Download Guidelines for Epidemiology surveillance laboratory

Guidelines for Epidemiology surveillance laboratory
Introduction
Outbreaks Of communicable disease cause significant morbidity and mortality, and
have the potential for international spread. They must be recognized and controlled
rapidly in order to minimize their impact.
The effective containment of an outbreak depends on:
- early detection and reporting of suspected cases.
- rapid epidemiological investigation.
- rapid laboratory confirmation of the diagnosis.
- the implementation of effective control measures.
Rapid identification of the causative agent and the likely source or mode of
transmission is essential. From this perspective, the initial investigation involves two
important processes:
 collection of information on suspect cases.
 collection of clinical specimens for laboratory diagnosis.
Successful laboratory confirmation of a disease depends on:
1. advance planning.
2. collection of appropriate and adequate specimens.
3. correct packaging and rapid transport to an appropriate laboratory.
4. the ability of the laboratory to accurately perform the diagnostic tests.
5. proper biosafety and decontamination procedures to reduce the risk of further
spread of the disease.
The purpose of this Guideline
Is To Ensure That The Correct Specimens Are collected, packaged, and transported
in a safe and standardized manner during a field investigation of an outbreak.
It is not intended to be a guide to ‘best practice’, or an exhaustive manual on
laboratory procedures.
It is hoped that this manual will assist technicians and members of an investigative
team to plan and guide their specimen collection in the field, leading to rapid
diagnostic confirmation and control of the infectious agent causing the outbreak
Target audience
This guide is intended for the Health workers and doctors and lab technicians, focal
point or chief officer who oversees the laboratories, the coordinator, and the
laboratory personnel. Focal persons at all levels, and partners.
Epidemiology surveillance laboratory
Failure access to reliable diagnostic testing is among the major challenges
contributing to the delay or lack of appropriate and timely response to outbreaks
and quality patient care. Because an epidemiology and laboratory medicine are two
disciplines that are closely interrelated, In Syria there are many major barriers for
laboratory capacity in Syria include: Insecurity, lack of funds weak health
infrastructure, lack of basic essential equipment and laboratory consumables,
scarcity of educators and training programs, inadequate logistical support,
insufficient monitoring of test quality, This situation calls for a major investment to
build the capacity for epidemiological surveillance and public health laboratories in
Syria, despite the above challenges, exemplary achievements have been
documented, For example, EWARN Program and polio surveillance activities take
place even in countries with difficult area and security risks.
EWARN lab was established in (Atareb district) in western rural Aleppo at the
beginning of 2015, the work at first was just limited to routine tests and some tests
related to water borne diseases, afterwards the work load, quantity and quality of
the lab tests improved by the beginning of 2016 to include some of the surveyed
syndromes in EWARN system. The second step is expanding the lab network to
different areas covered by EWARN.
The objective of EWARN Labs is to establish and develop referral laboratories at the
national level that contributes in improving the quality of health care and response
in emergencies.
For a Laboratory system to function efficiently the policy of the EWARN should be
based on supporting the Laboratories in order to achieve the following goals:
 Early diagnosis of for diseases with outbreak possibility and high morbidity
and mortality rates.
 Data base for diseases with high priorities, in order to use this information to
guide the response.
 Capacity building for laboratory staff in the epidemiological field, and
assuring the quality and improving it.
 Developing informatics system and participating in the public health research
field.
 Effective participation and coordination with the different actors working in
the field.
EWARN Lab delivery system:
In cooperation and coordination with the actors in the field, EWARN labs receive the
specimens collected by the DLOs (blood, serum, stool,) and dispatched to the lab by
trained logistician.
The working hours in the Lab are between 09:00-15:00, Saturday to Thursday. The
services are provided by receiving the samples along with the lab request, and then
sorted by the lab staff. Usually a statement of the available tests is distributed to the
different actors. All reports from the lab are kept as paper and electronic data base.
In case of an outbreak, coordination with the lab is essential in order to clarify the
guidelines for sample collection and shipment including the number of the samples
and the approximate time for arriving to the lab.
Actions necessary to activate and organize the Surveillance laboratory are:
1. Prioritize the provision of transportation, sampling supplies, and laboratory
reagents.
2. Ensure efficient receipt and processing of specimens.
3. Issue an early, accurate diagnosis of the diseases.
4. Establish flexible communication channels to ensure information dissemination
and feedback.
5. Update the knowledge of local technical personnel.
6. Maintain records and data.
The goal of Surveillance laboratory.
The main responsibility of these laboratories is to establish early diagnosis of
diseases with high mortality rates and to notify the department of EWARN Program.
Is to provide high quality, accurate and timely laboratory-based information can be
used for public health decisions directed at effective control and prevention of
Priority diseases, potential public health emergencies, and providing laboratory data
for high priority disease.
The functions of Surveillance laboratories
 Timely laboratory confirmation of disease pathogens for surveillance, including
epidemic alert, response and prevention, and monitoring microbiological safety
of water.
 Training and continuing education for laboratory personnel on laboratory
techniques, use of equipment, and appropriate and safe collection, storage and
transportation of specimens.
 Strengthened rapid response to outbreaks through timely testing of specimens
and identification of the causative agents and ensuring the capacity to process a
large volume of specimens in an emergency situation.
 Coordination and promotion of quality assurance programs for clinical
Others Functions
- Training of laboratory technicians/technologists in diagnostic techniques & bio
safety procedures.
- Training staff in specimen collection, safe handling, storage and shipment to the
laboratory.
- Collecting, compiling, analyzing and sharing laboratory data with laboratories,
other partners and dissemination to all concerned.
Responsibilities of a laboratory Technician
 Collect blood or other samples from patients
 Receive tissue samples from patients
 Log patient samples and prepare them for testing
 Set up medical laboratory equipment
 Conduct routine laboratory tests and sample analyses
 Clean and maintain medical laboratory and medical laboratory equipment.
Responsibilities of a laboratory physician
The responsibilities are diverse. He is responsible for the administration and
technical operation of the laboratory to ensure high-quality service. He must retain a
hand in all phases of laboratory operation, be familiar with all "stat" tests, routine
laboratory procedures and test turnaround times, the instruments, equipment and
technologies should be up to date, meet the laboratory needs and match the
resources allocated to maintain the service. Budget preparation, cost accounting,
employee selection and supervision of all delegated tests are important aspects of
the director's role. Other key factors are instrument and supply purchase,
management of personnel, quality assurance, quality control, safety, appropriate
disposal of waste, and the addition of new tests and the elimination of old ones.
Tests currently available in EWARN Laboratory are follows
Tests diseases that can be vaccine-preventable 
HBsAg -Mumps IgM -Rubella IgM -Measles IgM
Water-borne diseases Tests 
HEV IgM- HAV IgM
Bacterial culture tests 
Stool culture for: Typhoid fever, Shigellosis, Vibrio Cholera, Blood culture: (coming soon)
Hepatitis viruses (Blood Bank) 
HIV Abs -HCV Abs- HBs Ag
Immune tests 
PCR (coming soon)
chemical and blood tests 
Liver functions - Renal functions - Complete Blood Count
Other tests 
Sputum examination for tuberculosis - Gram stain for Malaria and Leishmaniasis
Common elements to for outbreak response
1. Define the possible causes of the outbreak.
2. Decide which specimens are required to confirm.
3. Select the laboratory for specimen testing, all aspects of the handling of clinical
specimens, from selection of sample type, collection materials, processing,
transport of specimens, and transmission of results should be organized in
consultation with laboratory. The laboratory may need to supply special media,
equipment, and instructions in advance. It is essential that contact personnel
Benominated in advance to be responsible for coordinating the logistical aspects
of sample handling
4. Decide who will collect, process and transport the specimens.
Decide whether a laboratory specialist or technician should join the team.
Otherwise, the team must receive training in the collection, handling, and transport
of the required specimen, as well as safety procedures.
5. Define the procedures necessary for specimen management.
Consider the logistic requirements for sampling equipment and supplies, specimen
handling and transport to the laboratory (timing, route, transit temperature
requirements, shipping procedures, and documentation), and decontamination
procedures in advance, In addition arrange transport, and protection , and secure
lines of communication (Mobile phone, etc.).
Basic safety precautions
1. Use latex, gloves when taking and handling specimens.
2. If possible wear protective clothing (gown, coat or apron) when collecting
samples.
3. Discard used needles directly into sharps box.
4. Work areas and surfaces should be organized and disinfected.
5. In special circumstances additional safety equipment, such as masks or goggles
are required to protect skin and mucous membranes.
Label specimen container/slide
Preprinted labels should be used whenever possible It should contain the:
- patient name.
- unique identification number.
- specimen type and date and place of collection.
- name or initials of specimen collector.
Glass slides for microscopy must be labeled individually, and this should not interfere
with the staining process. Each slide should bear the patient’s name.
Label accompanying forms
The laboratory may require other information to select and interpret the necessary
tests; this may include:
- Patient information: age (or date of birth), sex, complete address
- Clinical information : date of onset of symptoms, clinical and immunization
history, risk factors or contact history where relevant, antimicrobial drugs taken
prior to specimen collection
- Laboratory information: acute or convalescent specimen
- other specimens from the same patient
Storage of specimens
 Specimens for bacterial culture
Should be kept in appropriate transport media at the recommended temperature.
This ensures bacterial viability while minimizing overgrowth of other
microorganisms. With the exceptions of urine and sputum, most specimens may be
kept at ambient temperature if the specimen will be processed within 24 hours.
For longer periods, storage on at 4-8°C would be advisable with the exception of
particularly cold-sensitive organisms, such as shigella, meningococcus, and
pneumococcus. Longer delays are not advisable
 Specimens for antigen or antibody detection
Eliza method may be stored at 4-8°C for 24-48 hours or at –20°C for longer periods.
Some specimens may require special handling, for
example, freezing, so specific instructions should always be
sought prior to collection.
Sera for antibody detection may be stored at 4-8°C for up
to days.
It is important to avoid unnecessary freeze-thaw cycles, so do not freeze sera unless
the facilities are available to keep them frozen until delivery.
Sera stored at room temperature may still be useful for antibody testing even after
prolonged periods (weeks) if the sample is collected in a sterile container and is not
contaminated.
General guidelines for proper specimen collection
The quality of laboratory test results depends on the proper collection and handling
of the specimen. Correct patient preparation, specimen collection, packaging and
transportation are essential factors in obtaining timely and valid test results
a. Collect specimen before administering antimicrobial agents when possible
b. Collect specimen with as little contamination from indigenous microbiota as
possible to ensure that the sample will be representative of the infected site
c. Utilize appropriate collection devices. Use sterile equipment and aseptic technique
to collect specimens to prevent introduction of microorganisms during invasive
.procedures
d. Clearly label the specimen container with the patient’s name and identification
number or date of birth (DOB). Always include date and time of collection and your
initials.
e. Collect an adequate amount of specimen. Inadequate amounts of specimen may
yield false-negative results.
g. Identify the specimen source and/or specific site correctly, so that proper culture
media will be selected during processing the laboratory
Specimen Rejection Criteria
 Specimen is received without a requisition
 Requisition is received without a specimen
 Requisition or specimen label lacks two patient identifiers
 Requisition or specimen label information is illegible
 Requisition and specimen label information is not identical
 Requisition and/or specimen mislabeled (Patient identifiers inaccurate).
 Incorrect specimen container/tube is used
 Date of collection is not recorded
 Time of collection is not recorded
 10-Specimen is clotted
 Specimen is too old for testing
 Specimen container is leaking
 13-Specimen quantity is insufficient
 Specimen contamination, dilution or other interfering substances affect
specimen integrity; example: hemolysed, lipemic
 Inappropriate specimen
Blood specimen collection
Blood and separated serum are the most common specimens taken to investigate
outbreaks of communicable disease.
How to Collect Blood
This provides guidance on how to collect blood by venepuncture. For safety, all of
the supplies used to collect the blood are for single use only, do not reuse.
SUPPLIES NEEDED
• Gloves
• Tourniquet
• Adhesive plaster
• Sterile saline
• Alcohol (70%)
• Labels
and
indelible
marker pen
•
•
•
•
Sterile gauze pads
Sterile needle (18–22 G) and syringe
and Tourniquet
Safe box for sharps
Vacutainer or sterile screw-cap
tubes
Before beginning the procedure, obtain consent from the patient
1. Sterile gloves should Be worn when performing venepuncture and when
handling the specimen.
2. Place a tourniquet above the venipuncture site .Palpate and locate
the vein.
3. Disinfect the skin at the puncture site with alcohol (70%). Allow the
area to dry.
4. Do not touch the disinfected puncture site with ungloved hands.
1. Perform venepuncture using a sterile vacutainer or sterile needle and
syringe.
2. If using a needle and syringe, transfer the blood to sterile test tube.
3. Remove the tourniquet. Apply pressure to site with sterile gauze pad until
the bleeding stops.
4. Apply adhesive plaster, if desired
5. Adhere a specimen label to tube of blood
6. Safely dispose of all contaminated materials.
7. Do not recap used sharps. Discard directly into a safe box for sharps.
8. Volume of blood to collect
Adults 5–10 ml, Children 2–5 ml,Infants 0.5–2 ml
How to Collect Serum from Whole Blood
This provides guidance on how to process whole blood to separate serum from the
blood clot.
SUPPLIES NEEDED
ADDITIONAL SUPPLIES (if health
facility has a centrifuge)
• Gloves
Centrifuge tubes for balancing
• Sterile pipette
• Sterile, screw-capped tube (glass or plastic)
• Specimen label
1. Gloves should be worn at all times when handling the specimen.
2. Keep the whole blood at room temperature until there is complete retraction of
the clot from the serum.
If the health facility or district has a centrifuge, spin the whole blood at 1000 xg for
10 minutes to separate the serum.
Follow the standard operating procedures for centrifuge.
3. Remove the serum using a sterile pipette. Avoid extracting red cells.
4. Transfer the serum aseptically to a sterile, screw-capped tube. Secure cap tightly.
5. Adhere a specimen label to the tube of serum.
9. Safely dispose of all contaminated materials and the remaining clot.
( cycles should be avoided. Haemolysis and lipaema)
Specimen Handling and transport
• If serum will be required for testing, separation from blood should take place as
soon as possible, preferably within 24 hours at ambient temperature.
• If the specimen will not reach a laboratory for processing within 24 hours, serum
should be separated from blood prior to transportation. Sera may be stored at 48°C for up to 10 days.
• If testing is delayed for a long period, serum samples may be frozen.
• If separation on site is not possible, or is inadvisable for safety reasons, the blood
sample should be stored at 4-8°C. Protect such unseparated samples from
excessive vibration while transporting. Unseparated blood samples should not be
frozen.
 Capillary blood samples
Materials
- Disposable sterile lancets.
- Glass slides, cover slips, slide box.
- Filter paper.
- Fixatives such as methanol.
Method of collection
- Disinfect finger or thumb for adults, thumb for children, or side of heel for
infants by swabbing with 70% isopropyl alcohol, and prick with a sterile lancet.
- Wipe away the first drop of blood.
- Discard used lancets directly into the sharps disposal container.
- Collect blood directly onto labeled glass microscope slides and/or filter paper.
 Blood films preparation
Blood films should be made by trained personnel. If this is not possible, they can be
spread from EDTA blood specimens sent to the laboratory.
 Thick films for microscopy:
- Label the slide with patient identification number and name.
- Disinfect and prick site with a lancet.
- Touch one or more large drops of blood onto the center of the slide making sure
that the slide does not touch the skin.
- Spread the blood in a circle about 1 cm in diameter using the corner of another
slide.
- Air dry the film in a horizontal position. Do not dry the film by heating over
aflame or other heat source.
 Thin films for microscopy
Label the slide with patient identification number and name.
Touch another drop of blood to the glass slide about 2 cm from one end making
sure that the slide does not touch the skin.
- Place the slide horizontally on a flat surface.
- Hold the side of a second clean glass slide (the spreader) on to the center of the
specimen slide and move it back until it touches the drop and the blood spreads
along its base.
- At an angle of about 45°, move the spreader firmly and steadily across the
specimen slide and air dry the film quickly. Do not dry over a flame or other heat
source.
- Fix the dried film by dipping the glass slide in methanol or other fixative for a few
seconds and air dry.
Handling and transport
Air-dried and/or fixed films are transported at ambient temperature preferably
Within 24 Hours Of Specimen collection.
They Must not be refrigerated.
Thick and thin films are usually kept in separate slide boxes
Blood culture sample collection
Usually, two to three blood samples are collected over a period of time and from
different veins to increase the likelihood of detecting bacteria or fungi if they are
present in the blood. Multiple blood samples help to differentiate true pathogens,
which will be present in more than one blood culture, from skin bacteria that may
contaminate one of several blood cultures during the collection process.
Blood is obtained by inserting a needle into a vein in the arm. The phlebotomist will
put the blood into two culture bottles containing broth to grow microorganisms.
These two bottles constitute one blood culture set. A second set of blood cultures
should be collected from a different site, usually immediately after the first
venipuncture, depending on the procedure followed. Any subsequent samples may
be collected at later intervals. A single blood culture is collected from children since
they often have high numbers of bacteria present in their blood when they are
infected. For infants and young children, the quantity of each blood sample will be
smaller and appropriate for their body size
-
Cerebrospinal Fluid (CSF) specimen collection
The specimen must be taken by a physician or a person experienced in the
procedure, CSF is used to in the diagnosis of viral, bacterial meningitis.
How to Collect CSF
This provides guidance on how to collect cerebrospinal fluid (CSF) by lumbar
puncture. Lumbar puncture is an invasive technique. It should be performed under
sterile conditions by a medical officer or clinician experienced in the procedure.
SUPPLIES NEEDED
• Sterile gloves
• Sterile gown
• Sterile towels
• Sterile swabs
• Povidone iodine (10%)
• Local anesthetic
• Sterile needle and syringe
• Alcohol (70%)
• Sterile lumbar puncture needle
• Small, sterile, screw-capped tube
• Adhesive plaster
• Safe box for sharps
Before beginning the procedure, obtain consent from the patient
1. Sterile gloves should be worn when performing lumbar puncture and when
handling the specimen.
2. Locate the space between L3,4 or L4,5 vertebrae.
Follow the practice of your health facility in giving local anesthetic.
3. Disinfect the skin at the puncture site with povidone iodine (10%). Wipe
off excess iodine with alcohol (70%). Allow the area to dry.
4. Do not touch the disinfected puncture site with ungloved hands or nonsterile items.
5. Perform lumbar puncture using a sterile spinal needle.
Collect CSF by allowing the fluid to flow directly into the sterile tube. Do
not aspire CSF.
If CSF will be used for microscopy, biochemistry, and culture, collect 1 ml
for each of these tests in separate tubes.
6. Aseptically recap the tube tightly.
7. Safely dispose of all contaminated materials.
8. Do not recap used sharps. Discard directly into a safe box for sharps.
Handling and transport
specimens should be delivered to the laboratory and processed as soon
as possible.
- CSF Specimens for bacteriology are transported At ambient
temperature, generally without transport media.
- CSF specimens for virology do not need transport medium.
- They may be transported at 4-8°C for up to 48 hours.
Stool, Faecal specimen collection
Stool is the preferred specimen for culture of bacterial, viral, and parasitic diarrheal
pathogens, Stool specimens are most useful for microbiological diagnosis if collected
soon after onset of diarrhoea (for bacteria < 4 days), and preferably before the
initiation of antibiotic therapy, If required, two or three specimens may be collected
on separate days.
SUPPLIES NEEDED
• Gloves
• Adhesive tape
• Sterile cotton-tipped applicators (swabs) • Specimen label
• One tube of Cary Blair transport medium
Method of collecting a stool specimen
- Collect freshly passed stool, 5 ml liquid or 5 g solid (pea-size), in a container.
- Do not submit feces contaminated with urine or toilet water
- Label the container.
• Stool specimens should be transported at 4-8°C. and processed
within 1-2 days of collection. Shigella are particularly sensitive to
elevated temperatures. Transfer specimen into a Cary-Blair
transport medium container for routine bacterial stool culture or
the appropriate container Transport at ambient temperature within two hours of
collection
• Specimens to be examined for parasites should be mixed with 10% formalin, (3
parts stool to 1 part preservative).
• Transport at ambient temperature in containers sealed in plastic bags.
If transport medium is not available, do not allow specimen to dry, add a few drops
of 0.85% sodium chloride solution
How to Take Rectal Swab and Transfer to Transport Medium
SUPPLIES NEEDED
• Gloves
•
Sterile
cotton-tipped
applicators (swabs)
• One tube of Cary Blair
transport medium*
• Adhesive tape
• Specimen label
*For stool specimens, the Cary Blair
tube should be chilled
1–2 hours before using it.
This provides guidance on how to take a rectal swab for diagnosis of acute bacterial
diarrheal disease. Rectal swabs must be transported in Cary Blair transport
medium. Transport medium is used to preserve specimens for bacteriology
testing,
The specimen should be transferred to the transport medium immediately
after the specimen has been collected.
Before beginning the procedure, obtain consent from the patient
1. Chill the tube of Cary Blair transport medium by placing it on ice packs or in the
refrigerator 1 to 2 hours before collecting the specimen.
2. Gloves should be worn at all times when handling specimen.
3. Remove the wrapper from the handle end of the sterile swab; Do not touch the
tip of the swab.
4. Moisten the swab in chilled Cary Blair transport medium.
5. Insert the swab through the rectal sphincter 2 to 3 cm and gently rotate.
6. Withdraw and examine the swab to make sure faecal material is visible on the
tip.
7. Push the swab completely to the bottom of the tube of Cary Blair transport
medium.
8. Break off the top portion of the stick so the cap can be tightly screwed
onto the tube.
9. After screwing cap tightly onto the Cary Blair tube, seal the tube with
tape to prevent leakage.
10. Adhere specimen label to the container.
11. Keep the tube of serum at 4–8°C.
12. Safely dispose of all contaminated materials. Do not reuse.
Sputum sample for AFB Smear
Assure patient cooperation to get an adequate specimen. Instruct the patient as
follows:
1. Collect only material brought up from the lungs (Deep-chest sputum) after a
productive cough.
2. Do not collect sputum immediately after mouth wash.
3. Rinse mouth with tap water to remove food particles and debris.
4. Have patient breathe deeply and cough several times to achieve a deep
specimen.
5. Patient should expectorate into dry, sterile container. Immediate submission to
the laboratory after collection is recommended. 5 – 10 ml volume is adequate.
6. Tuberculosis patients should expectorate sputum in the early morning, into a
sterile container with lid sealed tightly. Leaking specimens may be cancelled.
7. Transport immediately at ambient temperature. Refrigerate if a delay of more
than one hour is anticipated.
8. Patients with clinical and chest x-ray findings compatible with TB should collect
first morning sputum (preferably on 3 separate days).
Nasopharyngeal specimen collection
A. Nasopharyngeal Swab Method
(Patients head should be inclined back as shown above)
Materials for Nasopharyngeal Swab Collection
• Flexible, soft or aluminum wire nasopharyngeal with synthetic tip
• 1 ml saline tube (for Rapid Influenza A & B)
• M4 Viral Transport Media (for viral culture or H1N1)
Procedure:
1. Insert swab into one nostril.
2. Rotate swab over surface of posterior nasopharynx.
3. Withdraw swab from collection site; insert into saline transport
tube or M4
4. Repeating procedure for the second nostril will deliver optimal combined sample.
5. After collection, immediately transport specimen to the laboratory for viral
testing and viral antigen detection. If transport is delayed, place specimen on ice or
in refrigeration.
B. Nasopharyngeal Wash
Materials:
• 3-5ml syringe with 22 inch sterile NG tube 8-french (length and diameter of
syringe and tubing as appropriate for infant, child or adult.)
• Viral transport M4 media for H1N1, or saline for RSV
• Specimen container
Procedure:
1. Fill syringe with saline; attach tubing to syringe tip.
2. Quickly instill saline into nostril.
3. Method A - Aspirate the recoverable nasopharyngeal specimen.
(Recovery must
occur immediately, as the instilled fluid will rapidly drain.)
4. Method B – (alternate) In appropriate cases, patients may tilt head forward to
allow specimen to drain into suitable sterile container.
5. (if aspirated) Inject aspirated specimen from syringe into sterile specimen
container.
6. Repeating procedure for the second nostril will deliver optimal combined sample.
7. Label specimen and transport to Laboratory immediately. If transport is delayed
refrigerate or place on ice
priority diseases which require laboratory confirmation
The priority diseases that are the leading causes of illness, death and
disability of this guideline. These diseases are divided into three groups:
epidemic-prone diseases, diseases targeted for eradication or elimination, and other
diseases of public health importance.
The Priority Diseases Are a combination of communicable and non- communicable
diseases, and not all of them require laboratory testing for confirmation.
Measles
Diagnosis:
Presence of IgM antibodies to measles virus in serum.
 .Collect blood samples on 5 suspected measles cases when the number of
cases exceeds the measles outbreak threshold, (more than 5 cases in a
district in a month).
 IgM ELISA tests are more sensitive between day 4 and 28 after rash onset
a single serum obtained at the first contact with the health care system, regardless
of which day following the rash onset this occurs, is onsidered adequate for measles
surveillance.
• Collect specimen from every suspected case of measles, and at first
opportunity or first visit to the health facility.
• For children, collect 1 to 5 ml of venous blood depending on size of child.
collect into a test tube, capillary tube or microtainer
• Let clot retract for 30 to 60 minutes at room temperature.
• Centrifuge at 2000 rpm for 10-20 minutes and pour off serum into a clean
glass tube. and Separate blood cells from serum.
• If no centrifuge, put sample in refrigerator overnight (4 to 6 hours) until clot
retracts. Pour off serum the next morning. ( don't freeze whole blood)
• If no centrifuge and no refrigerator: let blood sit at an angle for at least 60
minutes (without shaking or being driven in a vehicle). Pour off serum into a
clean tube.
• Store serum at 4-8°C.
• Transport serum samples using appropriate packaging to prevent breaking or
leaks during transport.
• The specimen should arrive at the laboratory within 3 days of being collected.
• Avoid shaking of specimen before serum has been collected.
• To prevent bacterial overgrowth, ensure that the serum is poured into a
clean glass test tube, (the test tube does not need to be sterile, just clean).
• Transport the serum in an EPI hand vaccine carrier to 4ºC to 8ºC to prevent
Bacterial Overgrowth (up To 7 days).
• (If not refrigerated, serum stored in a clean tube will be good
for at least 3 days).
• Results are usually available after 2 days, if as few as 3 out of 5
suspected measles cases are laboratory confirmed, the
outbreak is confirmed
Second blood samples
These may occasionally be required under the following circumstances:
1. the first blood sample submitted for IgM was collected within four days of
rash onset and is negative by ELISA. the laboratory may request a second
sample for repeat IgM testing given the probability of false negatives on early
samples.
2. the measles IgM capture ELISA gives an equivocal result ,the clinician needs
to make a definitive diagnosis on an individual patient with an initial negative
result.
A second sample for IgM testing may be collected anytime between 4 and 28 days
after rash onset. Collection of a second sample 10–20 days after the first will permit
the laboratory to retest for IgM or, if a quantitative method is available, test for an
increase in IgG antibody level.
Notes.
 absence of IgM, particularly in samples drawn within 3 days of rash onset, does
not exclude infection, Their presence provides strong evidence of current or
recent measles infection.
 serum samples collected within 72 hours after rash onset may give false negative
results.
 IgM is also produced on primary vaccination ,and, although it may decline more
rapidly than IgM produced in response to the wild virus, vaccine and wild virus
IgM cannot be distinguished by serological tests
 A vaccination history is therefore essential for interpretation of test results.
Acute Jaundice Syndrome
Diagnosis
Laboratory serological diagnosis of hepatitis A and E can be done with IgM
antibodies from a blood sample by Eiza testing.
Collection and Transport of Specimens
- Collect 5 ml blood by venipuncture in a sterile tube labeled with patient
identification and collection date.
- Centrifuge Whole blood at 1000g for10 minutes to separate the serum.
- If there is no centrifuge the blood should be kept in a refrigerator until there is
complete retraction of the clot from the serum.
- Blood can be stored at 4-8°C for up to 24 hours before the serum is separated.
- Do not freeze whole blood.
- Carefully remove the serum, avoid extracting red cells, and transfer aseptically to
a sterile labeled vial.
- Properly label the specimen with name, age, health facility, and date of
collection.
- Store the serum at 4-8°C until shipment takes place.
HIV/AIDS
Diagnosis:
ELISA for detecting Antibodies HIV.
• Collect 5 ml of venous blood.
• Let clot retract for 30 to 60 minutes at room temperature or centrifuge to
separate serum from red blood cells.
• Aseptically pour off serum into sterile, screw capped tubes.
• Store serum at 4°C.
• Transport serum samples using appropriate packaging to prevent breakage or
leakage.
• Use universal precautions to minimize exposure to sharps and any body fluid
Results:
HIV testing is highly regulated with strict controls on release of information. Results
are usually available within one week from arrival in the laboratory.
Acute Bloody Diarrhoea (Suspected Shigellosis)
Diagnosis:
By confirmed by isolation of Shigella dysenteriae type Sd1 from stool sample.
Collection and Transport of Specimens:
1- Within 4 days of illness onset, collect a fresh stool sample including portions with
blood and/or mucus from suspected cases.
2- Stool samples should be collected as soon as possible and before administration
of antibiotics for eligible patients. If a stool specimen cannot be obtained, a
rectal swab should be done.
3- Collect stool from patients in clean containers without disinfectant or detergent
residue and with tight-fitting, leak-proof lids.
4- Stool should be refrigerated and processed within a maximum of 2 hours after
collection.
5- Specimens that cannot be cultured within 2 hours of collection, should be placed
in transport medium and refrigerated immediately.
6- Fresh stool should reach the lab within 2 hours; if this is not possible, place
samples in Cary-Blair transport media and refrigerate at 4⁰ C. Samples should be
cultured within 48 hours of collection.
7- Properly label the specimen with name, date of birth, health facility name, and
date of collection.
8- All stool samples and rectal swabs should be sent to the pre-identified
laboratory.
9- The specimens should be packaged (triple packaging using absorbent material).
10- Specimens should be transported in a cold box at 4 degrees C.
Resources Needed
- Screw-top tubes of Cary-Blair media.
- Screw-top cups for whole stool collection
- Dry, cotton-tipped rectal swab (moisten in sterile Cary-Blair media) before
inserting into anus
- Designated cold chain for culture transport and an adequate number of ice
packs.
- The kit should consist of at least one cold box (e.g. vaccine carrier) and four ice
packs.
- Readily available communication to the laboratory for communication of results
Result
Culture results are usually available 2 to 4 days after receipt by the laboratory.
SD1 isolates should be characterized by antibiotic susceptibility. after confirmation
of an initial 5-10 cases in an outbreak, sample only a small number of cases until the
outbreak ends.
Acute Watery Diarrhoea, Suspected Cholera
Diagnosis
- Confirmed through isolation of Vibrio cholera by stool culture and determine O1
Sero type using polyvalent antisera for V.cholerae O1.
- Rapid diagnostic tests (RDT) allow quick testing at the patient’s bedside, all
positive RDTs should then be culture-confirmed.
Collection and Transport of Specimens
1- Collect stool sample from the first suspected cholera case.
2- If more than one suspected case, collect until specimens have been collected
from 5 to 10 cases.
3- Collect stool from patients fitting the case definition, and onset within last 5
days, and before antibiotics treatment has started.
Do not delay treatment of dehydrated patients. Specimens may be collected after
rehydration (ORS or IV therapy) has begun.
4- Place specimen (stool or rectal swab) in a clean, leak proof container and
transport to lab within 2 hours.
5- If more than 2- hour delay is expected, place stool-soaked swab into CaryBlair transport medium.
6- If Cary-Blair transport medium is not available and specimen will not reach
the lab within 2 hours, store at 4°C to 8°C
7- Do not allow specimen to dry. Add small amount of 0.85% Na Cl if necessary
8- transport in well-marked, leak proof container in cold box at 4ºC to 8ºC.
Cary-Blair transport medium: is stable and usually good for at least one year after
preparation, It does not require refrigeration if kept sterile and in properly sealed
container, If color changes (medium turns yellow) or shrinks (depressed meniscus)
do not use the medium.
 Culture results usually take 2 to 4 days after specimen arrives at the laboratory.
 Once an outbreak has been confirmed it is not necessary to collect specimens
for all suspect cases. However, additional specimens should be tested over the
course of the outbreak for antibiotic sensitivity testing.
Resources needed:
- Screw-top cups for whole stool collection
- Screw-top tubes of Cary-Blair media
- Dry, cotton-tipped rectal swab
- Designated cold chain for culture transport and an adequate number of ice
packs.
- The cholera kit should consist of at least one cold box (e.g. vaccine carrier) and
four ice packs.
Suspected Typhoid
Diagnosis
Diagnosis confirmed by isolation of Salmonella typhi from a blood culture
Collection and Transport of Specimens
- Collect specimens and properly label with name, date of birth, health facility
name,and date of collection.
- All Blood culture specimens should be transported at room tempreture The
specimens should be packaged in accordance with the guidelines for the ransport
of dangerous biological goods (triple packaging using absorbent material).
Resources Needed:
- Skin disinfection:70% alcohol (isopropanol, ethanol) or 10% povidone iodine,
swabs,gauze pads, adhesive dressings.
- Disposable latex or vinyl gloves.
- Tourniquet, Vacutainer or similar vacuum blood collection devices, or disposable
syringes and needles.
- Blood culture bottles (50ml for adults, 25 ml for children) with appropriate
media.
- Labels and indelible marker pen.
Stool culture:
- Culture and isolation is used for confirmation of cases and outbreaks:
- Specimen type: Feces; marble size amount in Cary-Blair
- Collection materials: Use enteric kit (bottle with Cary-Blair medium (0.16%)
- Timing of collection: Shedding of organism may be intermittent.
- the collection of specimens over several days may increase chances of isolation.
.
Suspected Meningitis
Diagnosis :
- Microscopic examination of CSF for Gram negative diplococcic.
- Culture and isolation of N.meningitidis from CSF.
- Complete lumbar puncture for the first 25 cases during an epidemic to confirm
diagnosis and serogroup,
- Once serogroup identified and confirmed, No need to do lumbar puncture on
every case
Collection and Transport of(CSF) Specimens.
Note: Cerebral spinal fluid is the specimen of choice for culture and microscopic
exam.
If CSF not available, collect blood (10 ml adults, 1-5 ml for children) for culture.
Collect specimens from 5 to 10 cases once the alert or epidemic threshold has been
reached.
 Prepare the patient and aseptically.
 collect CSF into sterile test tubes with tops
 Immediately place 1 ml of CSF into a pre-warmed bottle of trans-isolate
medium.




Incubate at body temperature (36EC to 37EC.)
Never refrigerate specimens that will be cultured.
Keep CSF for microscopic exam and chemistry in the original syringe(replace
cap).
Refrigerate the capped syringe and send it to the laboratory as soon as
possible.
Collect 1 to 2 ml of CSF aseptically in 2 tubes (each tube containing at least 20 drops)
of CSF, depending on the tests to be requested
-The first 25 cases will need gram stain, cell count and culture/sensitivity .
-If a culture is planned reserve one sterile tube for this purpose .
-Properly label the specimen with name, date of birth, health facility .
-The specimens should be packaged in accordance with the guidelines for the
transport of dangerous biological goods (triple packaging using absorbent material)
Sputum sample for AFB Smear
Diagnostic test:
Presence of acid fast bacillus (AFB) in Ziehl Neelsen stained smears.
Specimen:
Deep-chest sputum, collect sputum (not saliva) for direct smear microscopy and
examine at least three stained specimens taken on different days. smear should be
examined at health facility where the specimen Is taken.
Results :TB microscopy is read daily.
Malaria
Diagnostic test:
- Presence of malarial parasites in blood films for suspected cases admitted to
inpatient facility
- Malaria Rapid diagnostic test Hematocrit or hemoglobin for suspected malaria in
children2 months to 5 years in age.
Blood specimen:
Usually finger-stick or other accepted method for collecting blood .
- Blood smear: Collect blood directly onto correctly cleaned and labeled
microscope slides and prepare thick and thin smears.
- Allow smears to dry thoroughly
- Stain using the appropriate stain and technique
- Store stained and thoroughly dried slides at room temperature out of direct
sunlight.
Results:
Thick and thin smear results can be available the same day as preparation.
blood borne parasites. RDT result is obtained immediately
Acute Flaccid Paralysis (Suspected Poliomyelitis)
Diagnosis :
Isolation of polio virus from stool specimen
Collection and Transport of Specimens:
• Collect a sample from every suspected AFP case within 14 days of the onset
of paralysis,
• Each specimen should be 8-10 grams each about the size of one adult
thumb,
• Collect the first specimen when the case is investigated.
• And Collect a second specimen on the same patient 24 to 48 hours later.
• Place stool in clean, dry, leak-proof, screw-capped container and label
clearly.
• The container need , sterile and no preservative/transport media should be
used
• Immediately place in refrigerator or cold box not used for storing vaccines or
other medicines.
• After the specimens are collected and labeled, transport them in the “cold
chain”
• on frozen ice packs or ice, in a stool specimen carrier or a vaccine carrier
specifically designated for this purpose
• Transport specimens so they will arrive at designated polio laboratory within
72 hours of collection
• When there is a delay, and specimen will not be transported within 72 hours,
freeze specimen at -20 C or colder.
• Then transport frozen specimen with dry ice or cold packs also frozen at -20
C or colder.
• Confirmed results are usually available within 21 after receipt of specimen
by the Referral laboratory.
Note: If no specimen is collected, reevaluate patient after 60 days to confirm clinical
diagnosis of polio (AFP)
Outbreak Investigation Laboratory Guideline Checklist
DOCUMENTATION
Specimen label
Case investigation forms
Patient register book
Marker pen
Writing pens and pencils
Outbreak investigation guidelines
PERSONAL PROTECTIVE EQUIPMENT
Gowns/coveralls
Plastic apron
Masks
Cups
Disinfectants- JIK, soap, 70% alcohol, Povidone iodine 10%
Biohazard bags
Goggles
Caps
Scrub suits
Gloves – (surgical and disposable)
SPECIMEN COLLECTION, PACKAGING TRANSPORTATION AND REFERRAL
Racks
Needles (gauge; 21,23)
Tourniquet
Cotton wool
Alcohol swabs
CSF collection kit
Leak proof screw capped container
Vacutainers
Vacutainer sleeves
Adhesive tape
Lancets
Stool containers
Water sampling kits
Gauze large pack
Filter Paper
Slides
Cover slips
Plastic Pasteur pipettes
Absorbent materials
Parafilm (small rolls)
Thermometers
Tongue depressors
Kit boxes
Slide boxes
Staining racks
Microscopes (light binoculars)
Immersion oil
Water testing kits
Transport media
Triple packing systems
Colds box
Cold packs
Sterile cotton tipped applicator (e.g. for rectal swab)
Blood culture bottles
Sputum containers
Safe box/bio safety bags
Normal saline
INSTRUCTIONS/GUIDELINES FIELD KITS (RAPID DIAGNOSTIC KITS)
Rapid malaria diagnostic kit (room temp)
Rapid latex meningitis kit (room temp)
cholera diagnostic kit (dip stick)
Suspected
Diseases
Cholera
Dysentery
Laboratory Testing Requirements
Requirement for isolation and
* Requirement for
identification
Confirmation
• Biochemical: *Entero- bacteriaecae
• *Vibrio cholerae
API biochemical kit
typing
and TSI tube, Urea, Oxidase
antisera: Polyvalent O1
reagent, SIM medium
and O139
• Primary culture media:
• *Monovalent: ogawa,
MacConkey, XLD or DCA,
inaba
APW, TCBS, Plates, incubator,
wire loop, pipettes
• Susceptibility Testing
Agar: Mueller Hinton, 0.5
McFarland turbidity standard,
forceps, sterile swabs, zone
criteria chart, vernier caliper
• Discs for Sensitivity tests:
Chloramphenicol, Nalidixic
acid, Ciprofloxacin,
Tetracycline, Furazolidone,
Trimethoprim-sulfamethoxazole,
Erythromycin
• Biochemical: *Enterobacteriaecae
• *Respective
API biochemical kit
polyvalents
and TSI tube, Urea, Oxidase
and monovalents for:
• Primary culture media:
Sh.
MacConkey, XLD or DCA,
dysenteriae, Sh flexneri,
Plates, incubator, wire loop,
Sh
pipettes, reagent and SIM
boydii and Sh sonnei
medium
• *Salmonella typing:
• Susceptibility Testing
°°Polyvalent H (phase 1
Agar: Mueller Hinton, 0.5
and 2)
McFarland turbidity standard,
°°Polyvalent O (A-S).
forceps, sterile swabs, zone
°°Monovalents (O) 4,9
criteria chart, vernier caliper
°°Capsular Vi.
Meningitis
Typhoid
• Antibiotics: Chloramphenicol,
Nalidixic acid,
Ciprofloxacin, Tetracycline,
Furazolidone, Trimethoprim sulfame
thoxazole
• Gram stain reagents: Ziehl
Neelsen (ZN) stain reagents,
Leishman stain, counting
chamber, cover slips, slides,
protein standards, Turk’s solution,
salphosalicylic acid (SSA)
• Culture media: Chocolate
agar (CHOC), *Haemoglobin
powder, *E-test strips, blood
agar (BA), MacConkey agar
• Biochemical: X V, XV factors,
and 5-microgram Optochin
disc. Oxidase reagent, bile
salt (sodium desoxycholate)
• Susceptibility Testing:
Mueller Hinton agar
• Antibiotics: Chloramphenicol,
Penicillin, Ampicillin,
Ceftriaxone, Tetracycline,
Oxacillin ,Trimethoprimsulfamethoxazole,
Ciprofloxacin,
Vancomycin, Erythromycin,
Meropenem
• Zone criteria chart and vernier
caliper
• India ink
• Primary culture media:
MacConkey, Blood agar and
Chocolate agar, Plates, incubator,
wire loop, and burner
• Susceptibility testing media:
Mueller-Hinton
• Antibiotics discs: Chloramphenicol,
Ciprofloxacin,
Tetracycline,
Trimethoprimsulfamethoxazole,
Ampicillin
• 0.5 McFarland turbidity standard,
forceps, sterile swabs
• Zone criteria chart, ruler or
vernier caliper
°°Monovalents (H) d
• *Neisseria
meningitidis
typing sera
• Haemophilus
influenzae
typing sera
• *Salmonella typing:
• Polyvalent H (phase 1
and 2)
• Polyvalent O (A-S).
• Monovalents (O) 4,9
• Capsular Vi.
• Monovalents (H) d
H1N1 Investigation Form ‫استمارة تقصي االنفلونزا‬
Basic Information ‫المعلومات الرئيسية‬
Health Facility ‫المركز الصحي‬
HF Address ‫عنوان المركز‬
Case (C) Name ‫اسم المريض‬
EPID # ‫الرقم الوبائي‬
C - Governorate ‫المحافظة‬
C - District ‫المنطقة‬
C - Sub district ‫الناحية‬
C - Community ‫البلدة‬/‫القرية‬
Telephone ‫الهاتف‬
Address ‫العنوان‬
DoB ‫( تاريخ الميالد‬dd/mmm/yyyy)
Age ‫( العمر‬m)
Signs and symptoms ‫العالمات واألعراض‬
Fever ‫الحرارة‬
Dry cough ‫سعال جاف‬
Sore Throat ‫ألم بلعوم‬
Productive cough ‫سعال قشع‬
Chest pain ‫ألم صدري‬
Dyspnoea ‫زلة تنفسية‬
Haemoptysis ‫نفث دموي‬
Vomiting ‫إقياء‬
Diarrhoea ‫إسهال‬
Altered consciousness ‫تغيم وعي‬
Joint pain ‫ألم مفصلي‬
Muscle pain ‫ألم عضلي‬
Shortness of breath ‫ضيق نفس‬
Nausea ‫غثيان‬
Sneezing ‫عطاس‬
Conjunctivitis ‫التهاب ملتحمة‬
Headache ‫صداع‬
Seizures ‫اختالج‬
Respiratory failure ‫قصور تنفسي‬
Runny nose ‫سيالن أنف‬
Nose bleed ‫رعاف‬
Complications ‫االختالطات‬
Neurological complications ‫اختالطات عصبية‬
Pneumonia ‫ذات رئة‬
Pleural effusion ‫انصباب جنب‬
Cardiac Failure ‫قصور قلبي‬
ARDS ‫متالزمة عسرة تنفسية‬
Renal Failure ‫قصور كلوي‬
Others ‫غير ذلك‬
Please specify ‫يرجى التحديد‬
Epidemiological Information ‫المعلومات ال وبائية‬
Did the patient travel to other areas within the last 10 days ‫ أيام السابقة‬10 ‫هل زار المريض مناطق أخرى خالل‬
Specify the visited areas ‫حدد المناطق التي تمت زيارتها‬
Visitors from other areas within the last 10 days ‫ أيام السابقة‬10 ‫هل هناك زوار من مناطق أخرى خالل‬
Specify the visited areas ‫حدد المناطق التي تمت زيارتها‬
Onset Date ‫( بدء األعراض‬dd/mmm/yyyy)
Detection Date ‫( تاريخ المشاهدة‬dd/mmm/yyyy)
Treatment date of using antiviral ‫( تاريخ بدء العالج بالمضادات الفيروسية‬dd/mmm/yyyy)
Influenza vaccine history ‫سوابق لقاح االنفلونزا‬
No. of doses ‫عدد جرعات اللقاح‬
Endemic area ‫?منطقة موبوءة‬
Contacts with similar symptoms ‫وجود مخالطين بأعراض مشابهة‬
Risk Class ‫عوامل الخطورة‬
Children under 5 ‫أطفال تحت‬
Elderly above 65 ‫كهول فوق‬
Pregnancy ‫حمل‬
Patient with chronic illness ‫مريض لديه مرض مزمن‬
Health workers ‫عمال الرعاية الصحية‬
Hospitalization ‫االستشفاء‬
Admission date ‫( تاريخ القبول في المشفى‬dd/mmm/yyyy)
Reasons of ICU referral ‫أسباب القبول في العناية‬
Ventilation date ‫( تاريخ وضعه على المنفسة‬dd/mmm/yyyy)
Reasons of using mechanical ventilator ‫أسباب وضعه على المنفسة‬
Sampling Information ‫معلومات قطف العينات‬
Nasal swab ‫مسحة أنفية‬
Nasopharyngeal ‫مسحة بلعوم أنفي‬
Throat swab ‫مسحة بلعومية‬
Others ‫غير ذلك‬
Sent to Lab date ‫( تاريخ اإلرسال للمخبر‬dd/mmm/yyyy)
Received in Lab ‫( تاريخ تلقي المخبر للعينة‬dd/mmm/yyyy)
Filled by ‫اسم المتقصي‬
Signature ‫توقيع المتقصي‬
Suspected Mumps Investigation Form
‫استمارة تقصي حالة اشتباه النكاف‬
- Reporting site Information ‫بيانات مركز اإلبالغ‬
EPID # ‫الرقم الوبائي‬
Health Facility (HF) ‫المركز الصحي‬
Health Facility type ‫نوع المركزالصحي‬
Governorate ‫المحافظة‬
District ‫المنطقة‬
Subdistrict ‫الناحية‬
HF Address ‫عنوان المركز الصحي‬
Notification date ‫تاريخ اإلبالغ‬
Detection date ‫تاريخ االكتشاف‬
- Personal Information ‫بيانات شخصية‬
Patient Name ‫اسم المريض‬
Father name ‫اسم األب‬
Birth date ‫تاريخ الميالد‬
mother name ‫اسم األم‬
Age (Months) ‫)باألشهر(العمر‬
Sex ‫الجنس‬
Job ‫المهنة‬
Marital Status ‫الحالة االجتماعية‬
Childern No. ‫عدد األوالد‬
Residency Place ‫مكان اإلقامة‬
Governorate ‫المحافظة‬
District ‫المنطقة‬
Subdistrict ‫الناحية‬
IDP or Resident ‫?نازح أم مقيم‬
And since when (Months)? ‫ومنذ متى (أشهر)؟‬
If IDP or nomad, from where? ‫ من أين؟‬،‫بدو‬/‫إذا كان نازح‬
- Signs and Symptoms and complication ‫األعراض والعالمات المرضية والمضاعفات‬
onset date ‫تاريخ بدء األعراض‬
Complications ‫المضاعفات‬
meningitis ‫التهاب سحايا‬
Fever ‫حمى‬
deafness ‫صمم‬
Parotitis ‫التهاب غدة نكفية‬
orchitis ‫التهاب خصية‬
Other ‫)حدد(أخرى‬
Encephalitis ‫التهاب دماغ‬
Pancreatitis ‫التهاب بنكرياس‬
Admission in hopspital ‫هل قبل في المشفى‬
Hospital name ‫اسم المشفى‬
Vaccination status ‫الحالة التلقيحية‬
Information source ‫مصدر المعلومات‬
Case outcome ‫مصير الحالة‬
If dead, when ‫ متى؟‬،‫في حالة الوفاة‬
- Epidemiological findings ‫المشاهدات الوبائية الهامة‬
1- Was the patient in contact with patient with fever and/or swelling of parotid 3
weeks before symtoms ‫أو تورم في النكفة‬/‫هل كان المريض على تماس مع مريض مصاب بحرارة و‬
‫ أسابيع قبل ظهور األعراض‬3 ‫خالل‬
If yes, when ‫ متى؟‬،‫إذا كانت اإلجابة نعم‬
Village ‫القرية‬
District ‫المنطقة‬
Governorate ‫المحافظة‬
Has anyone in patient'shousehold or his closed contacts develop similar illness
‫هل ظهر لدى أحد في منزل المريض أو مخالطيه المقربين مرض مشابه‬
If yes, who ‫ من؟‬،‫إذا كانت اإلجابة نعم‬
Age ‫عمره‬
And Gender ‫جنسه‬
vaccination
status ‫حالته التلقيحية‬
- Laboratory investigation ‫التقصي المخبري‬
Samples collected ‫هل تم جمع عينة‬
If yes, what is the sample type ‫إذا كانت اإلجابة نعم ما نوع العينة‬
Sample collecting date ‫تاريخ جمع العينة‬
Sample sending date ‫تاريخ إرسال العينة‬
Sample receiving date ‫تاريخ استالم العينة في المخبر‬
Sample condition ‫حالة العينة‬
Lab name ‫اسم المختبر‬
Address ‫العنوان‬
Lab number ‫الرقم المخبري‬
Mumps IgM result ‫نتيجة الفحص المخبري للنكاف‬
Result sending date ‫تاريخ إرسال النتيجة‬
- Case classification ‫تصنيف الحالة‬
Final classification ‫التصنيف النهائي للحالة‬
Case classified by ‫قام بتصنيف الحالة‬
Inves. Date ‫تاريخ التقصي‬
Classification date ‫تاريخ التصنيف‬
Investigator ‫اسم المستقصي‬
And where
‫وأين؟‬
Subdistrict ‫الناحية‬
Suspected Measles Investigation Form
‫استمارة تقصي حالة اشتباه الحصبة‬
- Reporting site Information ‫بيانات مركز اإلبالغ‬
EPID # ‫الرقم الوبائي‬
Health Facility (HF) ‫المركز الصحي‬
Health Facility type ‫نوع المركزالصحي‬
Governorate ‫المحافظة‬
District ‫المنطقة‬
Subdistrict ‫الناحية‬
HF Address ‫عنوان المركز الصحي‬
Detection date ‫تاريخ االكتشاف‬
Notification date ‫تاريخ اإلبالغ‬
- Personal Information ‫بيانات شخصية‬
Patient Name ‫اسم المريض‬
Father name ‫اسم األب‬
Birth date ‫تاريخ الميالد‬
mother name ‫اسم األم‬
Age (Months) ‫)باألشهر(العمر‬
Sex ‫الجنس‬
Job ‫المهنة‬
Marital Status ‫الحالة االجتماعية‬
Childern No. ‫عدد األوالد‬
Residency Place ‫مكان اإلقامة‬
Governorate ‫المحافظة‬
District ‫المنطقة‬
Subdistrict ‫الناحية‬
IDP or Resident ‫?نازح أم مقيم‬
And since when (m) ‫?منذ متى باألشهر‬
If IDP OR nomad, from where? ‫ من أين؟‬،‫بدو‬/‫إذا كان نازح‬
- Signs and Symptoms and complicatio ‫األعراض والعالمات المرضية والمضاعفات‬
Maculopapular Rash ‫طفح بقعي حطاطي‬
Rash period (d)
‫مدة الطفح باليوم‬
Rash onset date ‫تاريخ ظهور الطفح‬
Fever ‫حمى‬
Coryza ‫زكام‬
Complications ‫المضاعفات‬
Pneumonia ‫التهاب رئوي‬
Cough ‫سعال‬
Malnutrition ‫سوء تغذية‬
Conjunctivitis ‫التهاب ملتحمة‬
Diarrhea ‫إسهال‬
Lymphadinitis ‫التهاب عقد لمفية‬
Encephalitis ‫التهاب دماغ‬
Arthritis ‫التهاب مفاصل‬
Others ‫أخرى‬
Admission in hopspital ‫هل قبل في المشفى‬
Hospital name ‫اسم المشفى‬
Vaccination status ‫الحالة التلقيحية‬
Information source ‫مصدر المعلومات‬
Case outcome ‫مصير الحالة‬
If dead, when ‫ متى؟‬،‫في حالة الوفاة‬
- Epidemiological findings ‫المشاهدات الوبائية الهامة‬
1- Was the patient in contact with measles case I the last 7-21 days
before rash ‫ الماضية قبل الطفح‬21-7 ‫هل كان المريض على تماس مع حالة حصبة في األيام‬
If yes, when
And where ‫وأين؟‬
‫ متى؟‬،‫إذا كانت اإلجابة نعم‬
Village
‫القرية‬
Governorate
‫المحافظة‬
District
‫المنطقة‬
Subdistrict
‫الناحية‬
Has the patient traveled within the 7-23 days before rash ‫ قبل ظهور الطفح‬23-7 ‫هل سافر المريض خالل األيام‬
If yes, when ‫ متى؟‬،‫إذا كانت اإلجابة نعم‬
Specify Location ‫حدد المكان‬
Governorate ‫المحافظة‬
District ‫المنطقة‬
Subdistrict ‫الناحية‬
- Laboratory investigation ‫التقصي المخبري‬
Samples collected ‫هل تم جمع عينة‬
If yes, what is the sample type ‫إذا كانت اإلجابة نعم ما نوع العينة‬
Sample collecting date ‫تاريخ جمع العينة‬
Sample sending date ‫تاريخ إرسال العينة‬
Sample receiving date ‫تاريخ استالم العينة في المخبر‬
Sample condition ‫حالة العينة‬
Lab name ‫اسم المختبر‬
Address ‫العنوان‬
Lab number ‫الرقم المخبري‬
Measles IgM result ‫نتيجة الفحص المخبري للحصبة‬
Rubella IgM result ‫نتيجة الفحص المخبري للحصبة األلمانية‬
Result sending date ‫تاريخ إرسال النتيجة‬
- Case classification ‫تصنيف العينة‬
Final classification ‫التصنيف النهائي للحالة‬
If discarded, what is the diagnosis ‫ ما هو التشخيص‬،‫إذا كانت مستبعدة‬
Case classified by ‫قام بتصنيف الحالة‬
Inves. Date ‫تاريخ التقصي‬
Classification date ‫تاريخ التصنيف‬
Investigator ‫اسم المستقصي‬
Suspected Cholera Investigation Form
‫استمارة تقصي مرض اشتباه الكوليرا‬
- Reporting site Information ‫بيانات مركز اإلبالغ‬
EPID # ‫الرقم الوبائي‬
Subdistrict ‫الناحية‬
Health Facility (HF) ‫المركز الصحي‬
HF Address ‫عنوان المركز الصحي‬
- Personal Information ‫بيانات شخصية‬
Patient Name ‫اسم المريض‬
Sex ‫الجنس‬
Age ‫العمر‬
Marital Status ‫الحالة االجتماعية‬
Father name ‫اسم األب‬
Residency Place ‫مكان اإلقامة‬
Governorate ‫المحافظة‬
Subdistrict ‫الناحية‬
IDP or Resident ‫?نازح أم مقيم‬
mother name ‫اسم األم‬
Job ‫المهنة‬
Childern No. ‫عدد األوالد‬
District ‫المنطقة‬
- Signs and Symptoms and complicatio ‫األعراض والعالمات المرضية والمضاعفات‬
Diarrhea ‫إسهال‬
Fever ‫حمى‬
Signs-onset date M/D/Y‫س‬/‫ي‬/‫تاريخ بدء األعراض ش‬
Any complications
‫?أية اختالطات‬
Vomitting ‫إقياء‬
Shock ‫صدمة‬
Dehydration ‫تجفاف‬
Unconciousness ‫غياب وعي‬
Pulmonary edema
Renal Failure
Hypokalemia
Hypoglycemia
Others ‫أخرى‬
Case management ‫تدبير الحالة‬
Was radid diagnostic tesd for cholera done ‫هل تم‬
‫?إجراء اختبار تشخيص سريع للكوليرا‬
Result ‫النتيجة‬
Had the patient been hospitalized ‫هل تم قبول المريض في‬
‫?مشفى‬
Outcome ‫النتيجة‬
Had the patient taken any medicine in the hospital‫هل‬
‫?أخذ المريض أدوية في المشفى‬
important epidemiological findings
‫المشاهدات ال وبائية ال هامة‬
1- Patint travels during the last five days before
onset of symptoms ‫تنقالت المريض خالل األيام الخمسة األولى‬
‫التي سبقت األعراض‬
Any other similar cases in the house ‫هل هناك حاالت‬
‫?مشابهة في البيت‬
Had the patient contacted similar case ‫هل اختلط‬
‫?المريض بحالة مشابهة‬
if yes, specify number
‫عند اإليجاب حدد العدد‬
If yes, date ‫في حال اإليجاب‬،
‫التاريخ؟‬
Contact location ‫مكان‬
‫المخالطة‬
Had the water been disinfected ‫هل تم تطهير‬
‫?المياه‬
Source of drinking water
‫مصدر مياه الشرب‬
Sanitation system ‫نظام الصرف الصحي‬
- The food that the patient had eaten through the last 5 days ‫الطعام الذي تناوله المريض خالل الخمسة أيام الماضية‬
Milk ‫حليب‬
Milk Products ‫مشتقات‬
‫الحليب‬
Fresh vegetables
‫خضار طازجة‬
Ice cream
‫بوظة‬
Soda ‫مياه غازية‬
Fresh fruits ‫فواكه طازجة‬
The source of the food that the patient had eaten through
the last 10 days ‫مصدر الطعام الذي تناوله المريض خالل العشرة أيام الماضية‬
Other remarks ‫مالحظات أخرى‬
Inves. Date ‫تاريخ التقصي‬
Investigator ‫اسم المستقصي‬
Uncooked meat ‫لحم‬
‫نيء‬
Others ‫أخرى‬
‫‪Suspected Tetanus Investigation Form‬‬
‫استمارة تقصي حالة اشتباه الكزاز‬
‫بيانات مركز اإلبالغ ‪- Reporting site Information‬‬
‫الرقم الوبائي ‪EPID #‬‬
‫المركز الصحي )‪Health Facility (HF‬‬
‫نوع المركزالصحي ‪Health Facility type‬‬
‫المحافظة ‪Governorate‬‬
‫المنطقة ‪District‬‬
‫الناحية ‪Subdistrict‬‬
‫عنوان المركز الصحي ‪HF Address‬‬
‫تاريخ اإلبالغ ‪Notification date‬‬
‫تاريخ االكتشاف ‪Detection date‬‬
‫بيانات شخصية ‪- Personal Information‬‬
‫اسم األم ‪mother name‬‬
‫اسم المريض ‪Patient Name‬‬
‫اسم األب ‪Father name‬‬
‫تاريخ الميالد ‪Birth date‬‬
‫)باألشهر(العمر )‪Age (Months‬‬
‫المهنة ‪Job‬‬
‫عدد األوالد ‪Childern No.‬‬
‫الجنس ‪Sex‬‬
‫الحالة االجتماعية ‪Marital Status‬‬
‫مكان اإلقامة ‪Residency Place‬‬
‫المحافظة ‪Governorate‬‬
‫المنطقة ‪District‬‬
‫الناحية ‪Subdistrict‬‬
‫?نازح أم مقيم ‪IDP or Resident‬‬
‫إذا كان نازح‪ ،‬من أين؟ ?‪If IDP, from where‬‬
‫ومنذ متى (أشهر)؟ ?)‪And since when (Months‬‬
‫األعراض والعالمات المرضية والمضاعفات ‪- Signs and Symptoms and complicatio‬‬
‫تاريخ بدء األعراض ‪onset date‬‬
‫تشنج الفكين ‪Stiffness of jaws‬‬
‫صعوبة بلع ‪Difficult swallowing‬‬
‫تشنج في الرقبة أو الذراع ‪Stffness in neck/arm/leg‬‬
‫أو الساق‬
‫تململ وقلق ‪Restlessness‬‬
‫)تكزز الفم(ضزز ‪Trismus‬‬
‫التكشيرة السردونية ‪Risus sardonicus‬‬
‫تشنج الظهر ‪opisthotonus‬‬
‫اختالجات ‪convulsions‬‬
‫اسم المشفى ‪Hospital name‬‬
‫هل قبل في المشفى ‪Admission in hopspital‬‬
‫في حال اإليجاب‪ ،‬كم جرعة تلقى؟‬
‫هل تلقى المريض لقاح الكزاز بعد التعرض‬
‫في حال اإليجاب‪ ،‬كم جرعة تلقى؟‬
‫هل تلقى المريض المصل المضاد للكزاز أوالغلوبولين المناعي للكزاز بعد التعرض‬
‫مصدر المعلومات ‪Information source‬‬
‫الحالة التلقيحية ‪Vaccination status‬‬
‫تاريخ آخر جرعة لقاح كزاز‬
‫عدد جرعات لقاح الكزاز المتلقاة‬
‫في حالة الوفاة‪ ،‬متى؟ ‪If dead, when‬‬
‫مصير الحالة ‪Case outcome‬‬
‫المشاهدات الوبائية الهامة ‪- Epidemiological findings‬‬
‫حالة التعرض‬
‫نمط اإلصابة‬
‫موضع الجرح‬
‫تصنيف الحالة ‪- Case classification‬‬
‫التصنيف النهائي للحالة ‪Final classification‬‬
‫تاريخ التصنيف ‪Classification date‬‬
‫اسم المستقصي ‪Investigator‬‬
‫قام بتصنيف الحالة ‪Case classified by‬‬
‫تاريخ التقصي ‪Inves. Date‬‬