Measles/Rubella lab aggregate data reporting form

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Outbreak Identification
(This question is mandatory)
Email address
(This question is mandatory)
Country
(This question is mandatory)
Year of report
(This question is mandatory)
Month of report
(This question is mandatory)
Overview
 
No. labs reporting
No. labs under surveillance
No. patients with specimen
Summary
(This question is mandatory)
Number of specimens
 
No. specimens received
1 Serum
2 Saliva/oral fluid
3 Nasopharyngeal swab
4 Dry blood spot
5 Urine
6 EDTA whole blood
7 Other specimen
8 Unknown
Performance indicators for IgM testing only
(This question is mandatory)

Number of specimens, Onset / Collection

  <4 days 4–7 days 8–21 days 22–30 days >30 days
For Measles IgM
For Rubella IgM
(This question is mandatory)

Number of specimens, Collection / Reception

  <3 days 3–7 days 8–14 days >14 days
For Measles IgM
For Rubella IgM
(This question is mandatory)

Number of specimens, Reception / Results

  <7 days 7–14 days >14 days Pending
For Measles IgM
For Rubella IgM
Tests results
(This question is mandatory)
No. of specimens
  To be tested Adequate for testing Pending Positive Negative Inconclusive
Measles IgM
Rubella IgM
(This question is mandatory)
No. of specimens
  To be tested Adequate for testing Pending Positive Negative
Measles RT-PCR
Rubella RT-PCR
(This question is mandatory)
No. of specimens
  To be tested Adequate for testing Pending Positive Negative
Measles virus isolation
Rubella virus isolation
(This question is mandatory)
No. of specimens
  To be tested Adequate for testing Pending
Measles genotyping
Rubella genotyping
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