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Unexplained Respiratory Disease Outbreaks (URDO)








Data Collection Forms						Print
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										The resources below can be used to collect information relevant to identifying etiologies of respiratory outbreaks. Do **not** use these forms to report a disease outbreak to CDC. For reporting assistance, please refer to your state health department.
Long form
The Data Collection—Long Form [13 pages] provides a comprehensive set of **questions to consider using when developing a case questionnaire**.
These questions cover a range of topic areas including:
Patient and family contact information
Occupation
Travel history and other exposures of interest
Extensive past medical history review
A comprehensive list of potential laboratory tests completedIt would be unusual to use the long form in its entirety for any particular outbreak. Instead, use pieces of the form based on factors surrounding the outbreak, including the differential diagnoses and the population affected.
Information needed to answer many of the questions on the long form may not be available. In addition, investigators may need to compile information from several sources, such as:
Medical records
Physician, patient, and family interviews
Public health partnersShort form
The Data Collection—Short Form [2 pages] **collects common or “core” data elements** needed in most respiratory disease outbreak investigations. Modify the form as necessary to accommodate the particular data requirements of the current outbreak investigation.
The first page of the form allows for collecting the following from a patient interview:
Basic demographics
Symptoms
Exposure informationThe second page collects objective clinical and laboratory testing information. You can collect this information by interviewing the treating or reporting physician or by reviewing the ill person’s medical record.
More informationInvestigate an Outbreak
Epidemiologic Curve
							
					
							Last Reviewed:  June 1, 2023						Source: 	National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases
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