Appendix 10-1

County: Enter the county of residence of the patient.

State: Enter the state of residence of the patient.

Zip Code (requested, but not required, for vaccine-preventable diseases): Enter a 5-digit zip 

code.

Birth Date: If known, enter the birth date. If unknown or before the year 1900, leave this blank 

and enter the age and age type.

Age and Age Type: If birth date is unknown and age is known, enter age of patient at onset of 

symptoms in number of years, months, weeks, or days as indicated by the age type codes.

Ethnicity, Race, and Sex: Enter appropriate responses.

Event Date and Event Type: Enter the date associated with the earliest known incident of 

disease. The event type describes the date entered in event date. The event types are listed in 

order of preference.

Reported: This field is used in various ways, such as to enter the date reported to the state, 

or local or other health department. Check with the State Epidemiologist to determine what 

guidelines apply in your state. 

Import Status: Indicate where the case acquired mumps based on whether exposure to the 

mumps virus occurred outside or inside the U.S. 

1) U.S. Acquired: is a case in which the patient had not been outside the U.S. during the 25 

days before onset of parotitis or other mumps-associated complications OR was known to 

have been exposed to mumps within the U.S.

 a) Import-Linked: any case in a chain of transmission that is epidemiologically linked 

to an internationally imported case.

 b) Imported Virus: any case for which an epidemiologic link to an internationally 

imported case was not identified BUT for which viral genetic evidence indicates an 

imported mumps virus genotype.

 c) Endemic Case: a case for which epidemiologic or virologic evidence indicates an 

endemic chain of transmission.

 d) Unknown Source: a case for which an epidemiologic or virologic link to importation 

or to endemic transmission within the U.S. cannot be established.

2) International Import: a case in which mumps results from exposure to virus outside the 

U.S. At least some of the exposure period (12-25 days before onset of parotitis or other 

mumps-associated complications) must occur outside the U.S. and the onset of parotitis 

MM/DD/YYYY: If the month and year for any date are known but the exact day is 

unknown, enter a 15 for the day (i.e. the middle of the month).

UNKNOWN: While “unknown” is an option for many questions, please make every effort 

to obtain the appropriate information.

POST RECORD SUBMISSION: If information is obtained after the record has been 

submitted to the Centers for Disease Control and Prevention (CDC), please update the 

NETSS record with the new information and resend the record during the next scheduled 

transmission.

PAPER FORM COPIES: If copies of the paper form are sent to CDC, either fold back the 

information above the dotted line or cut it off after photocopying and before sending the 

rest of the information to the CDC to preserve confidentiality.

Instructions for Completing the

Mumps Surveillance Worksheet

General

CS106190
Appendix 10-2

or other mumps-associated complications occur within 25 days of entering the U.S., with 

no known exposure to mumps virus in the U.S. during that time. 

Clinical Data

Parotitis: Indicate whether there was parotitis, if known. Check unilateral or bilateral, if 

known. 

Jaw Pain: Indicate whether there was jaw pain, if known.

Salivary Gland Swelling (including parotitis): Indicate whether there was any salivary gland 

swelling; record the onset date and duration in exact number of days, if known. Indicate if any 

swelling was submandibular or sublingual, if known. 

Complications

Death: If the patient died from mumps, verification with the physician is recommended.

Laboratory

Test Type: enter data for all testing types performed. Dates for when culture and PCR 

specimens were taken are entered under ‘Other Lab Results’ and dates for serological specimens 

are entered with IgM and/or IgG information.

IgG Result: This result is based on the interpretation of results from a paired serum specimen. 

The criterion for positivity is a four-fold rise in specimen antibody titer between acute and 

convalescent phase serum specimen. A single IgG result can assess immune status. 

Epidemiologic Information

Date First Reported to a Health Department: Date reported is considered the earliest date 

the case was initially reported to a health department, either local, district, or state level health 

department.

Outbreak Related: A case is outbreak related if ≥3 confirmed cases of mumps are clustered in 

time and space.

Source of Exposure for Current Case: A source case must be either a confirmed or probable 

case and have had face-to-face contact with a subsequent generation case. Exposure must have 

occurred 12 to 25 days before onset of symptoms of the new case, and between 3 days before 

onset of parotitis and 5 days after onset of parotitis of the source case. 

● Enter the country name if the source was out of USA.

● Enter the state name if the source was out-of-state. 

● Enter the state ID if the source was an in-state case.

Epi-Linked: An epi-linked case is either a source case or same generation case. Epi-linkage 

is characterized by direct face-to-face contact. For same generation cases that are epi-linked, a 

common exposure is likely.