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Peace Corps

Technical Guideline 410

EPIDEMIOLOGIC SURVEILLANCE SYSTEM

1. PURPOSE
The purpose of this guideline is to:

Define the objectives of the Peace Corps Epidemiologic Surveillance System (ESS)

Describe the operation of the ESS

Delineate the role and responsibilities of the PCMO in the operation of the ESS

Describe the role and responsibilities of OMS and the Peace Corps Medical Epidemiologist
(PCME) in the overall operation of the ESS

List the definitions to be used for each reporting category

2. BACKGROUND
The Peace Corps ESS was implemented in October 1985 to meet the following objectives:

Estimate the magnitude of health and safety problems among Volunteers in specific countries and
regions

Document the distribution and spread of specific health-related events in specific countries and
regions

Evaluate prevention and control strategies

Monitor changes in specific infectious diseases

Identify problems that need to be formally investigated using research protocols

Facilitate planning for PCMO and Volunteer training

The ESS is an active reporting system. Each month the PCMO is asked to report the number of
events (cases) of specific conditions occurring among Volunteers during a one-month period. Only
cases which meet the event/case definitions listed below should be reported. It is not necessary to
report all Volunteer illnesses. The surveillance system and event/case-specific definitions are not
intended to be used as clinical case definitions.

The revised event/case definitions contained in this Guideline


are to be used as of January 1, 2008.

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February 2008

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The standard reporting form is included in the Guideline (ATTACHMENT A). Using the event/case
definitions (section 5), a monthly report is sent to the Office of Medical Services (OMS.) The data
from each countrys report is entered into a database maintained by Epi Unit staff. The data are
analyzed periodically and the findings are sent to all PCMOs, CDs, and selected headquarters
managers.

3. ROLES AND RESPONSIBILITIES OF THE PCMO IN THE EPIDEMIOLOGIC


REPORTING SYSTEM (ESS)
3.1

Event/Case Classification

Report only conditions/events involving Volunteers and Trainees. Do not include legal
dependents of Volunteers and Trainees that fall under your care or Peace Corps staff
members. Do not report events that occur after Volunteers or Trainees close service or of
which you become aware after Volunteers or Trainees have closed service. Do report
conditions/events confirmed by laboratory results sent prior to close of service but received
after Volunteers or Trainees have closed service.

Classify all reportable events reported using standardized reporting definitions (see
Section 5). Use of these standardized reporting definitions permits us to make comparisons
within a country from year to year as well as to compare one country with another in the
same or different region.

Report only NEW cases in the monthly report.

Consult the PCME/OMS when it is unclear whether or not an event fulfills the criteria
for reporting.

Frequently asked questions about event/classification are listed below.


How do I report one Volunteer who has two of the same reportable events occurring in a single
month? Both are reported.
Example: A Volunteer develops acute diarrhea on 5 June. The Volunteer visits
the health unit, begins treatment and responds well to the therapy. On 29 June, 2
weeks after therapy was completed, the Volunteer again develops diarrhea. He
phones the PCMO on 29 June and begins a new course of treatment.
The PCMO should report this as two separate cases of diarrhea.

How do I report chronic conditions? These conditions should be reported at the time of the
initial diagnosis only.
Example: A Volunteer has genital warts diagnosed in January and continues to
be followed for this condition over the next 4 months. The event should only be
reported once, under Viral STDs (non-HIV) in January.

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How do I report multiple conditions/events concerning the same Volunteer? These


conditions/events should be reported as individual events.
Example: A Volunteer visits the PCMO in November and is found to have a dental
problem, diarrhea, and dermatitis. All three conditions should be reported in the
November ESS report.

How do I report a single event which may encompass more than one reporting category?
Report each condition/event as an individual event.
Example: A Volunteer is seriously injured in a car accident. Initially, the Volunteer
is hospitalized in-country to be stabilized and then is medevaced to the United
States for more definitive care. For this one Volunteer, three events should be
reported on the ESS report: One motor vehicle-related injury, one hospitalization,
and one OMS-Authorized medevac.

3.2

Correcting or Changing Previous ESS Reports.


Errors should be reported under the category Corrections in the month they are identified.
Include the category to be changed, number to be changed, and month the error was made.
Example: A blood smear collected from a febrile Volunteer is read as
Plasmodium falciparum in June. Reassessment of the smear by a reference
laboratory reports in August that the smear is negative for the parasite. Report
the change in the August report under Corrections as Delete one case of
falciparum malaria in June.

Events that occurred in the past should be reported in the month they are divulged to the PCMO
under the category Corrections.
Example: During an IST in June, a Volunteer reports he experienced an episode
of diarrhea in May that resolved with self-treatment. Report the diarrhea in the
June report under Corrections as Add one 'Other Diarrheal Condition' in May.

Updates in classification to a previously reported event should be reported under the category
Corrections. If event/case definition requires laboratory confirmation to be reported, do not
report the case until after the confirmation is made; then report the case for the month of onset
of symptoms in the Volunteer.
Example: A Volunteer has a suspected case of amebiasis in July which is
confirmed by the laboratory in August. Report under Corrections in the August
report as Add one case of amebiasis in July.

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3.3

Administrative Aspects of Reporting

Although crime information is no longer collected through the ESS, PCMOs are required to
assist with the new Crime Incident Reporting Form (CIRF), administered through the
Office of Safety and Security. Please consult the CIRF User Manual for specifics on the
role of PCMOs in crime reporting.

The monthly ESS report is a medically sensitive, not medically confidential, report. There
are no unique identifiers (names or social security numbers) included in the report. Only
the Country Director should see the report prior to sending it to OMS.

In some cases it may be possible for the Country Director to deduce the identity of a
Volunteer from the report (e.g., only one pregnancy and one medical evacuation to the U.S.
for the month.) Information that is deduced from the report should not be confirmed by
the PCMO. In addition, the Country Director, when extended medical confidentiality, is
required not to disclose such information concerning the identity of the Volunteer.

The monthly ESS report should be sent as an e-mail attachment to OMS. The ESS report
does not need to be sent as an encrypted attachment since it does not contain sensitive
patient information.

The ESS report should be sent to OMS by the fifth day of the month following the
completed reporting month. (See ATTACHMENT A)

4. ROLES AND RESPONSIBILITIES OF MEDICAL EPIDEMIOLOGIST/OMS IN


THE EPIDEMIOLOGIC SURVEILLANCE SYSTEM (ESS)
Answer PCMO questions concerning the reporting system in a timely fashion.
Ensure that all data contained in the monthly ESS reports is entered into the database.
Ask for clarification of ESS report data, when indicated.
Analyze the submitted data and make periodic reports to OMS, PCMOs, CDs, and other interested
PC personnel concerning the health and well-being of Volunteers.

Formally evaluate the ESS periodically to assess whether each of the events in the system should
continue to be under surveillance, describe how the system has been useful, assess the different
qualitative and quantitative attributes of the system, and recommend changes in the system.

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5. DEFINITIONS FOR REPORTING CATEGORIES


The following are standardized case definitions for each reporting category of the ESS. It is important to keep in
mind that the following are surveillance case definitions; although many of the categories have similar surveillance
and clinical case definitions, the surveillance case definitions are not intended to be used as clinical case
definitions.

EFFECTIVE DATE: January 1, 2008

Country:

Self explanatory.

Month:

Include the month of the report.

Region:

Self explanatory

Year:

Include the year of the report.

Alcohol-Related Problem
REPORT:
An incident where behavior was altered or physical/mental acuity was impaired due to alcohol
intoxication. Signs of intoxication may include violent behavior, slurred speech, decrease in physical
coordination, or unconsciousness.
INCLUDE: Incidents of intoxication that resulted in a behavioral change in the Volunteer; incidents observed by
medical staff, other in-country staff, Volunteers, or other reliable sources.

Office of Medical Services

February 2008

NOTE: Multiple incidents of

alcohol problems in the same


Volunteer during the same
month should only be reported
once that month.

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Asthma
REPORT:

Symptoms suggestive
of asthma

(1) New cases meeting the NIH Expert Panels criteria for asthma (see below), and
(2) Recurrences of previously controlled asthma.

Pulmonary function testing (PFT)

CONSULT: APCMO/OMS if asthma is suspected (new diagnosis.)

See flowchart summary of NIH Expert Panel recommendations.


CRITERIA: Symptoms, usually episodic, suggestive of asthma (cough, wheeze, shortness of
breath, exercise intolerance, chest tightness, and/or sputum production) associated
with the following findings:
(1) airflow obstruction on pulmonary function testing which is reversible by
bronchodilators*,
(2) home peak expiratory flow rate monitoring demonstrating airflow obstruction
(must be reversible with use of bronchodilators*), or
(3) a positive response to provocation testing (methacholine challenge.)

Consider
methacholine
challenge, other
diagnosis

FEV1/FVC
low?
Yes
Use bronchodilator, repeat PFT

FEV1
increased?

Yes

Inhaled steroids and bronchodilators


for 2-6 weeks, repeat PFT

*may require 2-6 weeks of bronchodilators and anti-inflammatory agents in severe


cases, also consider other cause for reversible airflow obstruction (foreign body in
airway, heart disease, COPD with reversible component.)

FEV1
increased?

Yes

Asthma likely

Consider COPD

Cardiovascular Problem
REPORT:
A condition related to the heart and blood vessels (e.g., hypertension, phlebitis, arrhythmias,
congestive heart failure, myocardial infarction, and stroke) that was evaluated either by the
PCMO or by another health care professional.
Although one cardiovascular problem may result in several visits/contacts/evaluations, it
should only be reported once.

Colposcopies (In-Country)
REPORT:
A colposcopy performed in the PCVs Country of Service at a clinic, hospital, or facility
authorized by medical staff for the diagnosis and/or treatment of a gynecological condition.

Office of Medical Services

February 2008

DO NOT REPORT incidents of

palpitations or chest pain unless


a diagnosis of a specific cardiac
disorder is made.
DO NOT INCLUDE visits for a refill of
medication for long-standing, well
controlled, stable treated
hypertension.
DO NOT INCLUDE colposcopies
performed in another country or region
(e.g. Volunteer medevaced to another
country for this procedure)

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Dengue
REPORT:

An infection with dengue virus, confirmed by demonstration of IgM antibodies or four-fold


change in IgG antibodies against dengue virus.

Dental Problem
REPORT:
A condition involving the teeth and gums that was evaluated by a dentist or other health care
professional.
Although a single dental problem may result in several visits to a dentist, it should only be
reported once.
Dermatitis (Infectious)
REPORT:
An infection of the skin due to bacterial, fungal, or parasitic organisms evaluated by a health
care professional.
INCLUDE: Laboratory-confirmed and unconfirmed cases.
Environmental Health Concerns
REPORT:
A one-on-one discussion (in-person or by telephone) with a Volunteer or Trainee regarding
his/her concerns about exposure to environmental threats including air pollution, heavy metal
exposures, pesticides, radiation, water pollution/poor water quality, food sanitation, and
disasters such as earthquakes, hurricanes.

DO NOT INCLUDE visits for routine

screening or prophylaxis.

DO NOT INCLUDE skin conditions due

to non-infectious causes (e.g., acne,


eczema, nonspecific rashes)

DO NOT INCLUDE actual exposures


in this category. Any documented
exposure to toxicants such as
chemicals or heavy metals should be
listed under Notes and Other
Conditions in the monthly report.

Other Febrile Illness


REPORT:
Any illness accompanied by a documented temperature of at least 38 degrees Celsius
(100.4F) that is of unknown etiology and does not fit into any of the other category in this
document (e.g., "Presumptive Malaria" or "Presumed Hepatitis").

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February 2008

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Filariasis
REPORT:

Any infection of the blood or other tissues with a filaria species (e.g., Wucheria bancrofti,
Brugia malayi, Onchocerca volvulus, Loa loa, Acanthocheilonema perstans, Dipetalonema
streptocerca, and Mansonella ozzardi confirmed by:
(1) demonstration of the parasite in blood or tissues, or
(2) specific antibody against the parasite, or
(3) circulating serum antigen.

Gastrointestinal Infection
Cases of chronic diarrhea should only be reported once, during the month when it was
REPORT:
diagnosed. Distinct episodes of gastrointestinal infections in the same Volunteer should be
reported each time.

DO NOT INCLUDE cases that were

identified through routine stool


screening unless there were compatible
signs of clinical disease in the
Volunteer.

Amebiasis
REPORT:

An infection of the gastrointestinal tract by Entamoeba histolytica confirmed by


demonstration of:
(1) cysts or trophozoites in stool, or
(2) trophozoites in tissue biopsy or ulcer scrapings by culture or histopathology.
Extraintestinal amebiasis is confirmed by demonstration of:
(1) trophozoites in tissue, or
(2) specific antibody against E. histolytica by the indirect hemagglutination (IHA),
enzyme-linked immunosorbent assay (ELISA), or other specific test among patients
with symptoms compatible with extraintestinal infection.

Giardiasis
REPORT:

An infection of the gastrointestinal tract by Giardia lamblia confirmed by demonstration


of:
(1) cysts or trophozoites in stool, duodenal fluid, or small intestinal biopsy, or
(2) G. lamblia antigen in stool by ELISA or other specific test.

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Helminths
REPORT:

An infection of the gastrointestinal tract by an intestinal helminth (e.g., ascaris, hookworm,


pinworm) confirmed by observation of the parasite or demonstration of eggs in stool.

Salmonellosis
REPORT:
An infection of the gastrointestinal tract with Salmonella species confirmed by
demonstration of the bacterium in stool culture.
NOTE:
Extraintestinal infections (e.g., septicemia, typhoid and paratyphoid fever) should be
reported under Febrile Illness with details under Notes and Other Major Conditions.
Shigellosis
REPORT:

An infection of the gastrointestinal tract with Shigella species confirmed by demonstration


of the bacterium in stool culture.

Bacterial Diarrhea, Other or Presumed


REPORT:
An infection of the gastrointestinal tract due to a bacterial species (other than one listed
above) confirmed by:
(1) culture of the organism from a clinical specimen or
(2) clinical presentation consistent with bacterial infection in which antibiotic treatment
was administered but bacterial etiology was not confirmed with laboratory testing.
Viral Diarrhea, Other or Presumed
REPORT: An infection of the gastrointestinal tract due to a viral species confirmed by:
(1) laboratory testing or
(2) clinical presentation consistent with infection of viral etiology without laboratory
testing.
Other Diarrheal Condition
REPORT:
Diarrhea (defined as four or more liquid or watery stools per day) due to:
(1) infection of the gastrointestinal tract by parasites or protozoa other than those listed
above,
(2) non-infectious causes (e.g., chemicals, heavy metals, food allergies, medications or
(3) an unknown etiology.

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February 2008

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Hepatitis
Hepatitis A
REPORT:

An infection of the liver causing jaundice or elevated aminotransferase levels and


confirmed by demonstration of IgM antibodies against hepatitis A virus.

Hepatitis B
REPORT:

An infection of the liver causing jaundice or elevated aminotransferase levels and


confirmed by demonstration of HBsAg (surface antigen) or IgM antibodies against HBc
(core antigen).

Hepatitis C
REPORT:

An infection of the liver causing jaundice or elevated aminotransferase levels and


confirmed by demonstration of IgG antibodies against hepatitis C virus.

Note: the interval between onset of


disease and detection of antibody may
be prolonged.

Hepatitis, Other or Presumed


REPORT:
An infection or other condition of the liver causing jaundice or elevated aminotransferase
levels due to causes other than hepatitis A, B, or C. If etiology is known, provide details
under Notes and Other Major Conditions.
In-Country Hospitalizations
REPORT:
An overnight stay in country at a clinic, hospital, or facility authorized by medical staff for the
monitoring or treatment of a health condition that required prolonged attendance by a medical
professional.
INCLUDE: Overnight stays at a non-health care facility (e.g., staff members residence) only if the
Volunteer had a condition that required hospitalization, but an appropriate hospital was not
available.

Office of Medical Services

February 2008

IMPORTANT: In-Country
Hospitalizations are to be reported in
both the monthly report and as a
separate incident report as described
in Technical Guideline 430.

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Injury (Unintentional)
In categorizing injuries (formerly called accidents), first consider whether the injury was intentional or
unintentional. Intentional injuries, even when they occur in a motor vehicle, should be reported using the
Crime Incident Reporting Form (CIRF). The categorization of unintentional injuries may depend on
whether a vehicle was involved. A vehicle is defined as a conveyance or a means of transport (e.g., bicycle,
motorcycle, motor vehicle, train, streetcar, animal-drawn vehicle).
REPORT:
Injuries that require medical evaluation or treatment by a health care professional
Injuries that involve vehicles are categorized depending on what the Volunteer was doing at the time of
injury and the type of vehicle involved.

DO NOT REPORT injuries that are self-

treated.
For example, do not report incidents
where the Volunteer skins a knee after
falling off a bicycle if the Volunteer
was not evaluated by a health care
professional.

Pedestrian Injury
REPORT:
An injury associated with a vehicle while the Volunteer was not riding in or on the vehicle.
Includes injuries while standing, walking, running, roller-skating or skate-boarding, as long
as the injury is associated with a vehicle.
Bicycle Riding Injury
REPORT:
An injury that is associated with operating or being a passenger on a bicycle (or unicycle or
tricycle). Includes injuries from falls or being hit by a vehicle while riding a bicycle.
PCMOs should note whether the injured Volunteer wore a helmet during the injury
under "Notes and Other Major Conditions."
Motorcycle Riding Injury
REPORT:
An injury that is associated with operating or being a passenger on a motorcycle (or
moped). Include injuries from falls or burns while riding on a motorcycle.
Motor Vehicle (non-motorcycle) Injury
REPORT:
An injury that is associated with operating or being a passenger in or on a motor vehicle
other than a motorcycle. Include any injury associated with cars, buses, trolleys, streetcars,
and trains.

Office of Medical Services

February 2008

NOTE: If a Volunteer is hit by a car

while riding a bicycle, the injury


should be reported as a bicycle injury,
not a Motor Vehicle (nonmotorcycle) Injury.
NOTE: If a Volunteer is hit by car

while riding a motorcycle, the injury


should be reported as a motorcycle
injury, not a Motor Vehicle (nonmotorcycle) Injury.
DO NOT include injuries involving
motorized boats; these should be
reported under Water-Related
Injury.

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Water-Related Injury/Event
REPORT:
An injury or event associated with swimming, diving, water skiing, boating, or other waterbased activity. Includes but is not limited to near-drowning, decompression sickness,
drowning, spinal-cord injury associated with water sports/events, ciguatera poisoning.
Provide further information about the event under Notes and Other Major
Conditions.
Sports-Related Injury (Note Sport In Notes)
REPORT:
An injury or event associated with engaging in a sporting activity. Includes but is not
limited to soccer, football, baseball, basketball, tennis, jogging, rock climbing, horse back
riding, marathon running, etc. Provide further information about the specific sport
under Notes and Other Major Conditions.

Other Unintentional Injuries


REPORT:
An injury that requires evaluation and/or treatment by a health care professional and is
not associated with the categories listed above (e.g., burns, falls, animal and insect bites,
poisoning, cuts, abrasions, and puncture wounds not associated with vehicles).
NOTE:
When noting type and number of injuries, keep this description brief (less than 15
characters). If there is more to report, continue in the Notes and Other Major
Conditions section.

Include injuries involving motorized


boats in this category.

NOTE: If a sports-related injury can be

reported in a previously specified


category (i.e., Pedestrian, BicycleRelated, Motorcycle-Related, Motor
Vehicle-Related, Water-Related
Injury), it should be reported only in
that category.
DO NOT include injuries incurred
while being a spectator at a sporting
event.
DO NOT include walking, unless
competitive.
DO NOT INCLUDE cases that do not
require evaluation or treatment by a
health care professional.

Injuries, Alcohol-Related
REPORT:
Any injury that requires evaluation and/or treatment by a health care professional and is
associated with any alcohol use by a Volunteer or Trainee.
INCLUDE: All injuries associated with alcohol use, even if already reported in one of the categories
above, should be included. For example, if a Volunteer falls while bicycling home from a bar
after drinking, this should be reported as both a Bicycle-Riding Injury and an AlcoholRelated Injury.

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February 2008

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Leishmaniasis
REPORT:
An infection with Leishmania species, confirmed by demonstration of:
(1) the parasite in smears, biopsy material, or blood, by microscopy or other specific
techniques, or
(2) specific antibody against the parasite.
Medevacs
Medevac to United States Home of Record or Washington, D.C. (OMS-Sponsored Medevac)
REPORT:
A medical evacuation to the United States (either to Washington, D.C. or to the Volunteer's
Home of Record) which requires authorization by the Office of Medical Services.
NOTE:
If a Volunteer's home of record is within the Washington, D.C. metropolitan area, the
category in which to count the medevac depends on where they will reside during the
medevac; if they reside at home or with a relative, it should be considered a medevac to
home of record; if they reside at a hotel arranged through Peace Corps Headquarters, it
should be considered a medevac to Washington, D.C.
Medevac to Other Country (Country Sponsored [Regional] Medevac)
REPORT:
An evacuation to an approved third-country intermediate medevac point (i.e., South Africa,
Senegal, Kenya, Panama, Thailand, Australia) that does not need prior authorization from
the Office of Medical Services.
REPORT:
If a Volunteer/Trainee is evacuated to a country other than South Africa, Senegal, Kenya,
Panama, or Thailand, indicate which country in the "Other" category. The "Other"
category also includes U.S. locations that are not the Volunteer's Home of Record (e.g.,
Hawaii, Miami, and Guam).
REPORT:
Only Volunteers who are evacuated to other countries should be reported as medevacs (e.g.,
South Africa should NOT report any medevacs to South Africa).

Office of Medical Services

February 2008

NOTE: Volunteers who were initially


evacuated to a non-U.S. location then
sent to the U.S. for further evaluation
or treatment should be reported once
as a Medevac to Other Country and
once as a Medevac to United States.

NOTE: Country Sponsored Medevacs


are reported both in the monthly
report and as a separate incident
report as described in Technical
Guideline 430.

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Mental Health Problems


Recurrence of Accommodated Condition
REPORT:

A one-to-one discussion (i.e., in person or by telephone) with a Volunteer regarding any nonenvironmental related problem dealing with a previously diagnosed AND accommodated
mental health issue.
INCLUDE: Only previously diagnosed AND accommodated conditions should be reported under this
category. These problems may or may not lead to medical evacuation to the United States for
further evaluation.
New adjustment disorder to Peace Corps
REPORT:
A one-to-one discussion (i.e., in person or by telephone) with a Volunteer regarding any nonenvironmental related problem dealing with adjustment issues related to Peace Corps
service.
INCLUDE: Include ONLY those mental health problems that are newly diagnosed and are a result of
Peace Corps service, e.g., episodes of minor depression, problems with interpersonal
relationships, minor reactions to stress, loneliness. These problems may or may not lead to
medical evacuation to the United States for further evaluation.
Other Mental Health Problem
REPORT:
A one-to-one discussion (i.e., in person or by telephone) with a Volunteer regarding any nonenvironmental related problem dealing with a mental health issue that is NOT a recurrence
of an accommodated condition or an adjustment disorder related to Peace Corps service.
INCLUDE: The problems included in this category are ONLY those that do not fit into the two mental
health categories listed above.

Office of Medical Services

February 2008

NOTE: If the Volunteer is seen


numerous times during the month for
the same problem, it should be
reported only once in this category. If
a Volunteer has more than one NEW
occurrence of a problem, then each
occurrence should be counted as a
problem.
DO NOT REPORT counseling
interactions for job- or project-related
issues unless the Volunteer
experienced a mental health problem
(e.g., depression, minor reaction to
stress) as a result of problems with
their job or project. Job- or projectrelated counseling interactions should
not be counted if the interaction only
involves the sharing of technical
advice.

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New Accommodated Conditions


REPORT:
The number of conditions that, when examined by the PCMO in-country, require
accommodation for medical and/or programmatic purposes. These conditions must be made
directly by the PCMO; these accommodated conditions are in addition to the accommodations
made by the screening unit.
REPORT:
Only the number of accommodated conditions should be reported, NOT the number of
Volunteers. For example, if a new Volunteer has two conditions identified by the PCMO as
requiring new accommodation, "2" should be indicated on the ESS.
NOTE:
Accommodated conditions may be either newly diagnosed or previously disclosed diagnoses
of such severity that they require accommodation as determined by the PCMO.
NOTE:
Accommodations are defined as situations when Volunteers may be assigned only to certain
sites in country or will require support from post that is different from the support generally
provided to other Volunteers due to medical reasons.

NOTE: PCMOS are encouraged to


review TG 195 for more guidance on
dealing with accommodated
conditions.

Pregnancy
REPORT:

A pregnancy confirmed by appropriate techniques. Include only pregnancies among


Volunteers (not among partners of Volunteers) in the month in which the pregnancy was
confirmed.

DO NOT REPORT the month of

conception.

HIV Post-Exposure Prophylaxis (PEP)


REPORT:
A case of Post Exposure Prophylaxis against HIV given to a Volunteer as per Technical
Guideline 710. Report the case in the month in which the first dose of PEP was given.

Office of Medical Services

February 2008

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Malaria Chemoprophylaxis
(Long-Term Only; NOT for Short-Term Travel)
(ALL countries must now report malaria chemoprophylaxis usage.)
REPORT:
The number of Volunteers currently on each of the following antimalarial chemoprophylactic
regimens:
(1) Mefloquine (Lariam)
(2) Chloroquine (Aralen)
(3) Doxycycline (Vibramycin)
(4) Malarone (atovaquone/proguanil)
(5) Other Chemoprophylaxis (specify agent used)
REPORT:

The number of Volunteers who are on seasonal or year-round antimalarial chemoprophylactic


regimens (e.g., 4 months during rainy season each year, but NOT those on short term travel.

Malaria
The categorization of malaria depends on the prophylaxis prescribed for the Volunteer, the species of
malaria and whether or not it was confirmed. Only laboratory-confirmed cases should be reported under
Falciparum Malaria or Non-falciparum Malaria.
Falciparum Malaria (confirmed)
REPORT:
An infection with Plasmodium falciparum confirmed by demonstration of the parasite in
blood or blood smears by microscopy or other specific techniques.
REPORT:
Confirmed cases only, categorized by the prophylaxis prescribed for the Volunteer.
Non-falciparum Malaria (confirmed)
REPORT:
An infection with Plasmodium vivax, ovale, or malariae confirmed by demonstration of the
parasite in blood or blood smears by microscopy or other specific techniques.
REPORT:
Confirmed cases only, categorized by the prophylaxis prescribed for the Volunteer.

Office of Medical Services

February 2008

NOTE: Cases in which Volunteers are


in a transition between two
antimalarial medications should be
reported in the category of the
preceding prophylaxis regimen until
the transition is completed; e.g., a
Volunteer switching from mefloquine
to doxycycline, on both medications
for a week or two, should be reported
as a case of mefloquine until the
conversion is complete.
NOTE: Short-term travel should be
considered to be <30 days in duration.

NOTE: If the Volunteer is not adherent


to their antimalarial
chemoprophylactic regimen, the case
should still be reported in the category
of prophylaxis that the Volunteer
should have been taking.

NOTE: For mixed infections, report


cases of each CONFIRMED species of
malaria; e.g., a case of mixed Vivax
and falciparum infection in a
Volunteer on doxycycline prophylaxis
should be reported as one case of
falciparum on doxycycline prophylaxis
as well as one case of non-falciparum
on doxycycline prophylaxis.

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Presumptive Malaria
REPORT:
An illness consistent with malaria (e.g., unexplained fever >38 degrees C in a malarious
area) in which treatment for malaria was administered, but was not confirmed by blood
smears or other specific techniques.
INCLUDE: Cases that were self-treated but blood slides were never collected or the slides were not
interpretable.
NOTE:
Cases in which treatment was first administered on clinical grounds, and later confirmed by
laboratory tests, should be reported under one of the above categories.

DO NOT REPORT Volunteers who were

self-treated and subsequently were


found to have had negative blood
slides collected before treatment.
However, compatible cases in which
negative slides were taken after
treatment and not before treatment
should be counted.

Schistosomiasis
Clinical Symptoms/Visualized Ova & Parasite
REPORT:

An infection with Schistosoma haematobium, mansoni, japonicum, or intercalatum,


confirmed by demonstration of: the parasite or its eggs in stool, urine, or tissue.
Positive Antibody Test
REPORT:

An infection with Schistosoma haematobium, mansoni, japonicum, or intercalatum,


confirmed by demonstration of specific antibody against the parasite.

Office of Medical Services

February 2008

Page 17

ESS
TG 410

Sexually Transmitted Disease


Bacterial STD
REPORT:
Sexually-transmitted infections caused by bacteria as noted below.
Syphilis:

(Primary or Secondary) defined as an infection of the genitals with Treponema pallidum


confirmed by demonstration of the spirochete in clinical specimens by darkfield,
fluorescent antibody, or equivalent microscopic techniques. Report as a case of syphilis in
the month the diagnosis was made.
Gonorrhea: Defined as an infection of the genitals with Neisseria gonorrhea confirmed by
demonstration of:
(1) the organism from culture of lesions, or
(2) gram-negative intracellular diplococci in a urethral smear from a man.
Chlamydia: Defined as an infection of the genitals with Chlamydia trachomatis confirmed by
demonstration of the bacterium by:
(1) culture, or
(2) antigen detection assays.
Trichomonas: Defined as an infection of the genitals with Trichomonas vaginalis confirmed by
demonstration of the parasite.
Chancroid: (Soft chancre) defined as an infection of the genitals with Haemophilus ducreyii
characterized by very painful, non-indurated, ragged and undermined ulcer(s) (1 to 10 may
be seen) with an erythematous halo. The lesion bleeds easily with manipulation.
Presumptive Bacterial STD
REPORT:
Cases of likely genital infection for which treatment was provided but no definitive testing
was done (e.g., nongonococcal mucopurulent cervicitis or nongonococcal urethritis that
resulted in treatment for suspected chlamydia, mycoplasma, or ureaplasma, etc.).

Office of Medical Services

February 2008

Page 18

ESS
TG 410

Viral STD (non-HIV)


REPORT:
Sexually-transmitted infections (except HIV) caused by virus as noted below.
Genital Herpes: (first episode or recurrence) defined as an infection of the genitals with herpes simplex
virus (usually type 2) confirmed by demonstration of:
(1) direct fluorescent antibody of material from lesions,
(2) virus from culture of lesions,
(3) rising antibody titer against the virus, or
(4) clinical diagnosis of primary infection followed by recurrence of lesions.
REPORT ONLY episodes where ulceration occurred. Extragenital infections should also be reported
here with details under Notes and Other Major Conditions.

Lymphogranuloma venereum: As confirmed by:


(1) isolation of an LGV serovar from a bubo, ulcer, or from the rectum, cervix or urethra,
(2) a complement fixation (CF) test with a fourfold increase in titer or a single titer of
1:64 or over to an LGV serovar, or
(3) microimmuno-fluorescent antibody titer >1:256 to one of the LGV serovars
REPORT ONLY episodes where ulceration occurred. Extragenital infections should also be reported here
with details under Notes and Other Major Conditions.

Human Papilloma Virus: (Genital Warts) confirmed by:


(1) characteristic histopathologic changes on biopsy or exfoliative cytology, or
(2) visualization of genital condyloma consistent with the infection.
Include: cases detected by routine Pap screening. Extragenital infections should also be reported here
with details under Notes and Other Major Conditions.

Office of Medical Services

February 2008

Page 19

ESS
TG 410

Other Gynecologic Infections


REPORT:
An infection of the female genitalia for which the transmission dynamics are not fully
understood but the presence of which may increase the risk of acquiring other sexually
transmitted diseases, including HIV, due to local inflammation.
REPORT:

Pelvic inflammatory disease defined as infection of the female genitalia characterized by


abdominal pain, adnexal or cervical motion tenderness and at least 1 of the following.
(1) temperature > 38C,
(2) leukocytosis (>10,0000/mm3), or
(3) erythrocyte sedimentation rate >14mm/hr

INCLUDE:

Non-specific vaginitis (bacterial vaginosis) and vaginal yeast infections.

HIV (Human Immunodeficiency Virus, Western Blot Positive)


REPORT:
An infection with HIV as confirmed by a positive Western Blot test.
Tuberculosis
PPD Skin Test Conversion
REPORT:
An infection with Mycobacterium tuberculosis confirmed by conversion from negative to
positive of a Mantoux intradermal skin test using Purified Protein Derivative (PPD) which
was placed on the Volunteer and read by the PCMO or other health care provider trained in
the placement and proper reading of this test.

DO NOT REPORT positive ELISA tests


or indeterminate Western Blot tests.

DO NOT REPORT Volunteers who are


symptomatic or who have signs or
radiologic findings consistent with
active tuberculosis.

Active Tuberculosis
REPORT:
An infection with Mycobacterium tuberculosis confirmed by culture of the organism from a
collected clinical specimen or a clinical presentation consistent with active tuberculosis that
is culture negative but responds to treatment with appropriate anti-tuberculosis therapy.

Office of Medical Services

February 2008

Page 20

ESS
TG 410

Vaccine-Preventable Diseases
REPORT:
Any disease that occurs in a Volunteer or Trainee for which there exists a vaccine that can
prevent the disease. Respective diseases should be confirmed by demonstration of specific
diagnostic laboratory tests.
INCLUDE: Measles, mumps, rubella, diphtheria, pertussis, tetanus, chicken pox, meningococcal
disease, haemophilus influenza type B disease, typhoid, yellow fever, Japanese B
encephalitis, tick-borne encephalitis, rabies, or any other vaccine-preventable disease.
Hepatitis A and hepatitis B virus infections are to be reported under Hepatitis above.

REPORT only cases of actual disease,

not adverse events from vaccinations.


Adverse events from vaccines should
be reported per TG 300..

Corrections
REPORT:

Any corrections (modifications, additions, and deletions) to data reported in previous


months. Specify the month being corrected, the health condition or event, and the number
of cases to add or delete.

Notes and Other Major Conditions


INCLUDE: Any major health condition that does not have a reporting category. Also report details of
conditions as specified in case definitions.

Office of Medical Services

February 2008

Page 21

TG 410 ATTACHMENT A

EPIDEMIOLOGIC SURVEILLANCE (ESS) REPORT FORM


Country:
Region:

Africa

ALCOHOL-RELATED PROBLEMS:
ASTHMA (NEW & EXACERBATIONS):
CARDIOVASCULAR PROBLEMS:
COLPOSCOPIES (IN-COUNTRY):
DENGUE:
DENTAL PROBLEMS:
DERMATITIS (INFECTIOUS):
ENVIRONMENTAL HEALTH CONCERNS:
OTHER FEBRILE ILLNESS:
FILARIASIS:
GASTROINTESTINAL CONDITIONS
Amebiasis:
Giardiasis:
Helminths:
Salmonellosis:
Shigellosis:
Bacterial Diarrhea, Other or Presumed:
Viral Diarrhea, Other or Presumed:
Other Diarrheal Condition:
HEPATITIS
Hepatitis A:
Hepatitis B:
Hepatitis C:
Hepatitis, Other or Presumed:
IN-COUNTRY HOSPITALIZATIONS:
INJURIES (UNINTENTIONAL)
Pedestrian:
Bicycle Riding (NOTE HELMET USE IN NOTES):
Motorcycle Riding:
Motor Vehicle (non-Motorcycle):
Water-Related Injury/Event:
Sports-Related (NOTE SPORT IN NOTES):
Other Unintentional Injuries:
(SPECIFY TYPE & NUMBER FOR EACH):
INJURIES, ALCOHOL-RELATED:
LEISHMANIASIS:
MEDEVACS
Medevac to US Home of Record:
Medevac to US Washington, DC.:
Medevac to South Africa:
Medevac to Senegal:
Medevac to Kenya:
Medevac to Thailand:
Medevac to Panama:
Medevac to Australia:
Medevac to Other Location:
(SPECIFY LOCATION):
MENTAL HEALTH PROBLEMS
Recurrence of Accommodated Condition:
New adjustment disorder to Peace Corps:
Other Mental Health Problem:
Revised: JANUARY 2013

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Month:

January

Year:

2014

NEW ACCOMMODATED CONDITIONS:


PREGNANCY:
HIV POST-EXPOSURE PROPHYLAXIS (PEP):
MALARIA CHEMOPROPHYLAXIS
(LONG-TERM ONLY; NOT FOR SHORT-TERM TRAVEL)
Mefloquine (Lariam):
Chloroquine (Aralen):
Doxycycline (Vibramycin):
Malarone (atovaquone/proguanil):
Other Chemoprophylaxis:
(SPECIFY AGENT USED):
FALCIPARUM MALARIA (CONFIRMED)
Falciparum on MEFLOQUINE:
Falciparum on CHLOROQUINE:
Falciparum on DOXYCYCLINE:
Falciparum on MALARONE:
NON-FALCIPARUM MALARIA (CONFIRMED)
Non-Falciparum on MEFLOQUINE:
Non-Falciparum on CHLOROQUINE:
Non-Falciparum on DOXYCYCLINE:
Non-Falciparum on MALARONE:
PRESUMPTIVE MALARIA
Presumptive on MEFLOQUINE:
Presumptive on CHLOROQUINE:
Presumptive on DOXYCYCLINE:
Presumptive on MALARONE:
SCHISTOSOMIASIS
Clinical Symptoms/Visualized Ova & Parasite:
Positive Antibody Test:

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SEXUALLY TRANSMITTED INFECTION

Bacterial STI:
Presumptive Bacterial STI:
Viral STI (non-HIV):
Other Gynecologic Infections:
HIV (Western Blot Positive):
TUBERCULOSIS
PPD Skin Test Conversion:
Active Tuberculosis:
VACCINE-PREVENTABLE DISEASES :
(SPECIFY TYPE AND NUMBER FOR EACH):
OCULAR CONDITIONS:
(SPECIFY NUMBER WITH CONTACT USE):
REFERRALS TO SPECIALISTS (SPECIFY NUMBER):
CORRECTIONS:
(SPECIFY NUMBER OF CASES, CATEGORY, AND MONTH)
ADD:
DELETE:
NOTES AND OTHER MAJOR CONDITIONS:

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Peace Corps
Technical Guideline 430

CASE NOTIFICATION

1. PURPOSE

To describe the requirement for case notification in the Volunteer Health System.

To describe the procedures for reporting country-sponosored (regional) medevacs and incountry hospitalizations.

2. BACKGROUND
For the purposes of both medical management and surveillance, Peace Corps Medical
Officers (PCMOs) are required to report significant Volunteer health conditions and events to
the Office of Medical Services (OMS). These events include country-sponsored (regional)
medevacs and in-country hospitalizations. Events may be reported concurrently or
retrospectively
Medical Management
Technical Guideline (TG) 370 Field Consultation identifies specific situations where field
consultation is appropriate or required.
TG 380 Medical Evacuation outlines the procedures for country-sponsored (regional)
medical evacuations (medevacs).
Surveillance
Reporting and analysis of country-sponsored (regional) medical evacuations and
hospitalizations provides specific case data about significant events in the Volunteer Health
System and permits OMS to track the severity of illness among Volunteers that is not
captured in the monthly epidemiologic reporting system.

3. REPORTING OF COUNTRY-SPONSORED (REGIONAL) MEDICAL


EVACUATIONS
Country-sponsored (regional) medical evacuation is defined as the transport of a Volunteer
from the country of service to a third country or territory when an illness or injury requires
evaluation and/or treatment beyond the scope of care available in country.

Regional evacuations require OMS or APCMO consultation and concurrence but do not
require OMS authorization (see TG 380 section 6 Medical Decisions).

Office of Medical Services

September 2008

Page 1

TG 430
Case Notification

Regional evacuations are managed by the PCMO and the staff at the evacuation site (see
TG 380 section 12.2 Management of Medevacs at a Regional or Other Non-U.S. site).

Funding for international medical travel and accompaniment (U.S., regional, and other
non-U.S medical travel) is allocated to post budgets from the Office of Volunteer Support
Centrally-Managed Accounts at the beginning of each fiscal year (see TG 380 section 11
Funding).

3.1

Procedures for Reporting


Upon completion of a country-sponsored medevac, the PCMO must report the
following information to OMS using the standard report form included in
ATTACHMENT A. Reports should be sent to the OMS Epidemiology Unit by fax
(202-692-1501) or cable.
1.

Name of PCV;

2.

SSN;

3.

Country of service;

4.

Age;

5.

Entered on duty date;

6.

Brief description of illness/health problem;

7.

Country and facility destination;

8.

Date of medical evacuation;

9.

Accompaniment, if any;

10. Type of accompaniment (medical or non-medical);


11. Whether chartered aircraft;
12. Prior history of the condition, if any;
13. Final diagnoses (list all diagnoses that resulted from the evacuation in
decreasing order of importanceDO NOT USE ICD 9 CM CODES);
14. Number of nights in hospital, if any;
15. Outcome status, i.e., return to country, onward evacuated to the U.S., etc.;
16. Date of disposition;
17. Notification to family by Volunteer, if any;
18. Authorization to discuss the case with the family if OMS is contacted.

4. REPORTING OF HOSPITALIZATIONS
A hospitalization is defined as an overnight stay at a clinic, hospital, or other facility
authorized by medical staff for the monitoring and/or treatment of a health condition that
requires prolonged attendance by a medical professional.
Office of Medical Services

September 2008

Page 2

TG 430
Case Notification

Overnight stays at a non-health care facility, such as the PCMOs residence, are to be
reported only if the Volunteer had a condition that required hospitalization, but an
appropriate hospital was not available.
4.1

Procedures for Reporting


Upon hospital discharge, the PCMO must report the following information concerning
the hospitalization to OMS using the standard report form included in
ATTACHMENT B. Reports should be sent to the OMS Epidemiology Unit by fax
(202-692-1501) or cable.
1.

Name of PCV:

2.

SSN:

3.

Country of service:

4.

Entered on duty date:

5.

Date of admission

6.

Place admitted (Include PCMOs/staff house if hospital/clinic not available and


hospitalization otherwise indicated):

7.

Date of discharge:

8.

Discharge diagnoses (list all diagnoses in decreasing order of importance


DO NOT USE ICD 9 CM CODES):
DX 1:
DX 2:
DX 3:
DX 4:
DX 5:

9.

Return to duty at site (yes or no):

10. Plan for Volunteer if not returning to site:


11. Family notified of hospitalization (yes or no):
12. OMS authorized to discuss with family if contacted (yes or no):

Office of Medical Services

September 2008

Page 3

TG 430 ATTACHMENT A

COUNTRY-SPONSORED (REGIONAL) MEDEVAC FAX FORM


FROM:
TO: OMS/DIRECTOR
1. NAME OF PCV:
2. SSN:
3. COUNTRY OF SERVICE:
4. AGE:
5. ENTERED ON DUTY DATE:
6. BRIEF DESCRIPTION OF ILLNESS/HEALTH PROBLEM:

7. COUNTRY AND FACILITY DESTINATION:


8. DATE OF MEDEVAC:
9. ACCOMPANIMENT (YES OR NO)
10. TYPE OF ACCOMPANIMENT (MEDICAL OR NON-MEDICAL)
11. CHARTERED AIRCRAFT USED (YES OR NO)
12. PRIOR HISTORY OF THE CONDITION (YES OR NO)
13. FINAL DIAGNOSIS (IN ORDER OF IMPORTANCE; DO NOT USED ICD-9 CODES)
DX 1
DX 2
DX 3
DX 4
DX 5

14. NUMBER OF NIGHTS IN HOSPITAL (IN NONE, INSERT 0)


15. OUTCOME STATUS (RETURNED TO COUNTRY, ONWARD EVAC TO US, ETC.)
16. DATE OF DISPOSITION:
17. FAMILY NOTIFIED: (YES OR NO)
18. OMS AUTHORIZED TO DISCUSS IF FAMILY CALLS (YES OR NO)

TG 430 ATTACHMENT B

IN-COUNTRY HOSPITALIZATION REPORT FORM

FROM:
TO: OMS/DIRECTOR

1.

Name of PCV:

2.

SSN:

3.

Country of service:

4.

Entered on duty date:

5.

Date of admission

6.

Place admitted (Include PCMOs/staff house if hospital/clinic not available and


hospitalization otherwise indicated):

7.

Date of discharge:

8.

Discharge diagnoses (list all diagnoses in decreasing order of importance


DO NOT USE ICD 9 CM CODES):
DX 1:
DX 2:
DX 3:
DX 4:
DX 5:

9.

Return to duty at site (yes or no):

10. Plan for Volunteer if not returning to site:


11. Family notified of hospitalization (yes or no):
12. OMS authorized to discuss with family if contacted (yes or no):