Download Daily Data Collection Form: SARI Hospitalizations and SARI Deaths

Daily Data Collection Form: SARI Hospitalizations and SARI Deaths
County:
Epidemiologic Week #:
Hospital/Clinic:
Today’s Date:
/
/
(dd/mm/yy)
Severe Acute Respiratory Infection (SARI) [This section is to be completed for Hospitals ONLY, not Clinics]
Total
<6 mths
6-11 mths
SARI Admissions
Hospital medical admissions
SARI Deaths
Deaths in medical admissions
Hospital Admissions
Deaths in hospitalized patients
Surveillance Coordinator
12-23
th
Signature:
2-4 yrs
5-14 yrs
15-49 yrs
50-64 yrs
≥65 years
Date:
Notes:
-
The Epidemiological Week begins on a Sunday and ends on a Saturday. The date on Sunday is recorded as the Week Start Date.
Hospital admissions constitutes all admissions to hospital
Hospital medical admissions constitute all admissions to the medical ward, medical admissions to the paediatric ward, and medical
admissions to the intensive care unit (for each particular age group).
Deaths in hospitalized patients constitute all deaths in those admitted to hospital.
Deaths in medical admissions constitutes all deaths on the medical ward, in medical patients on the paediatric ward, in medical patients in
the intensive care unit
Total visits constitutes all visits to hospital A&E/clinic
Form_2_April 27, 2009.
Daily SARI Surveillance for population of hospitalised patients.
Case Definitions for SARI in Children and Adults
SARI Case Definition for Persons ≥5 years old:




Sudden onset of fever over 38 C, AND
Cough or sore throat, AND
Shortness of breath or difficulty breathing, AND
Requiring hospital admission.
SARI Case Definition for Children 5 years old

Meets the case definition as above
OR

Any child  5 years old clinically suspected of having pneumonia or severe/very severe
pneumonia, and requiring hospital admission.
IMCI on Pneumonia:
A child with cough or difficulty breathing who has fast breathing and no general danger signs, no
chest indrawing and no stridor when calm is classified as having PNEUMONIA
IMCI on Severe Pneumonia or Very Severe Disease:
A child with cough or difficulty breathing and with any of the following signs – any general danger
sign, chest indrawing or stridor in a calm child – is classified as having severe pneumonia or very
severe disease.
General Signs of Danger:

Child unable to drink or be breastfed

Child is lethargic or unconscious

Child vomits everything

Convulsions
Difficult Breathing

If the child is 2 months - 12 months fast breathing is 50 breaths per minute or more

If the child is 12 months - 5 years fast breathing is 40 breaths per minute or more
Form_2_April 27, 2009.
Daily SARI Surveillance for population of hospitalised patients.