Influenza Capacities and Ebola Response Efforts - Survey

Form Approved
OMB No: 0920-1026
Exp. Date: 07/31/2017

Influenza Capacities and Ebola Response Efforts
Survey Introduction

The Centers for Disease Control and Prevention (CDC) Influenza Division is conducting a 10 question survey of our partners
in the African region. CDC is seeking feedback about how on-going influenza capacity-strengthening has contributed to
regional surveillance and response during emergency outbreaks, in particular to Ebola.
Participation in this survey is voluntary and will take 5 minutes to complete. Please include the name, title, and
phone number of the person completing this survey.

*1. Please provide the following:
Your Full Name:
Your Title:
City/town in which you
work:
Country in which you
work:
Email Address:
Phone Number:

2. Would you be willing to participate in a brief follow­up conversation about your
experience?

j Yes
k
l
m
n
j No
k
l
m
n

j Maybe
k
l
m
n

Comment: 

Public reporting burden of this collection of information is estimated to average 5 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 person 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 D74, Atlanta, Georgia 30333; ATTN: PRA (09201026).

Page 1

Form Approved
OMB No: 0920-1026
Exp. Date: 07/31/2017

Influenza Capacities and Ebola Response Efforts

3. 1. Please check anything that’s been used for Ebola surveillance or response: (check all
that apply)
c RT­PCR Machines acquired for influenza testing
d
e
f
g
c National influenza laboratory workspace
d
e
f
g
c National influenza laboratory staff
d
e
f
g
c Influenza SARI sites
d
e
f
g
c Influenza ILI sites
d
e
f
g

c Influenza Pandemic Preparedness Plans
d
e
f
g

c Influenza Rapid Response Training Guidelines
d
e
f
g

c Personal Protective Equipment procured for influenza preparedness
d
e
f
g

c Laboratory reagents or ancillary supplies from the Influenza Reagent Resource (IRR)
d
e
f
g
c CDC field staff or locally employed staff (LES) who normally work on influenza
d
e
f
g

Other (please specify) 

4. Are laboratory(s) that routinely test for influenza prepared to test specimens for Ebola
virus?

j Yes
k
l
m
n
j No
k
l
m
n

Public reporting burden of this collection of information is estimated to average 5 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 person 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 D74, Atlanta, Georgia 30333; ATTN: PRA (09201026).

Page 2

Form Approved
OMB No: 0920-1026
Exp. Date: 07/31/2017

Influenza Capacities and Ebola Response Efforts

5. If no, what are the challenges that prevent these labs from testing for the Ebola virus
5
6  

6. Does the laboratory have the primers and probes needed for Ebola testing?

j Yes
k
l
m
n
j No
k
l
m
n

7. Are you currently or do you plan to use influenza SARI or ILI sites in your country for
screening Ebola patients?
j No
k
l
m
n

j Currently Screening
k
l
m
n

j Plan to Use for Screening
k
l
m
n

8. Have you conducted training of staff at SARI or ILI sites for handling of potential Ebola
cases?

j Yes
k
l
m
n
j No
k
l
m
n

Public reporting burden of this collection of information is estimated to average 5 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 person 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 D74, Atlanta, Georgia 30333; ATTN: PRA (09201026).

Page 3

Form Approved
OMB No: 0920-1026
Exp. Date: 07/31/2017

Influenza Capacities and Ebola Response Efforts

9. If yes, please describe the type of training provided
5
6  

10. Please describe any capacities for influenza preparedness, surveillance and response
that have helped with Ebola preparedness:
5
6  

11. Other comments or feedback (Optional):
5
6  

Public reporting burden of this collection of information is estimated to average 5 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 person 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 D74, Atlanta, Georgia 30333; ATTN: PRA (09201026).

Page 4