Form 1 Data Elements

Sexually Transmitted Disease (STD) Morbidity Surveillance

Revised STD_XXXX_SuppStmnt_ATT3 072209

Sexually Transmitted Disease (STD) Morbidity Surveillance : State, City and county, and Territorial health departments

OMB: 0920-0819

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OMB No. 0920-XXXX

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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
Opt CT, G, CH

HIV status?

Documented or self-reported HIV status at this time.

P = HIV positive

New

Rec S
Opt CT, G, CH

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
Opt CT, G, CH

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
Opt CT, G, CH

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
Opt CT, G, CH

N = No

R = Refused to answer

D = Did not ask

Exchanged drugs/money for sex within past 12 months?


Y = Yes

New

Rec S
Opt CT, G, CH

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
Opt CT, G, CH

N = No

R = Refused to answer

D = Did not ask

Engaged in injection drug use within past 12 months?


Y = Yes

New

Rec S
Opt CT, G, CH

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
Opt CT, G, CH

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
Opt CT, G, CH

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
Opt CT, G, CH

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
Opt CT, G, CH

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
Opt CT, G, CH

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
Opt CH

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
Opt CT, G, CH

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
Opt CT, G, CH

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
Opt CT, G, CH

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
Opt S, CH

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
Opt CT, G, CH

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

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File Modified2009-08-27
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