Professional Documents
Culture Documents
1. PURPOSE
Define the objectives of the Peace Corps Epidemiologic Surveillance System (ESS)
Describe the operation of the ESS
Delineate the role and responsibilities of the PCMO in the operation of the ESS
Describe the role and responsibilities of OMS and the Peace Corps Medical Epidemiologist
(PCME) in the overall operation of the ESS
List the definitions to be used for each reporting category
2. BACKGROUND
The Peace Corps ESS was implemented in October 1985 to meet the following objectives:
Estimate the magnitude of health and safety problems among Volunteers in specific countries and
regions
Document the distribution and spread of specific health-related events in specific countries and
regions
Evaluate prevention and control strategies
Monitor changes in specific infectious diseases
Identify problems that need to be formally investigated using research protocols
Facilitate planning for PCMO and Volunteer training
The ESS is an active reporting system. Each month the PCMO is asked to report the number of
events (cases) of specific conditions occurring among Volunteers during a one-month period. Only
cases which meet the event/case definitions listed below should be reported. It is not necessary to
report all Volunteer illnesses. The surveillance system and event/case-specific definitions are not
intended to be used as clinical case definitions.
The standard reporting form is included in the Guideline (ATTACHMENT A). Using the event/case
definitions (section 5), a monthly report is sent to the Office of Medical Services (OMS.) The data
from each countrys report is entered into a database maintained by Epi Unit staff. The data are
analyzed periodically and the findings are sent to all PCMOs, CDs, and selected headquarters
managers.
Report only conditions/events involving Volunteers and Trainees. Do not include legal
dependents of Volunteers and Trainees that fall under your care or Peace Corps staff
members. Do not report events that occur after Volunteers or Trainees close service or of
which you become aware after Volunteers or Trainees have closed service. Do report
conditions/events confirmed by laboratory results sent prior to close of service but received
after Volunteers or Trainees have closed service.
Classify all reportable events reported using standardized reporting definitions (see
Section 5). Use of these standardized reporting definitions permits us to make comparisons
within a country from year to year as well as to compare one country with another in the
same or different region.
Report only NEW cases in the monthly report.
Consult the PCME/OMS when it is unclear whether or not an event fulfills the criteria
for reporting.
How do I report one Volunteer who has two of the same reportable events occurring in a single
month? Both are reported.
How do I report chronic conditions? These conditions should be reported at the time of the
initial diagnosis only.
Example: A Volunteer visits the PCMO in November and is found to have a dental
problem, diarrhea, and dermatitis. All three conditions should be reported in the
November ESS report.
How do I report a single event which may encompass more than one reporting category?
Report each condition/event as an individual event.
Errors should be reported under the category Corrections in the month they are identified.
Include the category to be changed, number to be changed, and month the error was made.
Events that occurred in the past should be reported in the month they are divulged to the PCMO
under the category Corrections.
Updates in classification to a previously reported event should be reported under the category
Corrections. If event/case definition requires laboratory confirmation to be reported, do not
report the case until after the confirmation is made; then report the case for the month of onset
of symptoms in the Volunteer.
Although crime information is no longer collected through the ESS, PCMOs are required to
assist with the new Crime Incident Reporting Form (CIRF), administered through the
Office of Safety and Security. Please consult the CIRF User Manual for specifics on the
role of PCMOs in crime reporting.
The monthly ESS report is a medically sensitive, not medically confidential, report. There
are no unique identifiers (names or social security numbers) included in the report. Only
the Country Director should see the report prior to sending it to OMS.
In some cases it may be possible for the Country Director to deduce the identity of a
Volunteer from the report (e.g., only one pregnancy and one medical evacuation to the U.S.
for the month.) Information that is deduced from the report should not be confirmed by
the PCMO. In addition, the Country Director, when extended medical confidentiality, is
required not to disclose such information concerning the identity of the Volunteer.
The monthly ESS report should be sent as an e-mail attachment to OMS. The ESS report
does not need to be sent as an encrypted attachment since it does not contain sensitive
patient information.
The ESS report should be sent to OMS by the fifth day of the month following the
completed reporting month. (See ATTACHMENT A)
The following are standardized case definitions for each reporting category of the ESS. It is important to keep in
mind that the following are surveillance case definitions; although many of the categories have similar surveillance
and clinical case definitions, the surveillance case definitions are not intended to be used as clinical case
definitions.
Alcohol-Related Problem
REPORT: An incident where behavior was altered or physical/mental acuity was impaired due to alcohol NOTE: Multiple incidents of
intoxication. Signs of intoxication may include violent behavior, slurred speech, decrease in physical alcohol problems in the same
coordination, or unconsciousness. Volunteer during the same
INCLUDE: Incidents of intoxication that resulted in a behavioral change in the Volunteer; incidents observed by month should only be reported
medical staff, other in-country staff, Volunteers, or other reliable sources. once that month.
Asthma
Symptoms suggestive
REPORT: (1) New cases meeting the NIH Expert Panels criteria for asthma (see below), and of asthma
Consider COPD
Cardiovascular Problem
DO NOT REPORT incidents of
REPORT: A condition related to the heart and blood vessels (e.g., hypertension, phlebitis, arrhythmias, palpitations or chest pain unless
congestive heart failure, myocardial infarction, and stroke) that was evaluated either by the a diagnosis of a specific cardiac
PCMO or by another health care professional. disorder is made.
Although one cardiovascular problem may result in several visits/contacts/evaluations, it DO NOT INCLUDE visits for a refill of
should only be reported once. medication for long-standing, well
controlled, stable treated
hypertension.
Colposcopies (In-Country)
DO NOT INCLUDE colposcopies
REPORT: A colposcopy performed in the PCVs Country of Service at a clinic, hospital, or facility performed in another country or region
authorized by medical staff for the diagnosis and/or treatment of a gynecological condition. (e.g. Volunteer medevaced to another
country for this procedure)
Dengue
REPORT: An infection with dengue virus, confirmed by demonstration of IgM antibodies or four-fold
change in IgG antibodies against dengue virus.
Dental Problem
REPORT: A condition involving the teeth and gums that was evaluated by a dentist or other health care DO NOT INCLUDE visits for routine
professional. screening or prophylaxis.
Although a single dental problem may result in several visits to a dentist, it should only be
reported once.
Dermatitis (Infectious)
REPORT: An infection of the skin due to bacterial, fungal, or parasitic organisms evaluated by a health DO NOT INCLUDE skin conditions due
care professional. to non-infectious causes (e.g., acne,
INCLUDE: Laboratory-confirmed and unconfirmed cases. eczema, nonspecific rashes)
Filariasis
REPORT: Any infection of the blood or other tissues with a filaria species (e.g., Wucheria bancrofti,
Brugia malayi, Onchocerca volvulus, Loa loa, Acanthocheilonema perstans, Dipetalonema
streptocerca, and Mansonella ozzardi confirmed by:
(1) demonstration of the parasite in blood or tissues, or
(2) specific antibody against the parasite, or
(3) circulating serum antigen.
Giardiasis
REPORT: An infection of the gastrointestinal tract by Giardia lamblia confirmed by demonstration
of:
(1) cysts or trophozoites in stool, duodenal fluid, or small intestinal biopsy, or
(2) G. lamblia antigen in stool by ELISA or other specific test.
Helminths
REPORT: An infection of the gastrointestinal tract by an intestinal helminth (e.g., ascaris, hookworm,
pinworm) confirmed by observation of the parasite or demonstration of eggs in stool.
Salmonellosis
REPORT: An infection of the gastrointestinal tract with Salmonella species confirmed by
demonstration of the bacterium in stool culture.
NOTE: Extraintestinal infections (e.g., septicemia, typhoid and paratyphoid fever) should be
reported under Febrile Illness with details under Notes and Other Major Conditions.
Shigellosis
REPORT: An infection of the gastrointestinal tract with Shigella species confirmed by demonstration
of the bacterium in stool culture.
Hepatitis
Hepatitis A
REPORT: An infection of the liver causing jaundice or elevated aminotransferase levels and
confirmed by demonstration of IgM antibodies against hepatitis A virus.
Hepatitis B
REPORT: An infection of the liver causing jaundice or elevated aminotransferase levels and
confirmed by demonstration of HBsAg (surface antigen) or IgM antibodies against HBc
(core antigen).
Hepatitis C
REPORT: An infection of the liver causing jaundice or elevated aminotransferase levels and Note: the interval between onset of
confirmed by demonstration of IgG antibodies against hepatitis C virus. disease and detection of antibody may
be prolonged.
Hepatitis, Other or Presumed
REPORT: An infection or other condition of the liver causing jaundice or elevated aminotransferase
levels due to causes other than hepatitis A, B, or C. If etiology is known, provide details
under Notes and Other Major Conditions.
In-Country Hospitalizations
REPORT: An overnight stay in country at a clinic, hospital, or facility authorized by medical staff for the IMPORTANT: In-Country
monitoring or treatment of a health condition that required prolonged attendance by a medical Hospitalizations are to be reported in
professional. both the monthly report and as a
INCLUDE: Overnight stays at a non-health care facility (e.g., staff members residence) only if the separate incident report as described
Volunteer had a condition that required hospitalization, but an appropriate hospital was not in Technical Guideline 430.
available.
Injury (Unintentional)
In categorizing injuries (formerly called accidents), first consider whether the injury was intentional or DO NOT REPORT injuries that are self-
unintentional. Intentional injuries, even when they occur in a motor vehicle, should be reported using the treated.
Crime Incident Reporting Form (CIRF). The categorization of unintentional injuries may depend on For example, do not report incidents
whether a vehicle was involved. A vehicle is defined as a conveyance or a means of transport (e.g., bicycle, where the Volunteer skins a knee after
motorcycle, motor vehicle, train, streetcar, animal-drawn vehicle). falling off a bicycle if the Volunteer
REPORT: Injuries that require medical evaluation or treatment by a health care professional was not evaluated by a health care
Injuries that involve vehicles are categorized depending on what the Volunteer was doing at the time of professional.
injury and the type of vehicle involved.
Pedestrian Injury
REPORT: An injury associated with a vehicle while the Volunteer was not riding in or on the vehicle.
Includes injuries while standing, walking, running, roller-skating or skate-boarding, as long
as the injury is associated with a vehicle.
Water-Related Injury/Event
REPORT: An injury or event associated with swimming, diving, water skiing, boating, or other water- Include injuries involving motorized
based activity. Includes but is not limited to near-drowning, decompression sickness, boats in this category.
drowning, spinal-cord injury associated with water sports/events, ciguatera poisoning.
Provide further information about the event under Notes and Other Major
Conditions.
Sports-Related Injury (Note Sport In Notes) NOTE: If a sports-related injury can be
REPORT: An injury or event associated with engaging in a sporting activity. Includes but is not reported in a previously specified
limited to soccer, football, baseball, basketball, tennis, jogging, rock climbing, horse back category (i.e., Pedestrian, Bicycle-
riding, marathon running, etc. Provide further information about the specific sport Related, Motorcycle-Related, Motor
under Notes and Other Major Conditions. Vehicle-Related, Water-Related
Injury), it should be reported only in
that category.
DO NOT include injuries incurred
while being a spectator at a sporting
event.
DO NOT include walking, unless
competitive.
Other Unintentional Injuries
REPORT: An injury that requires evaluation and/or treatment by a health care professional and is DO NOT INCLUDE cases that do not
not associated with the categories listed above (e.g., burns, falls, animal and insect bites, require evaluation or treatment by a
poisoning, cuts, abrasions, and puncture wounds not associated with vehicles). health care professional.
NOTE: When noting type and number of injuries, keep this description brief (less than 15
characters). If there is more to report, continue in the Notes and Other Major
Conditions section.
Injuries, Alcohol-Related
REPORT: Any injury that requires evaluation and/or treatment by a health care professional and is
associated with any alcohol use by a Volunteer or Trainee.
INCLUDE: All injuries associated with alcohol use, even if already reported in one of the categories
above, should be included. For example, if a Volunteer falls while bicycling home from a bar
after drinking, this should be reported as both a Bicycle-Riding Injury and an Alcohol-
Related Injury.
Leishmaniasis
REPORT: An infection with Leishmania species, confirmed by demonstration of:
(1) the parasite in smears, biopsy material, or blood, by microscopy or other specific
techniques, or
(2) specific antibody against the parasite.
Pregnancy
REPORT: A pregnancy confirmed by appropriate techniques. Include only pregnancies among DO NOT REPORT the month of
Volunteers (not among partners of Volunteers) in the month in which the pregnancy was conception.
confirmed.
REPORT: The number of Volunteers who are on seasonal or year-round antimalarial chemoprophylactic NOTE: Short-term travel should be
regimens (e.g., 4 months during rainy season each year, but NOT those on short term travel. considered to be <30 days in duration.
Malaria
The categorization of malaria depends on the prophylaxis prescribed for the Volunteer, the species of NOTE: If the Volunteer is not adherent
malaria and whether or not it was confirmed. Only laboratory-confirmed cases should be reported under to their antimalarial
Falciparum Malaria or Non-falciparum Malaria. chemoprophylactic regimen, the case
Falciparum Malaria (confirmed) should still be reported in the category
of prophylaxis that the Volunteer
REPORT: An infection with Plasmodium falciparum confirmed by demonstration of the parasite in should have been taking.
blood or blood smears by microscopy or other specific techniques.
REPORT: Confirmed cases only, categorized by the prophylaxis prescribed for the Volunteer.
Presumptive Malaria
REPORT: An illness consistent with malaria (e.g., unexplained fever >38 degrees C in a malarious DO NOT REPORT Volunteers who were
area) in which treatment for malaria was administered, but was not confirmed by blood self-treated and subsequently were
smears or other specific techniques. found to have had negative blood
INCLUDE: Cases that were self-treated but blood slides were never collected or the slides were not slides collected before treatment.
interpretable. However, compatible cases in which
NOTE: Cases in which treatment was first administered on clinical grounds, and later confirmed by negative slides were taken after
laboratory tests, should be reported under one of the above categories. treatment and not before treatment
should be counted.
Schistosomiasis
Clinical Symptoms/Visualized Ova & Parasite
Syphilis: (Primary or Secondary) defined as an infection of the genitals with Treponema pallidum
confirmed by demonstration of the spirochete in clinical specimens by darkfield,
fluorescent antibody, or equivalent microscopic techniques. Report as a case of syphilis in
the month the diagnosis was made.
Gonorrhea: Defined as an infection of the genitals with Neisseria gonorrhea confirmed by
demonstration of:
(1) the organism from culture of lesions, or
(2) gram-negative intracellular diplococci in a urethral smear from a man.
Chlamydia: Defined as an infection of the genitals with Chlamydia trachomatis confirmed by
demonstration of the bacterium by:
(1) culture, or
(2) antigen detection assays.
Trichomonas: Defined as an infection of the genitals with Trichomonas vaginalis confirmed by
demonstration of the parasite.
Chancroid: (Soft chancre) defined as an infection of the genitals with Haemophilus ducreyii
characterized by very painful, non-indurated, ragged and undermined ulcer(s) (1 to 10 may
be seen) with an erythematous halo. The lesion bleeds easily with manipulation.
Presumptive Bacterial STD
REPORT: Cases of likely genital infection for which treatment was provided but no definitive testing
was done (e.g., nongonococcal mucopurulent cervicitis or nongonococcal urethritis that
resulted in treatment for suspected chlamydia, mycoplasma, or ureaplasma, etc.).
Genital Herpes: (first episode or recurrence) defined as an infection of the genitals with herpes simplex
virus (usually type 2) confirmed by demonstration of:
(1) direct fluorescent antibody of material from lesions,
(2) virus from culture of lesions,
(3) rising antibody titer against the virus, or
(4) clinical diagnosis of primary infection followed by recurrence of lesions.
REPORT ONLY episodes where ulceration occurred. Extragenital infections should also be reported
here with details under Notes and Other Major Conditions.
REPORT ONLY episodes where ulceration occurred. Extragenital infections should also be reported here
with details under Notes and Other Major Conditions.
REPORT: Pelvic inflammatory disease defined as infection of the female genitalia characterized by
abdominal pain, adnexal or cervical motion tenderness and at least 1 of the following.
(1) temperature > 38C,
(2) leukocytosis (>10,0000/mm3), or
(3) erythrocyte sedimentation rate >14mm/hr
HIV (Human Immunodeficiency Virus, Western Blot Positive) DO NOT REPORT positive ELISA tests
REPORT: An infection with HIV as confirmed by a positive Western Blot test. or indeterminate Western Blot tests.
Tuberculosis
PPD Skin Test Conversion DO NOT REPORT Volunteers who are
REPORT: An infection with Mycobacterium tuberculosis confirmed by conversion from negative to symptomatic or who have signs or
positive of a Mantoux intradermal skin test using Purified Protein Derivative (PPD) which radiologic findings consistent with
was placed on the Volunteer and read by the PCMO or other health care provider trained in active tuberculosis.
the placement and proper reading of this test.
Active Tuberculosis
REPORT: An infection with Mycobacterium tuberculosis confirmed by culture of the organism from a
collected clinical specimen or a clinical presentation consistent with active tuberculosis that
is culture negative but responds to treatment with appropriate anti-tuberculosis therapy.
Vaccine-Preventable Diseases
REPORT: Any disease that occurs in a Volunteer or Trainee for which there exists a vaccine that can REPORT only cases of actual disease,
prevent the disease. Respective diseases should be confirmed by demonstration of specific not adverse events from vaccinations.
diagnostic laboratory tests. Adverse events from vaccines should
INCLUDE: Measles, mumps, rubella, diphtheria, pertussis, tetanus, chicken pox, meningococcal be reported per TG 300..
disease, haemophilus influenza type B disease, typhoid, yellow fever, Japanese B
encephalitis, tick-borne encephalitis, rabies, or any other vaccine-preventable disease.
Hepatitis A and hepatitis B virus infections are to be reported under Hepatitis above.
Corrections
REPORT: Any corrections (modifications, additions, and deletions) to data reported in previous
months. Specify the month being corrected, the health condition or event, and the number
of cases to add or delete.
Revised: JANUARY 2013 Save this document, then e-mail it as an attachment to the EPIUnit@peaceCorps.gov
Peace Corps
Technical Guideline 430
CASE NOTIFICATION
1. PURPOSE
To describe the requirement for case notification in the Volunteer Health System.
To describe the procedures for reporting country-sponosored (regional) medevacs and in-
country hospitalizations.
2. BACKGROUND
For the purposes of both medical management and surveillance, Peace Corps Medical
Officers (PCMOs) are required to report significant Volunteer health conditions and events to
the Office of Medical Services (OMS). These events include country-sponsored (regional)
medevacs and in-country hospitalizations. Events may be reported concurrently or
retrospectively
Medical Management
Technical Guideline (TG) 370 Field Consultation identifies specific situations where field
consultation is appropriate or required.
Surveillance
Regional evacuations are managed by the PCMO and the staff at the evacuation site (see
TG 380 section 12.2 Management of Medevacs at a Regional or Other Non-U.S. site).
Funding for international medical travel and accompaniment (U.S., regional, and other
non-U.S medical travel) is allocated to post budgets from the Office of Volunteer Support
Centrally-Managed Accounts at the beginning of each fiscal year (see TG 380 section 11
Funding).
1. Name of PCV;
2. SSN;
3. Country of service;
4. Age;
5. Entered on duty date;
6. Brief description of illness/health problem;
7. Country and facility destination;
8. Date of medical evacuation;
9. Accompaniment, if any;
10. Type of accompaniment (medical or non-medical);
11. Whether chartered aircraft;
12. Prior history of the condition, if any;
13. Final diagnoses (list all diagnoses that resulted from the evacuation in
decreasing order of importanceDO NOT USE ICD 9 CM CODES);
14. Number of nights in hospital, if any;
15. Outcome status, i.e., return to country, onward evacuated to the U.S., etc.;
16. Date of disposition;
17. Notification to family by Volunteer, if any;
18. Authorization to discuss the case with the family if OMS is contacted.
4. REPORTING OF HOSPITALIZATIONS
Overnight stays at a non-health care facility, such as the PCMOs residence, are to be
reported only if the Volunteer had a condition that required hospitalization, but an
appropriate hospital was not available.
Upon hospital discharge, the PCMO must report the following information concerning
the hospitalization to OMS using the standard report form included in
ATTACHMENT B. Reports should be sent to the OMS Epidemiology Unit by fax
(202-692-1501) or cable.
1. Name of PCV:
2. SSN:
3. Country of service:
4. Entered on duty date:
5. Date of admission
6. Place admitted (Include PCMOs/staff house if hospital/clinic not available and
hospitalization otherwise indicated):
7. Date of discharge:
8. Discharge diagnoses (list all diagnoses in decreasing order of importance
DO NOT USE ICD 9 CM CODES):
DX 1:
DX 2:
DX 3:
DX 4:
DX 5:
9. Return to duty at site (yes or no):
10. Plan for Volunteer if not returning to site:
11. Family notified of hospitalization (yes or no):
12. OMS authorized to discuss with family if contacted (yes or no):
FROM:
TO: OMS/DIRECTOR
1. NAME OF PCV:
2. SSN:
3. COUNTRY OF SERVICE:
4. AGE:
8. DATE OF MEDEVAC:
13. FINAL DIAGNOSIS (IN ORDER OF IMPORTANCE; DO NOT USED ICD-9 CODES)
DX 1
DX 2
DX 3
DX 4
DX 5
FROM:
TO: OMS/DIRECTOR
1. Name of PCV:
2. SSN:
3. Country of service:
5. Date of admission
7. Date of discharge: