__ /__ /____ Date __ /__ /____ Date admitted to ICU/HDU discharged Alive Dead Unknown 6 OUTCOME Patient outcome Date outcome information __ /__ /____ sought Testing must be organised according to the SoNG LABORATORY 7 Laboratory Testing Guidelines in CRITERIA discussion with jurisdictional public health laboratory Blood/ Throat swab Urine Specimens collected serum Date collected __ /__ /____ __ /__ /____ __ /__ /____ Laboratory that received specimens Yes No Unknown Specimens transferred to Jurisdictional PH lab (if relevant e.g. NSW, QLD) Yes No Unknown Detection of virus by PCR in Jurisdictional PH lab (if relevant) Yes No Unknown Specimens transferred to NHSQL Yes No Unknown Isolation of virus PCR Antigen Electron Detection of virus by detection microscopy IgG titre(s) Single high Titre --- Date titre __ /__ /____ Four fold 1st titre --- Date rise __ /__ /____ 2nd titre --- Date __ /__ /____ Yes No Unknown/not IgM positive done Special National pathogens Institute of Confirmation by lab Atlanta Virology, CDC Johannesburg Yes No Unknown Lymphopaenia Yes No Unknown Thrombocytopaenia __ /__ /____ __ /__ /____ (onset of EXPOSURE (onset of 8 Between dates: symptoms TO PERIOD symptoms minus 21 minus 1 day) days)
Date admitted to ICU/HDU __ /__ /____ Date discharged __ /__ /____ 6 OUTCOME Patient outcome Alive Dead Unknown Date outcome information sought __ /__ /____ 7 LABORATORY CRITERIA Testing must be organised according to the SoNG Laboratory Testing Guidelines in discussion with jurisdictional public health laboratory Specimens collected Blood/ serum Throat swab Urine Date collected __ /__ /____ __ /__ /____ __ /__ /____ Laboratory that received specimens Specimens transferred to Jurisdictional PH lab (if relevant e.g. NSW, QLD) Yes No Unknown Detection of virus by PCR in Jurisdictional PH lab (if relevant) Yes No Unknown Specimens transferred to NHSQL Yes No Unknown Isolation of virus Yes No Unknown Detection of virus by PCR Antigen detection Electron microscopy IgG titre(s) Single high titre Titre --- Date __ /__ /____ Four fold rise 1st titre --- Date __ /__ /____ 2nd titre --- Date __ /__ /____ IgM positive Yes No Unknown/not done Confirmation by Special pathogens lab Atlanta CDC National Institute of Virology, Johannesburg Lymphopaenia Yes No Unknown Thrombocytopaenia Yes No Unknown 8 EXPOSURE PERIOD Between dates: __ /__ /____ (onset of symptoms minus 21 days) TO __ /__ /____ (onset of symptoms minus 1 day)
EVD-SoNG.docx