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AES Guidelines

Apr 07, 2018

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    AESF1/1A = AES Cases & JE cases reporting Form from the States

    SSSL = Sentinel Surveillance Sites with laboratory facilities

    SSS = Sentinel Surveillance Sites without laboratory facilitiesIU = Informer Unit

    AESF2/2A = AES Cases & JE cases reporting Form from the Districts

    AESF3 = Line l isting Form

    AESF4 = Case Investigation Form

    AESF5 = Laboratory Report Form

    I N F O R M A T I O N F L O W D I A G R A M

    3.6 Surveillance activities at the national

    level

    The national level receives daily/weekly/monthly

    reports as per the disease status i.e daily report

    i n o ut br ea k s it ua ti on , w ee kl y r ep or t i n

    transmission period and monthly report in inter-

    epidemic period from various states. At the

    national level,the data from thestatesis collated

    and compiled to prepare the national report with

    epidemiological inferences. National data may

    be shared with international organization and

    other Institutes in due permission of concerned

    authorities. These reports will form the basis for

    planning JE containment activitiesand allocation

    of resourcesto the affectedareas.

    NVBDCP

    STATES SPO

    DISTRICTSDMO

    SSSL SSS IU

    AESF3,AESF4AESF3, AESF4, AESF5

    AESF2, AESF2A

    AESF1, AESF3

    AESF5

    AESF-1A & AESF-2A during an outbreak

    10

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    Annexure

    JE Reporting Formats

    PROFORMAFOR

    MONTHLYREPORT

    ON

    ACUTE

    ENCEPHALITISSYNDROME

    CASES/

    JAPANESE

    ENCEPHA

    LITIS

    *F

    ROMSTATES

    Sta

    te________________D

    istric

    t_________________

    Per

    iod

    inc

    lude

    dinth

    ere

    port:From

    ________________to__

    _____________________

    Dat

    eo

    fR

    eport:

    No

    .o

    fC

    asesreporte

    d

    Agew

    ise

    No

    .o

    fD

    ea

    thsreporte

    d

    Agew

    ise

    Cumu

    lati

    ve

    total

    No

    .fo

    un

    d+v

    e

    for

    JE

    Remarks

    **

    0-1 ?

    1-5

    6-1

    5

    >15

    yrs

    .

    To

    tal

    0-1 ?

    1-5

    6-1

    5

    >15

    yrs

    To

    tal

    C

    ases

    Dea

    ths

    S

    l.

    N

    o

    Name

    of

    the

    District

    Dis

    ease

    No

    .o

    f

    aff

    ec

    t

    ed

    PHC

    s

    M

    F

    M

    F

    M

    F

    M

    F

    M

    F

    M

    F

    M

    F

    M

    F

    M

    F

    M

    F

    V

    N

    V

    N

    No

    .o

    f

    Samp

    les

    co

    llec

    ted

    V

    N

    AES

    JE

    AES

    JE

    AES

    JE

    C:C

    ases

    D:

    Dea

    th

    M:

    Ma

    leF

    :F

    ema

    le

    V:

    Vacc

    ina

    ted

    N:

    Not

    Vacc

    ina

    ted

    **M

    entioncausesof

    encephalitisor

    AESunknown

    .

    (Name

    &Signa

    ture

    )

    Des

    igna

    tion

    Sen

    dth

    isre

    port

    toN

    VBDCP

    ,Ne

    wDe

    lhi

    by

    Fax

    No

    .011

    -23968329

    ,e

    -ma

    il:namp

    @n

    dc

    .vsn

    l.ne

    t.in

    AESF

    1

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    P

    ROFORMAFOR

    DAILY/WEEKLY

    REPORT

    ONACUTEE

    NCEPHALITIS

    SYNDROME

    CASES/

    JAPANESE

    ENCEPHALITIS

    *F

    ROMSTATES

    S

    tate

    ___________

    Year

    _____

    Month

    _________

    Weekly

    Re

    port

    (from---------to---------)

    /D

    aily

    Report

    (date--------

    )

    Sl.

    No

    Nameo

    f

    the

    District

    Disease

    During

    thewee

    k/day

    Progress

    ive

    Tota

    l

    (From

    1st

    Januaryto

    ------------

    )

    Remarks

    Cas

    es

    Dea

    ths

    No

    .o

    f

    samp

    les

    co

    llec

    ted

    No

    .fou

    nd

    +v

    efor

    JE

    Cases

    Dea

    ths

    No

    .o

    f

    samp

    les

    co

    llec

    ted

    No

    .fo

    un

    d

    +v

    efo

    rJ

    E

    AES

    1

    .

    JE

    AES

    2

    .

    JE

    *=

    Da

    ilyreport

    duringep

    idem

    ic/out

    brea

    kan

    dwee

    klyreport

    intransm

    iss

    ionseason

    (N

    ame

    &Signature)

    Designation

    D

    uring

    ou

    tbrea

    ks,s

    en

    dth

    isrep

    ort

    da

    ilytoN

    VBDCP

    ,N

    ew

    Delhi

    Fax

    No

    .011

    -23968329

    ,e

    -ma

    il:namp

    @n

    dc

    .vsn

    l.ne

    t.in

    AESF

    1A

    PRO

    FORMAFOR

    MONTHLYREPO

    RTONACUTEENCEPHALITIS

    SYNDROMECASES/

    JAPANESEENCEPHALITIS*

    FROM

    DISTRICTS

    Stat

    e________________

    District__

    _______________

    Peri

    odinc

    lude

    dinthereport:

    From

    ________________

    to_______

    ________________

    Date

    of

    Report:

    No

    .o

    fC

    asesreporte

    d

    Agew

    ise

    No

    .o

    fD

    ea

    thsreporte

    d

    Agew

    ise

    Cumu

    lative

    total

    No

    .fo

    un

    d+ve

    for

    JE

    Remarks

    **

    0-1 ?

    1-5

    6-1

    5

    >15yrs

    .

    To

    tal

    0-1 ?

    1-5

    6-1

    5

    >15yrs

    To

    tal

    Cases

    Dea

    ths

    Sl.

    No

    Name

    of

    the

    SSSL

    or

    SSS

    Disease

    No

    .o

    f

    affec

    t

    ed

    PHCs

    M

    F

    M

    F

    M

    F

    M

    F

    M

    F

    M

    F

    M

    F

    M

    F

    M

    F

    M

    F

    V

    N

    V

    N

    No

    .o

    f

    Samp

    les

    co

    llec

    ted

    V

    N

    AES

    JE

    AES

    JE

    AES

    JE

    C:Cases

    D:

    Dea

    th

    M:

    Ma

    leF:

    Fema

    le

    V:

    Vacc

    ina

    ted

    N:

    No

    tV

    acc

    ina

    ted

    **Men

    tioncauseso

    fe

    ncep

    ha

    litisor

    AESun

    known

    .

    (Name

    &Signa

    ture

    )

    Des

    igna

    tion

    Sen

    dthisreport

    toStateProgramm

    eOfficer

    (SPO),

    __________b

    yFax

    Num

    ber

    ________

    or

    em

    ail

    id

    AESF2

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    PROFORMAFOR

    DAILY/WEEKLY

    REP

    ORT

    ONACUTEENCEPHALIT

    ISSYNDROMECASES/

    JAPANESEENCEPHALITIS*

    FROMDISTRICTS

    State

    __________D

    istric

    t__________Y

    ear

    ________W

    ee

    kly

    Report

    (from---------t

    o---

    ------

    )/D

    aily

    Report

    (da

    te--------

    )

    Sl.

    No

    Name

    of

    the

    Sen

    tine

    l

    Surve

    illance

    Sites

    Disease

    During

    thew

    ee

    k/day

    Progre

    ss

    ive

    To

    tal

    (From

    1s

    tJa

    nuary

    to------------

    )

    Remarks

    Cases

    Dea

    ths

    No.o

    f

    Samp

    les

    colle

    cted

    No

    .fo

    un

    d

    +v

    efo

    rJE

    Cases

    Dea

    ths

    No

    .o

    f

    Samp

    les

    co

    llec

    ted

    No

    .fo

    un

    d

    +v

    efo

    r

    JE

    AES

    1.

    JE

    AES

    2.

    JE

    *=

    Da

    ilyreport

    duringepid

    em

    ic/o

    utbrea

    kan

    dwee

    kly

    report

    in

    transm

    iss

    ionseason

    (Name

    &Signa

    ture

    )

    Des

    igna

    tion

    Duringou

    tbrea

    ks

    ,s

    en

    dth

    isreport

    da

    ily

    toStateProgramm

    eOfficer

    (SPO),

    __________

    by

    Fax

    Num

    ber

    ________

    or

    email

    id

    AESF

    2A

    LinelistofA

    ES/JECases

    Mon

    thly/

    Wee

    kly/

    Da

    ily

    Rep

    ort

    (Enc

    irc

    leth

    ea

    ppropria

    te*)

    Thisreportisse

    ntfrom

    ________________

    ______(SpecifyNameof

    SSS/District/State)

    Period

    Included

    inth

    is

    report

    from

    __________________to________________________

    Total

    Number

    of

    Cases

    inth

    isp

    eriod

    ___________(Wr

    ite

    Nil

    ifth

    ere

    are

    no

    cases)

    Date

    of

    Report:

    Personsendingthereport:_

    ___

    ______________________

    Designation

    __________________________

    Signature

    __________

    (1)

    Re

    lig

    ion:

    H=

    Hindu

    ,M

    =Mus

    lim

    ,O

    =Others

    (7)

    Da

    teo

    fo

    nse

    to

    ffe

    ver

    (2)

    Sexo

    fc

    hild:

    M=

    Ma

    le,F

    =Fema

    le

    (8)

    Change

    inmen

    tal

    status

    (3)

    Age

    (9)

    Se

    izuresyes=

    1,n

    o=

    2,u

    nknown=

    3

    (4)

    No

    .o

    fv

    acc

    ina

    tion

    doses

    &da

    teo

    fla

    st

    JEvacc

    ina

    tion

    (10)

    Spec

    ifiedtypeo

    fs

    amp

    lesco

    llecte

    di.e

    .b

    loo

    dor

    CSF&da

    teo

    fc

    ollec

    tion

    (5)Da

    teo

    fA

    dm

    iss

    ion

    (11)

    La

    bResu

    lt:

    1=

    Pos

    itive

    ,2

    =Nega

    tiv

    e,3

    =No

    tte

    sted

    ,4

    =Un

    known

    (6)

    Da

    teo

    fo

    nse

    to

    fs

    ymp

    toms

    (12)

    Statusa

    tD

    isc

    harge:

    Norma

    l/Disable/Diedon

    /Anyo

    ther

    (13)

    Fina

    lC

    lass

    ifica

    tion:

    1=

    La

    bCon

    fir

    me

    dJE

    2=

    Pro

    ba

    bleJE3=

    AESUn

    known

    ,4

    =AESo

    thera

    gen

    tDa

    teo

    fd

    ea

    thor

    disc

    harge

    *D

    aily

    report

    during

    ep

    idem

    ic/outbrea

    k,W

    ee

    kly

    report

    intr

    ansm

    iss

    ion

    season

    an

    dMon

    thly

    reportevery

    mon

    th

    District

    Name

    Re

    lig

    io

    n

    Sex

    Age

    No

    .o

    f

    Doses

    Da

    teo

    f

    las

    tJ

    E

    vacc

    i-

    na

    tion

    Da

    te

    Of

    Adm

    i-

    ss

    ion

    Da

    teo

    f

    onse

    t

    of

    symp

    to

    ms

    Da

    te

    of

    onse

    t

    fever

    Change

    inmen

    tal

    status

    (Y/N)

    Se

    izure

    (Y/N)

    Typeo

    f

    samp

    le

    Da

    teo

    f

    samp

    le

    co

    llec

    ti

    on

    La

    b

    Resu

    lt

    Out

    c

    ome

    Remark

    AESF

    3

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    FORMAT FOR MOSQUITO BREEDING SURVEY REPORTS

    1) State------------------Zone-----------------Dist.--------------PHC---------Locality------

    2) Month --------------------------Year----------------------

    DETAILS OFMOSQUITOBREEDING SITES

    NO.CHECKED

    NO. FOUND+ VE DENSITY / DIP

    NAME OFSPECIESIDENTIFIED*

    1 Anopheles Culex Aedes

    2

    34

    5

    6

    7

    8

    *For identification of JE vectors: Larvae of mosquitoes may be reared inthe Laboratories for adult emergence, as adult is easy to identify.

    1) Remarks:-----------------------------------------------------------

    Signature of the investigator

    Designation

    AESF 6 FORMAT FOR MONITORING OFJAPANESE ENCEPHALITIS VECTORS DENSITY

    A.1) State_____ Zone_______ District ________PHC _____Village_________

    2) Month of collection_________________

    3) Name of the insecticide sprayed---------------------- Date of last spray ---------

    4) Spray coverage- Population Room House CS

    In % ---------------- ---------------------- -------------------

    B. JE Vector Density (Per man hour density)

    1. Time of collection (Morning his collection) 6 a.m. 8 a.m.

    2. Total time spent-------------- No. of structure ------ No. of persons ------------

    NAME OF THESPECIES INDOOR

    OUTDOOR

    HD CS MD PMHD PMHD

    HD = Human dwelling CS = Cattle sheds MD = Mixed dwelling

    PMHD = Per man hour density = No. of mosquito caught------------------------------No. of person x Time in hours

    C. ABDOMINAL CONDITION

    NAME OF THE

    SPECIES

    UF FF SG G TOTAL

    UF = Unfed FF = Full fed SG = Semi Gravid G = Gravid

    Remarks if any ---------------------------------

    Signature of InvestigatorName & Designation

    AESF 7

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    FORMAT FOR MONITORING OF JAPANESE ENCEPHALITIS VECTORMOSQUITOES DENSITY BY WHOLE NIGHT VECTOR LANDING

    COLLECTION

    State --------------------------------- Zone------------------ District---------------------PHCs-

    1. Date of the study--------------------------

    2. No. of Baits-------------------

    3.

    HUMAN / BAIT ANIMAL/ BAITNight hoursCollection

    Vectors Collected Vectors Collected

    INDOOR OUTDOOR INDOOR OUTDOOR

    18-19 1 2 3 1 2 3 1 2 3 1 2 3

    19-20

    20-21

    21-22

    22-23

    -

    05-06Bait Night Bait

    Name of the species1)=2) =3) =

    5 Weather condition -

    (Tick Marks )

    Wind Rain Fog Cloudy

    Signature of the investigator

    Designation

    AESF 8

    FORMAT FOR MONITORING OF INSECTICIDE SUSCEPTIBILITY STATUSOF JAPANESE ENCEPHALITIS VECTOR MOSQUITOES

    (ADULT/ LARVAL STAGE)

    State--------------------------- Zone--------------------District------------------ PHC-----------

    1) Date of test----------------------------------------------------

    2) Species tested-----------------------------------------

    3) Insecticide tested-----------------------------Name of insecticide------------------------Concentration---------------------------------------

    4) Test sample----- source of collection --------Physiological stage UF/ FF/SG

    5) Test Results

    REPLICATE-I REPLICATE- II REPLICATE- -III

    Test group Test Control Test Control Test Control

    No. exposed

    No. dead

    % Mortality

    Most corrected

    UF = Unfed FF = Full fed SG = Semi Gravid G = Gravid

    6) Temp:

    7) Humidity:

    Signature of the investigator

    Designation

    AESF 9

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    OUTBREAK INVESTIGATION REPORT

    General information

    State :

    District:

    PHC/Town:

    Village/ Ward :

    Population :

    Background information

    Person reporting the outbreak:

    Date of report

    Date when investigations started

    Person(s) investigating the outbreak

    Details of investigation

    Describe how cases were found (may include a) house to house search inthe affected area; (b) visiting blocks adjacent to the affected area; (c )conducting record reviews at local hospitals; (d) requesting health workersto report similar cases in their areas etc.):

    Descriptive epidemiology

    Cases by time, place and person (attach summary tables and relevant graphsand maps)

    Age specific attack rates and mortality rates

    High risk age groups and geographical areasVaccination status of cases, unaffected population

    AESF 10

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    Annexure-2

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    Sl. No. STATE DISTRICT CODE

    56 1 U TTAR PR AD ES H MU ZA FFA RN AG AR M ZN

    562 UTTAR PRADESH PILIBHIT PIL

    563 UTTAR PRADESH PRATAPGARH PTG

    564 UTTAR PRADESH RAEBARELI RBL565 UTTAR PRADESH RAMPUR RMP

    5 66 U TTA R P RA DE SH S AN T K AB IR N AG AR S KN

    567 UTTAR PRADESH SHAHARANPUR SHP

    56 8 UT TAR PR AD ES H S HA HJ AH AN PU R S HA

    5 69 U TTA R P RA DE SH S ID DH AR TH NA GA R S DN

    570 UTTAR PRADESH SITAPUR STP

    571 UTTAR PRADESH SONBHADRA SBD

    572 UTTAR PRADESH SRAWASTI SRW

    573 UTTAR PRADESH SULTANPUR SUL

    574 UTTAR PRADESH UNNAO UNN

    575 UTTAR PRADESH VARANASI VRN

    576 UTTARANCHAL ALMORA AMR

    577 UTTARANCHAL BAGESHWAR BGW

    578 UTTARANCHAL CHAMOLI CML

    579 UTTARANCHAL CHAMPAWAT CPT

    580 UTTARANCHAL DEHARADUN DDN

    581 UTTARANCHAL GARHWAL GRL

    582 UTTARANCHAL HARDWAR HRD

    583 UTTARANCHAL NAINITAL NNT

    584 UTTARANCHAL PITHORAGARH PRG

    585 UTTARANCHAL RUDRAPRAYAG RPG

    586 UTTARANCHA L TEHRI GARHWAL TGL

    5 87 U TTA RA NC HA L U DH AM SI NG H N AG AR U DS

    588 UTTARANCHAL UTTAR KASHI UKS

    5 89 W ES T B EN GA L 2 4- PA RG AN AS N OR TH N PG

    5 90 W ES T B EN GA L 2 4- PA RG AN AS S OU TH S PG

    591 WEST BENGAL BANKURA BKR

    592 WEST BENGAL BARDHAMAN BDN

    593 WEST BENGAL BIRBHUM BBM

    594 WEST BENGAL CALCUTTA CAL

    59 5 WE ST BE NG AL D AK SH IN DI NA JPU R D DJ

    596 WEST BENGAL DARJILING DJL

    597 WEST BENGAL HOWRA HRA

    598 WEST BENGAL HUGLI HGL

    599 WEST BENGAL JALPAIGURI JPG

    600 WEST BENGAL KOCH BIHAR KBR

    601 WEST BENGAL MALDAH MLD

    602 WEST BENGAL MEDINIPUR MNP

    603 WEST BENGAL MURSHIDABAD MBD

    604 WEST BENGAL NADIA NDA

    605 WEST BENGAL PURULIA PRL

    606 WEST BENGAL TAMLUK TML

    607 WEST BENGAL UTTAR DINAJPUR UDJ

    Table

    -1

    Coun

    try

    Disease

    STATE

    States

    Nameo

    f

    Dis

    trictsGora

    khpur

    District-Co

    de

    32

    PHCs

    /CHCs

    /MC

    Co

    de

    Co

    de

    Co

    de

    Districts

    Co

    de

    Co

    de

    IN

    D

    JE

    Uttar

    UP

    Agra

    1

    Be

    lgha

    t

    1IND

    -AES

    -UP

    -32

    -01

    -001

    Pra

    des

    h

    Aligarh

    2

    Bha

    tth

    2

    Alla

    ha

    ba

    d

    3

    Bra

    hmpur

    3

    Am

    be

    dkar

    nagar

    4

    Charganva

    4

    Aura

    iya

    5

    Derava

    5

    Azamgarh

    6

    Gag

    ha

    6

    Ba

    daun

    7

    Janga

    lk

    oria

    7

    Ba

    do

    hi

    8

    Kha

    jni

    8

    Bag

    hpa

    t

    `

    9

    Ko

    diram

    9

    Ba

    hra

    ich

    10

    Sardarnagar

    10

    Ba

    llia

    11

    Bansgavn

    11

    Ba

    lrampur

    12

    Ba

    hra

    lgan

    j

    12

    Ban

    da

    13

    Chouric

    houra

    13

    Bara

    ban

    ki

    14

    Goa

    la

    14

    Bare

    illy

    15

    Harna

    i

    15

    Bas

    ti

    16

    Pa

    li

    16

    Bijnor

    17

    Pipra

    ich

    17

    Bu

    lan

    ds

    ha

    har

    18

    Kamp

    ion

    18

    Chan

    dau

    li

    19

    Sa

    han

    java

    19

    Chitra

    koo

    t

    20

    District

    Hosp

    ita

    lG

    pur

    20

    Deoria

    21

    BRDMe

    d.C

    ollege

    21IND

    -AES

    -UP

    -32

    -21

    -001

    Etah

    22Pv

    t.

    Pv

    t.Hosp

    ita

    l-1

    22

    Etawa

    h

    23Hosp

    ita

    l

    Pv

    t.Hosp

    ita

    l-2

    23

    Fa

    iza

    ba

    d

    24

    Pv

    t.Hosp

    ita

    l-3

    24

    Farru

    kha

    ba

    d

    25

    25

    Fa

    tehpur

    26

    26

    Feroza

    ba

    d

    27

    27

    Gau

    tam

    Bu

    dhNagar

    28

    28

    Ga

    haziabda

    29

    29

    Ghaz

    ipur

    30

    30

    Gon

    da

    31

    31

    Gorakhpur

    32

    32

    Ham

    irpur

    33

    33

    Hardo

    i

    34

    34

    Ha

    thras

    35

    35

    Ja

    laun

    36

    36

    Jaunpur

    37

    37

    Ex

    amp

    leo

    fth

    e

    pa

    tien

    tc

    odings

    cheme

    for

    AESCaseso

    fo

    ne

    D

    istrict

    -Gora

    khpu

    rin

    Uttar

    Pra

    d

    es

    h

    year

    of

    onse

    t

    MC

    PHCs

    /CHCs

    /Me

    dica

    lC

    ollegese

    tc.

    PHCs

    CHCs

    Pa

    tien

    tsCo

    de

    Vii

    DISTRICT CODES

  • 8/6/2019 AES Guidelines

    30/30

    Jhansi

    38

    38

    JyotibaPhule

    Nagar

    39

    39

    Kannauj

    40

    40

    Kanpur(Dehat

    41

    41

    Dkanpur(Nagar)

    42

    42

    Kaushambi

    43

    43

    Kheri

    44

    44

    Kushinagar

    45

    45

    Lalitpur

    46

    46

    Lucknow

    47

    47

    Maharajganj

    48

    48

    Mahoba

    49

    49

    Mainpuri

    50

    50

    Mathura

    51

    51

    Mau

    52

    52

    Meerut

    53

    53

    Mirzapur

    54

    54

    Moradabad

    55

    55

    Muzaffarnagar

    56

    56

    Pilibhit

    57

    57

    Pratapgarh

    58

    58

    Raebareli

    59

    59

    Rampur

    60

    60

    SantKabirNagar

    61

    61

    Shaharanpur

    62

    62

    Shahjahanpur

    63

    63

    Siddharthnagar

    64

    64

    Sitapur

    65

    65

    Sonbhadra

    66

    66

    Srawasti

    67

    67

    Sultanpur

    68

    68

    Unnao

    69

    69

    Varanasi

    70

    70

    MC=MedicalCollege

    *NotethatthePHCs/CHCs/M

    edicalCollegeetcindistrictG

    orakhpurshouldbearrangedinalphabeticalorder,