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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
8/6/2019 AES Guidelines
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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
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,