Community Influenza-Like Illness Weekly Surveillance Form

Saskatchewan

ILI is the acute onset of respiratory illness with fever and cough and with one or more of the following: sore throat, arthralgia, myalgia, or prostration which could be due to influenza virus. In children under 5, gastrointestinal symptoms may also be present. In patients under 5 or 65 and older, fever may not be prominent.

Reviewed each influenza season

To:Disease Prevention Unit
Fax:(306) 787-9576
E-mail:

COMMUNITY INFLUENZA-LIKE ILLNESS WEEKLY SURVEILLANCE FORM

Name of RHA: / Surveillance date:
(dd/mm/yy)
Reported by: / Ph:
ILI is the acute onset of respiratory illness with fever and cough and with one or more of the following: sore throat, arthralgia, myalgia, or prostration which could be due to influenza virus. In children under 5, gastrointestinal symptoms may also be present. In patients under 5 or 65 and older, fever may not be prominent.

Reviewed each influenza season

ACTIVITY LEVEL THIS WEEK (check one):

Reviewed each influenza season

0. Community sentinel sites report no influenza-like activity at all.

1. Sporadically occurring influenza-like illness but no lab confirmations.

2. Sporadically occurring influenza-like illness when there has been at least one laboratory confirmed influenza case but no outbreaks detected.

3. At least one lab confirmed influenza in your health region together withILIoutbreak(s) in schools, worksites or a laboratory confirmed influenza outbreak(s) in a residential institution(s). Re-emergent school outbreaks are considered NEW if there has been an intervening 8 weeks of Level 0-2 ILI activity in the community.

Reviewed each influenza season

The following influenza/influenza-like outbreaks had their ONSET at some point during this surveillance week. List only those outbreaks meeting this criterion.

Town/City where outbreak is located / Health Region outbreak number

Outbreak reporting for influenza follows the same protocol as for all other outbreaks. This table does not constitute an outbreak notification. An outbreak notification form must still be submitted on each outbreak from a communicable disease.

Fax or e-mail this completed form by 4 pm each Thursday. Thank you.

Reviewed each influenza season