**RECREATIONAL WATER OUTBREAK IN *\[LOCATION\]***

Matched CONTROL number \|\_\_\| - \|\_\_\|\_\_\|\_\_\| - \|\_\_\|

CASE report number \|\_\_\| - \|\_\_\|\_\_\|\_\_\|

**NAME OF
INTERVIEWER\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**CONTROL: LAST NAME\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ FIRST
NAME\_\_\_\_\_\_\_\_\_\_\_\_\_**

# TELEPHONE NUMBER\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 

# DATE OF INTERVIEW\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|\_\_\|\_\_\|

**[Telephone Contact History]{.underline}**

Date (mm/dd) Time (am/pm) Outcome/Comment Initials

1.\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_

2.\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_

3.\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_

4.\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_

5.\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_

6.\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_

7.\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_

8.\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_

9.\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_

10.\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_

**OUTCOME CODES:**

01 = completed interview 08 = no eligible respondent

02 = refused interview 09 = language barrier

03 = no answer 10 = interview terminated within questionnaire

04 = busy tone 11 = physical/mental impairment

05 = non-working number 12 = answering machine

06 = fax machine 13 = setting up a better time

07 = business phone 99 = unknown

+-----------------------------------------------------------------------+
| \* TEXT IN REGULAR TYPE IS TO BE READ TO THE RESPONDENT.              |
|                                                                       |
| **\* TEXT IN BOLD IS AN INSTRUCTION FOR THE INTERVIEWER AND SHOULD    |
| NOT BE READ TO THE RESPONDENT.**                                      |
+-----------------------------------------------------------------------+

**ADULT CONTROL QUESTIONNAIRE**

**RECREATIONAL WATER OUTBREAK IN *\[LOCATION\]***

**If the control needs to be 18 years or older,**

**GO TO Q 1**

**If the control needs to be younger than 18 years but older than or
equal to 12 years of age,**

**GO TO 18**

##### If the control needs to be younger than 12 years of age, 

##### GO TO PEDIATRIC CONTROL QUESTIONNAIRE 

**[AGE 18 YEARS OR OLDER]{.underline}**

**\[TO THE PERSON ANSWERING THE PHONE IF AN ADULT, OTHERWISE ASK FOR AN
ADULT\]**

**1.** Hello, my name is \_\_\_\_\_\_\_\_\_. I\'m calling from the
\_\_\_\_\_\_\_\_ Health Department. We are investigating an outbreak of
diarrhea occurring among people who live in
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ (*location*). To determine what
factors may have played a role in causing illness among people living in
*(your/our)* community, we are conducting a survey of BOTH healthy and
sick individuals. We would like to speak to a member of your family who
is between the ages of \_\_\_\_\_\_ and *\_\_\_\_\_\_* *(state age
range)* about this outbreak and what may have influenced it.

**2.** Are there any people in this household between *\_\_\_\_\_* and
\_\_\_\_\_ years of age *(state age range)*?

> \_\_\_\_ YES
>
> \_\_\_\_ NO **\...** Sorry to have disturbed you. Thank you for your
> time.
>
> **END INTERVIEW**

**3.** Is there more than one person between \_\_\_\_ and \_\_\_\_\_
years of age *(state age range)* in this household?

\_\_\_\_ YES **(GO TO Q. 4)**.

\_\_\_\_ NO **(GO TO Q. 8).**

**4.** May I speak with the person between the ages of \_\_\_\_\_ and
\_\_\_\_\_ years of age *(stage age range)* who had the most recent
birthday?

\_\_\_\_ YES, already on phone

> **(IF THE CONTROL IS THE PERSON TO WHOM YOU HAVE BEEN SPEAKING, GO TO
> Q. 13)**

\_\_\_\_ YES, not on phone

> (**IF THE CONTROL IS SOMONE OTHER THAN THE PERSON TO WHOM YOU HAVE
> BEEN SPEAKING, GO TO Q. 12)**

\_\_\_\_ YES, but not home now **(GO TO Q. 5)**

\_\_\_\_ NO, not able to speak with him/her (**GO TO Q. 6)**

**5.** Is there another telephone number at which I could reach
(*him/her*)?

\_\_\_\_\_ YES

**(LIST ALTERNATE NUMBER
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_)**

Thank you very much for your assistance.

**END INTERVIEW**

\_\_\_\_\_ NO **(GO TO Q. 5a)**

**5a.** When would be a good time to call back to reach (*him/her*)?

**(LIST DAY AND TIME \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_)**

Thank you very much for your time

**END INTERVIEW**

**6**. Why am I not able to speak with *him/her*?

\_\_\_\_ Died **(GO TO Q.7)**

\_\_\_\_ Hospitalized **(GO TO Q. 7)**

\_\_\_\_ Mentally incapacitated **(GO TO Q. 7)**

\_\_\_\_ Doesn't speak English **(GO TO Q. 7)**

\_\_\_\_Other, specify\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ **(GO TO Q.
7)**

**7.** Sorry to have disturbed you. Thank you for your time.

**END INTERVIEW**

**8.** May I speak with the person who is between the ages of \_\_\_\_\_
and \_\_\_\_\_ years of age *(state age range)*?

\_\_\_\_ YES, already on phone

> **(IF THE CONTROL IS THE PERSON WITH WHOM YOU HAVE BEEN SPEAKING, GO
> TO Q. 13)**

\_\_\_\_ YES, not on phone

> (**IF THE CONTROL IS A PERSON OTHER THAN WITH WHOM YOU HAVE BEEN
> SPEAKING, GO TO Q. 12)**

\_\_\_\_ YES, but not home now **(GO TO Q. 9)**

\_\_\_\_ NO, not able to speak with him/her **(GO TO Q. 10)**

**9.** Is there another telephone number at which I could reach
*him/her*?

\_\_\_\_\_ YES

> **(LIST ALTERNATE NUMBER
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_)**
>
> Thank you very much for your assistance.
>
> **END INTERVIEW**

\_\_\_\_\_ NO **(GO TO Q. 9a)**

**9a.** When would be a good time to call back to reach *him/her?*

**(LIST DAY AND TIME \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_)**

Thank you very much for your time

**END INTERVIEW**

10. Why am I not able to speak with *him/her*?

\_\_\_\_ Died **(GO TO Q.11)**

\_\_\_\_ Hospitalized **(GO TO Q.11)**

\_\_\_\_ Mentally incapacitated **(GO TO Q. 11)**

\_\_\_\_ Doesn't speak English **(GO TO Q. 11)**

\_\_\_\_Other, list \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ **(GO TO Q.
11)**

11. Sorry to have disturbed you. Thank you for your time.

**END INTERVIEW**

**[TO THE CONTROL]{.underline}**

**12.** Hello, my name is \_\_\_\_\_\_\_\_\_. I\'m calling from the
\_\_\_\_\_\_\_\_ Health Department. We are investigating cases of
diarrhea occurring among people who live in
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ (location). To determine what
factors may have played a role in causing illness among people living in
*(your/our)* community, we are conducting a survey of BOTH healthy and
sick individuals.

**13.** We are working to find out why people in *(your/our)* community
are getting ill with the diarrheal illness called Cryptosporidiosis.
Therefore, we'd like to ask some questions about your health, your
contact with ill people, what food you ate, what you drank, and your
recent activities.

We know that you may not have been ill. However, to understand why
others have been ill we need to ask healthy people like you questions as
well. This will allow us to compare your answers to those given by ill
people to see what they did differently. Your participation in these
efforts will greatly improve our understanding of this illness in
*(your/our)* community.

This should take approximately \_\_\_\_\_\_\_\_ minutes *(adjust time
for number of questions to be asked).* Your participation is voluntary
and all information you give will be kept confidential to the extent
legally possible. Some of the questions may be sensitive. You may refuse
to answer any question at any time. Neither your name nor any
identifying information will appear on any report. We will be happy to
answer all your questions at the end of the interview. A final report
will be available at the health department.

Do you agree to participate in the survey?

\_\_\_\_ NO, **END INTERVIEW**... Sorry to have disturbed you. Thank you
for your time.

\_\_\_\_ I DON'T HAVE TIME NOW, **END INTERVIEW (GO TO Q. 14)**

> \_\_\_\_ YES, **CONTINUE INTERVIEW**... It would be helpful if you had
> a calendar in front of you, as we will be discussing specific dates.
> Would you like a minute to get one? (**GO TO Q. 13a.)**

**13a.** May we begin now?

\_\_\_\_ YES, **(GO TO Q. 15)**

**\_\_\_\_** NO, **(GO TO Q. 14)**

**14.** Your participation in this study is very important. We are
trying to determine why people in the community are getting sick. May I
schedule a time to talk that would be more convenient for you?

> \_\_\_\_\_ YES
>
> **(LIST DATE AND TIME
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ).**
>
> Thank you very much for your time. We will call you again at the
> arranged time.
>
> **END INTERVIEW**

\_\_\_\_\_ NO... Sorry to have disturbed you. **END INTERVIEW**

15. May I have your first name?
    \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ (*control's first
    name)*

16. Before we continue, between \_\_\_\_\_\_\_\_\_\_\_\_\_\_
    *(MM/DD/YY)* and *\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ (MM/DD/YY) (match
    dates to case-patient)*, did you have any amount of diarrhea
    (meaning loose or watery stools or bowel movements)?

> \_\_\_\_YES .......1 **(GO TO Q. 17)**
>
> **\_\_\_\_** NO ........2 **(GO TO SECTION B, Q.B-1)...Note, there is
> NO Section A.**
>
> **\_\_\_\_** UNKOWN ..........77 **(GO TO Q. 17)**
>
> \_\_\_\_ REFUSED ..........99 **(GO TO Q. 17)**

**17.** Thank you very much for your information. For this part of the
study, we need to talk to people who have had NO diarrhea between
\_\_\_\_\_\_\_\_\_\_ *(MM/DD/YY)* and *\_\_\_\_\_\_\_\_\_\_\_\_
(MM/DD/YY)* *(match to case-patient)*. Since you have had diarrhea, you
are not eligible. We appreciate your time.

**END INTERVIEW**

**[YOUNGER THAN 18 YEARS BUT OLDER THAN OR EQUAL TO 12 YEARS OF
AGE]{.underline}**

**\[TO THE PERSON ANSWERING THE PHONE IF AN ADULT, OTHERWISE ASK FOR AN
ADULT\]**

**18.** Hello, my name is \_\_\_\_\_\_\_\_\_. I\'m calling from the
\_\_\_\_\_\_\_\_ Health Department. We are investigating an outbreak of
diarrhea occurring among people who live in
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ (*location)*. To determine what
factors may have played a role in causing illness among people living in
*(your/our)* community, we are conducting a survey of BOTH healthy and
sick individuals. We would like to speak to a member of your family who
is between the ages of \_\_\_\_\_\_ and *\_\_\_\_\_\_* *(state age
range)* about this outbreak and what may have influenced it.

**19.** Are there any people in this household between *\_\_\_\_\_* and
\_\_\_\_\_ years of age *(state age range)*?

> \_\_\_\_ YES
>
> \_\_\_\_ NO **\...** Sorry to have disturbed you. Thank you for your
> time.
>
> **END INTERVIEW**

**20.** Is there more than one child between \_\_\_\_ and \_\_\_\_\_
years of age?

\_\_\_\_ YES **(GO TO Q. 20a)**

\_\_\_\_ NO **(GO TO Q. 21)**

> **20a.** We would like to ask some questions of the child between
> *\_\_\_\_\_* and *\_\_\_\_\_\_* years of age *(state age range)* who
> had the most recent birthday. What is (*his/her*) first name?

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *(control's first
name)* **(GO TO Q. 22)**

**21.** We would like to ask some questions of this child. What is
*(his/her)* first name?

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *(control's first
name)* **(GO TO Q. 22)**

**22.** Are you the parent or guardian for (*control's first name)
\_\_\_\_\_\_\_\_\_\_\_*\_\_\_\_\_\_\_\_\_\_\_\_*\_\_\_\_*?

\_\_\_\_ YES **(GO TO Q. 24)**

\_\_\_\_ NO **(GO TO Q. 22a)**

> **22a. If NO**, Could I speak with the parent or guardian of
> *(control's first name)*\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_?
>
> \_\_\_\_ YES **(GO TO Q. 23)**
>
> **\_\_\_\_** YES, but not home now **(GO TO Q. 29)**
>
> **\_\_\_\_** NO, not able to speak to him/her or NOT AVAILABLE **(GO
> TO Q. 26)**

**\[TO THE PARENT OR GUARDIAN \-\-\-- ADULT PERMISSION\]**

**23**. Hello, my name is \_\_\_\_\_\_\_\_\_. I\'m calling from the
\_\_\_\_\_\_\_\_ Health Department. We are investigating cases of
diarrhea occurring among people who live in
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ (*location)* to determine what
factors may have played a role in causing illness among people living in
(*your/our*) community, we are conducting a survey of BOTH healthy and
sick individuals.

**24.** We are working to find out why people in *(your/our)* community
are getting ill with the diarrheal illness called Cryptosporidiosis.
Therefore, we'd like to ask \_\_\_\_\_\_\_\_\_\_\_\_\_\_ *(control's
first name)* some questions about (*his/her*) health, (*his/her*)
contact with ill people, what food (*he/she*) ate, what (*he/she*)
drank, and (*his/her*) recent activities.

We know that *\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ (control's first name)* may
not have been ill. However, to understand why others have been ill we
need to ask healthy people like (*him/her*) questions as well. This will
allow us to compare (*his/her*) answers to those given by ill people to
see what they did differently. Your child's participation in these
efforts will greatly improve our understanding of this illness in
(*your/our*) community.

This should take approximately \_\_\_\_\_\_\_\_ minutes *(adjust time
for number of questions to be asked).* Your child's participation is
voluntary and all information (*he/she*) gives will be kept confidential
to the extent legally possible. Some of the questions may be sensitive.
Your child may refuse to answer any question at any time. Neither your
child's name nor any identifying information will appear on any report.
We will be happy to answer all your questions at the end of the
interview. A final report will be available at the health department.

Do you agree to allow *\_\_\_\_\_\_\_\_\_\_\_\_\_\_ (control's first
name)* to participate in this survey?

\_\_\_\_ NO, **END INTERVIEW** ... Sorry to have disturbed you. Thank
you for your time.

\_\_\_\_ NO, WE DON'T HAVE TIME NOW, **END INTERVIEW (GO TO Q. 26)**

\_\_\_\_ YES **(GO TO Q. 25)**

**25.** May I have permission to speak with
*\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ (control's first name)?*

\_\_\_\_ YES **(GO TO Q. 27)**

\_\_\_\_ NO **(GO TO Q. 26)**

**26.** Your family's participation in this study is very important. We
are trying to determine why people in the community are getting sick.
May I schedule a time to talk with *him/her* that would be more
convenient?

> \_\_\_\_ YES
>
> **(LIST DATE AND TIME
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_).**
>
> Thank you very much for your time. We will call you again at the
> arranged time.
>
> **END INTERVIEW**

\_\_\_\_ NO or DON'T KNOW .... Sorry to have disturbed you.

> **END INTERVIEW**

**27.** Before we continue, between \_\_\_\_\_\_\_\_\_\_\_\_\_\_
*(MM/DD/YY)* and *\_\_\_\_\_\_\_\_\_\_\_\_\_ (MM/DD/YY) (match dates to
case-patient)*, did \_\_\_\_\_\_\_\_\_\_\_\_\_\_ *(control's first
name)* have any amount of diarrhea (meaning loose or watery stools or
bowel movements)?

> \_\_\_\_YES ............\.......1 **(GO TO Q. 27a)**
>
> **\_\_\_\_** NO ...............\.....2 **(GO TO Q. 28)**
>
> **\_\_\_\_** UNKNOWN ......77 **(GO TO Q. 28)**
>
> \_\_\_\_ REFUSED .........99 **(GO TO Q. 28)**
>
> **27a.** Thank you very much for your information. For this part of
> the study, we need to talk to people who have had NO diarrhea between
> \_\_\_\_\_\_\_\_\_\_ *(MM/DD/YY)* and *\_\_\_\_\_\_\_\_\_\_\_\_
> (MM/DD/YY)* *(match to case-patient)*. Since your child had diarrhea,
> *(he/she)* is not eligible. We appreciate your time. **END INTERVIEW**

**28.** May I now speak with \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *(control's
first name)?*

\_\_\_\_ YES **(GO TO Q. 32)**

**\_\_\_\_** YES, but not home **(GO TO Q. 29)**

\_\_\_\_ YES, but not able **(GO TO 30)**

**29**. Is there another telephone number at which I could reach
\_\_\_\_\_\_\_\_\_\_\_\_ *(Parent/Guardian or child's name)?*

> \_\_\_\_ YES
>
> **(LIST ALTERNATE NUMBER
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_).**
>
> Thank you very much for your assistance.
>
> **END INTERVIEW**

**\_\_\_\_** NO **(GO TO Q. 29a)**

> **29a.** When would be a good time to call back to reach
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *(parent/guardian or child's name)*?
>
> **(LIST DAY AND TIME \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_).** Thank you
> very much for your time. **END INTERVIEW**

**30**. Why am I not able to speak with
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_*(Parent/Guardian or child's name)*?

\_\_\_\_ Died **(GO TO Q. 31)**

\_\_\_\_ Hospitalized **(GO TO Q.31)**

\_\_\_\_ Mentally incapacitated **(GO TO Q. 31)**

\_\_\_\_ Doesn't speak English **(GO TO Q.31)**

\_\_\_\_Other, specify \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ **(GO TO Q.
31)**

**31.** Sorry to have disturbed you. Thank you for your time.

**END INTERVIEW**

**\[TO CONTROL \-\-- 12-17 YEAR OLD ASSENT\]**

**32.** Hello, my name is \_\_\_\_\_\_\_\_\_. I\'m calling from the
\_\_\_\_\_\_\_\_ Health Department. We are investigating cases of
diarrhea occurring among people who live in
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ (*location*). To determine what
factors may have played a role in causing illness among people living in
(*your/our*) community, we are conducting a survey of BOTH healthy and
sick individuals.

We are working to find out why people in (*your/our*) community are
getting ill with the diarrheal illness called Cryptosporidiosis.
Therefore, we'd like to ask some questions about your health, your
contact with ill people, what food you ate, what you drank, and your
recent activities.

We know that you may not have been ill. However, to understand why
others have been ill we need to ask healthy people like you questions as
well. This will allow us to compare your answers to those given by ill
people to see what they did differently. Your participation in these
efforts will greatly improve our understanding of this illness in
(*your/our*) community.

This should take approximately \_\_\_\_\_\_\_\_ minutes *(adjust time
for number of questions to be asked).* Your participation is voluntary
and all information you give will be kept confidential to the extent
legally possible. Some of the questions may be sensitive. You may refuse
to answer any question at any time. Neither your name nor any
identifying information will appear on any report. We will be happy to
answer all your questions at the end of the interview. A final report
will be available at the health department.

Do you agree to participate in the survey?

\_\_\_\_ NO, **END INTERVIEW**... Sorry to have disturbed you. Thank you
for your time.

\_\_\_\_ I DON'T HAVE TIME NOW, **END INTERVIEW (GO TO Q. 33)**

> \_\_\_\_ YES, **CONTINUE INTERVIEW**... It would be helpful if you had
> a calendar in front of you, as we will be discussing specific dates.
> Would you like a minute to get one? (**GO TO Q. 32a.)**

**32a.** May we begin now?

> \_\_\_\_ YES **(GO TO Q. 34)** Please have your parent or guardian
> present to help you with the questions

**\_\_\_\_** NO **(GO TO Q. 33)**

**33.** Your participation in this study is very important. We are
trying to determine why people in (*your/our*) community are getting
sick. May I schedule a time to talk that would be more convenient for
you?

> \_\_\_\_\_ YES
>
> **(LIST DATE AND TIME \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
> ).**
>
> Thank you very much for your time. We will call you again at the
> arranged time.

**END INTERVIEW**

\_\_\_\_\_ NO... Sorry to have disturbed you. **END INTERVIEW**

34. Before we continue, between \_\_\_\_\_\_\_\_\_\_\_\_\_\_
    *(MM/DD/YY)* and *\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ (MM/DD/YY) (match
    dates to case-patient)*, did you have any amount of diarrhea
    (meaning loose or watery stools or bowel movements)?

> \_\_\_\_YES .......1 **(GO TO Q. 34a)**
>
> **\_\_\_\_** NO ........2 **(GO TO SECTION B, Q.B-1)...Note, there is
> NO Section A.**
>
> **\_\_\_\_** UNKNOWN .......77 **(GO TO Q. 34a)**
>
> \_\_\_\_ REFUSED ..........99 **(GO TO Q. 34a)**
>
> **34a.** Thank you very much for your information. For this part of
> the study, we need to talk to people who have had NO diarrhea between
> \_\_\_\_\_\_\_\_\_\_ *(MM/DD/YY)* and *\_\_\_\_\_\_\_\_\_\_\_\_
> (MM/DD/YY)* *(match to case-patient)*. Since you had diarrhea, you are
> not eligible. We appreciate your time.

**END INTERVIEW** **(GO TO Q. 34b)**

> **34b.** May I please speak with your (*parent/guardian*) again?

**PROVIDE EXPLANATION TO PARENT:**

> Thank you very much for your information. For this part of the study,
> we need to talk to people who have had NO diarrhea between
> \_\_\_\_\_\_\_\_\_\_ *(MM/DD/YY)* and *\_\_\_\_\_\_\_\_\_\_\_\_
> (MM/DD/YY)* *(match to case-patient)*. Since
> *\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ (control's first name)* reported
> having diarrhea during that time, (*he/she*) is not eligible. We
> appreciate your time.

**END INTERVIEW**

**[SECTION A.]{.underline} CLINICAL INFORMATION**

\*This section is not applicable to the control interview. Please skip
to SECTION B.\*

**[SECTION B.]{.underline} PERSON-TO-PERSON CONTACT AND CHILDCARE
INFORMATION**

**read:** NOW I WOULD LIKE TO ASK ABOUT THE ADULTS (18 YEARS OF AGE OR
OLDER) IN YOUR HOUSE.

**B1.** What are the adult's sexes and did they have diarrhea during the
2 week period from **(match to case-patient's A2)**
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
to
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|?

+--------------------+------+--------+--------+--------+--------+------+
| **ADULT**          | What |        | Had    |        |        |      |
|                    | sex? |        | dia    |        |        |      |
|                    |      |        | rrhea? |        |        |      |
|                    | **(1 |        |        |        |        |      |
|                    | =MAL |        | **YES  |        |        |      |
|                    | E,** |        | NO UNK |        |        |      |
|                    |      |        | REF**  |        |        |      |
|                    | *    |        |        |        |        |      |
|                    | *2=F |        |        |        |        |      |
|                    | EMAL |        |        |        |        |      |
|                    | E)** |        |        |        |        |      |
+--------------------+------+--------+--------+--------+--------+------+
| **ADULT 1**        | 1    | 2      | 1      | 2      | 77     | 99   |
+--------------------+------+--------+--------+--------+--------+------+
| **ADULT 2**        | 1    | 2      | 1      | 2      | 77     | 99   |
+--------------------+------+--------+--------+--------+--------+------+
| **ADULT 3**        | 1    | 2      | 1      | 2      | 77     | 99   |
+--------------------+------+--------+--------+--------+--------+------+
| **ADULT 4**        | 1    | 2      | 1      | 2      | 77     | 99   |
+--------------------+------+--------+--------+--------+--------+------+
| **ADULT 5**        | 1    | 2      | 1      | 2      | 77     | 99   |
+--------------------+------+--------+--------+--------+--------+------+
| **ADULT 6**        | 1    | 2      | 1      | 2      | 77     | 99   |
+--------------------+------+--------+--------+--------+--------+------+

**read:** Now I would now like to ask you a few questions about your
contact with children younger than 18 years of age and with persons with
diarrhea during the 2 weeks from **(match to case-patient's A2)**
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
TO
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|

**B2.** Do you have children (younger than 18 years old) living in your
home?

**IF INTERVIEWING AN ADOLESCENT:** Do you have children (younger than 18
years old) -- ***[other than yourself]{.underline}*** - living in your
home?

> YES\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....
> 1
>
> NO\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....
> 2 **(GO TO B10)**
>
> UNKNOWN\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....
> 77 **(GO TO B10)**
>
> REFUSED\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.........\...
> 99 **(GO TO B10)**
>
> **B3. IF YES TO B2,** How many children live in your house?
>
> **IF INTERVIEWING AN ADOLESCENT:** How many children - ***[other than
> yourself]{.underline}*** **--** live in your house?
>
> **NUMBER OF CHILDREN** \|\_\_\|\_\_\|
>
> UNKNOWN 77
>
> REFUSED 99
>
> **B4. IF YES TO B2,** What are the children's age(s) in years, their
> sexes, and did they have diarrhea in the 2 weeks from **(match to
> case-patient's A2)**
> \|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
> to
> \|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|?
>
> **IF INTERVIEWING AN ADOLESCENT: *[Other than
> yourself]{.underline}***, what are the children's age(s) in years,
> their sexes and did they have diarrhea in the 2 weeks from **(match to
> case-patient's A2)**
> \|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
> to
> \|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|?

+---------+---------+---------+----+-----+----+-----+-----+--------+
| **      | AGE?    | Does    | Wh |     | H  |     |     |        |
| CHILD** |         | the     | at |     | ad |     |     |        |
|         | **(I    | child   | se |     | di |     |     |        |
|         | NDICATE | wear    | x? |     | ar |     |     |        |
|         | YRS OR  | d       |    |     | rh |     |     |        |
|         | MO      | iapers? | ** |     | ea |     |     |        |
|         | NTHS)** |         | (1 |     | in |     |     |        |
|         |         | **Y N** | =M |     | t  |     |     |        |
|         |         |         | AL |     | he |     |     |        |
|         |         |         | E, |     | *  |     |     |        |
|         |         |         | ** |     | ** |     |     |        |
|         |         |         |    |     | [2 |     |     |        |
|         |         |         | *  |     | w  |     |     |        |
|         |         |         | *2 |     | ee |     |     |        |
|         |         |         | =F |     | ks |     |     |        |
|         |         |         | EM |     | ]{ |     |     |        |
|         |         |         | AL |     | .u |     |     |        |
|         |         |         | E) |     | nd |     |     |        |
|         |         |         | ** |     | er |     |     |        |
|         |         |         |    |     | li |     |     |        |
|         |         |         |    |     | ne |     |     |        |
|         |         |         |    |     | }* |     |     |        |
|         |         |         |    |     | ** |     |     |        |
|         |         |         |    |     | fr |     |     |        |
|         |         |         |    |     | om |     |     |        |
|         |         |         |    |     |    |     |     |        |
|         |         |         |    |     | \| |     |     |        |
|         |         |         |    |     | \_ |     |     |        |
|         |         |         |    |     | \_ |     |     |        |
|         |         |         |    |     | \| |     |     |        |
|         |         |         |    |     | \_ |     |     |        |
|         |         |         |    |     | \_ |     |     |        |
|         |         |         |    |     | \| |     |     |        |
|         |         |         |    |     | -\ |     |     |        |
|         |         |         |    |     | |\ |     |     |        |
|         |         |         |    |     | _\ |     |     |        |
|         |         |         |    |     | _\ |     |     |        |
|         |         |         |    |     | |\ |     |     |        |
|         |         |         |    |     | _\ |     |     |        |
|         |         |         |    |     | _\ |     |     |        |
|         |         |         |    |     | |- |     |     |        |
|         |         |         |    |     | \| |     |     |        |
|         |         |         |    |     | [\ |     |     |        |
|         |         |         |    |     | _\ |     |     |        |
|         |         |         |    |     | _] |     |     |        |
|         |         |         |    |     | {. |     |     |        |
|         |         |         |    |     | un |     |     |        |
|         |         |         |    |     | de |     |     |        |
|         |         |         |    |     | rl |     |     |        |
|         |         |         |    |     | in |     |     |        |
|         |         |         |    |     | e} |     |     |        |
|         |         |         |    |     | \| |     |     |        |
|         |         |         |    |     | [\ |     |     |        |
|         |         |         |    |     | _\ |     |     |        |
|         |         |         |    |     | _] |     |     |        |
|         |         |         |    |     | {. |     |     |        |
|         |         |         |    |     | un |     |     |        |
|         |         |         |    |     | de |     |     |        |
|         |         |         |    |     | rl |     |     |        |
|         |         |         |    |     | in |     |     |        |
|         |         |         |    |     | e} |     |     |        |
|         |         |         |    |     | \| |     |     |        |
|         |         |         |    |     | to |     |     |        |
|         |         |         |    |     | \| |     |     |        |
|         |         |         |    |     | \_ |     |     |        |
|         |         |         |    |     | \_ |     |     |        |
|         |         |         |    |     | \| |     |     |        |
|         |         |         |    |     | \_ |     |     |        |
|         |         |         |    |     | \_ |     |     |        |
|         |         |         |    |     | \| |     |     |        |
|         |         |         |    |     | -\ |     |     |        |
|         |         |         |    |     | |\ |     |     |        |
|         |         |         |    |     | _\ |     |     |        |
|         |         |         |    |     | _\ |     |     |        |
|         |         |         |    |     | |\ |     |     |        |
|         |         |         |    |     | _\ |     |     |        |
|         |         |         |    |     | _\ |     |     |        |
|         |         |         |    |     | |- |     |     |        |
|         |         |         |    |     | \| |     |     |        |
|         |         |         |    |     | [\ |     |     |        |
|         |         |         |    |     | _\ |     |     |        |
|         |         |         |    |     | _] |     |     |        |
|         |         |         |    |     | {. |     |     |        |
|         |         |         |    |     | un |     |     |        |
|         |         |         |    |     | de |     |     |        |
|         |         |         |    |     | rl |     |     |        |
|         |         |         |    |     | in |     |     |        |
|         |         |         |    |     | e} |     |     |        |
|         |         |         |    |     | \| |     |     |        |
|         |         |         |    |     | [\ |     |     |        |
|         |         |         |    |     | _\ |     |     |        |
|         |         |         |    |     | _] |     |     |        |
|         |         |         |    |     | {. |     |     |        |
|         |         |         |    |     | un |     |     |        |
|         |         |         |    |     | de |     |     |        |
|         |         |         |    |     | rl |     |     |        |
|         |         |         |    |     | in |     |     |        |
|         |         |         |    |     | e} |     |     |        |
|         |         |         |    |     | \| |     |     |        |
|         |         |         |    |     |    |     |     |        |
|         |         |         |    |     | *  |     |     |        |
|         |         |         |    |     | *Y |     |     |        |
|         |         |         |    |     | ES |     |     |        |
|         |         |         |    |     | NO |     |     |        |
|         |         |         |    |     | U  |     |     |        |
|         |         |         |    |     | NK |     |     |        |
|         |         |         |    |     | R  |     |     |        |
|         |         |         |    |     | EF |     |     |        |
|         |         |         |    |     | ** |     |     |        |
+---------+---------+---------+----+-----+----+-----+-----+--------+
| **CHILD |         | 1 2     | 1  | 2   | 1  | 2   | 77  | 99     |
| 1**     |         |         |    |     |    |     |     |        |
+---------+---------+---------+----+-----+----+-----+-----+--------+
| **CHILD |         | 1 2     | 1  | 2   | 1  | 2   | 77  | 99     |
| 2**     |         |         |    |     |    |     |     |        |
+---------+---------+---------+----+-----+----+-----+-----+--------+
| **CHILD |         | 1 2     | 1  | 2   | 1  | 2   | 77  | 99     |
| 3**     |         |         |    |     |    |     |     |        |
+---------+---------+---------+----+-----+----+-----+-----+--------+
| **CHILD |         | 1 2     | 1  | 2   | 1  | 2   | 77  | 99     |
| 4**     |         |         |    |     |    |     |     |        |
+---------+---------+---------+----+-----+----+-----+-----+--------+
| **CHILD |         | 1 2     | 1  | 2   | 1  | 2   | 77  | 99     |
| 5**     |         |         |    |     |    |     |     |        |
+---------+---------+---------+----+-----+----+-----+-----+--------+
| **CHILD |         | 1 2     | 1  | 2   | 1  | 2   | 77  | 99     |
| 6**     |         |         |    |     |    |     |     |        |
+---------+---------+---------+----+-----+----+-----+-----+--------+
| **CHILD |         | 1 2     | 1  | 2   | 1  | 2   | 77  | 99     |
| 7**     |         |         |    |     |    |     |     |        |
+---------+---------+---------+----+-----+----+-----+-----+--------+
| **CHILD |         | 1 2     | 1  | 2   | 1  | 2   | 77  | 99     |
| 8**     |         |         |    |     |    |     |     |        |
+---------+---------+---------+----+-----+----+-----+-----+--------+
| **CHILD |         | 1 2     | 1  | 2   | 1  | 2   | 77  | 99     |
| 9**     |         |         |    |     |    |     |     |        |
+---------+---------+---------+----+-----+----+-----+-----+--------+
| **CHILD |         | 1 2     | 1  | 2   | 1  | 2   | 77  | 99     |
| 10**    |         |         |    |     |    |     |     |        |
+---------+---------+---------+----+-----+----+-----+-----+--------+
| **CHILD |         | 1 2     | 1  | 2   | 1  | 2   | 77  | 99     |
| 11**    |         |         |    |     |    |     |     |        |
+---------+---------+---------+----+-----+----+-----+-----+--------+
| **CHILD |         | 1 2     | 1  | 2   | 1  | 2   | 77  | 99     |
| 12**    |         |         |    |     |    |     |     |        |
+---------+---------+---------+----+-----+----+-----+-----+--------+
| **CHILD |         | 1 2     | 1  | 2   | 1  | 2   | 77  | 99     |
| 13**    |         |         |    |     |    |     |     |        |
+---------+---------+---------+----+-----+----+-----+-----+--------+
| **CHILD |         | 1 2     | 1  | 2   | 1  | 2   | 77  | 99     |
| 14**    |         |         |    |     |    |     |     |        |
+---------+---------+---------+----+-----+----+-----+-----+--------+
| **CHILD |         | 1 2     | 1  | 2   | 1  | 2   | 77  | 99     |
| 15**    |         |         |    |     |    |     |     |        |
+---------+---------+---------+----+-----+----+-----+-----+--------+

> **B5. IF YES TO B2,** Were any children in your household in childcare
> outside of your home at any time during the 2 weeks from **(match to
> case-patient's A2)**
> \|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
> to
> \|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|?
>
> YES\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\........\.....
> 1
>
> NO\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.......\....
> 2 **(GO TO B8)**
>
> UNKNOWN\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...
> 77 **(GO TO B8)**
>
> REFUSED\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.........\....
> 99 **(GO TO B8)**
>
> **B6. IF YES TO B5,** Did *(he/she/they)* participate in any
> water-related activities, such as swimming, wading, or water table
> play at *(his/her)* childcare outside of your home?
>
> YES\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....
> 1
>
> NO\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....
> 2
>
> UNKNOWN\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....
> 77
>
> REFUSED\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\............
> 99
>
> **B7. IF YES TO B5,** Were any children at your child's childcare
> location ***[in diapers]{.underline}***?
>
> YES\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....
> 1
>
> > NO\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....
> > 2
>
> > UNKNOWN\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....
> > 77
>
> REFUSED\...\...\...\...\...\...\...\...\...\...\...\...\...\.........\...
> 99
>
> **B8. IF YES TO B2,** Were any children in your household in a ***day
> camp*** during the 2 weeks from **(match to case-patient's A2)**
> \|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
> to
> \|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|?
> By a day camp I mean a center with activities where children spend all
> or part of the day, often during the summer months when school is out.
> By comparison, a day care center is often for toddlers.
>
> YES\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....1
>
> NO\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....2
> **(GO TO B10)**
>
> UNKNOWN.................................\...77 **(GO TO B10)**
> UNKNOWN\...\...\...\...\...\...\...\...\...\...\...\...\...\.....77
> **(GO TO B10)**
>
> REFUSED\...\...\...\...\...\...\...\...\...\......\...\...\...\...\....99
> **(GO TO B10)**
>
> **B9. IF YES TO B8,** Did *(he/she/they)* participate in any
> water-related activities, such as swimming, wading, or water tables at
> his or her ***[day camp]{.underline}***?
>
> YES\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....
> 1
>
> NO\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....
> 2
>
> UNKNOWN\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...
> 77
>
> REFUSED\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\........\....
> 99

**B10.** During the 2 weeks from **(match to case-patient's A2**)
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
to
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|,
did you ***[provide]{.underline}*** childcare in any of the following
childcare settings? **\[Read THE LIST. cIRCLE ALL THAT APPLY\]**

+------------------------------+------+-------+----------+-----------+
| **SETTING**                  | **Y  | *     | **U      | **        |
|                              | ES** | *NO** | NKNOWN** | REFUSED** |
+------------------------------+------+-------+----------+-----------+
| a\. Out-of-home childcare    | 1    | 2     | 77       | 99        |
| center                       |      |       |          |           |
+------------------------------+------+-------+----------+-----------+
| b\. In-home childcare center | 1    | 2     | 77       | 99        |
+------------------------------+------+-------+----------+-----------+
| c\. Out-of-home babysitter   | 1    | 2     | 77       | 99        |
+------------------------------+------+-------+----------+-----------+
| d\. In-home babysitter       | 1    | 2     | 77       | 99        |
+------------------------------+------+-------+----------+-----------+
| e\. Other                    | 1    | 2     | 77       | 99        |
|                              |      |       |          |           |
| f\. Specify:                 |      |       |          |           |
+------------------------------+------+-------+----------+-----------+

**B11.** During the 2 weeks from **(match to case-patient's A2)**
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
to
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|,
did you have contact with any children in diapers?

> YES\...\...\...\...\...\...\...\...\...\...\...\...\...\... 1
>
> NO\...\...\...\...\...\...\...\...\...\...\...\...\...\... 2 **(GO TO
> B13)**
>
> UNKNOWN\...\...\...\...\...\...\...\...\...\.... 77 **(GO TO B13)**
>
> REFUSED\...\...\...\...\...\...\...\...\... 99 **(GO TO B13)**
>
> **B12. If yes TO B11,** During the 2 weeks from **(match to
> case-patient's A2)**
> \|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
> to
> \|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|,
> did ***[you]{.underline}*** change any diapers?
>
> YES\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....
> 1
>
> NO\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...
> 2
>
> UNKNOWN\...\...\...\...\...\...\...\...\...\...\...\...\...77
>
> REFUSED\...\...\...\...\...\...\...\...\...\...........\... 99

**B13.** During the 2 weeks from **(match to case-patient's A2)**
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
to
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|,
did you come in contact with anyone who had diarrhea?

> YES\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....
> 1
>
> NO\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...
> 2 **(GO TO B16)**
>
> UNKNOWN\...\...\...\...\...\...\...\...\...\...\...\...\...77 **(GO TO
> B16)**
>
> REFUSED\...\...\...\...\...\...\...\...\...\...........\... 99 **(GO
> TO B16)**
>
> **B14. IF YES TO B13,** Did they include:
>
> **\[Read THE LIST. cIRCLE ALL THAT APPLY\]**

  ------------------------------ --------- -------- ------------- -------------
                                 **YES**   **NO**   **UNKNOWN**   **REFUSED**

  a\. Children [\<]{.underline}  1         2        99            77
  3 years of age                                                  

  b\. Children 4 to \<13 years   1         2        99            77
  of age                                                          

  c\. Teenagers                  1         2        99            77
  [\>]{.underline}13 to \<18                                      
  years                                                           

  d\. Adults 18 years or older   1         2        99            77
  ------------------------------ --------- -------- ------------- -------------

> **B15. IF YES TO B13,** Did you provide direct care to a person with
> diarrhea?
>
> YES\...\...\...\...\...\...\...\...\...\...\...\...\...\...\... 1
>
> NO\...\...\...\...\...\...\...\...\...\...\...\...\...\...\..... 2
>
> UNKNOWN\...\...\...\...\...\...\...\...\...\...\....77
>
> REFUSED\...\...\...\...\...\...\...\...\...\......... 99

**B16.** Are you aware of anyone in your immediate household or social
group that had diarrhea from **(match to case-patient's ILLNESS DATES)**
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
to
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|?
**NOTE: THIS INTERVAL IS *[NOT THE SAME]{.underline}* AS PREVIOUS
INTERVALS.**

**THIS INTERVAL IS FROM THE DATE OF ONSET OF DIARRHEA IN THE
CASE-PATIENT (MATCH TO CASE-PATIENT'S A1 OR A2) UNTIL
*[EITHER]{.underline}* (1) CASE-PATIENT'S A8, OR (2) DATE OF
CASE-PATIENT'S INTERVIEW**

> YES.....................................1
>
> NO......................................2
>
> UNKNOWN........................\...77
>
> REFUSED.............................99

**B17.** Are you aware of anyone in your immediate household or social
group that had diarrhea during the 2 weeks from **(match to
case-patient's 2 weeks after illness)**
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
to
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|?

YES.....................................1

NO......................................2

UNKNOWN........................\...77

REFUSED.............................99

**B18.** Did you prepare food for others from
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
to
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|?

**NOTE: THIS INTERVAL IS *[NOT THE SAME]{.underline}* AS PREVIOUS
INTERVALS.**

**THIS INTERVAL IS FROM THE DATE OF ONSET OF DIARRHEA IN THE
CASE-PATIENT (MATCH TO CASE-PATIENT'S A1/A2) UNTIL
*[EITHER]{.underline}* (1) CASE-PATIENT'S A8, OR (2) DATE OF
CASE-PATIENT'S INTERVIEW**

YES....................................1

NO.....................................2

UNKNOWN..........................77

REFUSED............................99

**[SECTION C]{.underline}. DIETARY EXPOSURES**

**read:** I WOULD LIKE TO TALK ABOUT YOUR DIET DURING THE ***[2
WEEKS]{.underline}*** **(match to case-patient's A2)** FROM
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
TO
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|.

**C1.** During the 2 weeks from **(match to case-patient's A2)**
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
TO
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|,
did you eat any of the following food items? **\[READ THE LIST. ENTER
ALL THAT APPLY\]**

+-------------------------------------+------+------+--------+--------+
| **FOOD**                            | *    | *    | **U**  | **R**  |
|                                     | *Y** | *N** |        |        |
+-------------------------------------+------+------+--------+--------+
| **a.** Lettuce or garden salad      | 1    | 2    | 77     | 99     |
+-------------------------------------+------+------+--------+--------+
| **b.** Cold cuts, chicken salad,    | 1    | 2    | 77     | 99     |
| egg salad, or tuna salad            |      |      |        |        |
+-------------------------------------+------+------+--------+--------+
| **c.** Other cold salads (such as   | 1    | 2    | 77     | 99     |
|                                     |      |      |        |        |
| coleslaw, potato salad, or pasta    |      |      |        |        |
| salad)                              |      |      |        |        |
+-------------------------------------+------+------+--------+--------+
| **d.** Raw vegetables (such as      | 1    | 2    | 77     | 99     |
|                                     |      |      |        |        |
| carrots, tomatoes, cucumbers, green |      |      |        |        |
| onions)                             |      |      |        |        |
+-------------------------------------+------+------+--------+--------+
| **e.** Raw berries (such as         | 1    | 2    | 77     | 99     |
| strawberries and raspberries)       |      |      |        |        |
+-------------------------------------+------+------+--------+--------+
| **f.** Raw fruits                   | 1    | 2    | 77     | 99     |
| ***[with]{.underline}*** skin/peel  |      |      |        |        |
| (such as melons, apples)            |      |      |        |        |
+-------------------------------------+------+------+--------+--------+
| **g.** Cider or juice               | 1    | 2    | 77     | 99     |
+-------------------------------------+------+------+--------+--------+
| **h.** Raw shellfish                | 1    | 2    | 77     | 99     |
+-------------------------------------+------+------+--------+--------+
| **i.** Cooked shellfish             | 1    | 2    | 77     | 99     |
+-------------------------------------+------+------+--------+--------+

**C2.** During the 2 weeks from **(match to case-patient's A2)**
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
TO
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|,
did you consume any of the following ***[unpasteurized]{.underline}***
foods or drinks? This may include products supplied from health food
stores, local farms, or imported from other countries.

**\[Read THE LIST. ENTER ALL THAT APPLY\]**

+--------------------------+------+-------+-------------+-------------+
| **FOOD**                 | **Y  | *     | **UNKNOWN** | **REFUSED** |
|                          | ES** | *NO** |             |             |
+--------------------------+------+-------+-------------+-------------+
| **a.** Unpasteurized     | 1    | 2     | 77          | 99          |
| milk                     |      |       |             |             |
+--------------------------+------+-------+-------------+-------------+
| **b**. Unpasteurized     | 1    | 2     | 77          | 99          |
| apple juice/cider        |      |       |             |             |
+--------------------------+------+-------+-------------+-------------+
| **c.** Other             | 1    | 2     | 77          | 99          |
| unpasteurized juices     |      |       |             |             |
+--------------------------+------+-------+-------------+-------------+
| **d.** Unpasteurized     | 1    | 2     | 77          | 99          |
| cheese                   |      |       |             |             |
|                          |      |       |             |             |
| (e.g. goat cheese,       |      |       |             |             |
| farmer's cheese, queso   |      |       |             |             |
| fresco)                  |      |       |             |             |
+--------------------------+------+-------+-------------+-------------+
| **e.** Other             | 1    | 2     | 77          | 99          |
|                          |      |       |             |             |
| Specify:                 |      |       |             |             |
| \_\_\_\_\_\_\_\_\_\_\_\_ |      |       |             |             |
+--------------------------+------+-------+-------------+-------------+

**[SECTION D]{.underline}. DRINKING WATER EXPOSURES**

**read:** I WOULD LIKE TO TALK ABOUT YOUR EXPOSURE TO DRINKING WATER
DURING THE ***[2 WEEKS]{.underline}*** FROM **(match to case-patient's
A2)**
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
TO
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|.

**D1.** During the 2 weeks from **(match to case-patient's A2)**
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
TO
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|,
did you drink water from home?

> YES.....................................1
>
> NO......................................2 **(GO TO D3)**
>
> UNKNOWN........................\...77 **(GO TO D3)**
>
> REFUSED.............................99 **(GO TO D3)**
>
> **D2.** **IF YES TO D1,** What were your sources of drinking water
> ***[at home]{.underline}***?
>
> **\[Read THE LIST. ENTER ALL THAT APPLY\]**

+--------------------+-----------+----------+------------+------------+
| **QUESTION**       | **YES**   | **NO**   | *          | *          |
|                    |           |          | *UNKNOWN** | *REFUSED** |
+--------------------+-----------+----------+------------+------------+
| **a.** Municipal   | 1         | 2        | 77         | 99         |
| or city water      |           |          |            |            |
| direct from tap    |           |          |            |            |
+--------------------+-----------+----------+------------+------------+
| **b**. Municipal   | 1         | 2        | 77         | 99         |
| or city water with |           |          |            |            |
| additional         |           |          |            |            |
| filtration or      |           |          |            |            |
| treatment          |           |          |            |            |
+--------------------+-----------+----------+------------+------------+
| **c.**             | 1         | 2        | 77         | 99         |
| Refrigerator       |           |          |            |            |
| dispenser          |           |          |            |            |
+--------------------+-----------+----------+------------+------------+
| **d.** Private     | 1         | 2        | 77         | 99         |
| well water         |           |          |            |            |
+--------------------+-----------+----------+------------+------------+
| **e.** Private     | 1         | 2        | 77         | 99         |
| well water with    |           |          |            |            |
| additional         |           |          |            |            |
| filtration or      |           |          |            |            |
| treatment          |           |          |            |            |
+--------------------+-----------+----------+------------+------------+
| **f**.             | 1         | 2        | 77         | 99         |
| Commercially       |           |          |            |            |
| bottled water      |           |          |            |            |
+--------------------+-----------+----------+------------+------------+
| **g.** Other       | 1         | 2        | 77         | 99         |
|                    |           |          |            |            |
| Specify:           |           |          |            |            |
| \_\_\_\_\_\_\_\_\_ |           |          |            |            |
+--------------------+-----------+----------+------------+------------+

**D3.** During the 2 weeks from **(match to case-patient's A2)**
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
to
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|,
did you drink water ***[outside the home]{.underline}***, for example,
at school, or work?

YES.....................................1

NO......................................2 **(GO TO D5)**

UNKNOWN........................\...77 **(GO TO D5)**

REFUSED.............................99 **(GO TO D5)**

> **D4**. **IF YES TO D3,** What were your sources of drinking water
> ***[outside the home]{.underline}***, for example, at school, or work?
> **\[Read THE LIST. ENTER ALL THAT APPLY.\]**

+---------------------------------+-----+-----+-----------+-----------+
| **QUESTION**                    | *   | **N | **        | **        |
|                                 | *YE | O** | UNKNOWN** | REFUSED** |
|                                 | S** |     |           |           |
+---------------------------------+-----+-----+-----------+-----------+
| **a.** Municipal or city water  | 1   | 2   | 77        | 99        |
| direct from tap (including a    |     |     |           |           |
| water fountain)                 |     |     |           |           |
+---------------------------------+-----+-----+-----------+-----------+
| **b**. Municipal or city water  | 1   | 2   | 77        | 99        |
| with additional filtration or   |     |     |           |           |
| treatment                       |     |     |           |           |
+---------------------------------+-----+-----+-----------+-----------+
| **c.** Refrigerator dispenser   | 1   | 2   | 77        | 99        |
+---------------------------------+-----+-----+-----------+-----------+
| **d**. Private well water       | 1   | 2   | 77        | 99        |
+---------------------------------+-----+-----+-----------+-----------+
| **e.** Private well water with  | 1   | 2   | 77        | 99        |
| additional filtration or        |     |     |           |           |
| treatment                       |     |     |           |           |
+---------------------------------+-----+-----+-----------+-----------+
| **f.** Commercially bottled     | 1   | 2   | 77        | 99        |
| water                           |     |     |           |           |
+---------------------------------+-----+-----+-----------+-----------+
| **g.** Brought water from home  | 1   | 2   | 77        | 99        |
+---------------------------------+-----+-----+-----------+-----------+
| **h**. Other                    | 1   | 2   | 77        | 99        |
|                                 |     |     |           |           |
| Specify: \_\_\_\_\_\_\_\_\_     |     |     |           |           |
+---------------------------------+-----+-----+-----------+-----------+

**D5.** What was your usual source of ***[ice]{.underline}*** during the
2 weeks from **(match to case-patient's A2)**
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
to
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|?

**\[Read THE LIST. ENTER ALL THAT APPLY\]**

+----------------------------+------+------+------------+------------+
| **SOURCE**                 | **Y  | **   | *          | *          |
|                            | ES** | NO** | *UNKNOWN** | *REFUSED** |
+----------------------------+------+------+------------+------------+
| **a.** Do not use ice      | 1    | 2    | 77         | 99         |
| **(GO TO D6)**             |      |      |            |            |
+----------------------------+------+------+------------+------------+
| **b.** From home           | 1    | 2    | 77         | 99         |
+----------------------------+------+------+------------+------------+
| **c.** From outside the    | 1    | 2    | 77         | 99         |
| home                       |      |      |            |            |
+----------------------------+------+------+------------+------------+
| **d.** Commercially-bought | 1    | 2    | 77         | 99         |
| ice                        |      |      |            |            |
+----------------------------+------+------+------------+------------+
| **e**. Other               | 1    | 2    | 77         | 99         |
|                            |      |      |            |            |
| Specify:                   |      |      |            |            |
| \_\_\_\_\_\_\_\_\_         |      |      |            |            |
+----------------------------+------+------+------------+------------+

**D6.** During the 2 weeks from **(match to case-patient's A2)**
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
to
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|,
did you drink any untreated water from a lake, river, or stream?

> YES\...\...\...\...\...\...\...\...\...\...\...\...\...\..... 1
>
> NO\...\...\...\...\...\...\...\...\...\...\...\...\...\...... 2
>
> UNKNOWN\...\...\...\...\...\...\...\...\...\....77
>
> REFUSED\...\...\...\...\...\...\...\...\...\...\.....99

**[SECTION E]{.underline}. RECREATIONAL WATER EXPOSURE**

**read:** I WOULD LIKE TO TALK ABOUT YOUR EXPOSURE TO RECREATIONAL
WATER. WE WILL FIRST FOCUS ON THE PERIOD ***[2 WEEKS]{.underline}***
FROM **(match to case-patient's A2)**
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
TO
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|.

**E1.** During the 2 weeks from **(match to case-patient's A2)**
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
to
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|,
did you swim or enter recreational water (which means water other than
in a bathtub or shower)?

> YES\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....1
>
> NO\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...2
> **(GO TO E28)**
>
> UNKNOWN\...\...\...\...\...\...\...\...\...\.....77 **(GO TO E28)**
>
> REFUSED...\...\...\...\...\...\...\...\...\...\.....99 **(GO TO E28)**

**E2.** During the 2 weeks from **(match to case-patient's A2)**
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
to
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|,
which recreational water settings did you swim in, wade in, or enter?
**\[Read THE LIST. enter ALL THAT APPLY\]**

+--------------+--------+----+--------+--------------+--------------+
| # IF YES, on |        | ** |        |              |              |
|  how many da |        | IF |        |              |              |
| ys did you s |        | YE |        |              |              |
| wim or enter |        | S, |        |              |              |
|  the water i |        | ** |        |              |              |
| n the 2 week |        | d  |        |              |              |
| s from \|\_\ |        | id |        |              |              |
| _\|\_\_\|-\| |        | y  |        |              |              |
| \_\_\|\_\_\| |        | ou |        |              |              |
| -\|[\_\_]{.u |        | p  |        |              |              |
| nderline}\|[ |        | ut |        |              |              |
| \_\_]{.under |        | yo |        |              |              |
| line}\| to \ |        | ur |        |              |              |
| |\_\_\|\_\_\ |        | fa |        |              |              |
| |-\|\_\_\|\_ |        | ce |        |              |              |
| \_\|-\|[\_\_ |        | u  |        |              |              |
| ]{.underline |        | nd |        |              |              |
| }\|[\_\_]{.u |        | er |        |              |              |
| nderline}\|? |        | t  |        |              |              |
|              |        | he |        |              |              |
|              |        | wa |        |              |              |
|              |        | te |        |              |              |
|              |        | r? |        |              |              |
+--------------+--------+----+--------+--------------+--------------+
| # Setting    | **Y N  |    | **     |              | **Y N U R**  |
|              | U R**  |    | Number |              |              |
|              |        |    | of     |              |              |
|              |        |    | d      |              |              |
|              |        |    | ays?** |              |              |
|              |        |    |        |              |              |
|              |        |    | **1    |              |              |
|              |        |    | 2-5    |              |              |
|              |        |    | 6-10   |              |              |
|              |        |    | \>11 U |              |              |
|              |        |    | R**    |              |              |
+--------------+--------+----+--------+--------------+--------------+
| **a.** Lake, | 1 2 77 |    | 1 2 3  |              | 1 2 77 99    |
| Pond, River  | 99     |    | 4 77   |              |              |
| or Stream    |        |    | 99     |              |              |
+--------------+--------+----+--------+--------------+--------------+
| **b**. Hot   | 1 2 77 |    | 1 2 3  |              | 1 2 77 99    |
| Tub, Spa,    | 99     |    | 4 77   |              |              |
| Whirlpool,   |        |    | 99     |              |              |
| Jacuzzi      |        |    |        |              |              |
+--------------+--------+----+--------+--------------+--------------+
| **c**.       | 1 2 77 |    | 1 2 3  |              | 1 2 77 99    |
| Recreational | 99     |    | 4 77   |              |              |
| Water Park   |        |    | 99     |              |              |
| other than   |        |    |        |              |              |
| swimming     |        |    |        |              |              |
| pools (*list |        |    |        |              |              |
| area         |        |    |        |              |              |
| examples, if |        |    |        |              |              |
| known*)      |        |    |        |              |              |
+--------------+--------+----+--------+--------------+--------------+

**E3.** During the 2 weeks from **(match to case-patient's A2)**
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
to
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|,
did you swim, wade in, or enter a swimming pool?

YES\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....1

NO\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...2
**(GO TO E28)**

UNKNOWN\...\...\...\...\...\...\...\...\...\.....77 **(GO TO E28)**

REFUSED...\...\...\...\...\...\...\...\...\...\.....99 **(GO TO E28)**

**read:** THE FOLLOWING QUESTIONS ASK ABOUT TYPICAL SWIMMING ACTIVITIES
DURING VISITS TO POOLS

**E4.** On a typical visit during the 2 weeks from **(match to
case-patient's A2)**
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
to
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|,
did you usually ***[wade or play]{.underline}*** in the water without
swimming?

YES..................\....1

NO......................2

UNKNOWN\...\...\...\....77

REFUSED...\...\...\...\....99

**E5.** On a typical visit during the 2 weeks from **(match to
case-patient's A2)**
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
to
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|,
did you get water ***[splashed in your face]{.underline}***?

YES..................\....1

NO......................2

UNKNOWN\...\...\...\....77

REFUSED...\...\...\...\....99

**E6.** On a typical visit during the 2 weeks from **(match to
case-patient's A2)**
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
to
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|,
did you put ***[your face in the water]{.underline}***?

YES..................\....1

NO......................2

UNKNOWN\...\...\...\....77

REFUSED...\...\...\...\....99

**E7.** On a typical visit during the 2 weeks from **(match to
case-patient's A2)**
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
to
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|,
did you get ***[any]{.underline}*** water in your
***[mouth]{.underline}***?

YES.....................1

NO....................\...2 **(GO TO E9)**

UNKNOWN...\...\.....77 **(GO TO E9)**

REFUSED.......\...\... 99 **(GO TO E9)**

> **E8. IF YES TO E7,** On a typical visit during the 2 weeks from
> **(match to case-patient's A2)**
> \|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
> to
> \|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|,
> did you ***[swallow]{.underline}*** any of this water?

YES.......................1

NO........................2

UNKNOWN...\...\...\....77

REFUSED..............99

**E9.** On a typical visit during the 2 weeks from **(match to
case-patient's A2)**
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
to
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|,
did you ***[dive or jump]{.underline}*** into the water?

YES..................\....1

NO......................2

UNKNOWN\...\...\...\....77

REFUSED...\...\...\...\....99

**E10.** On a typical visit during the 2 weeks from **(match to
case-patient's A2)**
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
to
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|,
did you ***[use a slide]{.underline}*** to enter the water?

YES..................\....1

NO......................2

UNKNOWN\...\...\...\....77

REFUSED...\...\...\...\....99

**E11**. On a typical visit during the 2 weeks from **(match to
case-patient's A2)**
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
to
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|,
did you ***[eat]{.underline}*** while visiting the pool?

YES..................\....1

NO......................2

UNKNOWN\...\...\...\....77

REFUSED...\...\...\...\....99

**E12**. On a typical visit during the 2 weeks from **(match to
case-patient's A2)**
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
to
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|,
did you consume any drink with ***[ice]{.underline}***, for example, ice
tea or soda from the soda fountain?

YES..................\....1

NO......................2

UNKNOWN\...\...\...\....77

REFUSED...\...\...\...\....99

**E13**. On a typical visit during the 2 weeks from **(match to
case-patient's A2)**
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
to
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|,
did you drink from the ***[water fountain]{.underline}*** at the
swimming pool?

YES..................\....1

NO......................2

UNKNOWN\...\...\...\....77

REFUSED...\...\...\...\....99

**E14**. On a typical visit during the 2 weeks from **(match to
case-patient's A2)**
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
to
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|,
did you go to the restrooms at the swimming pool to....

+--------------------------+------+-------+-------------+-------------+
| **SOURCE**               | **Y  | *     | **UNKNOWN** | **REFUSED** |
|                          | ES** | *NO** |             |             |
+--------------------------+------+-------+-------------+-------------+
| **a.** Change diapers    | 1    | 2     | 77          | 99          |
+--------------------------+------+-------+-------------+-------------+
| **b.** Wash hands        | 1    | 2     | 77          | 99          |
+--------------------------+------+-------+-------------+-------------+
| **c.** Urinate           | 1    | 2     | 77          | 99          |
+--------------------------+------+-------+-------------+-------------+
| **d.** Have bowel        | 1    | 2     | 77          | 99          |
| movements                |      |       |             |             |
+--------------------------+------+-------+-------------+-------------+
| **e.** Shower            | 1    | 2     | 77          | 99          |
+--------------------------+------+-------+-------------+-------------+
| **e**. Other             | 1    | 2     | 77          | 99          |
|                          |      |       |             |             |
| Specify:                 |      |       |             |             |
| \_\_\_\_\_\_\_\_\_       |      |       |             |             |
+--------------------------+------+-------+-------------+-------------+

**E15**. On a typical visit during the 2 weeks from **(match to
case-patient's A2)**
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
to
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|,
did you touch or play on the playground equipment at a playground near
the swimming pool?

YES..................\....1

NO......................2

UNKNOWN\...\...\...\....77

REFUSED...\...\...\...\....99

**read:** NOW I WOULD LIKE TO ASK YOU ABOUT THE SWIMMING POOLS YOU
VISITED.

**E16.** During the 2 weeks from **(match to case-patient's A2)**
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
to
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|,
please list the swimming pools that you swam in or entered.

**\[ENTER ALL THAT APPLY\]**

+---------+----+-----+---+---------+---+---------+---------+----------+
| ## **IF |    | *   |   | **(IF   | * |         |         |          |
|  YES,** |    | *IF |   | CANNOT  | * |         |         |          |
|  on how |    | YES |   | RECALL  | I |         |         |          |
|  many d |    | ,** |   | EXACT   | F |         |         |          |
| ays in  |    | ple |   | D       | Y |         |         |          |
| those 2 |    | ase |   | ATES,** | E |         |         |          |
|  weeks? |    | l   |   | prompt  | S |         |         |          |
|         |    | ist |   | for     | , |         |         |          |
|         |    | da  |   | ***     | * |         |         |          |
|         |    | tes |   | [week]{ | * |         |         |          |
|         |    |     |   | .underl | d |         |         |          |
|         |    |     |   | ine}*** | i |         |         |          |
|         |    |     |   | of      | d |         |         |          |
|         |    |     |   | s       | y |         |         |          |
|         |    |     |   | wimming | o |         |         |          |
|         |    |     |   | in that | u |         |         |          |
|         |    |     |   | l       | p |         |         |          |
|         |    |     |   | ocation | u |         |         |          |
|         |    |     |   | and     | t |         |         |          |
|         |    |     |   | enter   | y |         |         |          |
|         |    |     |   | date of | o |         |         |          |
|         |    |     |   | *       | u |         |         |          |
|         |    |     |   | **[Wedn | r |         |         |          |
|         |    |     |   | esday]{ | f |         |         |          |
|         |    |     |   | .underl | a |         |         |          |
|         |    |     |   | ine}*** | c |         |         |          |
|         |    |     |   | of that | e |         |         |          |
|         |    |     |   | week    | u |         |         |          |
|         |    |     |   |         | n |         |         |          |
|         |    |     |   |         | d |         |         |          |
|         |    |     |   |         | e |         |         |          |
|         |    |     |   |         | r |         |         |          |
|         |    |     |   |         | t |         |         |          |
|         |    |     |   |         | h |         |         |          |
|         |    |     |   |         | e |         |         |          |
|         |    |     |   |         | w |         |         |          |
|         |    |     |   |         | a |         |         |          |
|         |    |     |   |         | t |         |         |          |
|         |    |     |   |         | e |         |         |          |
|         |    |     |   |         | r |         |         |          |
|         |    |     |   |         | ? |         |         |          |
+---------+----+-----+---+---------+---+---------+---------+----------+
| ## Pool | *  |     | * |         |   | ######  | ######  | **Y N U  |
|         | *Y |     | * |         |   | ## **Li | ## **Li | R**      |
|         | N  |     | N |         |   | st date | st date |          |
|         | U  |     | u |         |   | s (MM/D | s (MM/D |          |
|         | R  |     | m |         |   | D/YY)** | D/YY)** |          |
|         | ** |     | b |         |   |         |         |          |
|         |    |     | e |         |   |         |         |          |
|         |    |     | r |         |   |         |         |          |
|         |    |     | o |         |   |         |         |          |
|         |    |     | f |         |   |         |         |          |
|         |    |     | d |         |   |         |         |          |
|         |    |     | a |         |   |         |         |          |
|         |    |     | y |         |   |         |         |          |
|         |    |     | s |         |   |         |         |          |
|         |    |     | ? |         |   |         |         |          |
|         |    |     | * |         |   |         |         |          |
|         |    |     | * |         |   |         |         |          |
|         |    |     |   |         |   |         |         |          |
|         |    |     | * |         |   |         |         |          |
|         |    |     | * |         |   |         |         |          |
|         |    |     | 1 |         |   |         |         |          |
|         |    |     | 2 |         |   |         |         |          |
|         |    |     | - |         |   |         |         |          |
|         |    |     | 5 |         |   |         |         |          |
|         |    |     | 6 |         |   |         |         |          |
|         |    |     | - |         |   |         |         |          |
|         |    |     | 1 |         |   |         |         |          |
|         |    |     | 0 |         |   |         |         |          |
|         |    |     | \ |         |   |         |         |          |
|         |    |     | > |         |   |         |         |          |
|         |    |     | 1 |         |   |         |         |          |
|         |    |     | 1 |         |   |         |         |          |
|         |    |     | U |         |   |         |         |          |
|         |    |     | R |         |   |         |         |          |
|         |    |     | * |         |   |         |         |          |
|         |    |     | * |         |   |         |         |          |
+---------+----+-----+---+---------+---+---------+---------+----------+
| **a.**  | 1  |     | 1 |         |   |         |         | 1 2 77   |
| *(Pool  | 2  |     | 2 |         |   |         |         | 99       |
| A)*     | 77 |     | 3 |         |   |         |         |          |
|         | 99 |     | 4 |         |   |         |         |          |
|         |    |     | 7 |         |   |         |         |          |
|         |    |     | 7 |         |   |         |         |          |
|         |    |     | 9 |         |   |         |         |          |
|         |    |     | 9 |         |   |         |         |          |
+---------+----+-----+---+---------+---+---------+---------+----------+
| **b.**  | 1  |     | 1 |         |   |         |         | 1 2 77   |
| *(Pool  | 2  |     | 2 |         |   |         |         | 99       |
| B)*     | 77 |     | 3 |         |   |         |         |          |
|         | 99 |     | 4 |         |   |         |         |          |
|         |    |     | 7 |         |   |         |         |          |
|         |    |     | 7 |         |   |         |         |          |
|         |    |     | 9 |         |   |         |         |          |
|         |    |     | 9 |         |   |         |         |          |
+---------+----+-----+---+---------+---+---------+---------+----------+
| **c.**  | 1  |     | 1 |         |   |         |         | 1 2 77   |
| *(Pool  | 2  |     | 2 |         |   |         |         | 99       |
| C)*     | 77 |     | 3 |         |   |         |         |          |
|         | 99 |     | 4 |         |   |         |         |          |
|         |    |     | 7 |         |   |         |         |          |
|         |    |     | 7 |         |   |         |         |          |
|         |    |     | 9 |         |   |         |         |          |
|         |    |     | 9 |         |   |         |         |          |
+---------+----+-----+---+---------+---+---------+---------+----------+
| **d.**  | 1  |     | 1 |         |   |         |         | 1 2 77   |
| *(Pool  | 2  |     | 2 |         |   |         |         | 99       |
| D)*     | 77 |     | 3 |         |   |         |         |          |
|         | 99 |     | 4 |         |   |         |         |          |
|         |    |     | 7 |         |   |         |         |          |
|         |    |     | 7 |         |   |         |         |          |
|         |    |     | 9 |         |   |         |         |          |
|         |    |     | 9 |         |   |         |         |          |
+---------+----+-----+---+---------+---+---------+---------+----------+
| **e.**  | 1  |     | 1 |         |   |         |         | 1 2 77   |
| *(Pool  | 2  |     | 2 |         |   |         |         | 99       |
| E)*     | 77 |     | 3 |         |   |         |         |          |
|         | 99 |     | 4 |         |   |         |         |          |
|         |    |     | 7 |         |   |         |         |          |
|         |    |     | 7 |         |   |         |         |          |
|         |    |     | 9 |         |   |         |         |          |
|         |    |     | 9 |         |   |         |         |          |
+---------+----+-----+---+---------+---+---------+---------+----------+
| **f.**  | 1  |     | 1 |         |   |         |         | 1 2 77   |
| Other   | 2  |     | 2 |         |   |         |         | 99       |
|         | 77 |     | 3 |         |   |         |         |          |
| S       | 99 |     | 4 |         |   |         |         |          |
| pecify: |    |     | 7 |         |   |         |         |          |
| \_\_\   |    |     | 7 |         |   |         |         |          |
| _\_\_\_ |    |     | 9 |         |   |         |         |          |
|         |    |     | 9 |         |   |         |         |          |
+---------+----+-----+---+---------+---+---------+---------+----------+

**IF THE PERSON DID NOT SWIM AT *\[POOL OF INTEREST\]*, GO TO E28**

**READ:** NOW I WOULD LIKE TO ASK YOU ABOUT YOUR ACTIVITIES AT THE
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ (*POOL OF INTEREST*) **(THESE
QUESTIONS WILL NEED TO BE TAILORED TO THE SPECIFICS OF THE POOL)**

**E17.** Regarding your activities at the \_\_\_\_\_\_\_\_\_\_\_*(the
pool of interest)* during the 2 weeks from **(match to case-patient's
A2)**
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
to
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
did you swim in or enter the ***[wading pool]{.underline}***?

YES\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....1

NO\...\...\...\...\...\...\...\...\...\...\...\...\...\........2

UNKNOWN\...\...\...\...\...\...\...\...\...\.....77

REFUSED\...\...\...\...\...\...\...\...\...\...\...\...99

**E18.** Did you swim in or enter the ***[main pool]{.underline}*** *(if
applicable)*?

YES\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....1

NO\...\...\...\...\...\...\...\...\...\...\...\...\...\........2 **(GO
TO E23)**

UNKNOWN\...\...\...\...\...\...\...\...\...\.....77 **(GO TO E23)**

REFUSED\...\...\...\...\...\...\...\...\...\...\...\...99 **(GO TO
E23)**

> **E19. IF YES TO E18,** When you were in the main pool did you ever
> use the ***[water slide]{.underline}** (if applicable)*?
>
> YES\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....1
>
> NO\...\...\...\...\...\...\...\...\...\...\...\...\...\........2
>
> UNKNOWN\...\...\...\...\...\...\...\...\...\.....77
>
> REFUSED\...\...\...\...\...\...\...\...\...\...\...\...99
>
> **E20. IF YES TO E18,** When you were in the main pool did you ever
> use the ***[frog slide]{.underline}** (if applicable)*?
>
> YES\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....1
>
> NO\...\...\...\...\...\...\...\...\...\...\...\...\...\........2
>
> UNKNOWN\...\...\...\...\...\...\...\...\...\.....77
>
> REFUSED\...\...\...\...\...\...\...\...\...\...\...\...99
>
> **E21. IF YES TO E18,** When you were in the main pool did you ever go
> under the ***[raindrop tree]{.underline}*** *(if applicable)*?
>
> YES\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....1
>
> NO\...\...\...\...\...\...\...\...\...\...\...\...\...\........2
>
> UNKNOWN\...\...\...\...\...\...\...\...\...\.....77
>
> REFUSED\...\...\...\...\...\...\...\...\...\...\...\...99
>
> **E22. IF YES TO E18,** When you were in the main pool did you ever
> use the ***[diving boards]{.underline}*** *(if applicable)*?
>
> YES\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....1
>
> NO\...\...\...\...\...\...\...\...\...\...\...\...\...\........2
>
> UNKNOWN\...\...\...\...\...\...\...\...\...\.....77
>
> REFUSED\...\...\...\...\...\...\...\...\...\...\...\...99

**E23.** During the 2 weeks from **(match to case-patient's A2)**
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
to
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|,
did you swim at a swim meet at the \_\_\_\_\_\_\_\_\_\_\_*(the pool of
interest)*?

> YES\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....1
>
> NO\...\...\...\...\...\...\...\...\...\...\...\...\...\........2 **(GO
> TO E25)**
>
> UNKNOWN\...\...\...\...\...\...\...\...\...\.....77 **(GO TO E25)**
>
> REFUSED\...\...\...\...\...\...\...\...\...\...\...\...99 **(GO TO
> E25)**
>
> **E24. IF YES TO E23,** What date?
> \|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|

MM DD YY

**E25.** When the \_\_\_\_\_\_\_\_\_\_\_*(the pool of interest)* closed,
the period between
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
to
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|,
did you enter the water or swim at any other facility or recreational
area?

> YES\...\...\...\...\...\...\...\...\...\...\...\...\...\..... 1
>
> NO\...\...\...\...\...\...\...\...\...\...\...\...\...\........2 **(GO
> TO E27)** UNKNOWN\...\...\...\...\...\...\...\...\...\.....77 **(GO TO
> E27)**
>
> REFUSED\...\...\...\...\...\...\...\...\...\...\...\...99 **(GO TO
> E27)**
>
> **E26.** **IF YES TO E25,** What pool/recreational area(s) did you
> swim in while the \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_*(the pool of
> interest)* was closed
> (\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
> to
> \|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|)?
> **(WRITE IN NAME OF POOL/RECREATIONAL AREA)**

[Name of Pool/Recreational Area]{.underline}

a.\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

b.\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

c.\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

d.\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

######## **E27**. During the 2 weeks from **(match to case-patient's A2)** \|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\| to \|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|, did you participate as a member of any of the following groups at the \_\_\_\_\_\_\_\_\_\_\_(the pool of interest)? **\[READ ALL AND ENTER ALL THAT APPLY\] (THIS QUESTION WILL NEED TO BE TAILORED TO THE SPECIFICS OF THE POOL)**

> Swimming/diving team.........................\.......1
>
> Swimming lessons......................\................2
>
> Water aerobics.......................................\...3
>
> UNKNOWN...........................\...\...\...\...\...\.....77
>
> OTHER................................................88
>
> If Other, specify: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> REFUSED.............................................99

**E28.** Are you a member of the \_\_\_\_\_\_\_\_\_\_\_*(the pool of
interest)*?

YES\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....1

NO\...\...\...\...\...\...\...\...\...\...\...\...\...\........2

UNKNOWN\...\...\...\...\...\...\...\...\...\.....77

REFUSED\...\...\...\...\...\...\...\...\...\...\...\...99

**READ:** NOW WE WILL FOCUS ON YOUR RECREATIONAL WATER EXPOSURE DURING
THE ***[ONE MONTH FROM]{.underline}***
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
to
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|*.*

**NOTE: THIS INTERVAL IS *[NOT THE SAME]{.underline}* AS PREVIOUS
INTERVALS.**

**THIS INTERVAL IS FROM THE DATE OF *[ONSET]{.underline}* OF DIARRHEA IN
THE CASE-PATIENT (MATCH TO CASE-PATIENT'S A2) UNTIL *[ONE MONTH
LATER]{.underline}*.**

**E29.** During the ***[one month from]{.underline}***
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
to
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|,
did you swim or enter recreational water (other than in a bathtub or
shower)?

> YES\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....1
>
> NO\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...2
> **(GO TO SECTION F)**
>
> UNKNOWN\...\...\...\...\...\...\...\...\...\.....77 **(GO TO SECTION
> F)**
>
> REFUSED...\...\...\...\...\...\...\...\...\...\.....99 **(GO TO
> SECTION F)**

**E30.** During the ***[one month from]{.underline}***
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
to
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|,
which recreational water settings did you swim in, wade in, or enter?
**\[Read THE LIST. enter ALL THAT APPLY\]**

+-----------------+-------------------+--------------------------------+
|                 |                   | # IF Y                         |
|                 |                   | ES, on how many days did you s |
|                 |                   | wim or enter the water in the  |
|                 |                   | *[one month from]{.underline}* |
|                 |                   |  \|\_\_\|\_\_\|-\|\_\_\|\_\_\| |
|                 |                   | -\|[\_\_]{.underline}\|[\_\_]{ |
|                 |                   | .underline}\| to \|\_\_\|\_\_\ |
|                 |                   | |-\|\_\_\|\_\_\|-\|[\_\_]{.und |
|                 |                   | erline}\|[\_\_]{.underline}\|? |
+-----------------+-------------------+--------------------------------+
| # Setting       | **Y N U R**       | **Number of days?**            |
|                 |                   |                                |
|                 |                   | **1 2-5 6-10 \>11 U R**        |
+-----------------+-------------------+--------------------------------+
| **a.** Lake,    | 1 2 77 99         | 1 2 3 4 77 99                  |
| Pond, River or  |                   |                                |
| Stream          |                   |                                |
+-----------------+-------------------+--------------------------------+
| **b**. Hot Tub, | 1 2 77 99         | 1 2 3 4 77 99                  |
| Spa, Whirlpool, |                   |                                |
| Jacuzzi         |                   |                                |
+-----------------+-------------------+--------------------------------+
| **c**.          | 1 2 77 99         | 1 2 3 4 77 99                  |
| Recreational    |                   |                                |
| Water Park      |                   |                                |
| other than      |                   |                                |
| swimming pools  |                   |                                |
| (*list area     |                   |                                |
| examples, if    |                   |                                |
| known*)         |                   |                                |
+-----------------+-------------------+--------------------------------+

**E31.** During the ***[one month from]{.underline}***
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
to
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|,
did you swim, wade in, or enter a swimming pool?

> YES\...\...\...\...\...\...\...\...\...\...\...\...\...\..... 1
>
> NO\...\...\...\...\...\...\...\...\...\...\...\...\...\........2 **(GO
> TO SECTION F)**
>
> UNKNOWN\...\...\...\...\...\...\...\...\...\.....77 **(GO TO SECTION
> F)**
>
> REFUSED\...\...\...\...\...\...\...\...\...\...\...\...99 **(GO TO
> SECTION F)**

######## **E32.** During the **[one month from]{.underline}** \|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\| to \|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|, please list the swimming pools that you swam in or entered. **\[ENTER ALL THAT APPLY\]**

+---------+-----------+--------------+---------------+----------------+
|         |           | ## **IF Y    | **IF YES,**   | **IF CANNOT    |
|         |           | ES,** on how | please list   | RECALL EXACT   |
|         |           |  many days d | dates         | DATES,**       |
|         |           | id you swim  |               | prompt for     |
|         |           | or enter the |               | ***[week]{     |
|         |           |  water durin |               | .underline}*** |
|         |           | g the month? |               | of swimming in |
|         |           |              |               | that location  |
|         |           |              |               | and enter date |
|         |           |              |               | of             |
|         |           |              |               | *              |
|         |           |              |               | **[Wednesday]{ |
|         |           |              |               | .underline}*** |
|         |           |              |               | of that week   |
+---------+-----------+--------------+---------------+----------------+
| ## Pool | **Y N U   | **Number of  | ########      | ######         |
|         | R**       | days?**      |  **List dates | ## **List date |
|         |           |              |  (MM/DD/YY)** | s (MM/DD/YY)** |
|         |           | **1 2-5 6-10 |               |                |
|         |           | \>11 U R**   |               |                |
+---------+-----------+--------------+---------------+----------------+
| **a.**  | 1 2 77 99 | 1 2 3 4 77   |               |                |
| *(Pool  |           | 99           |               |                |
| A)*     |           |              |               |                |
+---------+-----------+--------------+---------------+----------------+
| **b.**  | 1 2 77 99 | 1 2 3 4 77   |               |                |
| *(Pool  |           | 99           |               |                |
| B)*     |           |              |               |                |
+---------+-----------+--------------+---------------+----------------+
| **c.**  | 1 2 77 99 | 1 2 3 4 77   |               |                |
| *(Pool  |           | 99           |               |                |
| C)*     |           |              |               |                |
+---------+-----------+--------------+---------------+----------------+
| **d.**  | 1 2 77 99 | 1 2 3 4 77   |               |                |
| *(Pool  |           | 99           |               |                |
| D)*     |           |              |               |                |
+---------+-----------+--------------+---------------+----------------+
| **e.**  | 1 2 77 99 | 1 2 3 4 77   |               |                |
| *(Pool  |           | 99           |               |                |
| E)*     |           |              |               |                |
+---------+-----------+--------------+---------------+----------------+
| **f.**  | 1 2 77 99 | 1 2 3 4 77   |               |                |
| Other   |           | 99           |               |                |
|         |           |              |               |                |
| S       |           |              |               |                |
| pecify: |           |              |               |                |
| \_\_\   |           |              |               |                |
| _\_\_\_ |           |              |               |                |
+---------+-----------+--------------+---------------+----------------+

########  **IF THE PERSON DID NOT SWIM AT THE** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ **(POOL OF INTEREST), GO TO SECTION F.**

**READ:** NOW I WOULD LIKE TO ASK YOU ABOUT YOUR ACITIVITIES AT THE
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ (*POOL OF INTEREST*)

**E33.** During the ***[one month from]{.underline}***
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
to
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|,
did you participate as a member of any of the following groups at the
\_\_\_\_\_\_\_\_\_\_\_*(the pool of interest)*?

**\[READ ALL AND ENTER ALL THAT APPLY\]**

> Swimming/ diving team.........................\.......1
>
> Swimming lessons......................\............ ....2
>
> UNKNOWN........................\...\...\...\...\...\...\...\.....77
>
> OTHER .................................................88
>
> If Other, specify \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> REFUSED..............................................99

**E34.** During the ***[one month from]{.underline}***
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
to
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|,
did you swim in or enter the ***[wading pool]{.underline}*** *(if
applicable)*?

> YES\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....1
>
> NO\...\...\...\...\...\...\...\...\...\...\...\...\...\........2
>
> UNKNOWN\...\...\...\...\...\...\...\...\...\.....77
>
> REFUSED\...\...\...\...\...\...\...\...\...\...\...\...99

**E35.** During the ***[one month from]{.underline}***
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
to
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|,
did you swim in or enter the ***[main pool]{.underline}***?

> YES\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....1
>
> NO\...\...\...\...\...\...\...\...\...\...\...\...\...\........2
>
> UNKNOWN\...\...\...\...\...\...\...\...\...\.....77
>
> REFUSED\...\...\...\...\...\...\...\...\...\...\...\...99

**[SECTION F.]{.underline} EVENTS**

**READ:** NOW I WOULD LIKE TO TALK TO YOU ABOUT THE EVENTS THAT YOU
ATTENDED FROM **(match to case-patient's Section F)**
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
TO
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|.

**F1.** From **(match to case-patient's Section F)**
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
to
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|,
did you attend any large social gatherings with 50 or more persons
present, such as picnics, county fairs, or other events?

> YES\...\...\...\...\...\...\...\...\...\...\...\...\...\..... 1
>
> NO\...\...\...\...\...\...\...\...\...\...\...\...\...\........2 **(GO
> TO F3)**
>
> UNKNOWN\...\...\...\...\...\...\...\...\...\.....77 **(GO TO F3)**
>
> REFUSED\...\...\...\...\...\...\...\...\...\...\...\...99 **(GO TO
> F3)**
>
> **F2. IF YES TO F1,** Please list the event(s) that you attended:
> **\[CIRCLE THOSE MENTIONED\]**
>
> **\[If specific events are in question, list here. If not, use general
> questions\]**
>
> *Event A (*
> \|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
> *date)*................01
>
> *Event B (*
> \|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
> *date)*................02
>
> *Event C (*
> \|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
> *date)*................03
>
> *Event D (*
> \|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
> *date)*................04
>
> *Event E (*
> \|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}
> \|*date)*................05
>
> Other - please specify: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 06

**F3.** Did you attend any events/parties/potlucks held at the
\_\_\_\_\_\_\_\_\_\_\_*(the pool of interest)*?

> YES\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....1
>
> NO\...\...\...\...\...\...\...\...\...\...\...\...\...\........2 (**GO
> TO F5**)
>
> UNKNOWN\...\...\...\...\...\...\...\...\...\.....77 (**GO TO F5**)
>
> REFUSED\...\...\...\...\...\...\...\...\...\...\...\...99 (**GO TO
> F5**)
>
> **F4.** **IF YES TO F3,** Please name the events/parties/potlucks?
>
> **[Name]{.underline} [Date (MM/DD/YY)]{.underline}**
>
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
> \|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
>
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
> \|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
>
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
> \|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|

**F5.** Did you attend any events/parties/potlucks from **(match to
case-patient's Section F)**
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
to
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
at any other pool other than the \_\_\_\_\_\_\_\_\_\_\_*(the pool of
interest)*?

> YES\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....1
>
> NO\...\...\...\...\...\...\...\...\...\...\...\...\...\........2 (**GO
> TO F7**)
>
> UNKNOWN\...\...\...\...\...\...\...\...\...\.....77 (**GO TO F7**)
>
> REFUSED\...\...\...\...\...\...\...\...\...\...\...\...99 (**GO TO
> F7**)
>
> **F6.** **IF YES TO F5,** Please name the events/parties/potlucks?
>
> **[Name]{.underline} [Date (MM/DD/YY)]{.underline}**
>
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
> \|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
>
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
> \|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
>
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
> \|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
>
> **F7.** While attending ***[any]{.underline}*** of these events, did
> you drink any beverage made with water, such as ice tea, lemonade, or
> other powdered or concentrated drink mix?
>
> YES\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....1
>
> NO\...\...\...\...\...\...\...\...\...\...\...\...\...\........2 (**GO
> TO F9**)
>
> UNKNOWN\...\...\...\...\...\...\...\...\...\.....77 (**GO TO F9**)
>
> REFUSED\...\...\...\...\...\...\...\...\...\...\...\...99 (**GO TO
> F9**)

**F8.** **IF YES TO F7,** Please name the events/parties/potlucks?

> **[Name]{.underline} [Date (MM/DD/YY)]{.underline}**
>
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
> \|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
>
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
> \|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
>
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
> \|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
>
> **F9.** While attending ***[any]{.underline}*** of these events, did
> you eat any food that was not commercially packaged?
>
> YES\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....1
>
> NO\...\...\...\...\...\...\...\...\...\...\...\...\...\........2 (**GO
> TO SECTION G**)
>
> UNKNOWN\...\...\...\...\...\...\...\...\...\.....77 (**GO TO SECTION
> G**)
>
> REFUSED\...\...\...\...\...\...\...\...\...\...\...\...99 (**GO TO
> SECTION G**)
>
> **F10.** **IF YES TO F9,** Please name the events/parties/potlucks?
>
> **[Name]{.underline} [Date (MM/DD/YY)]{.underline}**
>
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
> \|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
>
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
> \|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
>
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
> \|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|

####### **[SECTION G]{.underline}. TRAVEL HISTORY**

**READ:** NOW I WOULD LIKE TO TALK TO YOU ABOUT YOUR TRAVEL HISTORY
DURING THE ***[2 WEEKS]{.underline}*** FROM **(match to case-patient's
A2)**
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
TO
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|.

> **G1.** During the 2 weeks from **(match to case-patient's A2)**
> \|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
> to
> \|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|,
> did you travel within the state?
>
> YES\...\...\...\...\...\...\...\...\...\...\...\...\...\..... 1
>
> NO\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.... 2
> **(GO TO G3)**
>
> REFUSED\...\...\...\...\...\...\...\...\...\...\..... 8 **(GO TO G3)**
>
> UNKNOWN\...\...\...\...\...\...\...\...\...\..... 9 **(GO TO G3)**
>
> **G2.** **IF YES TO G1,** Please tell me where you went within the
> state:
>
> **(WRITE IN LOCATION)**
>
> LOCATION CODE
>
> A\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \|\_\_\|\_\_\|
>
> B\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \|\_\_\|\_\_\|
>
> C\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \|\_\_\|\_\_\|
>
> **G3.** During the 2 weeks from **(match to case-patient's A2)**
> \|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
> to
> \|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|,
> did you travel to another state within the United States?
>
> YES\...\...\...\...\...\...\...\...\...\...\...\...\...\..... 1
>
> NO\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.... 2
> **(GO TO G5)**
>
> REFUSED\...\...\...\...\...\...\...\...\...\...\..... 8 **(GO TO G5)**
>
> UNKNOWN\...\...\...\...\...\...\...\...\...\..... 9 **(GO TO G5)**
>
> **G4.** **IF YES TO G3,** Please tell me the name of the cities and
> states that you traveled to:
>
> **(WRITE IN LOCATION)**
>
> CITY/STATE CODE
>
> A\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \|\_\_\|\_\_\|
>
> B\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \|\_\_\|\_\_\|
>
> C\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \|\_\_\|\_\_\|
>
> **G5.** During the 2 weeks from **(match to case-patient's A2)**
> \|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
> to
> \|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|,
> did you travel to another country?
>
> YES\...\...\...\...\...\...\...\...\...\...\...\...\...\..... 1
>
> NO\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.... 2
> **(GO TO G7)**
>
> REFUSED\...\...\...\...\...\...\...\...\...\...\..... 8 **(GO TO G7)**
>
> UNKNOWN\...\...\...\...\...\...\...\...\...\..... 9 **(GO TO G7)**
>
> **G6.** **IF YES TO G5,** Please tell me which country or countries
> you traveled to:
>
> **(WRITE IN LOCATION)**
>
> COUNTRY CODE
>
> A\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \|\_\_\|\_\_\|
>
> B\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \|\_\_\|\_\_\|
>
> C\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \|\_\_\|\_\_\|

**G7.** During the 2 weeks from **(match to case-patient's A2)**
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
to
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|,
did you travel to \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ (*name of specific
location*)?

> YES\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....1
>
> NO\...\...\...\...\...\...\...\...\...\...\...\...\...\........2 **(GO
> TO SECTION H)**
>
> UNKNOWN\...\...\...\...\...\...\...\...\...\.....77 **(GO TO SECTION
> H)**
>
> REFUSED\...\...\...\...\...\...\...\...\...\...\...\...99 **(GO TO
> SECTION H)**

## 

## **FOLLOW THIS QUESTION WITH QUESTIONS ABOUT SPECIFIC ACTIVITIES, IF APPLICABLE** 

## **[SECTION H]{.underline}. ANIMAL CONTACT** 

**READ:** NOW I WOULD LIKE TO TALK TO YOU ABOUT YOUR CONTACT WITH
ANIMALS DURING THE ***[2 WEEKS]{.underline}*** FROM **(match to
case-patient's A2)**
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
TO
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|.

**H1**. During the 2 weeks from **(match to case-patient's A2)**
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
to
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|,
did you have contact with any animals (at home, on a farm, at a zoo, at
a fair, festival or other event)?

> YES\...\...\...\...\...\...\...\...\...\...\...\...\...\..... 1
>
> NO\...\...\...\...\...\...\...\...\...\...\...\...\...\........2 **(GO
> TO H3)**
>
> UNKNOWN\...\...\...\...\...\...\...\...\...\.....77 **(GO TO H3)**
>
> REFUSED\...\...\...\...\...\...\...\...\...\...\...\...99 **(GO TO
> H3)**
>
> **H2.** **IF YES TO H1,** To which of the following animals?
>
> **Read THE LIST. ENTER AND ASK THE CORRESPONDING QUESTIONS.**

+---------------------------+--------------------+--------------------+
| **ANIMAL**                | Did you have       | Did this animal    |
|                           | contact with this  | have diarrhea?     |
|                           | animal (feeding,   |                    |
|                           | petting, playing)? | **Y N U R**        |
|                           |                    |                    |
|                           | **Y N U R**        |                    |
+---------------------------+--------------------+--------------------+
| a.  Kitten (\< 6 months)  | 1 2 77 99          | 1 2 77 99          |
+---------------------------+--------------------+--------------------+
| b.  Cat                   | 1 2 77 99          | 1 2 77 99          |
+---------------------------+--------------------+--------------------+
| c.  Puppy (\< 6 months)   | 1 2 77 99          | 1 2 77 99          |
+---------------------------+--------------------+--------------------+
| d.  Dog                   | 1 2 77 99          | 1 2 77 99          |
+---------------------------+--------------------+--------------------+
| e.  Calf                  | 1 2 77 99          | 1 2 77 99          |
+---------------------------+--------------------+--------------------+
| f.  Cow/Bull/Steer        | 1 2 77 99          | 1 2 77 99          |
+---------------------------+--------------------+--------------------+
| **g.** Deer               | 1 2 77 99          | 1 2 77 99          |
+---------------------------+--------------------+--------------------+
| **h.** Goat/Sheep/Lamb    | 1 2 77 99          | 1 2 77 99          |
+---------------------------+--------------------+--------------------+
| **i.** Horse              | 1 2 77 99          | 1 2 77 99          |
+---------------------------+--------------------+--------------------+
| **j.** Pigs               | 1 2 77 99          | 1 2 77 99          |
+---------------------------+--------------------+--------------------+
| **k.** Poultry            | 1 2 77 99          | 1 2 77 99          |
|                           |                    |                    |
| (chicken, turkey, etc.)   |                    |                    |
+---------------------------+--------------------+--------------------+
| **l.** Rabbit             | 1 2 77 99          | 1 2 77 99          |
+---------------------------+--------------------+--------------------+
| **m.** Amphibian/reptile  | 1 2 77 99          | 1 2 77 99          |
| (frog, turtle, lizard,    |                    |                    |
| snake, etc.)              |                    |                    |
+---------------------------+--------------------+--------------------+
| **n.** Other              | 1 2 77 99          | 1 2 77 99          |
|                           |                    |                    |
| Specify:                  |                    |                    |
| \                         |                    |                    |
| _\_\_\_\_\_\_\_\_\_\_\_\_ |                    |                    |
+---------------------------+--------------------+--------------------+

**H3.** During the 2 weeks from **(match to case-patient's A2)**
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
to
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|,
did you touch or shovel animal waste/ manure or walk through any area
where animal waste/ manure was on the ground?

> YES\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....1
>
> NO\...\...\...\...\...\...\...\...\...\...\...\...\...\........2
>
> UNKNOWN\...\...\...\...\...\...\...\...\...\.....77
>
> REFUSED\...\...\...\...\...\...\...\...\...\...\...\...99

**H4.** Did you visit, work on, or live on a farm during the 2 weeks
from **(match to case-patient's A2)**
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|
to
\|\_\_\|\_\_\|-\|\_\_\|\_\_\|-\|[\_\_]{.underline}\|[\_\_]{.underline}\|?

> YES\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....1
>
> NO\...\...\...\...\...\...\...\...\...\...\...\...\...\........2
>
> UNKNOWN\...\...\...\...\...\...\...\...\...\.....77
>
> REFUSED\...\...\...\...\...\...\...\...\...\...\...\...99

**[SECTION I]{.underline} : DEMOGRAPHIC INFORMATION**

**READ:** FINALLY, I WOULD LIKE TO ASK YOU SOME QUESTIONS ABOUT
YOURSELF.

**I1.** What is your ZIP code? \|\_\_\|\_\_\|\_\_\|\_\_\|\_\_\|

UNKNOWN............77777

REFUSED............\... 99999

**I2.** What is your age?

\|\_\_\_\|\_\_\_\|

Age (years)

**I3.** What is your gender?

MALE ................ 1

FEMALE ............ 2

UNKNOWN......\....77

REFUSED.........\....99

**I4**. What county do you live in?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**IF RESPONDENT ANSWERS "DON'T KNOW", ASK:**

**I5.** What city do you live
in?\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**I6.** What racial or ethnic group do you consider yourself part of ?

> **PROMPT IF NECESSARY:**
>
> WHITE, NON-HISPANIC\...\...\...\...\...\...\...\...\...\............ 1
>
> BLACK,
> NON-HISPANIC\...\...\...\...\...\...\...\...\...\...\...\...\..... 2
>
> WHITE,
> HISPANIC\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....
> 3
>
> BLACK,
> HISPANIC\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...
> 4
>
> AMERICAN INDIAN/ALASKAN NATIVE\...\...\...\... 5
>
> ASIAN/PACIFIC ISLANDER\...\...\...\...\...\...\...\...\...\...\...\...
> 6
>
> OTHER.......................................................7
>
> Specify\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> UNKNOWN\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....
> 77
>
> REFUSED\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....
> 99

**END OF QUESTIONNAIRE:** This concludes our questionnaire. I would like
to thank you very much for your time, patience, and cooperation in
answering our questions. I would be happy to answer any questions you
may have at this point.

If you have any questions in the future please contact the
**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** (*city/county health
department*) at \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_(*phone number*).