PIDSR Case Definitions

Precious May R. Gabalfin, RN

Senior Health Program Officer
 Category I - Immediately
Notifiable

Case Investigation Form (CIF)

Category II - Weekly Notifiable

Case Report Form

 Vaccine
Preventable
Diseases
Acute Flaccid Paralysis
(Poliomyelitis)
Measles-Rubella
Neonatal Tetanus
Diphtheria
Pertussis
 Acute Flaccid Paralysis
• Any child less than
15 years of age
with acute flaccid
paralysis
OR
• A person of any age
in whom
poliomyelitis is
suspected
 Acute Flaccid Paralysis

• Acute: sudden onset (within 3-4 days or

up to 2 weeks)

• Flaccid: “floppy” (loss of muscle tone of

affected limb)

• Paralysis: reduced or loss of ability to

move the affected limb
 AFP “Hot Case”

• An AFP that is <5 years

old with <3 doses of
OPV and has fever at
onset of asymmetrical
paralysis

OR

• An AFP case or a person

of any age whose stool
specimen(s) has L20B+
isolate
 Differential Diagnosis for AFP
Detection
• Guillain-Barre Syndrome • HIV neuropathy
• Myelitis (e.g. Transverse myelitis,
Pott’s disease) • Hypokalemia

• Traumatic neuritis • Stroke of the young

• Acute meningitides
• Other motor
• Acute intermittent porphyria polyneuropathies
• Acute encephalitides caused by
coxsackie virus and echoviruses,
• Other disease as long as
Japanese encephalitis AFP is manifested
 60-Day Follow-Up

• Follow-up visit to AFP case to determine

presence of residual paralysis

• 60th day from onset of paralysis

• Lost to follow-up: after 3 failed attempts

to locate the case within 90 days from
onset of paralysis
 Measles-Rubella
Suspected case
• Any person with
fever and
maculopapular rash Fever Maculopapular rash

(non-vesicular) AND
one of the following:
cough, coryza (runny
nose), or Runny nose

conjunctivitis (red Cough

eyes)
Red eyes
Neonatal Tetanus

Suspect case
• Any neonatal death from 3-28 days of age in
which the cause of death is unknown

OR
• Any neonate reported as having suffered from
neonatal tetanus from 3-28 days of age and
not investigated
Neonatal Tetanus

Clinically-confirmed case
• Any neonate (<=28 days of life) that sucks and cries
normally during the first 2 days of life, and becomes ill from
3 to 28 days of age and develops an inability to suck and
diffuse muscle rigidity (stiffness) and spasms (jerking of
muscles), which may include trismus, clenched fist or feet,
continuously pursed lips, and/or curved back (opisthotonus)

OR

• Any neonate diagnosed as a case of tetanus by a physician

 Diphtheria
Probable case
• A person with illness
of the upper
respiratory tract
characterized by
laryngitis or
pharyngitis or
tonsilitis, AND
adherent membranes
on tonsils, pharnyx
and/or nose
 Pertussis
• A person with a cough
lasting at least 2 weeks
with at least one of the
following:

Paroxysms of
coughing

Inspiratory “whooping”

Post-tussive vomiting

without other apparent

cause
 Adverse Events Following
Immunization (AEFI)
• Any untoward medical
occurrence which follows
immunization and which
does not necessarily have
a causal relationship with
the usage of the vaccine

Unfavourable/
unintended sign

Abnormal laboratory
finding, symptom, or
disease
 Types of AEFI
• Common/minor reaction

• Serious/rare reaction

Hospitalized

Disability

Life-threatening

Death

• Cluster of minor AEFIs (2 or more cases in same area in 4 weeks)

Cause-Specific Categorization
of AEFIs
Cause-specific
Definition
Categorization
Vaccine product- An AEFI that is caused or precipitated by a vaccine due
related reaction to one or more of the inherent properties of the vaccine
product
Vaccine quality defect- An AEFI that is caused or precipitated by a vaccine that
related reaction is due to one or more quality defects of the vaccine
product including its administration device as provided
by the manufacturer
Immunization error- Immunization error-related reaction: An AEFI that is
related reaction caused by inappropriate vaccine handling, prescribing or
administration and thus by its nature is preventable
Immunization anxiety- An AEFI arising from anxiety about the immunization
related reaction
Coincidental event An AEFI that is caused by something other than the
vaccine product, immunization error or immunization
anxiety
 Vector-
Borne
Diseases
Dengue
Chikungunya
Malaria
 Dengue
Dengue without warning signs

• Person with acute febrile illness of 2-7 days

duration plus 2 of the following:

Headache

Body malaise

Myalgia (muscle pain)

Arthralgia (joint pain)

Retro-orbital pain (eye pain)

Anorexia

Nausea/vomiting

Diarrhea

Flushed skin

Rash
Fever
 Chikungunya

•A patient with
acute onset of
fever, rash (over
limbs or trunk) and
severe arthralgia
or arthritis not
explained by other
medical conditions
 Malaria
Uncomplicated malaria
• Fever

• Splenomegaly

• Anemia

• Headache

• Back pain

• Chills

• Sweating

• Myalgia

• nausea/vomiting
 Food and
Water-Borne
Diseases
Acute Bloody Diarrhea
Hepatitis A
(Acute Viral Hepatitis)
Cholera
Paralytic Shellfish Poisoning
Rotavirus
Typhoid
 Acute Bloody Diarrhea

•Aperson with
acute
diarrhea with
visible blood
in the stool
 Acute Viral Hepatitis
• A person with
acute illness
characterized by
acute jaundice,
dark urine, loss of Jaundice Dark urine

appetite, body
weakness, extreme
fatigue, and high
upper quadrant Loss of appetite

tenderness Right upper quadrant

tenderness
 Cholera
Disease unknown in
the area
• A person aged 5
years or more with
severe Severe dehydration

dehydration or
who died from
acute watery
diarrhea Diarrhea
 Paralytic Shellfish Poisoning
• A person who develops one or more of
the following:

sensory: paresthesias (tingling

sensations on skin), numbness (lack of
sensation) of the oral mucosa and lips,
numbness of extremities

motor: difficulty in speaking,

swallowing, or breathing, weakness or
paralysis of extremities

after taking shellfish meal or soup

 Rotavirus

• Any child <5 years

of age and is
currently undergoing
treatment for acute
diarrhea in any
participating sentinel
hospital
 Typhoid

• A person with an
illness characterized
by insidious onset
of sustained fever
with headache,
malaise, anorexia,
relative bradycardia,
constipation or
diarrhea, and non-
productive cough
Zoonotic
Diseases
Anthrax
Leptospirosis
Rabies
 ANTHRAX
• Cutaneous - painless skin lesion (2-6 days); fever, malaise,
lymphadenopathy

• Inhalation - prodrome (viral respiratory distress), hypoxia, dyspnea

or acute respiratory distress with resulting cyanosis and shock;
radiological evidence of mediastinal widening or pleural effusion

• Gastrointestinal - severe abdominal pain and tenderness, nausea,

vomiting, hematemesis, bloody diarrhea, anorexia, fever,
abdominal swelling and septicemia

• Oropharyngeal - painless mucosal lesion in the oral cavity or

oropharynx, with cervical adenopathy, edema, pharyngitis, fever
and possibly septicemia

• Meningeal - fever, convulsions, coma or meningeal signs

 Leptospirosis

person who developed acute febrile illness

• A
with headache, myalgia and prostration
associated with any of the following:
conjunctival suffusion, meningeal irritation, anuria
or oliguria and/or proteinuria, jaundice,
hemorrhages (from the intestines or lungs),
cardiac arrhythmia or failure, skin rash and other
common symptoms that in- clude nausea,
vomiting, abdominal pain, diarrhea, arthralgia
AFTER exposure to infected animals or an
environment contaminated with animal urine
(e.g. wading in flood waters, rice fields, drainage)
 Rabies
• A person presenting with an acute
neurological syndrome
(encephalitis) dominated by forms
of hyperactivity (furious rabies) or
paralytic syndromes (dumb rabies)
that progresses towards coma
and death, usually by respiratory
failure, within 7 to 10 days after
the first symptom if no intensive
care is instituted
 Other
Notifiable
Diseases
Acute Encephalitis Syndrome
Baterial Meningitis
Acute Meningitis-Encephalitis
Syndrome
Acute Hemorrhagic Fever Syndrome
Hand, Foot, and Mouth Disease
Influenza-like Illness
Meningococcal Disease
Non-neonatal Tetanus
 Acute Encephalitis Syndrome
(Japanese Encephalitis)
• A person of any age with
acute onset of fever
AND at least one of the
following:

Change in mental
status (confusion,
disorientation, coma
or inability to talk)

New onset of seizures

(excluding simple
febrile seizures)
 Bacterial Meningitis
• A person with sudden onset of
fever (≥38.5°C rectal or 38°C
axillary) and one of the
following signs:

Neck stiffness

Altered consciousness Meningeal sign

Altered
consciousness
Other meningeal sign
(bulging fontanelle, Kernig’s/
Brudzinski sign)
Neck stiffness
 Acute Meningitis-Encephalitis
Syndrome (AMES)
• Acute Encephalitis Syndrome + Bacterial Meningitis

• A person of any age with sudden onset of fever plus one of

the following:

Change in mental status (confusion, disorientation, coma

or inability to talk)

New onset of seizures (excluding simple febrile seizures)

Neck stiffness

Other meningeal sign (bulging fontanelle, Kernig’s/

Brudzinski sign)
Acute Hemorrhagic Fever Syndrome
• Any hospitalized person with acute onset of fever of less than 3 weeks
duration and with any 2 of the following:

Hemmorhagic or purpuric rash

Epistaxis (nose bleeding)

Hematemesis (vomiting of blood)

Hemoptysis (coughing out blood)

Blood in stools

Other hemorrhagic symptoms

and the diagnosis is not laboratory confirmed Dengue

Hand, Foot, and Mouth Disease
• Any individual,
regardless of age,
who develop acute
febrile illness with
papulovesicular or Maculopapular rash on
palms
maculopapular rash
on palms and
lesions/ulcers in mouth
soles, with or
without vesicular
lesion/ulcers in the
mouth Rash on soles of feet
 Influenza-Like Illness

• A person with sudden

onset of fever of >=38C
AND cough or sore
throat in the absence
of other diagnoses
SARI

Influenza

Human Avian Influenza

SARS
 Meningococcal Disease
• A person with sudden
onset of fever (>38.5C
rectal or >38C axillary)
and one or more of the
following:

Neck stiffness Altered

consciousness

Altered consciousness

Other meningeal signs

Meningeal sign

Petechial or purpural
rash
Purpuric rash
 Non-Neonatal Tetanus
Confirmed case

• Acute onset of hypertonia

and/or painful muscular
contractions (usually
muscles of the neck and
jaw) and generalized
muscle spasms without
other apparent cause as
reported by a healthcare
professional
LABORATORY CONFIRMATION
SPECIMEN COLLECTION QUICK GUIDE
 For Microbiology
Container/
Time of
Disease Specimen Quantity Transport Storage
Collection
Medium
Acute Bloody Fresh stool As soon as 2-5 ml/pea- Sterile, wide- Body of
Diarrhea/ possible after size mouthed, refrigerator
Cholera/ onset of screw-
Typhoid illness capped, spill-
proof
container
Rectal swab 1-2 swabs Cary-Blair Room
temperature
Leptospirosis Serum 5-10 days or ≥0.5 ml Sterile, screw- Freezer
later after capped tube
onset of
symptoms
Meningococc Serum Onset of ≥0.5 ml Sterile, screw- Freezer
al Disease illness capped tube
 For Microbiology
Container/
Time of
Disease Specimen Quantity Transport Storage
Collection
Medium
Diphtheria Throat and Onset of 2 swabs (1 AMIES without Body of
Nasal Swab illness throat and 1 charcoal refrigerator
nasal)

Pertussis Nasopharynge <2 weeks 2 Dacron Regan Lowe Body of

al swab (NPS) post-cough swabs (left Transport refrigerator
onset and right Media
notrils)
Bacterial Blood Onset of 3-5 ml EDTA Tube Freezer
Meningitis illness (Purple top)

Serum 0.5-1 ml Sterile, screw-

capped tube
 For Microbiology
Container/
Time of
Disease Specimen Quantity Transport Storage
Collection
Medium
Typhoid Blood 1st week Adult: Blood Room
after onset 1:10 ratio culture broth temperature
of illness with BCB (BCB)

Infant/Child:
1:5 to 1:10
ratio with
BCB
 For Virology
Container/
Time of
Disease Specimen Quantity Transport Storage
Collection
Medium
Acute Flaccid Stool Within 14 days 2 samples Separately in Body of
Paralysis from onset of thumb size (8-10 leak-proof, refrigerator
paralysis grams); 5-10 ml screw cap-type
collected if diarrheic containers
24hours apart
Measles Serum Obtain a single At least 1-2 ml Sterile, screw- Freezer
sample at the capped tube
Dried blood spot first contact with 3 dried spots in Individually in Allow dried spot
the healthcare 1 DBS card resealable bag to dry
system at any with dessicant thoroughly; do
time within 28 not expose to
days after onset heat; room
of rash temperature
Nasopharyngeal Within the first 3 1 NPS or 1 OPS Viral/universal Body of
/Oropharyngeal days after onset transport media refrigerator
swab (NPS/ of rash (VTM/UTM)
OPS)
 For Virology
Container/
Time of
Disease Specimen Quantity Transport Storage
Collection
Medium
Influenza-like Nasopharyng Within 5 days 1 NPS or 1 Viral/universal Body of
Illness/ eal/ from onset of OPS transport refrigerator
Human Avian Oropharynge illness media (VTM/
Influenza/ al swab UTM)
Severe Acute (NPS/OPS)
Respiratory
Syndrome
Acute Serum Within 5 days At least 1-2 Sterile, Freezer
Encephalitis from onset of ml screw-capped
Syndrome CSF illness 1ml minimum; tube Freezer
3-4 ml (ideal)
Dengue Serum Within 5 days 1-2 ml Sterile, Freezer
from onset of screw-capped
illness tube
 For Parasitology
Container/
Time of
Disease Specimen Quantity Transport Storage
Collection
Medium
Rabies Brain tissue Antemortem Sterile -20°C or
/Postmortem specimen lower
container; freezer
no temperature
preservatives
Regan Lowe Transport Blood Culture Broth/
Medium Bottle

Universal Transport
Medium

Cary-Blair AMIES Transport Medium

“Stay positive and happy. Work hard and don’t
give up hope. Be open to criticism and keep
learning. Surround yourself with happy, warm,
and genuine people. ”

–Tena Desae