Spreadsheet: 1f063c67-ac3c-4ea3-8e5d-32acce9b876a
Sheet: Sheet1

PHE Acute Respiratory Illness (ARI) outbreak reporting form | Unnamed: 1 | Unnamed: 2 | Unnamed: 3 | Unnamed: 4 | Unnamed: 5
Please fill in this form for all outbreaks (two or more cases in an institution with onset within 7 days of each other) of acute respiratory infections (whether virologically confirmed or not).  Final data is required, but if outbreak is ongoing please inform Flu Section of the Respiratory Diseases Department at Colindale using this form in an email, and send finalised form as soon as possible after the outbreak is over.  All reports and forms, along with any queries should be sent to [EMAIL]
NB:  This form replaces previous reporting form and should be used for ALL acute respiratory disease outbreaks
 |  |  | Virological test done? |  | Region
Data Item | [NAME] Your data here ↓ [NAME] | Instructions | Yes |  | North East
Date of report |  |  | No |  | North West
Number (CFI) |  |  | Unknown |  | Yorkshire & Humber
Comments (CFI) |  |  |  |  | West Midlands
HPZone No. |  |  |  |  | East Midlands
Virological test done? |  | Select'Yes', 'No' or 'Unknown' from drop-down list | Influenza A(H1N1) 2009 |  | East of England
Virological result |  | Select from drop-down list - if the result is not listed use comments field below. | Influenza A (H1 - seasonal) |  | London
Virological result comments |  |  | Influenza A (H3) |  | South East
Institution type (School/care home/hospital/other) |  | Select from drop-down list - use comments below if required | Influenza A (untyped) |  | South West
Institution type (details) |  | Select from drop-down list - use comments below if required | Influenza B |  | Scotland
Institution type comments |  |  | RSV |  | Northern Ireland
Name & Address of institution |  | Please include post code if possible | Other (use comments) |  | Wales
Referring HP team/Lab |  | Name of Health Protection team dealing with the outbreak (preferred) or regional lab testing the samples | Combination (use comments) |  | Unknown
Region |  | Select from drop-down list | Not Applicable - not tested
Any link to foreign travel |  | Select'Yes', 'No' or 'Unknown' from drop-down list | Results pending - please resend report when available
Foreign travel country |  | If infection is thought to me imported please describe and give country/region | Unknown |  | Any link to foreign travel
Age group affected |  | Give age range of those affected in months or years. |  |  | Yes
Clinical comments |  | Comments about clinical presentation if relavent |  |  | No
No. people with symptoms |  | Total number of people with symptoms | Institution type (School/care home/hospital/other) |  | Unknown
No. virologically confirmed cases |  | Total number of people who had a sample taken which tested positive | School
Denominator |  | Total number of people 'exposed' - this may be the total number in the institution or in one class/block etc if the outbreak was confined to one section. | Care home |  | Were antivirals provided?
Attack rate (all cases) |  | This should be calculated from the number of cases and denominator - if this is unavailable an estimate can be given. | Hospital |  | Tamiflu
No. Deaths associated with outbreak |  | Number of deaths presumed due fully or in part to the respiratory illness - please do state if this number is 0 | other (use comments) |  | [NAME]
No. virologically confirmed deaths |  | Number of deaths presumed due fully or in part to the respiratory illness - from whom samples have tested positive for the virus. |  |  | Tamiflu&Relenza
Case fatality rate (all) |  | Calculated from number of deaths and the total number of cases. |  |  | Yes - Name unknown
No. hospitalisations associated with outbreak |  | Number of hospitalisations presumed due fully or in part to the respiratory illness - please do state if this number is 0 | Institution type |  | Other drug
No. virologically confirmed hospitalisations |  | Number of hospitalisations presumed due fully or in part to the respiratory illness - from whom samples have tested positive for the virus. | Nursery (day) |  | No
Hospitalisation rate (all) |  | Calculated from number of hospitalisations and the total number of cases. | Primary School (day) |  | Unknown
No. ICU admissions associated with outbreak |  | Number of patients admitted to Intensive Care Unit (ICU) presumed due fully or in part to the respiratory illness - please do state if this number is 0 | Middle School (day)
No. ARDS cases associated with outbreak |  | Number of patients diagnosed with Acute Respiratory Distress Syndrome (ARDS) presumed due fully or in part to the respiratory illness - please do state if this number is 0 | Secondary School (day)
Onset date of first case |  | If known | School other age range (day)
Week no of onset of first case |  | Using standard week numbers for weeks ending Sunday | Nursery (boarding)
Duration of outbreak (first onset-final case resolved) in days |  | If known | Primary School (boarding)
Were antivirals provided? |  | Select drug used (or 'no' or 'unknown') from drop-down list | Middle School (boarding)
How many cases had received current seasonal flu vaccination? |  | Number of people with symptoms who had been vaccinated with the current seasonal flu vaccine | Secondary School (boarding)
How many non-cases had received the current seasonal flu vaccination? |  | Number of people without symptoms who had been vaccinated with the current seasonal flu vaccine | University
Estimate of seasonal flu vaccine effectiveness |  | VE = 100x(ARU - ARV)/ARU, where VE = vaccine efficacy; ARU = attack rate in the unvaccinated population and ARV = attack rate in the vaccinated population. | Elderly care home
Epidemiology Comments |  | Please include any other relevant information | Other care home (use comments)
Name/phone number/email of person to contact about outbreak |  |  | Adult hospital ward (use comments if required)
 |  |  | Paediatric hospital ward (use comments if required)
 |  |  | Other (use comments)
 |  |  | Unknown