a Case Investigation Form Survelance and Response Measles-Rubella (ICD 10 Code: 805; 806) Wame of ORU: = oo Jomu complete Adress Type: ORHU CICHO CGovt Hospital CiPrivate Hospital Clinic I Gov" Laboratory Private Laboratory ClAipor’Seaport |. PATIENT INFORMATION aaa |pavent Number i 10 [Patient's First Name Middle Name LastName | Fenn hares Sex OMe Female Gace gas 7] Pregnant?” OY ONG U mu 00 ve 1F¥es, wooks of pregnancy lpetice THz: Patient admitted? GY ON © [Date Admitted ee Ss a SeoniConsut ‘ame of parenicaregiver: [Contact Nos. [ees a [eT ae wo ap [bate of Report Name of reporter: [contact Nos. [oat ot | | | |name of investigators: — 7 investigation: - a tigator/s; |Contact Nos. |IEGLINCAL DATA, Fees OY ON Arthralgia/arthats DY GN | Are there any complications? Date onset_/_/ ___|Swollen lymphatic nodules: OY ON | GY GN Rast) = OY ON YES, speciy Date onset;__/__» | tyes, specify locaton: Other symptoms: Cough: ay oN CO cenical CD sub-occipital oplksign: = OY ON 1 post-auricular ‘WorkingiFinal Diagnosis: Runny naselooryza: gy on Dothers, specity Red eyeslconjunctiviis: OY ON lll, VACCINATION HISTORY AND VITAMIN A SUPPLEMENTATION | Patient received measles-containing vaccine (MCV)? oy aN IFYes, indicate the number of doses whichever is applicable: Mv MRL MMR__ Date last dose received MCV: ‘Wes vaccination received during special campaigns? oy oN \atient did not receive any MCV, state the reason's 1 Mother was busy {Child was sick 0 Forgot schedule iat er reasons, speci Against beet No vaccine avaliable Doth pecity ‘O Medical contraindication 1D Vaccinator not available - - = O Fear of side effects CD Not eligible for vaccination th 2 ON 1135 e patient given Vitamin A during this illness: ay 'Y. EXPOSURE HISTORY stay of travel in another province, cily or country: ON FY Wf Yes: YES. spec piace = ‘ont Fm fp to ) te fining of travel relative to rash onset ere | 18595 an ash onset CD 7-24 cays tom rashonset C721 aS Lye ofp venly acer eadayeane OBatanDsy CHE Ochoa! CHeathCareFactly | te Yh of place where exposure probably "mlory Qwork place Others, specity Was there cont rela cave core wh cat an fever) 7-21 dave por rash onset? LY ON Cy © Contact with a menslesiubedlia Case (OF Mabel {28S ta name ofan eae 1° Of barar a A there aaay & municipalityiciy suaiess of presence of 3's) nthe communi? By ~* here other known cases with fever and rash (regal On ou Not the ie answer to any of the last two questions is YES. coordinate he SU for validation and field investigation inswer to any of the f seal ach L :Measles-Rubella Case Investigation Form V. LABORATORY TESTS | Specimen collected ves. Date sent to Bane inthe box ; |Provces) alse Many TAN \ i - Date roceved MURITR Measles ight Rubel aM vis Resa tealaton Fest tobe filed up | Result DSerum |Dibried Blood Spot ‘oropharyngeal! ; ‘Nasopharyngeal swab? Doraco? SS j all |VIl. SOURCE OF INFECTION, [Doreco? ___". Vi. FINAL CLASSIFICATION 1D Laboratory confirmed measles 1D Laboratory confirmed rubella.) Endemic 1D Epidinked confirmed measles 1D. Epitinked confirmed rubella [Imported 1D Ciinically Measles compatible 1D Discarded as non-measles/non- |) Import-elated TE Vaccine-associated measios rubella 1D Unknown Date died:_/_/— vu ouTcoMe: © Alive 0 Died 0 Unknown FINAL DIAGNOSIS: ‘CASE DEFINITION suspected case: Any person with fever and maculopapular rash (non-vesicular) and elther junctivitis (red eyes) cough, coryza (runny nose) or con. CLASSIFICATION onltmed by the National Measles Laboratory (NM) varaior postive for measles virus isolation or Pa ‘A suspected measles case that has been co 1. Laboratory-confirmed measles cast ive for measles 1gM antiboce OF the Re-search Insitute for Topical Medicine as posit | merase Chain Reaction (PCR) 12t has. ot been confirmed by a laboratory but tempo 2. Epidemiologically linked confirmed measles case: A suspect measies as? “10.2 laboratory-confirmed case oF te Zinvvane geogrepnicaly related. with dates of rash onset occuring between! 7-21 days ¢ uentare'chain of transmission to anather epidemiologicaly-tinked measies x0 adequate specimen was taken and which has no! beer 4. Clinically measles compatible case: A suspect measles case for which 0 ‘confirmed communicable disease. inked ep. demlologicaly fo laboratory confirmed measles case or another laboratory confirmed by the NML as positive for rubelia IgM ant 4. Laboratory-confirmed rubella case: A suspected measles case that has been bodies, 5. Epidemiotogically linked confirmed rubella case: A patient witha febrile rash llness that is negative for measles and epidemics | ally linked toa laboratory-confirmed rubella case i ella: A suspect case that has been investigated and discarded as a non-measles ans "0 6. Discarded as Non-measles and Non-Rubs firmed caseloutbreak of aro!" ae eset tesing.by tne No) epdemiiogial Inkage to aboraton-con communicable disease that is neither measles nor rubella. - ELABORATORY CONFIRMATION: + Positive serologic test result for antimeastes IgM antibodies ‘+ Fourfold se in ant-meastes IgG antibodies in acute and convalescent serum 1+ Isolation of meastes virus Dot immunobinging assay Polymerase chain reaction testing for measles nucleic acid ‘Therapeutic Dosage of Vitamin A for Measles cases: $50,000 1U for children <6 months old 100,000 10 for chiigren 6 t0 11 months old 200,000 1U for chidren 12 10 71 months old ‘upon diagnosis reganitass of whan the Last dose of wana A 8