Appendix 8-1

Instructions for Completing the

Measles Surveillance Worksheet

General

● If the month and year for any date is known but the exact day is unknown, enter a 15 for the 

day (i.e. the middle of the month). 

● While “unknown” is an option for many questions, please make every effort to obtain the 

appropriate information. 

● If information is obtained after the record has been submitted to the Centers for Disease 

Control and Prevention (CDC), please update the NETSS records with the new information 

and resend the record during the next scheduled transmission.

● 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 CDC to 

preserve confidentiality.

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 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 rash onset 

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

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

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

order of preference. For measles, please enter rash onset date.

Outbreak Associated: Enter 1 if the case is outbreak associated and the state does not assign 

numerical values to outbreaks; if the state assigns numerical values to outbreaks, enter the 

assigned value; if the case is known to be not associated with an outbreak, enter 0. If unknown, 

enter 999. 

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

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

apply in your state. 

Imported: Indicate where the patient acquired measles. This is a required field for measles 

reports.

Indigenous—In state; any case that cannot be proven to be imported

 International—Out of U.S.; international importation from another country; onset of rash 

is within 18 days of entering the United States

 Out of state—importation from another state; documentation that the person either had 

face-to-face contact with a case of measles outside the state or was out of the state for the 

entire period when he or she might have become infected (7–18 days before rash onset)

Complications

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

Laboratory

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

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

convalescent phase serum specimens. 

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.

CS106190
Appendix 8-2

Outbreak Related: An outbreak is defined as >3 cases (with at least one laboratory confirmed 

case) clustered in space and time. 

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 case. Exposure must have occurred 

7 to 18 days before rash onset of the subsequent case, and between 4 days before rash onset 

and 7 days after rash of the source case. Enter state ID if source was an in-state case (imported 

entry on core screen = 1), enter country name if source was out of USA (imported entry on core 

screen = 2), enter state name if source was out of state (imported entry on core screen =3).

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.