and vomiting. The disease can be prolonged and life-threatening in severely immunocompromised persons. Confirmed A case that meets the clinical description and detection of a member of the genus Cryptosporidium by at least one of the following methods: 1. Organisms in stool, intestinal fluid, or tissue samples or biopsy s 2. Antigens in stool or intestinal fluid, or 3. Nucleic acid by PCR in stool, intestinal fluid, or tissue samples or biopsy s Probable a case that meets the clinical description and that is epidemiologically linked to a confirmed case Massachusetts Event Classification: Confirmed Positive laboratory report only

40 CRYPTOSPORIDIOSIS (continued) Report Type Test Type Source Result Microscopy (Stain, O&P, IFA) Stool Select: Microscopy : Prld: Pt: xxx: m: Ova and parasite preparation Wet mount Clinical Cryptosporidium (organisms, cysts, or beyond Cryptosporidium (organisms, cysts, CONFIRMED oocytes) seen CONFIRMED oocytes) seen Select: Microscopy: Prld: Pt: xxx: m: Wet preparation PCR Stool Positive Select: Cryptosporidium parvum DNA: Acnc: Pt: xxx: Ord: Probe.Amp.T EIA, DFA Stool, Tissue, Antigen detected Intestinal fluid Select: Cryptosporidium sp Ag: ACnc: Pt: Stl: Ord: EIA Morbidity Report (non- Boston) Antigen test Clinical Select: Cryptosporidium sp Ag: ACnc: Pt: Stl: Ord: Positive CONFIRMED CONFIRMED CONFIRMED

41 CYCLOSPORIASIS NON- IMMEDIATE NOTIFICATION EPIDEMIOLOGY PROGRAM Event Name: Event Time Period: Clinical Description (CDC 2010) CYCLO 1 year An illness of variable severity caused by the protozoan parasite Cyclospora cayetanensis. The most common symptom is watery diarrhea. Other common symptoms include loss of appetite, weight loss, abdominal cramps/bloating, nausea, body aches, and fatigue. Vomiting and lowgrade fever also may be noted. CDC Event Classification (2010): Confirmed A clinically compatible case with at least one of the following laboratory criteria: 1. C. cayetanensis oocysts in stool, intestinal fluid/aspirate, or intestinal biopsy s 2. demonstration of C. cayetanensis DNA in stool, intestinal fluid/aspirate, or intestinal biopsy s Massachusetts Event Classification: Probable Confirmed Probable A case that meets the clinical description and that is epidemiologically linked to a confirmed case Follows the CDC event classification N/A

42 CYCLOSPORIASIS (continued) Report Type Test Type Source Result or beyond Microscopy, Stain, O&P Stool Cyclospora (oocysts, cysts or organisms) seen CONFIRMED Select: Microscopy: PrId: Pt: xxx: m: Ova and parasite preparation Wet mount stain Clinical Cyclospora (oocysts, cysts or organisms) seen CONFIRMED Select: Microscopy: PrId: Pt: xxx: m: Wet preparation PCR Stool, Positive Duodenal/jejunal aspirates, or small bowel biopsies CONFIRMED Morbidity Report Select: Cyclospora cayetanensis DNA: Acnc: Pt: xxx: Ord: Probe.Amp.

43 DENGUE FEVER NON-IMMEDIATE NOTIFICATION EPIDEMIOLOGY PROGRAM Event Name: DENG Event Time Period: 180 days (6 months) Clinical Description (CDC 2010): An acute febrile illness characterized by two or more of the following: retro-orbital or ocular pain, headache, muscle and/or joint pain, rash, leukopenia or hemorrhagic manifestations. Severe manifestations (e.g., dengue hemorrhagic fever and dengue shock syndrome) are rare but may be fatal. Symptoms of DHS also include thrombocytopenia and evidence of plasma leakage. Symptoms of DS include all of those listed above plus circulatory failure. CDC Event Classification (2010): Confirmed a clinically compatible case with laboratory confirmation (culture, serology, smear) by: 1. isolation of dengue virus from tissue, blood, CSF or other body fluid; OR Massachusetts Event Classification: Probable Suspect Confirmed Probable Suspect 2. evidence of dengue virus in tissue, blood, CSF or other body fluid by PCR, IHC or IF, OR 3. seroconversion as demonstrated by a negative finding for dengue-specific IgM antibody in a sample 5 days post symptom onset and a positive finding for dengue-specific IgM antibody > 5 days post-symptom onset clinically compatible AND supportive serologic evidence by: dengue-specific IgM serum antibodies with a P/N ration of 2 Clinically compatible case that is epi linked to a confirmed case by: travel to a dengue endemic country or place with an ongoing outbreak in the 2 weeks prior to symptom onset Follows CDC case definition Follows CDC case definition Follows CDC case definition OR recipt of positive laboratory report

44 DENGUE FEVER (continued Report Type Test Type Source Result Culture Clinical speicmen Dengue virus Select: Virus identified : PrId : Pt : xxx : m : Virus culture Antibody titer, Clinical Positive total or not specified Select: Dengue virus Ab : Titr : Pt : Ser : Qn : IF PCR Clinical Dengue virus Select: Dengue virus DNA : ACnc : Pt : xxx : Ord : Probe EIA IgG or Clinical Dengue virus IgM Select (IgM-specific): Dengue virus Ab.IgM : ACnc : Pt : Ser : Qn : EIA Select (IgG-specific): Dengue virus Ab.IgG : ACnc : Pt : Ser : Qn : EIA RIBA or Clinical Dengue virus Western Blot IgM Select: Dengue virus Ab.IgM : ACnc : Pt : Ser : Ord : IB IgM IgG, method not specified Clinical Positive Select (IgM-specific): Dengue virus Ab.IgM : ACnc : Pt : Ser : Ord : Select (IgG-specific): Dengue virus Ab.IgG : ACnc : Pt : Ser : Ord : IFA Clinical Positive Select (IgG-specific): Dengue virus Ab.IgG : ACnc : Pt : Ser : Qn : IF Select (antibody not Dengue virus Ag : ACnc : Pt : xxx : Ord : IF specificed): or beyond

45 DENGUE FEVER (continued Report Type Test Type Source Result Morbidity Report or beyond

46 DIPHTHERIA IMMEDIATE NOTIFICATION IMMUNIZATION PROGRAM Event Name: Event Time Period: Clinical Description (CDC 1995): CDC Event Classification (1995): Massachusetts Event Classification: DIP Lifelong immunity An upper respiratory tract illness characterized by sore throat, low-grade fever, and an adherent membrane of the tonsil(s), pharynx, and/or nose Confirmed a clinically compatible case that is epidemiologically linked to a laboratory confirmed case; OR a clinically compatible case with laboratory confirmation by positive culture of Corynebacterium diphtheriae or histopathologic diagnosis of diphtheria Probable a clinically compatible case that is NOT laboratory confirmed nor epidemiologically linked to a laboratory-confirmed case Follows CDC event classification Report Type Test Type Source Result Laboratory Report OR Culture Any source Corynebacterium diphtheriae Select: Microorganism : PrId : Pt : xxx : m : Culture Select (subtyping): Microorganism : PrId : Pt : Islt : m : Bacterial subtyping Laboratory Report OR Laboratory Report OR Morbidity Card or beyond Toxin testing Any source Corynebacterium spp. toxin Select: Corynebacterium spp toxin : PrId : Pt : xxx : m : Immune diffusion Serology + IgG ONLY DO NOT ENTER

47 EHRLICHIOSIS NON-IMMEDIATE NOTIFICATION EPIDEMIOLOGY PROGRAM NOTE: Enter results for all tickborne diseases (positive and negative) in lab screen when at least one positive result is available (Lyme, Babesiosis, Tularemia, Rocky Mountain Spotted Fever, Anaplasmosis). Do NOT enter Ehrlichia phagocytophila as an ehrlichiosis event. It should be created as a Human Granulocytic Anaplasmosis event. Event Name: EHR Event Time Period: 1 year Clinical Description (CDC Any reported fever and one or more of the following: headache, myalgia, anemia, leucopenia, thrombocytopenia, or any 2008) CDC Event Classification (2008): hepatic transaminase elevation. Confirmed clinically compatible and meets one of the following laboratory criteria: 1. serological evidence of a four-fold or greater change in IgG specific antibody titer to Ehlichia chaffeensis antigen by IFA in paired serum samples (one taken in first week of illness and a second 2-4 weeks later), OR 2. identification of E. chaffeensis or E. ewingii by PCR, OR 3. demonstration of ehrlichial antigen in a biopsy/autopsy sample by IHC, OR 4. isolation of E. chaffeensis from a clinical in culture Probable A clinically compatible case with the following laboratory evidence: 1. serological evidence of elevated IgG or IgM antibody reactive with E. chaffeensis antigen by IFA, ELISA, dot-elisa, or assays in other formats, OR 2. identification of morulae in the cytoplasm of neutrophils or eosinophils by microscopic examination Massachusetts Event Classification: te: There is no probable category for infection with E. ewingii follows the CDC event classification

48 EHRLICHIOSIS (continued) NOTE: Enter results for all tickborne diseases (positive and negative) in lab screen when at least one positive result is available (Lyme, Babesiosis, Tularemia, Rocky Mountain Spotted Fever, Anaplasmosis). or beyond Report Type Test Type Source Result Laboratory Report OR Laboratory Report OR Culture Clinical Select: Microorganism: PrId: Pt: xxx: m: Culture IFA CSF or Serum Ehrlichia chaffensis OR E. ewingii OR E. ristici OR E. canisi Positive or equivocal for Ehrlichia chaffensis OR Human monocytic ehrlichiosis Select: Human monocytic ehrlichiosis Ab: Titr: Pt: Ser: Qn: IF Select (IgG-specific): Human monocytic ehrlichiosis Ab.IgG: Titr: Pt: Ser: Qn: IF Select (IgM-specific): Human monocytic ehrlichiosis Ab.IgM: Titr: Pt: Ser: Qn: IF Laboratory Report OR Titer Clinical Positive for Ehrlichia canis Select: Ehrlichia canis Ab: Titr: Pt: Ser: Qn: Laboratory Report OR IgG or IgM Clinical Positive for Ehrlichia chaeffeensis Select (IgG-specific): Ehrlichia chaffeensis Ab.IgG: Acnc: Pt: Ser: Ord: Select (IgM-specific): Ehrlichia chaffeensis Ab.IgM: ACnc: Pt: Ser: Ord: Laboratory Report OR EIA CSF or Serum Positive or equivocal for Ehrlichia chaffensis OR Human monocytic ehrlichiosis Select IgG specific: Ehrlichia chaffeensis Ab.IgG: ACnc: Pt: Ser: Qn: EIA Select IgM specific: Ehrlichia chaffeensis Ab.IgM: ACnc: Pt: Ser: Ord: EIA Laboratory Report OR PCR CSF or Serum Positive or equivocal for Ehrlichia chaffensis OR Human monocytic ehrlichiosis Select: Ehrlichia chaffeensis DNA: ACnc: Pt: xxx: Ord: Probe.Amp.Tar