Alberta TB Outbreak Reporting Form Definitions and Instructions

Alberta TB Outbreak Reporting Form (AORF)
Definitions and Instructions for Completing the AORF
Specific to Tuberculosis
All outbreaks are reportable by fastest means possible to Alberta Health and a AORF must be submitted.
AORF Report Submission Timelines:
Section 1: Submit Initial Notification/Contact Information immediately after opening the investigation.
Section 2: In the case of respiratory illness outbreaks, complete and submit an update as soon as the
causative organism has been confirmed on a laboratory report. Section 2 is required to be completed for ALL
outbreaks as soon as the organism(s) is identified.
Section 3: Submit Final Report within 2 days of closing the investigation.
An update/amendment should be provided if there were any errors or significant additional information being
reported (e.g., an additional organism has been identified).
DO NOT submit an AORF for outbreaks associated with out-of-province travel even though there may be
cases from Alberta associated with the outbreak. If these Alberta cases lead to further spread and an
outbreak within Alberta, THEN submit an AORF for this new outbreak.
The following definitions are not intended to have legal interpretations. They provide a short explanation of the
terms used or instructions of how to complete the form in order to maximize consistency with data collection.
Examples provided in this document are not all-inclusive. They are included to provide guidance to the person
completing the form.
For the purpose of this document, any reference to ‘clients’ refers to: patients, students, childcare attendees,
restaurant patrons, hotel guests and other individuals (other than site staff) relevant to the outbreak.
Please refer to disease specific case definitions in the Alberta Public Health Notifiable Disease Management
Guidelines for identifying confirmed, probable and suspect cases.
Section 1 – Initial Notification
EI# - Exposure
The unique exposure investigation (EI) number assigned by the Provincial
Investigation Number
Laboratory for Public Health (ProvLab) or by the Zone which is specific to the
outbreak being reported.
Onset Date
Date of diagnosis of the index case(s).
Date Investigation
Date that the secondary case is identified.
Opened
Date Reported to Alberta The date the initial outbreak information was submitted to Alberta Health.
Health
Zone-Region Reporting
Name of the Zone-Region where the index case resides.
FNIHB Reporting
Check to indicate if the outbreak is reported by FNIHB and/or is identified in a
FNIHB community..
Primary Investigator
Name of primary contact for the outbreak in the Zone or FNIHB.
Telephone Number
Phone number for the primary investigator in the Zone or FNIHB.
1. Suspected Organism Pick TB from pull down list.
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Alberta TB Outbreak Reporting Form (AORF) – Definitions and Instructions
2. Suspected Source
3. Location of Outbreak
Choose person, place or thing suspected to be the source of the outbreak from
drop down list provided. This field does not refer to mode of transmission.
Person-to-Person
Non-sexual contact with an infected
person, either direct or indirect (e.g.,
droplet, contact, airborne, fomite).
Sexual Contact
Deep kissing, sexual intercourse (vaginal,
oral or anal) or any other sexual activities
that expose an individual to the body fluids
of another person.
Blood and Body Fluid Exposure
An event where blood or other potentially
infectious body fluids comes into contact
with skin, mucous membranes or
subcutaneous tissue (via percutaneous
injury e.g., needlestick, tattoo, piercing).
Drinking Water
Potable water intended for human
consumption, including private water
systems (e.g., wells, cisterns, small
distribution systems) and treated municipal
water.
Swimming Pool
Water from a pool, wading pool, water
spray park and whirlpool that has a permit
issued under Part 4 of the Public Health Act
Swimming Pool, Wading Pool and Water
Spray Park Regulation.
Recreational Water
Water that is neither drinking water nor
swimming pool water (e.g., beach, lake,
stream).
Human Food
Any substance, including ice, intended for
use in whole or in part for human
consumption, but does not include a drug,
medication or a regulated health related
product and, for the purpose of disease
reporting, does not include drinking water.
Pet Food
Any substance intended for use in whole or
in part for animal consumption (e.g., feeder
mice, pig ear treats).
Animal
Any living thing that is not human or plant
(e.g., insects, birds, fish and includes
domestic pets, livestock and wild animals).
Unknown
Indicate ‘Unknown’ when it is not possible
to determine how the disease was likely
acquired.
Other, specify
Indicate any other source of infection
identified or suspected.
Check the appropriate box to select from the following options:
Acute Care Facility
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Alberta Health, April 2014
Any acute care facility in the province. May
be confined to a unit, floor or to the entire
facility.
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Child Care Facility
Community
Community Organization Function
Correctional Facility
Facility Living
(e.g., Long-term Care Sites)
Shelter
Permitted/Approved Establishment
Personal Services
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Alberta Health, April 2014
Site where care is provided for children
(e.g., daycare centre, family day-home,
preschool, playschool).
NOTE: This does not include residential
care facilities for children under 18 years of
age (refer to Facility Living definition)
Indicate ‘Community’ when outbreak is
unrelated to a specific event or location
(e.g., pandemic influenza, province-wide
mumps outbreak).
An event or function, open to the general
public, where foods/beverages served have
been prepared at home and/or in a nonpermitted facility by volunteers (e.g., wild
game dinners, fundraising suppers, bake
sales).
NOTE: This box should only be selected
when illness is associated with the food or
beverage served at the event.
Facilities for incarceration (e.g., prisons,
remand centre, youth offender centre).
A care facility for individuals who have
highly complex health needs and whose
care cannot be safely provided in their own
home, or in supportive living. Under the
direction of a family physician, an onsite
Registered Nurse supervises care with the
support of Licensed Practical Nurses,
Health Care Aides and other health-care
providers as appropriate. 24-hour nursing
care is provided by nursing staff that are
able to respond to client needs.
A temporary residence or place of stay
(e.g., overnight or longer) which seeks to
protect vulnerable populations (e.g.,
homeless shelters, men’s or women’s
shelters, Youth Emergency Center, Family
Violence Emergency Shelter)
A food establishment listed on a valid food
handling permit issued under Part 1 of the
Food Regulation and for the purposes of
disease reporting includes temporary food
establishments operating as special events
and catered events.
Risk Category: Low, Moderate, High – refer
to Food Establishment Hazard Assessment
Worksheet
Includes services such as but not limited to
tattooing, piercing, electrolysis, esthetics,
foot care, massage therapy, spas and
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Private Dwelling
Restricted Function
School (Post Secondary)
School (K-12)
Supportive Living/ Home Living
Sites
Swimming Pool
Other:
© Government of Alberta
Alberta Health, April 2014
beauty salons.
Housing accommodations (e.g., private
residence, rental accommodations)
An event or function, not open to the
general public, where foods/beverages
served have been prepared at home and/or
in a non-permitted facility by volunteers.
Attendance at these functions is generally
by personal invitation only (e.g., potlucks,
bake sales, family reunions).
NOTE: this box should only be selected
when illness is associated with the food or
beverage served at the event.
An institution that is attended beyond high
school (e.g., college, university)
A private or public primary educational
institution.
Grade: Provide the grade(s) of the ill
student(s) unless the entire school is
affected.
A Supportive Living site (e.g., Assisted
Living) provides a home-like setting where
people can maintain control over their lives
while also receiving the support they need
through the provision of services such as
24-hour monitoring, emergency response,
security, meals, housekeeping and life
enrichment activities. The buildings are
specifically designed with common areas
and features to allow individuals to “age in
place”. Publicly-funded personal care and
health services are provided to supportive
living residents based on assessed unmet
needs depending on client needs. This
would also include group homes.
A Home Living site (e.g., Seniors Lodge) is
a primary housing option for persons who
are able to live independently and with
minimal support services. Home Living is
the housing option for persons who
choose to and who are able to maintain
active, healthy, independent living while
remaining in their family home as long as
possible. Basic Home Care services may
be provided by or funded through AHS
and/or the individual can purchase
services from another agency.
A pool other than a swimming pool at a
private dwelling (e.g., municipal pool).
Any locations or event not identified on this
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list where an outbreak has occurred.
4. Location (Facility)
Name
Name of the facility in which the outbreak is occurring or is suspected to have
been associated with.
Municipality: The city, town, village or summer village, municipal district or
specialized municipality.
Unit: The unit in the facility where the outbreak is occurring, if applicable.
Floor: The floor in the facility on which the outbreak is occurring, if applicable.
Shelter or community facility: Fill in the name of the shelter or community
facility.
5. Initial # of People ill
Not applicable in TB outbreak – leave blank
6. Initial Population at
Means those that require contact tracing and are listed on the contact list. Does
Risk
NOT include case findings.
Section 2 – Laboratory Confirmed Organism Identification
7. Primary Organism Enteric/Non-Enteric/Respiratory: Using the drop down lists provided, choose
Identified
Tuberculosis.
Section 3 – Final Report
8. Species
Indicate strain differentiation, if applicable. This field includes all forms of
differentiation (e.g., serotype/serogroup, sequence type, subtype, phagetype,
PFGE).
9. Onset Date of Last Indicate the diagnosis date if the last case.
Case
10. Date Investigation
Indicate the date when the contact investigation is complete and no further
Closed
contacts identified.
11. Is there evidence
The fields in this section should be filled out when there are cases identified
of spread of
outside the original location. Check the appropriate box.
disease from
Cases on other floors/units within Indicate if there is evidence of spread of
original
the same facilities/sites
disease to other floors/units within the
location/facility
same facility/site.
Cases in other facilities/sites
Indicate if there is evidence of spread of
within the same zone
disease to facility/sites within the same
Zone.
Cases in other municipalities
Indicate if there is evidence of spread of
within the same zone
disease to other municipalities with the
same Zone.
Cases in other zones/FNIHB,
Indicate if there is evidence of spread of
Specify where
disease to other Zones or FNIHB. Indicate
the Zone(s) involved (aside from the
current outbreak zone).
Cases in other Canadian
Indicate if there is evidence of spread of
provinces/territories, Specify
disease to other Canadian
where
provinces/territories outside of Alberta. If
YES, specify the Province(s) or
Territory(ies) involved.
12. Source
Indicate the most likely person, place or thing implicated as the source of the
outbreak.
Person-to-Person
Non-sexual contact with an infected
person, either direct or indirect (e.g.,
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Alberta TB Outbreak Reporting Form (AORF) – Definitions and Instructions
Sexual Contact
Blood and Body Fluid Exposure
Drinking Water
Swimming Pool
Recreational Water
droplet, contact, airborne, fomite).
Deep kissing, sexual intercourse (vaginal,
oral or anal) or any other sexual activities
that expose an individual to the body fluids
of another person.
An event where blood or other potentially
infectious body fluid comes into contact
with skin, mucous membranes or
subcutaneous tissue (via percutaneous
injury (e.g., needlestick, tattoo, piercing).
Potable water intended for human
consumption, including private water
systems (e.g., wells, cisterns, small
distribution systems) and treated municipal
water.
Water from a pool, wading pool, water
spray park and whirlpool that has a permit
issued under Section 4 of the Swimming
Pool, Wading Pool and Water Spray Park
Regulation.
Water that is neither drinking water nor
swimming pool water (e.g., beach, lake,
stream).
Human Food
13. Population at Risk
Any substance, including ice, intended for
use in whole or in part for human
consumption, but does not include a drug,
medication or a regulated health related
product and, for the purpose of disease
reporting, does not include drinking water.
Pet Food
Any substance intended for use in whole or
in part for animal consumption (e.g., feeder
mice, pig ear treats).
Animal
Any living thing that is not human or plant
(e.g., insects, birds, fish and includes
domestic pets, livestock and wild animals).
Unknown
Indicate ‘Unknown’ when it is not possible
to determine how the disease was likely
acquired.
Other, specify
Indicate any other source of infection
identified or suspected.
Confirmed/Probable/Unknown – Check the appropriate box to indicate the status
of the source, as appropriate.
Indicate total population at risk:
(a) Total number of clients/residents at risk.
(b) Total number of staff at risk (for outbreaks occurring in a public site/facility).
(c) Sum total of (a) plus (b).
NB: This number may or may not be different from what was reported in the initial notification.
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Alberta TB Outbreak Reporting Form (AORF) – Definitions and Instructions
14. Final # ill
15. Final # of Cases
16. Final #
Hospitalized
17. Final # Fatal Cases
Adequately
Immunized* Prior
to Onset
19. # Colonized (ARO
Only)
20. Is this outbreak
part of a larger
national or
international
outbreak?
21. Date Final
Summary
Submitted to
Alberta Health
22. Outbreak
Summary /
Comments
18.
Not applicable in TB outbreak – leave blank
(a) Total number of laboratory confirmed cases (= positive culture).
(b) Total number of probable cases (= those that are Epi-linked to index case).
(c) Sum total of (a) plus (b) will equal TOTAL number of those treated.
Not applicable in TB outbreak – leave blank
Means contributed to/and or caused death. Taken from death certificate or
reviewed with a TB physician.
Not applicable in TB outbreak – leave blank
Not applicable in TB outbreak – leave blank
Check the appropriate box, ‘No’ or ‘Yes’, to indicate if the outbreak is part of a
larger national or international outbreak investigation. If Yes, specify the
Province(s), Territory(ies) or Country(ies) involved.
Enter the date when the final summary is reported to Alberta Health.
Provide a summary of any actions that may be relevant to the investigation of the
outbreak. Some examples include:
• A DESCRIPTION of the outbreak, including characteristics, unusual
presentations, patterns or scope (e.g. recent refugees, youth camp for children,
student at school, crossing zones).
• A LIST of KEY COMMUNICATIONS that were initiated such as with AH, CNPHI
alerts, zonal alerts to the public including media, physician notifications and
teleconferences with other zones/provincial/federal.
• A SUMMARY of PUBLIC HEALTH ACTIONS taken and other characteristics
such as severity of disease, source case drug resistant, source immigration
status environmental factors.
The level of detail of the summary corresponds to how unusual, unique or large the
outbreak is or its level of public health significance. More information may be
requested depending on the outbreak.
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