Data Collection (check all that apply): Line list Absentee reports from school Other (specify): Assessment of Infection Control Measures (check all that apply): Site visit Conference call with school Other (specify): Laboratory (specify total number of specimens collected): Rapid tests: PCRs: Cultures: Control Measures: Date school started implementing control recommendations: Sent letter home with students Discontinued group activities Provided education on hand hygiene and respiratory Kept same students in one classroom while rotating etiquette teachers Increased environmental cleaning Other (specify): Results (attach any epidemic curve and/or other data analysis): Highest recorded absentee rate Outbreak Closure Information: (If school absentee baseline is unknown, use threshold of 10% absentee) Date when absentee rate was first detected above baseline: Date when absentee rate returned to baseline: Number of students admitted to a hospital: Number of students who died: Clinical Illness Characteristics Predominant Symptoms (check all that apply): Sore throat Fever ≥100°F Cough Chills Laboratory (please attach documentation of laboratory confirmation) Was there laboratory confirmation of this outbreak: Yes # of specimens tested #positive for influenza influenza type: No Limitations: (discuss any limitations to this investigation): Conclusion/Discussion (discuss interpretation of investigation and any conclusions): A person-to-person outbreak of occurred at school that resulted in an absentee rate of %. Date that absenteeism was detected above baseline was on . Absentee rate at the school returned to baseline on .
Data Collection (check all that apply): Line list Absentee reports from school Other (specify): Assessment of Infection Control Measures (check all that apply): Site visit Conference call with school Other (specify): Laboratory (specify total number of specimens collected): Rapid tests: PCRs: Cultures: Control Measures: Date school started implementing control recommendations: Sent letter home with students Provided education on hand hygiene and respiratory etiquette Increased environmental cleaning Discontinued group activities Kept same students in one classroom while rotating teachers Other (specify): Results (attach any epidemic curve and/or other data analysis): Highest recorded absentee rate Outbreak Closure Information: (If school absentee baseline is unknown, use threshold of 10% absentee) Date when absentee rate was first detected above baseline: Date when absentee rate returned to baseline: Number of students admitted to a hospital: Number of students who died: Clinical Illness Characteristics Predominant Symptoms (check all that apply): Fever ≥100°F Cough Sore throat Chills Laboratory (please attach documentation of laboratory confirmation) Was there laboratory confirmation of this outbreak: Yes # of specimens tested #positive for influenza influenza type: No Limitations: (discuss any limitations to this investigation): Conclusion/Discussion (discuss interpretation of investigation and any conclusions): A person-to-person outbreak of occurred at school that resulted in an absentee rate of %. Date that absenteeism was detected above baseline was on . Absentee rate at the school returned to baseline on .
flu-outbreak-form-schools.docx