Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
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