Form approved
OMB No. 0920-XXXX
Expiration date:
Attachment 3
Changes in the information content of nationally notifiable STD case report by data element
Sexually Transmitted Disease (STD) Morbidity Surveillance System
Updated July 23, 2009
Changes in the information content of
nationally notifiable STD case report by data element
Public reporting burden of this collection of information is estimated to average 20 minutes per response,, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a persons is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; Attn: PRA (0920-XXXX)
Data Element Name |
Data Element Definition |
Data Element "legal" Values |
Variable Status* |
Recommended/Optional By STD** |
Treatment date |
Date treatment initiated for the condition that is the subject of this case report. |
YYYYMMDD format (Unknown=99999999) |
New |
Rec
S |
HIV status? |
Documented or self-reported HIV status at this time. |
P = HIV positive |
New |
Rec
S |
N = HIV negative |
||||
E = Equivocal HIV test result |
||||
U = Unknown |
||||
R = Refused to answer |
||||
D = Did not ask |
||||
Had sex with an anonymous partner within past 12 months? |
|
Y = Yes |
New |
Rec
S |
N = No |
||||
R = Refused to answer |
||||
D = Did not ask |
||||
Had sex with a person known to him/her to be an IDU within past 12 months? |
|
Y = Yes |
New |
Rec
S |
N = No |
||||
R = Refused to answer |
||||
D = Did not ask |
||||
Had sex while intoxicated and/or high on drugs within past 12 months? |
|
Y = Yes |
New |
Rec
S |
N = No |
||||
R = Refused to answer |
||||
D = Did not ask |
||||
Exchanged drugs/money for sex within past 12 months? |
|
Y = Yes |
New |
Rec
S |
N = No |
||||
R = Refused to answer |
||||
D = Did not ask |
||||
Had sex with a person who is known to her to be an MSM within past 12 months? |
NOTE: For women only. |
Y = Yes |
New |
Rec
S |
N = No |
||||
R = Refused to answer |
||||
D = Did not ask |
||||
Engaged in injection drug use within past 12 months? |
|
Y = Yes |
New |
Rec
S |
N = No |
||||
R = Refused to answer |
||||
D = Did not ask |
||||
During the past 12 months, which of the following injection or non-injection drugs have been used? |
|
Crack |
New |
Rec
S |
Cocaine |
||||
Heroin |
||||
Methamphetamines |
||||
Nitrates/Poppers |
||||
Erectile dysfunction (ED) medications (e.g., Viagra) |
||||
Other drug(s) used? |
||||
No drug use reported |
||||
Been incarcerated within past 12 months? |
|
Y = Yes |
New |
Rec
S |
N = No |
||||
R = Refused to answer |
||||
D = Did not ask |
||||
History of ever having an STD prior to this STD diagnosis? |
Does the patient have a history of ever having had an STD prior to the condition reported in this case report? |
Y=Yes, patient has a history of STD |
New |
Rec
S |
N=No, patient has never had a prior STD |
||||
U=Unknown if patient has had a prior STD |
||||
R = Patient refused to answer any questions regarding prior STD history |
||||
Have you met sex partners through the Internet in the last 12 months? |
Did the patient use an online computer site to exchange messages by typing them onscreen to engage in conversation with other visitors to the site for the purpose of having sex? |
Y = Yes |
New |
Rec
S |
N = No |
||||
R = Refused to answer |
||||
D = Did not ask |
||||
Total number of sex partners last 12 months? |
Total number of sex partners that the case patient has had in the last 12 months. Total partners equals the sum of all male, female, and transgender partners during the period. |
### |
New |
Rec
S |
888=Patient refused to answer questions regarding number of sex partners |
||||
999=Unknown number of sex partners in last 12 months |
||||
Clinician-observed lesion(s) indicative of syphilis were identified at which of the following anatomic site(s)? (Mark all that apply.) |
If condition = any stage of syphilis, report anatomic site(s) of clinician-observed lesion(s) (e.g., chancre, rash, condyloma lata) at time of initial exam or specimen collection. Mark all that apply. |
A=Anus/Rectum |
New |
Rec
S |
B=Penis |
||||
C=Scrotum |
||||
D=Vagina |
||||
E=Cervix |
||||
F=Nasopharynx |
||||
G=Mouth/Oral cavity |
||||
H=Eye/conjunctiva |
||||
I=Head |
||||
J=Torso |
||||
K=Extremities (Arms, legs, feet, hands) |
||||
N= No lesion noted |
||||
O=Other anatomic site not represented in other defined anatomic sites |
||||
U=Unknown |
||||
Type of non-treponemal serologic test for syphilis |
What type of non-treponemal serologic test for syphilis was performed on specimen collected to support case patient's diagnosis of syphilis? |
1= Rapid Plasma Reagin (RPR) |
New |
Rec
S |
2= Venereal Disease Research Laboratory test (VDRL) (serology) |
||||
3=VDRL test of cerebrospinal fluid (CSF) |
||||
9 = Unknown test type |
||||
Quantitative syphilis test result |
If the test performed provides a quantifiable result, provide quantitative result (e.g. if RPR is positive, provide titer, e.g. 1:64) |
#### |
New |
Rec
S |
Census tract of case-patient residence |
Census tract where the address is located is a unique identifier associated with a small statistical subdivision of a county. Census tract data allows a user to find population and housing statistics about a specific part of an urban area. A single community may be composed of several census tracts. |
6-character length alphanumeric |
New |
Opt CT, G, CH, S |
STD IMPORT |
Was case imported? Was disease acquired elsewhere? Indicates probable location of disease acquisition relative to reporting state. |
N - Not an imported case |
Revised, adopted National Notifiable Disease Surveillance System (NNDSS) standard format for variable responses. |
Opt CT, G, CH, S |
C - Yes imported from another country |
||||
S - Yes, imported from another state |
||||
J - Yes, imported from another county/jurisdiction in the state |
||||
D - Yes, imported but not able to determine source state and/or country |
||||
U - Unknown |
||||
Date of initial health exam associated with case report "health event" |
Date of earliest healthcare encounter/visit /exam associated with this event/case report. May equate with date of exam or date of diagnosis. |
YYYYMMDD format (Unknown=99999999) |
Revised; added date type as specific date’. |
Opt CT, G, CH, S |
Date of first report of case/event to public health system |
Date of first report of case to local or state health department (first tier of public health system in reporting jurisdiction; may equate to city, county, region, or state public health system level). |
YYYYMMDD format (Unknown=99999999) |
Revised; added date type as specific date’. |
Opt CT, G, CH, S |
Date case report initially sent from reporting jurisdiction to CDC |
INITIAL date case report was sent from reporting jurisdiction to CDC. Generated by the reporting jurisdiction at the time of report to CDC. Can be generated by the information system. |
YYYYMMDD format (Unknown=99999999) |
Revised; added date type as specific date’. |
Opt CT, G, CH, S |
Had sex with a male within past 12 months? |
|
Y = Yes |
Revised; modified question response format. |
Rec
S |
N = No |
||||
R = Refused to answer |
||||
D = Did not ask |
||||
Had sex with a female within past 12 months? |
|
Y = Yes |
Revised; modified question response format. |
Rec
S |
N = No |
||||
R = Refused to answer |
||||
D = Did not ask |
||||
INFOSRCE - Facility Type (STD dx, rx) |
Setting or health care facility where a person first received diagnosis, treatment or testing for STD or associated syndrome reported in this case report (i.e., facility type of STD diagnosis, facility type where person was tested for STD). |
01=HIV Counseling and Testing Site |
Revised; updated question response categories. |
Rec CT, G, CH, S |
02=STD clinic |
||||
03=Drug Treatment |
||||
04=Family Planning |
||||
06=Tuberculosis clinic |
||||
07=Other Health Department Clinic |
||||
08=Private Physician/HMO |
||||
10= Hospital - Emergency Room; Urgent Care facility |
||||
11=Correctional facility |
||||
12=Laboratory |
||||
13=Blood Bank |
||||
14=Labor and delivery |
||||
15=Prenatal |
||||
16=National Job Training Program |
||||
17=School-based Clinic |
||||
18=Mental Health Provider |
||||
29=Hospital - Other |
||||
66=Indian Health Service |
||||
77=Military |
||||
88=Other |
||||
99=Unknown (if data not available) |
||||
Method of Case Detection
|
How did the case patient first come to the attention of the health department for this condition?
|
20=Screening |
Revised; updated question response categories.
|
Rec
S |
21=Self-referred |
||||
22=Patient Referred Partner |
||||
23=Health Department referred partner |
||||
24=Cluster related |
||||
88=Other |
||||
Specimen source |
Anatomic site or specimen type from which positive lab specimen was collected. |
01=Cervix/Endocervix |
Revised; updated question response categories. |
Rec
CT, G |
02=Lesion-Genital |
||||
03=Lesion-Extra Genital |
||||
04=Lymph Node Aspirate |
||||
05=Oropharynx |
||||
06=Ophthalmia/Conjunctiva |
||||
07=Other |
||||
08=Other Aspirate |
||||
09=Rectum |
||||
10=Urethra |
||||
11=Urine |
||||
12=Vagina |
||||
13=Blood/Serum |
||||
14 - Cerebrospinal fluid (CSF) |
||||
88=Not Applicable |
||||
99=Unknown |
||||
American Indian/ Alaska native? |
Case patient reported Am Indian/Alaska Native (AI/AN) race |
Y = Yes; Variable value is Y or Blank, dependent upon case-patient's reported race. |
Revised, per 1997 OMB Directive 15 and based on U.S. Census population data. |
Rec CT, G, CH, S |
Asian? |
Case patient reported Asian race |
Y = Yes; Variable value is Y or Blank, dependent upon case-patient's reported race. |
Rec CT, G, CH, S |
|
Black/African American? |
Case patient reported black/African american (B) race |
Y = Yes; Variable value is Y or Blank, dependent upon case-patient's reported race. |
Rec CT, G, CH, S |
|
Native Hawaiian/ Pacific Islander? |
Case patient reported Native Hawaiian/Pacific Island (NH/PI) race |
Y = Yes; Variable value is Y or Blank, dependent upon case-patient's reported race. |
Rec CT, G, CH, S |
|
White? |
Case patient reported White (W) race |
Y = Yes; Variable value is Y or Blank, dependent upon case-patient's reported race. |
Rec CT, G, CH, S |
|
Other race? |
Case patient reported some other race (not AI/NA, Asian, Black, NH/PI, white) |
Y = Yes; Variable value is Y or Blank, dependent upon case-patient's reported race. |
Rec CT, G, CH, S |
|
Refused to report race |
Case patient refused to report race |
Y = Yes; Variable value is Y or Blank, dependent upon case-patient's reported race. |
Rec CT, G, CH, S |
|
Unknown race |
Case patient could not answer this question for any reason |
Y = Yes; Variable value is Y or Blank, dependent upon case-patient's reported race. |
Rec CT, G, CH, S |
|
State |
State reporting case information & jurisdiction of case (based on patient residence) |
2-digit FIPS code |
No change |
Rec CT, G, CH, S |
Year |
MMWR Year for which case information was reported to CDC. Derived from MMWR week. |
2-digit year |
No change |
Rec CT, G, CH, S |
Case report ID |
Unique case report ID assigned by state |
Non-identifying ID; 6 digit numeric. |
No change |
Rec CT, G, CH, S |
Week |
MMWR week on surveillance calendar – assigned by reporting jurisdiction. |
01 through 53 – representing week during surveillance year |
No change |
Rec CT, G, CH, S |
Event or diagnosis |
STD or associated syndrome (health event) for which the case-patient has been diagnosed |
Chancroid, Chlamydia, Gonorrhea, Primary syphilis, Secondary syphilis, Early latent syphilis, Late latent syphilis, Unknown latent syphilis, Late syphilis with clinical manifestations |
No change |
Rec CT, G, CH, S |
County |
Standard FIPS code for county of case-patient’s residence in reporting state |
3-digit county FIPS |
No change |
Rec CT, G, CH, S |
Date of birth |
Date of birth of case-patient |
YYYYMMDD |
No change |
Opt CT, G, CH, S |
Age |
Age of case-patient at time of initial exam or specimen collection for the case report “condition” |
### |
No change |
Rec CT, G, CH, S |
Age type |
Indicates the units (years, months, etc.) for AGE field |
0=0-120 years; 1=0-11 Months; 2=0-52 weeks; 3=0-28 days; 9= Age unknown |
No change |
Rec CT, G, CH, S |
Sex |
Current sex of patient |
1= Male; 2 = Female; 9 = Unknown |
No change |
Rec CT, G, CH, S |
Outbreak |
Indicates whether the case was associated with an outbreak |
1=Yes; 2=No; 9 = Unknown |
No change |
Rec CT, G, CH, S |
ZIP |
5-digit Zip code of residence of the case patient. |
#####; (Unknown=99999, if data not available) |
No change |
Rec CT, G, CH, S |
Pregnant - initial exam |
Was the case patient pregnant at time of initial exam for the condition reported in this case report? |
1=Yes |
No change |
Rec
S |
2=No |
||||
9=Unknown |
||||
Neurological involvement? |
If event = some stage of syphilis, does the patient have neurologic involvement based on current case definition? |
1=Yes, Confirmed |
No change |
Rec S |
2=Yes, Probable |
||||
3=No |
||||
9=Unknown |
||||
Hispanic/Latino? |
Indicator for case-patient's Hispanic/Latino ethnicity. |
Y=Yes |
No change |
Rec CT, G, CH, S |
N=No |
||||
U=Unknown |
||||
R = Refused to answer |
||||
Date of laboratory specimen collection |
Date of collection of initial laboratory specimen used for diagnosis of health event reported in this case report. |
YYYYMMDD format (Unknown=99999999) |
No change |
Rec CT, G, CH, S |
*Variable Status:
New = Data variable added, NOT currently OMB-approved (n = 17)
Revised = Currently OMB-approved variable values are revised (n = 10)
No change = Variable is currently OMB-approved per Weekly and Annual Morbidity and Mortality Reports (MMWR, OMB #0920-0007) (n = 16)
**Recommended/Optional by STD
Rec = Recommended
Opt = Optional
STDs: CH = Chancroid, CT = Chlamydia, G = Gonorrhea, S = Syphilis
Page
File Type | application/msword |
File Title | Attachment 1 |
Author | Sam Groseclose |
Last Modified By | Seleda.Perryman |
File Modified | 2009-08-27 |
File Created | 2009-08-27 |