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THE EUROPEAN COMMISSION,
Having regard to the Treaty on the Functioning of the European Union,
Having regard to Decision No 2119/98/EC of the European Parliament and of the Council of 24 September 1998 setting up a network for the epidemiological surveillance and control of communicable diseases in the Community(1), and in particular Article 3(c) thereof,
Whereas:
(1) According to Article 2 of Commission Decision 2002/253/EC(2), the case definitions laid down in the Annex to that Decision should be updated to the extent necessary on the basis of the latest scientific data.
(2) In accordance with Article 9 of Regulation (EC) No 851/2004 of the European Parliament and of the Council of 21 April 2004 establishing a European Centre for disease prevention and control(3) (ECDC), the ECDC provided, at the request of the Commission, a scientific opinion on case definitions aiding the Commission and the Member States in the development of intervention strategies in the field of surveillance of and response to communicable diseases.
(3) The case definitions already listed in the Annex to Decision 2002/253/EC for HIV/AIDS, diphtheria, Haemophilus influenzae (invasive disease), hepatitis B and C, meningococcal disease, mumps, legionellosis, congenital rubella, shiga toxin/verocytotoxin producing Escherichia coli infection (STEC/VTEC), salmonellosis and leptospirosis should be updated on the basis of that scientific opinion provided by ECDC.
(4) A generic case definition of antimicrobial resistance, a generic definition of nosocomial infections, a number of specific case definitions of nosocomial infections, and a case definition for tick-borne encephalitis should also be added to the Annex to Decision 2002/253/EC on the basis of that scientific opinion provided by ECDC.
(5) For the purpose of clarity, it is appropriate to restructure the Annex to Decision 2002/253/EC in order to ensure that case definitions for communicable diseases are in a separate list from those for special health issues, and that, within each list, the case definitions appear in numerical order.
(6) The measures provided for in this Decision are in accordance with the opinion of the Committee set up by Decision No 2119/98/EC,
HAS ADOPTED THIS DECISION:
The Annex to Decision 2002/253/EC is replaced by the Annex to this Decision.
This Decision is addressed to the Member States.
Done at Brussels, 8 August 2012.
For the Commission
John Dalli
Member of the Commission
Clinical criteria include common and relevant signs and symptoms of the disease which either individually or in combination constitutes a clear or indicative clinical picture of the disease. They give the general outline of the disease and do not necessarily indicate all the features needed for individual clinical diagnosis.
Laboratory criteria are a list of laboratory methods that are used to confirm a case. Usually only one of the listed tests will be enough to confirm the case. If a combination of methods is needed to meet the laboratory confirmation, this is specified. The type of specimen to be collected for the laboratory tests is only specified when only certain specimen types are considered relevant for the confirmation of a diagnosis. Laboratory criteria for a probable case are included for some agreed exceptional cases. Those laboratory criteria consist of a list of laboratory methods which can be used to support the diagnosis of a case but which are not confirmatory.
Epidemiological criteria are deemed to have been met when an epidemiological link can be established.
Epidemiological link, during the incubation period, means one of the following six:
:
the fact that a person has had contact with a laboratory confirmed human case in such a way as to have had the opportunity to acquire the infection
:
the fact that a person has had contact with an animal with a laboratory confirmed infection/colonisation in such a way as to have had the opportunity to acquire the infection
:
the fact that a person has been exposed to the same common source or vehicle of infection, as a confirmed human case
:
the fact that a person has consumed food or drinking water with a laboratory confirmed contamination or has consumed potentially contaminated products from an animal with a laboratory confirmed infection/colonisation
:
the fact that a person has bathed in water or has had contact with a contaminated environmental source that has been laboratory confirmed
:
the fact that a person has worked in a laboratory where there is a potential for exposure
A person may be considered epidemiologically linked to a confirmed case if at least one case in the chain of transmission is laboratory confirmed. In case of an outbreak of faeco-oral or airborne transmitted infections, the chain of transmission does not necessarily need to be established to consider a case epidemiologically linked.
Transmission may occur by one or more of the following routes:
:
by projection of aerosol from an infected person onto the mucous membranes while coughing, spitting, singing or talking, or when microbial aerosols dispersed into the atmosphere are inhaled by others
:
direct contact with an infected person (faecal-oral, respiratory droplets, skin or sexual exposure) or animal (e.g. biting, touching) or indirect contact to infected materials or objects (infected fomites, body fluids, blood)
:
from mother to child, often in utero, or as a result of the incidental exchange of body fluids usually during the perinatal period
:
indirect transmission by infected mosquitoes, mites, flies and other insects which transmit disease to humans through their bites
:
consumption of potentially contaminated food or drinking water.
Cases are classified as ‘possible’, ‘probable’ and ‘confirmed’. The incubation periods for diseases are given in the additional information to facilitate the assessment of the epidemiological link.
A possible case means a case classified as possible for reporting purposes. It is usually a case meeting the clinical criteria as described in the case definition without epidemiological or laboratory evidence of the disease in question. The definition of a case as possible has high sensitivity and low specificity. It allows for detection of most cases but some false positives cases will be included into this category.
A probable case means a case classified as probable for reporting purposes. It is usually a case with clinical criteria and an epidemiological link as described in the case definition. Laboratory tests for probable cases are specified only for some diseases.
A confirmed case means a case classified as confirmed for reporting purposes. Confirmed cases are laboratory confirmed and may or may not fulfil the clinical criteria as described in the case definition. The definition of a case as confirmed is highly specific and less sensitive; therefore most of the collected cases will be true cases although some will be missed.
The clinical criteria of some diseases do not allude to the fact that many acute cases are asymptomatic, (e.g. hepatitis A, B and C, campylobacteriosis, salmonellosis) although these cases may still be important from a public health perspective on national level.
Confirmed cases fall in one of the three subcategories listed below. They will be assigned to one of those subcategories during the analysis of data using the variables collected within the context of the case information.
The case meets the laboratory criteria for case confirmation and the clinical criteria included in the case definition.
The case meets the laboratory criteria for case confirmation but there is no information available regarding the clinical criteria (e.g. only laboratory report).
The case meets the laboratory criteria for case confirmation but doesn’t meet the clinical criteria in the case definition or is asymptomatic.
Any person who has any of the clinical conditions as defined in the European AIDS case definition for:
Adults and adolescents ≥ 15 years
Children < 15 years of age
Adults, adolescents and children aged ≥ 18 months
At least one of the following three:
Positive result of a HIV screening antibody test or a combined screening test (HIV antibody and HIV p24 antigen) confirmed by a more specific antibody test (e.g. Western blot)
Positive result of 2 EIA antibody test confirmed by a positive result of a further EIA test
Positive results on two separate specimens from at least one of the following three:
Detection of HIV nucleic acid (HIV-RNA, HIV-DNA)
Demonstration of HIV by HIV p24 antigen test, including neutralisation assay
Isolation of HIV
Children aged < 18 months
Positive results on two separate specimens (excluding cord blood) from at least one of the following three:
Isolation of HIV
Detection of HIV nucleic acid (HIV-RNA, HIV-DNA)
Demonstration of HIV by HIV p24 antigen test, including neutralisation assay in a child ≥ 1 month of age
HIV infection
Any person meeting the laboratory criteria for HIV infection
AIDS
Any person meeting the clinical criteria for AIDS and the laboratory criteria for HIV infection
Any person with at least one of the following clinical forms:
At least one the following two:
Papular or vesicular lesion
Depressed black eschar with surrounding oedema
Fever or feverishness
AND at least one of the following two:
Severe abdominal pain
Diarrhoea
Fever or feverishness
AND at least one of the following two:
Acute respiratory distress
Radiological evidence of mediastinal widening
Fever
AND at least one of the following three:
Convulsions
Loss of consciousness
Meningeal signs
Isolation of Bacillus anthracis from a clinical specimen
Detection of Bacillus anthracis nucleic acid in a clinical specimen
Positive nasal swab without clinical symptoms does not contribute to a confirmed diagnosis of a case
At least one of the following three epidemiological links:
Animal to human transmission
Exposure to a common source
Exposure to contaminated food/drinking water
Any person meeting the clinical criteria and with an epidemiological link
Any person meeting the clinical and the laboratory criteria
Any person with one of the following two:
Fever AND signs and symptoms of acute respiratory infection
Death from an unexplained acute respiratory illness
At least one of the following three:
Isolation of influenza A/H5N1 from a clinical specimen
Detection of influenza A/H5 nucleic acid in a clinical specimen
Influenza A/H5 specific antibody response (four-fold or greater rise or single high titre)
At least one of the following four:
Human to human transmission by having been in close contact (within 1 metre) to a person reported as probable or confirmed case
Laboratory exposure: where there is a potential exposure to influenza A/H5N1
Close contact (within 1 metre) with an animal with confirmed A/H5N1 infection other than poultry or wild birds (e.g. cat or pig)
Reside in or have visited an area where influenza A/H5N1 is currently suspected or confirmed(4) AND at least one of the following two:
Having been in close contact (within 1 metre) with sick or dead domestic poultry or wild birds(5) in the affected area
Having been in a home or a farm where sick or dead domestic poultry have been reported in the previous month in the affected area
Any person meeting the clinical and the epidemiological criteria
Any person with a positive test for influenza A/H5 or A/H5N1 performed by a laboratory which is not a National Reference Laboratory participating in the EU Community Network of Reference Laboratories for human influenza (CNRL)
Any person with a positive test for influenza A/H5 or A/H5N1 performed by a National Reference Laboratory participating in the EU Community Network of Reference Laboratories for human influenza (CNRL)
Any person with a laboratory confirmation by a WHO Collaborating Centre for H5
Any person with at least one of the following clinical forms:
At least one of the following two:
Bilateral cranial nerve impairment (e.g. diplopia, blurred vision, dysphagia, bulbar weakness)
Peripheral symmetric paralysis
Any infant with at least one of the following six:
Constipation
Lethargy
Poor feeding
Ptosis
Dysphagia
General muscle weakness
The type of botulism usually encountered in infants (< 12 months of age) can affect children also over 12 months of age and occasionally adults, with altered gastrointestinal anatomy and microflora
At least one of the following two:
Isolation of Clostridium botulinum for infant botulism (stool) or wound botulism (wound) (isolation of Clostridium botulinum in stool of adults not relevant for the diagnosis of food-borne botulism)
Detection of botulinum toxin in a clinical specimen
At least one of the following two epidemiological links:
Exposure to a common source (e.g. food, sharing of needles or other devices)
Exposure to contaminated food/drinking water
Any person meeting the clinical criteria and with an epidemiological link
Any person meeting the clinical and the laboratory criteria
Any person with Fever
And at least one of following seven:
Sweating (profuse, malodorous, specially nocturnal)
Chills
Arthralgia
Weakness
Depression
Headache
Anorexia
At least one of the following two:
Isolation of Brucella spp. from a clinical specimen
Brucella specific antibody response (Standard Agglutination Test, Complement Fixation, ELISA)
At least one of the following four epidemiological links:
Exposure to contaminated food/drinking water
Exposure to products from a contaminated animal (milk or milk products)
Animal to human transmission (contaminated secretions or organs e.g. vaginal discharge, placenta)
Exposure to a common source
Any person meeting the clinical criteria and with an epidemiological link
Any person meeting the clinical and the laboratory criteria
Any person with at least one of the following three:
Diarrhoea
Abdominal pain
Fever
Isolation of Campylobacter spp. from stool or blood
Differentiation of Campylobacter spp. should be performed if possible
At least one of the following five epidemiological links:
Animal to human transmission
Human to human transmission
Exposure to a common source
Exposure to contaminated food/drinking water
Environmental exposure
Any person meeting the clinical criteria and with an epidemiological link
Any person meeting the clinical and the laboratory criteria
Any person with at least one of the following clinical forms:
At least one of the following six:
Urethritis
Epididymitis
Acute salpingitis
Acute endometritis
Cervicitis
Proctitis
In newborn children at least one of the following two:
Conjunctivitis
Pneumonia
At least one of the following five:
Urethritis
Genital ulcer
Inguinal lymphadenopathy
Cervicitis
Proctitis
At least one of the following three:
Isolation of Chlamydia trachomatis from a specimen of the ano-genital tract or from the conjunctiva
Demonstration of Chlamydia trachomatis by DFA test in a clinical specimen
Detection of Chlamydia trachomatis nucleic acid in a clinical specimen
At least one of the following two:
Isolation of Chlamydia trachomatis from a specimen of the ano-genital tract or from the conjunctiva
Detection of Chlamydia trachomatis nucleic acid in a clinical specimen
AND
Identification of serovar (genovar) L1, L2 or L3
An epidemiological link by human to human transmission (sexual contact or vertical transmission)
Any person meeting the clinical criteria and with an epidemiological link
Any person meeting the laboratory criteria
Any person with at least one of the following two:
Diarrhoea
Vomiting
Isolation of Vibrio cholerae from a clinical specimen
AND
Demonstration of O1 or O139 antigen in the isolate
AND
Demonstration of cholera-enterotoxin or the cholera-enterotoxin gene in the isolate
At least one of the following four epidemiological links:
Exposure to a common source
Human to human transmission
Exposure to contaminated food/drinking water
Environmental exposure
Any person meeting the clinical criteria and with an epidemiological link
Any person meeting the clinical and the laboratory criteria
Any person with a progressive neuropsychiatric disorder with a duration of illness of at least six months
Routine investigations do not suggest an alternative diagnosis
No history of exposure to human pituitary hormones or human dura mater graft
No evidence of a genetic form of transmissible spongiform encephalopathy
Any person with at least four of the following five:
Early psychiatric symptoms(6)
Persistent painful sensory symptoms(7)
Ataxia
Myoclonus or chorea or dystonia
Dementia
Neuropathological confirmation: spongiform change and extensive prion protein deposition with florid plaques throughout the cerebrum and cerebellum
EEG does not show the typical appearance(8) of sporadic CJD(9) in the early stages of the illness
Bilateral pulvinar high signal on MRI brain scan
A positive tonsil biopsy(10)
An epidemiological link by human to human transmission (e.g. blood transfusion)
Any person fulfilling the preconditions
AND
meeting the clinical criteria
AND
a negative EEG for sporadic CJD(11)
Any person fulfilling the preconditions
AND
meeting the clinical criteria
AND
a negative EEG for sporadic CJD(12)
AND
a positive MRI brain scan
OR
Any person fulfilling the preconditions
AND
a positive tonsil biopsy
Any person fulfilling the preconditions
AND
meeting the diagnostic criteria for case confirmation
Any person with at least one of the following two:
Diarrhoea
Abdominal pain
At least one of the following four:
Demonstration of Cryptosporidium oocysts in stool
Demonstration of Cryptosporidium in intestinal fluid or small-bowel biopsy specimens
Detection of Cryptosporidium nucleic acid in stool
Detection of Cryptosporidium antigen in stool
One of the following five epidemiological links:
Human to human transmission
Exposure to a common source
Animal to human transmission
Exposure to contaminated food/drinking water
Environmental exposure
Any person meeting the clinical criteria and with an epidemiological link
Any person meeting the clinical and the laboratory criteria
Any person with at least one of the following clinical forms:
An upper respiratory tract illness with laryngitis or nasopharyngitis or tonsillitis
AND
an adherent membrane/pseudomembrane
An upper respiratory tract illness with laryngitis or nasopharyngitis or tonsillitis
WITHOUT
an adherent membrane/pseudomembrane.
Skin lesion
Lesion of conjunctiva or mucous membranes
Isolation of toxin-producing Corynebacterium diphtheriae, Corynebacterium ulcerans or Corynebacterium pseudotuberculosis from a clinical specimen.
At least one of the following epidemiological links:
Human to human transmission
Animal to human transmission
Any person meeting the clinical criteria for classical respiratory diphtheria
Any person meeting the clinical criteria for diphtheria (Classic Respiratory Diphtheria, Mild Respiratory Diphtheria, Cutaneous Diphtheria, Diphtheria of other sites) with an epidemiological link to a human confirmed case or with an epidemiological link to animal to human transmission
Any person meeting the laboratory criteria AND at least one of the clinical forms
Not relevant for surveillance purposes
At least one of the following five:
Histopathology or parasitology compatible with Echinococcus multilocularis or granulosus (e.g. direct visualisation of the protoscolex in cyst fluid)
Detection of Echinoccocus granulosus pathognomonic macroscopic morphology of cyst(s) in surgical specimens
Typical organ lesions detected by imaging techniques (e.g. computerised tomography, sonography, MRI) AND confirmed by a serological test
Echinococcus spp. specific serum antibodies by high-sensitivity serological test AND confirmed by a high specificity serological test
Detection of Echinococcus multilocularis or granulosus nucleic acid in a clinical specimen
Any person meeting the diagnostic criteria
Any person with at least one of the following four:
Diarrhoea
Abdominal pain
Bloating
Signs of malabsorption (e.g. steatorrhoea, weight loss)
At least one of the following two:
Demonstration of Giardia lamblia cysts or trophozoites in stool, duodenal fluid or small-bowel biopsy
Demonstration of Giardia lamblia antigen in stool
At least one of the following four epidemiological links:
Exposure to contaminated food/drinking water
Human to human transmission
Exposure to a common source
Environmental exposure
Any person meeting the clinical criteria and with an epidemiological link
Any person meeting the clinical and the laboratory criteria
Any person with at least one of the following eight:
Urethritis
Acute salpingitis
Pelvic inflammatory disease
Cervicitis
Epididymitis
Proctitis
Pharyngitis
Arthritis
OR
Any newborn child with conjunctivitis
At least one of the following four:
Isolation of Neisseria gonorrhoeae from a clinical specimen
Detection of Neisseria gonorrhoeae nucleic acid in a clinical specimen
Demonstration of Neisseria gonorrhoeae by a non-amplified nucleic acid probe test in a clinical specimen
Microscopic detection of intracellular gram negative diploccocci in a urethral male specimen
An epidemiological link by human to human transmission (sexual contact or vertical transmission)
Any person meeting the clinical criteria and with an epidemiological link
Any person meeting the laboratory criteria
Not relevant for surveillance purposes
At least one of the following two:
Isolation of Haemophilus influenzae from a normally sterile site
Detection of Haemophilus influenzae nucleic acid from a normally sterile site
Any person meeting the laboratory criteria
Any person with a discrete onset of symptoms (e.g. fatigue, abdominal pain, loss of appetite, intermittent nausea and vomiting)
AND
At least one of the following three:
Fever
Jaundice
Elevated serum aminotransferase levels
At least one of the following three:
Detection of hepatitis A virus nucleic acid in serum or stool
Hepatitis A virus specific antibody response
Detection of hepatitis A virus antigen in stool
At least one of the following four:
Human to human transmission
Exposure to a common source
Exposure to contaminated food/drinking water
Environmental exposure
Any person meeting the clinical criteria and with an epidemiological link
Any person meeting the clinical and the laboratory criteria
Not relevant for surveillance purposes
Positive results of at least one or more of the following tests or combination of tests:
IgM hepatitis B core antibody (anti-HBc IgM)
Hepatitis B surface antigen (HBsAg)
Hepatitis B e antigen (HBeAg)
Hepatitis B nucleic acid (HBV-DNA)
Not relevant for surveillance purposes
Any person meeting the laboratory criteria
Not relevant for surveillance purposes
At least one of the following three:
Detection of hepatitis C virus nucleic acid (HCV RNA)
Detection of hepatitis C virus core antigen (HCV-core)
Hepatitis C virus specific antibody (anti-HCV) response confirmed by a confirmatory (e.g. immunoblot) antibody test in persons older than 18 months without evidence of resolved infection)
Any person meeting the laboratory criteria
Any person with at least one of the following clinical forms:
Sudden onset of symptoms
AND
at least one of the following four systemic symptoms:
Fever or feverishness
Malaise
Headache
Myalgia
AND
At least one of the following three respiratory symptoms:
Cough
Sore throat
Shortness of breath
Sudden onset of symptoms
AND
At least one of the following four respiratory symptoms:
Cough
Sore throat
Shortness of breath
Coryza
AND
A clinician’s judgement that the illness is due to an infection
At least one the following four:
Isolation of influenza virus from a clinical specimen
Detection of influenza virus nucleic acid in a clinical specimen
Identification of influenza virus antigen by DFA test in a clinical specimen
Influenza specific antibody response
Sub typing of the influenza isolate should be performed, if possible
An epidemiological link by human to human transmission
Any person meeting the clinical criteria (ILI or ARI)
Any person meeting the clinical criteria (ILI or ARI) and with an epidemiological link
Any person meeting the clinical (ILI or ARI) and the laboratory criteria
Any person with one of the following three:
fever > 38 °C AND signs and symptoms of acute respiratory infection
pneumonia (severe respiratory illness)
death from an unexplained acute respiratory illness
At least one of the following tests:
RT-PCR
viral culture (requiring BSL 3 facilities)
four-fold rise in novel influenza virus A(H1N1) specific neutralising antibodies (implies the need for paired sera, from acute phase illness and then at convalescent stage 10-14 days later minimum)
At least one of the following three in the seven days before disease onset:
a person who was a close contact to a confirmed case of novel influenza A(H1N1) virus infection while the case was ill
a person who has travelled to an area where sustained human-to-human transmission of novel influenza A(H1N1) is documented
a person working in a laboratory where samples of the novel influenza A(H1N1) virus are tested
Any person meeting the clinical and epidemiological criteria
Any person meeting the clinical AND epidemiological criteria AND with a laboratory result showing positive influenza A infection of an unsubtypable type
Any person meeting the laboratory criteria for confirmation
Any person with pneumonia
Laboratory criteria for case confirmation
At least one of the following three:
Isolation of Legionella spp. from respiratory secretions or any normally sterile site
Detection of Legionella pneumophila antigen in urine
Significant rise in specific antibody level to Legionella pneumophila serogroup 1 in paired serum samples
Laboratory criteria for a probable case
At least one of the following four:
Detection of Legionella pneumophila antigen in respiratory secretions or lung tissue e.g. by DFA staining using monoclonal-antibody derived reagents
Detection of Legionella spp. nucleic acid in respiratory secretions, lung tissue or any normally sterile site
Significant rise in specific antibody level to Legionella pneumophila other than serogroup 1 or other Legionella spp. in paired serum samples
Single high level of specific antibody to Legionella pneumophila serogroup 1 in serum
Any person meeting the clinical criterion AND at least one laboratory criterion for a probable case
Any person meeting the clinical criterion AND at least one laboratory criterion for a confirmed case
Any person with
Fever
OR
At least two of the following eleven:
Chills
Headache
Myalgia
Conjunctival suffusion
Haemorrhages into skin and mucous membranes
Rash
Jaundice
Myocarditis
Meningitis
Renal impairment
Respiratory symptoms such as haemoptysis
At least one of the following four:
Isolation of Leptospira interrogans or any other pathogenic Leptospira spp. from a clinical specimen
Detection of Leptospira interrogans or any other pathogenic Leptospira spp. nucleic acid in a clinical specimen
Demonstration of Leptospira interrogans or any other pathogenic Leptospira spp. by immunofluorescence in a clinical specimen
Leptospira interrogans or any other pathogenic Leptospira spp. specific antibody response
At least one of the following three epidemiological links:
Animal to human transmission
Environmental exposure
Exposure to a common source
Any person meeting the clinical criteria and with an epidemiological link
Any person meeting the clinical and the laboratory criteria
Any person with at least one of the following three:
Listeriosis of newborns defined as
Stillbirth
OR
At least one of the following five in the first month of life:
Granulomatosis infantiseptica
Meningitis or meningoencephalitis
Septicaemia
Dyspnoea
Lesions on skin, mucosal membranes or conjunctivae
Listeriosis in pregnancy defined as at least one of the following three:
Abortion, miscarriage, stillbirth or premature birth
Fever
Influenza-like symptoms
Other form of listeriosis defined as at least one of the following four:
Fever
Meningitis or meningoencephalitis
Septicaemia
Localised infections such as arthritis, endocarditis, and abscesses
At least one of the following two:
Isolation of Listeria monocytogenes from a normally sterile site
Isolation of Listeria monocytogenes from a normally non-sterile site in a foetus, stillborn, newborn or the mother at or within 24 hours of birth
At least one of the following three epidemiological links:
Exposure to a common source
Human to human transmission (vertical transmission)
Exposure to contaminated food/drinking water
Incubation period 3-70 days, most often 21 days
Any person meeting the clinical criteria and with an epidemiological link
Any person meeting the laboratory criteria
OR
Any mother with a laboratory confirmed listeriosis infection in her foetus, stillborn or newborn
Any person with fever OR a history of fever
At least one of the following three:
Demonstration of malaria parasites by light microscopy in blood films
Detection of Plasmodium nucleic acid in blood
Detection of Plasmodium antigen
Differentiation of Plasmodium spp. should be performed if possible
Any person meeting the clinical and the laboratory criteria
Any person with fever
AND
Maculo-papular rash
AND at least one of the following three:
Cough
Coryza
Conjunctivitis
At least one of the following four:
Isolation of measles virus from a clinical specimen
Detection of measles virus nucleic acid in a clinical specimen
Measles virus specific antibody response characteristic for acute infection in serum or saliva
Detection of measles virus antigen by DFA in a clinical specimen using measles specific monoclonal antibodies
Laboratory results need to be interpreted according to the vaccination status. If recently vaccinated, investigate for wild virus
An epidemiological link by human to human transmission
Any person meeting the clinical criteria
Any person meeting the clinical criteria and with an epidemiological link
Any person not recently vaccinated and meeting the clinical and the laboratory criteria
Any person with at least one of the following symptoms:
Meningeal signs
Haemorrhagic rash
Septic shock
Septic arthritis
At least one of the following four:
Isolation of Neisseria meningitidis from a normally sterile site, or from purpuric skin lesions
Detection of Neisseria meningitidis nucleic acid from a normally sterile site, or from purpuric skin lesions
Detection of Neisseria meningitidis antigen in CSF
Detection of gram negative stained diplococcus in CSF
An epidemiological link by human to human transmission
Any person meeting the clinical criteria
Any person meeting the clinical criteria and with an epidemiological link
Any person meeting the laboratory criteria
Any person with
Fever
AND
At least one of the following three:
Sudden onset of unilateral or bilateral tender swelling of the parotid or other salivary glands without other apparent cause
Orchitis
Meningitis
At least one of the following three:
Isolation of mumps virus from a clinical specimen
Detection of mumps virus nucleic acid
Mumps virus specific antibody response characteristic for acute infection in serum or Saliva
Laboratory results need to be interpreted according to the vaccination status
An epidemiological link by human to human transmission
Any person meeting the clinical criteria
Any person meeting the clinical criteria and with an epidemiological link
Any person not recently vaccinated and meeting the laboratory criteria
In case of recent vaccination: any person with detection of wild-type mumps virus strain
Any person with a cough lasting at least two weeks
AND at least one of the following three:
Paroxysms of coughing
Inspiratory ‘whooping’
Post-tussive vomiting
OR
Any person diagnosed as pertussis by a physician
OR
Apnoeic episodes in infants
At least one of the following three:
Isolation of Bordetella pertussis from a clinical specimen
Detection of Bordetella pertussis nucleic acid in a clinical specimen
Bordetella pertussis specific antibody response
An epidemiological link by human to human transmission
Any person meeting the clinical criteria
Any person meeting the clinical criteria and with an epidemiological link
Any person meeting the clinical and the laboratory criteria
Any person with at least one of the following clinical forms:
Fever
AND
Sudden onset of painful lymphadenitis
Fever
Fever
AND
At least one of the following three:
Cough
Chest pain
Haemoptysis
At least one of the following three:
Isolation of Yersinia pestis from a clinical specimen
Detection of Yersinia pestis nucleic acid from a clinical specimen (F1 antigen)
Yersinia pestis anti-F1 antigen specific antibody response
At least one of the following four epidemiological links:
Human to human transmission
Animal to human transmission
Laboratory exposure (where there is a potential exposure to plague)
Exposure to a common source
Any person meeting the clinical criteria and with an epidemiological link
Any person meeting the laboratory criteria
Not relevant for surveillance purposes
At least one of the following three:
Isolation of Streptococcus pneumoniae from a normally sterile site
Detection of Streptococcus pneumoniae nucleic acid from a normally sterile site
Detection of Streptococcus pneumoniae antigen from a normally sterile site
Any person meeting the laboratory criteria
Any person < 15 years of age with Acute flaccid paralysis (AFP)
OR
Any person in whom polio is suspected by a physician
At least one of the following three:
Isolation of a polio virus and intratypic differentiation — Wild polio virus (WPV)
Vaccine derived poliovirus (VDPV) (for the VDPV at least 85 % similarity with vaccine virus in the nucleotide sequences in the VP1 section)
Sabin-like poliovirus: intratypic differentiation performed by a WHO-accredited polio laboratory (for the VDPV a > 1 % up to 15 % VP1 sequence difference compared with vaccine virus of the same serotype)
At least one of the following two epidemiological links:
Human to human transmission
An history of travel to a polio-endemic area or an area with suspected or confirmed circulation of poliovirus
Any person meeting the clinical criteria
Any person meeting the clinical criteria and with an epidemiological link
Any person meeting the clinical and the laboratory criteria
Any person with at least one of the following three:
Fever
Pneumonia
Hepatitis
At least one of the following three:
Isolation of Coxiella burnetii from a clinical specimen
Detection of Coxiella burnetii nucleic acid in a clinical specimen
Coxiella burnetii specific antibody response (IgG or IgM phase II)
At least one of the following two epidemiological links:
Exposure to a common source
Animal to human transmission
Any person meeting the clinical criteria and with an epidemiological link
Any person meeting the clinical and the laboratory criteria
Any person with an acute encephalomyelitis
AND
At least two of the following seven:
Sensory changes referred to the site of a preceding animal bite
Paresis or paralysis
Spasms of swallowing muscles
Hydrophobia
Delirium
Convulsions
Anxiety
At least one of the following four:
Isolation of Lyssa virus from a clinical specimen
Detection of Lyssa virus nucleic acid in a clinical specimen (e.g. saliva or brain tissue)
Detection of viral antigens by a DFA in a clinical specimen
Lyssa virus specific antibody response by virus neutralisation assay in serum or CSF
Laboratory results need to be interpreted according to the vaccination or immunisation status
At least one of the following three epidemiological links:
Animal to human transmission (animal with suspected or confirmed infection)
Exposure to a common source (same animal)
Human to human transmission (e.g. transplantation of organs)
Any person meeting the clinical criteria
Any person meeting the clinical criteria and with an epidemiological link
Any person meeting the clinical and the laboratory criteria
Any person with sudden onset of generalised maculo-papular rash
AND
At least one of the following five:
Cervical adenopathy
Sub-occipital adenopathy
Post-auricular adenopathy
Arthralgia
Arthritis
Laboratory criteria for case confirmation
At least one of the following three:
Isolation of rubella virus from a clinical specimen
Detection of rubella virus nucleic acid in a clinical specimen
Rubella virus specific antibody response (IgG) in serum or saliva
Laboratory criteria for probable case
Rubella virus specific antibody response (IgM(13))
Laboratory results need to be interpreted according to the vaccination status
An epidemiological link by human to human transmission
Any person meeting the clinical criteria
Any person meeting the clinical criteria and with at least one of the following two:
An epidemiological link
Meeting the laboratory criteria for a probable case
Any person not recently vaccinated and meeting the laboratory criteria for case confirmation
In case of recent vaccination, a person with detection of wild-type rubella virus strain
No clinical criteria can be defined for CRI
Any infant < 1 year of age or any stillborn with:
At least two of the conditions listed in (A)
OR
One in category (A) and one in category (B)
Cataract(s)
Congenital glaucoma
Congenital heart disease
Loss of hearing
Pigmentary retinopathy
Purpura
Splenomegaly
Microcephaly
Developmental delay
Meningo-encephalitis
Radiolucent bone disease
Jaundice that begins within 24 hours after birth
At least one of the following four:
Isolation of rubella virus from a clinical specimen
Detection of Rubella virus nucleic acid
Rubella virus specific antibody response (IgM)
Persistence of rubella IgG between 6 and 12 months of age (at least two samples with similar concentration of rubella IgG)
Laboratory results need to be interpreted according to the vaccination status
Any infant or any stillborn born to a woman with a laboratory confirmed rubella infection during pregnancy by human to human transmission (vertical transmission)
Any stillborn or infant either not tested OR with negative laboratory results with at least one of the following two:
An epidemiological link AND at least one of the conditions listed in the category ‘A’ CRS clinical criteria
Meeting the clinical criteria for CRS
Any stillborn meeting the laboratory criteria
OR
Any infant meeting the laboratory criteria AND at least one of the following two:
An epidemiological link
At least one of the conditions listed in the category ‘A’ CRS clinical criteria
Any person with at least one of the following four:
Diarrhoea
Fever
Abdominal pain
Vomiting
Isolation of Salmonella (other than Salmonella typhi and Salmonella paratyphi) from stool, urine, body site (e.g. infected wound) or any normally sterile body fluids and tissues (e.g. blood, CSF, bone, synovial fluid, etc.)
At least one of the following five epidemiological links:
Human to human transmission
Exposure to a common source
Animal to human transmission
Exposure to contaminated food/drinking water
Environmental exposure
Any person meeting the clinical criteria and with an epidemiological link
Any person meeting the clinical and the laboratory criteria
Any person with fever or a history of fever
AND
At least one of the following three:
Cough
Difficulty in breathing
Shortness of breath
AND
At least one of the following four:
Radiographic evidence of pneumonia
Radiographic evidence of acute respiratory distress syndrome
Autopsy findings of pneumonia
Autopsy findings of acute respiratory distress syndrome
AND
No alternative diagnosis which can fully explain the illness
Laboratory criteria for case confirmation
At least one of the following three:
Isolation of virus in cell culture from any clinical specimen and identification of SARS-CoV using method such as RT-PCR
Detection SARS-CoV nucleic acid in at least one of the following three:
At least two different clinical specimens (e.g. nasopharyngeal swab and stool)
The same clinical specimen collected on two or more occasions during the course of the illness (e.g. sequential nasopharyngeal aspirates)
Two different assays or repeat RT-PCR using a new RNA extract from the original clinical sample on each occasion of testing
SARS-CoV specific antibody response by one of the following two:
Seroconversion by ELISA or IFA in acute and convalescent phase serum tested in parallel
Four-fold or greater rise in antibody titre between acute and convalescent phase sera tested in parallel
Laboratory criteria for a probable case
At least one of the following two:
A single positive antibody test for SARS-CoV
A positive PCR result for SARS-CoV on a single clinical specimen and assay
At least one of the following three:
Any person with at least one of the following three:
Employed in an occupation associated with an increased risk of SARS-CoV exposure (e.g. staff in a laboratory working with live SARS-CoV/SARS-CoV-like viruses or storing clinical specimens infected with SARS-CoV; persons with exposure to wildlife or other animals considered a reservoir of SARS-CoV, their excretions or secretions, etc.)
Close contact(14) of one or more persons with confirmed SARS or under investigation for SARS
History of travel to, or residence in, an area experiencing an outbreak of SARS
Two or more health-care workers(15) with clinical evidence of SARS in the same health-care unit and with onset of illness in the same 10-day period
Three or more persons (health-care workers and/or patients and/or visitors) with clinical evidence of SARS with onset of illness in the same 10-day period and epidemiologically linked to a healthcare facility
Also applies during an outbreak in a non-affected country or area
Any person meeting the clinical criteria and with an epidemiological link
Any person meeting the clinical criteria AND with an epidemiological link AND meeting the laboratory criteria for a probable case
Any person meeting the clinical and the laboratory criteria for case confirmation where the testing has been performed at a national reference laboratory
Any person meeting the clinical and the laboratory criteria for case confirmation where the testing has been performed at a WHO SARS verification and reference laboratory
Applies during an outbreak in a country/area where at least one person has been laboratory confirmed by a WHO SARS verification and reference laboratory
Any person meeting the clinical criteria
Any person meeting the clinical criteria and with an epidemiological link to a nationally confirmed or a confirmed case
Any person meeting the clinical and the laboratory criteria for case confirmation where the testing has been performed at a national reference laboratory
One of the following three:
Any person meeting the clinical and the laboratory criteria for case confirmation where the testing has been performed at a WHO SARS verification and reference laboratory
Any nationally confirmed case with an epidemiological link to a chain of transmission where at least one case has been independently verified by a WHO SARS Reference and Verification Laboratory
Any person meeting the clinical criteria and with laboratory criteria for probable case with an epidemiological link to a chain of transmission where at least one case has been independently verified by a WHO SARS Reference and Verification Laboratory
Any person with at least one of the following two:
Diarrhoea
Abdominal pain
Any person with acute renal failure and at least one of the following two:
Microangiopatic haemolytic anaemia
Thrombocytopenia
At least one of the following four:
Isolation of an Escherichia coli strain that produces Shigatoxin (Stx) or harbours stx1 or stx2 gene(s)
Isolation of non-sorbitol-fermenting (NSF) Escherichia coli O157 (without Stx or stx gene testing)
Direct detection of stx1 or stx2 gene(s) nucleic acid (without strain isolation)
Direct detection of free Stx in faeces (without strain isolation)
Only for HUS the following can be used as laboratory criterion to confirm STEC/VTEC:
Escherichia coli serogroup-specific (LPS) antibody response
Isolation of an STEC/VTEC strain and additional characterisation by serotype, phage type, eae genes, and subtypes of stx1/stx2 should be performed if possible
At least one of the following five epidemiological links:
Human to human transmission
Exposure to a common source
Animal to human transmission
Exposure to contaminated food/drinking water
Environmental exposure
Any person meeting the clinical criteria for HUS
Any person meeting the clinical criteria and with an epidemiological link
Any person meeting the clinical and the laboratory criteria
Any person with at least one of the following four:
Diarrhoea
Fever
Vomiting
Abdominal pain
Isolation of Shigella spp. from a clinical specimen
At least one of the following five epidemiological links:
Human to human transmission
Exposure to a common source
Animal to human transmission
Exposure to contaminated food/drinking water
Environmental exposure
Any person meeting the clinical criteria and with an epidemiological link
Any person meeting the clinical and the laboratory criteria
Any person with at least one of the following two:
Fever
AND
Vesicles or firm pustules rash at the same stage of development with a centrifugal distribution
Atypical presentations defined as at least one of the following four:
Haemorrhagic lesions
Flat velvety lesions not progressing to vesicles
Variola sine eruptione
Milder type
Laboratory criteria for case confirmation
At least one of the following two laboratory tests:
Isolation of smallpox (Variola virus) from a clinical specimen followed by sequencing (designated P4 laboratories only)
Detection of Variola virus nucleic acid in a clinical specimen followed by sequencing
Laboratory results need to be interpreted according to the vaccination status
Laboratory criteria for a probable case
Identification of orthopox virus particles by EM
At least one of the following two epidemiological links:
Human to human transmission
Laboratory exposure (where there is a potential exposure to Variola virus)
Any person meeting the clinical criteria
Any person meeting the clinical criteria and with at least one of the following two:
An epidemiological link to a confirmed human case by human to human transmission
Meeting the laboratory criteria for a probable case
Any person meeting the laboratory criteria for case confirmation
During an outbreak: any person meeting the clinical criteria and with an epidemiological link
Primary syphilis
Any person with one or several (usually painless) chancres in the genital, perineal, anal area or mouth or pharyngeal mucosa or elsewhere extragenitally
Secondary syphilis
Any person with at least one of the following five:
Diffuse maculo-papular rash often involving palms and soles
Generalised lymphadenopathy
Condyloma lata
Enanthema
Allopetia diffusa
Early latent syphilis (< 1 year)
A history of symptoms compatible with those of the earlier stages of syphilis within the previous 12 months
Late latent syphilis (> 1 year)
Any person meeting laboratory criteria (specific serological tests)
At least one of the following four laboratory tests:
Demonstration of Treponema pallidum in lesion exudates or tissues by dark-field microscopic examination
Demonstration of Treponema pallidum in lesion exudates or tissues by DFA test
Demonstration of Treponema in lesion exudates or tissues by PCR
Detection of Treponema pallidum antibodies by screening test (TPHA, TPPA or EIA) AND additionally detection of Tp-IgM antibodies (by IgM-ELISA, IgM immunoblot or 19S-IgM-FTA-abs) — confirmed by a second IgM assay
Primary/secondary syphilis
An epidemiological link by human to human (sexual contact)
Early latent syphilis (< 1 year)
An epidemiological link by human to human (sexual contact) within the 12 previous months
Any person meeting the clinical criteria and with an epidemiological link
Any person meeting the laboratory criteria for case confirmation
Any infant < 2 years of age with at least one of the following 10:
Hepatospenomegaly
Mucocutaneous lesions
Condyloma lata
Persistent rhinitis
Jaundice
Pseudoparalysis (due to periostitis and osteochondritis)
Central nervous involvement
Anaemia
Nephrotic syndrome
Malnutrition
Laboratory criteria for case confirmation
At least one of the following three:
Demonstration of Treponema pallidum by dark field microscopy in the umbilical cord, the placenta, a nasal discharge or skin lesion material
Demonstration of Treponema pallidum by DFA-TP in the umbilical cord, the placenta, a nasal discharge or skin lesion material
Detection of Treponema pallidum — specific IgM (FTA-abs, EIA)
AND a reactive non-treponemal test (VDRL, RPR) in the child’s serum
Laboratory criteria for a probable case
At least one of the following three:
Reactive VDRL-CSF test result
Reactive non-treponemal and treponemal serologic tests in the mother’s serum
Infant’s non-treponemal antibody titre is four-fold or greater than the antibody titre in the mother’s serum
Any infant with an epidemiological link by human to human transmission (vertical transmission)
Any infant or child meeting the clinical criteria and with at least one of the following two:
An epidemiological link
Meeting the laboratory criteria for a probable case
Any infant meeting the laboratory criteria for case confirmation
Any person with at least two of the following three:
Painful muscular contractions primarily of the masseter and neck muscles leading to facial spasms known as trismus and ‘risus sardonicus’
Painful muscular contractions of trunk muscles
Generalised spasms, frequently position of opisthotonus
At least one of the following two:
Isolation of Clostridium tetani from an infection site
Detection of tetanus toxin in a serum sample
Any person meeting the clinical criteria
Any person meeting the clinical and the laboratory criteria
Any person with symptoms of inflammation of the CNS (e.g. meningitis, meningo-encephalitis, encephalomyelitis, encephaloradiculitis)
Laboratory criteria for case confirmation:
At least one of the following five:
TBE specific IgM AND IgG antibodies in blood
TBE specific IgM antibodies in CSF
Sero-conversion or four-fold increase of TBE-specific antibodies in paired serum samples
Detection of TBE viral nucleic acid in a clinical specimen,
Isolation of TBE virus from clinical specimen
Laboratory criteria for a probable case:
Detection of TBE-specific IgM-antibodies in a unique serum sample
Exposure to a common source (unpasteurised dairy products)
Any person meeting the clinical criteria and the laboratory criteria for a probable case,
OR
Any person meeting the clinical criteria and with an epidemiological link
Any person meeting the clinical and laboratory criteria for case confirmation
Not relevant for surveillance purposes
At least one of the following four:
Demonstration of Toxoplasma gondii in body tissues or fluids
Detection of Toxoplasma gondii nucleic acid in a clinical specimen
Toxoplasma gondii specific antibody response (IgM, IgG, IgA) in a newborn
Persistently stable IgG Toxoplasma gondii titres in an infant (< 12 months of age)
Any infant meeting the laboratory criteria
Any person with at least three of the following six:
Fever
Muscle soreness and pain
Diarrhoea
Facial oedema
Eosinophilia
Subconjunctival, subungual and retinal haemorrhages
At least one of the following two:
Demonstration of Trichinella larvae in tissue obtained by muscle biopsy
Trichinella specific antibody response (IFA test, ELISA or Western Blot)
At least one of the following two epidemiological links:
Exposure to contaminated food (meat)
Exposure to a common source
Any person meeting the clinical criteria and with an epidemiological link
Any person meeting the clinical criteria and the laboratory criteria
Any person with the following two:
Signs, symptoms and/or radiological findings consistent with active tuberculosis in any site
AND
A clinician’s decision to treat the person with a full course of anti-tuberculosis therapy
OR
A case discovered post-mortem with pathological findings consistent with active tuberculosis that would have indicated anti-tuberculosis antibiotic treatment had the patient been diagnosed before dying
Laboratory criteria for case confirmation
At least one of the following two:
Isolation of Mycobacterium tuberculosis complex (excluding Mycobacterium bovis-BCG) from a clinical specimen
Detection of Mycobacterium tuberculosis complex nucleic acid in a clinical specimen AND positive microscopy for acid-fast bacilli or equivalent fluorescent staining bacilli on light microscopy
Laboratory criteria for a probable case
At least one of the following three:
Microscopy for acid-fast bacilli or equivalent fluorescent staining bacilli on light microscopy
Detection of Mycobacterium tuberculosis complex nucleic acid in a clinical specimen
Histological appearance of granulomata
Any person meeting the clinical criteria
Any person meeting the clinical criteria and the laboratory criteria for a probable case
Any person meeting the clinical and the laboratory criteria for case confirmation
Any person with at least one of the following clinical forms:
Ulceroglandular tularaemia
Cutaneous ulcer
AND
Regional lymphadenopathy
Glandular tularaemia
Enlarged and painful lymph nodes without apparent ulcer
Oculoglandular tularaemia
Conjunctivitis
AND
Regional lymphadenopathy
Oropharyngeal tularaemia
Cervical lymphadenopathy
AND at least one of the following three:
Stomatitis
Pharyngitis
Tonsillitis
Intestinal tularaemia
At least one of the following three:
Abdominal pain
Vomiting
Diarrhoea
Pneumonic tularaemia
Pneumonia
Typhoidal tularaemia
At least one of the following two:
Fever without early localising signs and symptoms
Septicaemia
At least one of the following three:
Isolation of Francisella tularensis from a clinical specimen
Detection of Francisella tularensis nucleic acid in a clinical specimen
Francisella tularensis specific antibody response
At least one of the following three epidemiological links:
Exposure to a common source
Animal to human transmission
Exposure to contaminated food/drinking water
Any person meeting the clinical criteria and with an epidemiological link
Any person meeting the clinical and the laboratory criteria
Any person with at least one of the following two:
Onset of sustained fever
At least two of the following four:
Headache
Relative bradycardia
Non-productive cough
Diarrhoea, constipation, malaise or abdominal pain
Paratyphoid fever has the same symptoms as typhoid fever, however usually a milder course
Isolation of Salmonella typhi or paratyphi from a clinical specimen
At least one of the following three epidemiological links:
Exposure to a common source
Human to human transmission
Exposure to contaminated food/drinking water
Any person meeting the clinical criteria and with an epidemiological link
Any person meeting the clinical and the laboratory criteria
Any person with at least one of the following two:
Fever
Haemorrhagic manifestations in various forms that may lead to multi-organ failure
At least one of the following two:
Isolation of specific virus from a clinical specimen
Detection of specific virus nucleic acid in a clinical specimen and genotyping
At least one of the following:
Travel in the last 21 days to a region where VHF cases are known or believed to have occurred
Exposure within the last 21 days to a probable or confirmed case of a VHF whose onset of illness was within the last six months
Any person meeting the clinical criteria and with an epidemiological link
Any person meeting the clinical and the laboratory criteria
Any person with Fever
OR
At least one of the following two:
Encephalitis
Meningitis
Laboratory test for case confirmation
At least one of the following four:
Isolation of WNV from blood or CSF
Detection of WNV nucleic acid in blood or CSF
WNV specific antibody response (IgM) in CSF
WNV IgM high titre AND detection of WNV IgG, AND confirmation by neutralisation
Laboratory test for a probable case
WNV specific antibody response in serum
Laboratory results need to be interpreted according to flavivirus vaccination status
At least one of the following two epidemiological links:
Animal to human transmission (residing, having visited or having been exposed to mosquito bites in an area where WNV is endemic in horses or birds)
Human to human transmission (vertical transmission, blood transfusion, transplants)
Any person meeting the clinical criteria AND with at least one of the following two:
an epidemiological link
a laboratory test for a probable case
Any person meeting the laboratory criteria for case confirmation
Any person with Fever
AND
At least one of the following two:
Jaundice
Generalised haemorrhage
At least one of the following five:
Isolation of yellow fever virus from a clinical specimen
Detection of yellow fever virus nucleic acid
Detection of yellow fever antigen
Yellow fever specific antibody response
Demonstration of typical lesions in post mortem liver histopathology
Laboratory results need to be interpreted according to flavivirus vaccination status
Travel in the last 1 week to a region where yellow fever cases are known or believed to have occurred
Any person meeting the clinical criteria and with an epidemiological link
Any person not recently vaccinated meeting the clinical and the laboratory criteria
In case of recent vaccination, a person with detection of wild-type yellow fever virus strain
Any person with at least one of the following five:
Fever
Diarrhoea
Vomiting
Abdominal pain (pseudoappendicitis)
Tenesmus
Isolation of human pathogenic Yersinia enterocolitica or Yersinia pseudotuberculosis from a clinical specimen
At least one of the following four epidemiological links:
Human to human transmission
Exposure to a common source
Animal to human transmission
Exposure to contaminated food
Any person meeting the clinical criteria and with an epidemiological link
Any person meeting the clinical and the laboratory criteria
A nosocomial infection associated to the current hospital stay is defined as infection that matches one of the case definitions AND
the onset of symptoms was on Day 3 or later (day of admission = Day 1) of the current hospital admission OR
the patient underwent surgery on day 1 or day 2 and develops symptoms of a Surgical Site Infection before day 3 OR
an invasive device was placed on day 1 or day 2 resulting in an HAI before day 3
A nosocomial infection associated to a previous hospital stay is defined as infection that matches one of the case definitions
AND
the patient presents with an infection but has been readmitted less than two days after a previous admission to an acute care hospital
OR
the patient has been admitted with an infection that meets the case definition of a Surgical Site Infection i.e. the SSI occurred within 30 days of the operation (or in the case of surgery involving an implant was a deep or organ/space SSI that developed within a year of the operation) and the patient either has symptoms that meet the case definition and/or is on antimicrobial treatment for that infection
OR
the patient has been admitted (or develops symptoms within two days) with Clostridium difficile infection less than 28 days from a previous discharge from an acute care hospital.
For the purpose of point prevalence surveys, an active nosocomial infection present on the day of the survey is defined as an infection for which signs and symptoms of the infection are present on the survey date or signs and symptoms were present in the past and the patient is (still) receiving treatment for that infection on the survey date. The presence of symptoms and signs should be verified until the start of the treatment in order to determine whether the treated infection matches one of the case definitions of nosocomial infection
Osteomyelitis must meet at least one of the following criteria:
Patient has organisms cultured from bone
Patient has evidence of osteomyelitis on direct examination of the bone during a surgical operation or histopathologic examination
Patient has at least two of the following signs or symptoms with no other recognised cause: fever (> 38 °C), localised swelling, tenderness, heat, or drainage at suspected site of bone infection
AND at least one of the following:
organisms cultured from blood
positive blood antigen test (e.g. Haemophilus.influenzae, Streptococcus pneumoniae)
radiographic evidence of infection (e.g. abnormal findings on x-ray, CT scan, MRI, radiolabel scan [gallium, technetium, etc.]).
Report mediastinitis following cardiac surgery that is accompanied by osteomyelitis as surgical site infection-organ/space (SSI-O).
Joint or bursa infections must meet at least one of the following criteria:
Patient has organisms cultured from joint fluid or synovial biopsy
Patient has evidence of joint or bursa infection seen during a surgical operation or histopathologic examination
Patient has at least two of the following signs or symptoms with no other recognised cause: joint pain, swelling, tenderness, heat, evidence of effusion or limitation of motion
AND at least one of the following:
organisms and white blood cells seen on Gram’s stain of joint fluid
positive antigen test on blood, urine, or joint fluid
cellular profile and chemistries of joint fluid compatible with infection and not explained by an underlying rheumatologic disorder
radiographic evidence of infection (e.g. abnormal findings on x-ray, CT scan, MRI, radiolabel scan [gallium, technetium, etc.])
Vertebral disc space infection must meet at least one of the following criteria:
Patient has organisms cultured from vertebral disc space tissue obtained during a surgical operation or needle aspiration
Patient has evidence of vertebral disc space infection seen during a surgical operation or histopathologic examination
Patient has fever (> 38 °C) with no other recognised cause or pain at the involved vertebral disc space
AND radiographic evidence of infection, (e.g. abnormal findings on x-ray, CT scan, MRI, radiolabel scan [gallium, technetium, etc.]).
Patient has fever (> 38 °C) with no other recognised cause and pain at the involved vertebral disc space
AND positive antigen test on blood or urine (e.g. Haemophilus influenzae, Streptococcus pneumoniae, Neisseria meningitidis, or Group B Streptococcus).
One positive blood culture for a recognised pathogen
OR
Patient has at least one of the following signs or symptoms: fever (> 38 °C), chills, or hypotension
AND Two positive blood cultures for a common skin contaminant (from two separate blood samples, usually within 48 hours)
Skin contaminants = coagulase-negative staphylococci, Micrococcus spp., Propionibacterium acnes, Bacillus spp., Corynebacterium spp.
Source of bloodstream infection:
:
the same micro-organism was cultured from the catheter or symptoms improve within 48 hours after removal of the catheter (C-PVC: peripheral catheter, C-CVC: central venous catheter (note: report C-CVC or C-PVC BSI as CRI3-CVC or CRI3-PVC respectively if microbiologically confirmed, see CRI3 definition)).
:
the same micro-organism was isolated from another infection site or strong clinical evidence exists that bloodstream infection was secondary to another infection site, invasive diagnostic procedure or foreign body
Pulmonary (S-PUL)
Urinary tract infection (S-UTI)
Digestive tract infection (S-DIG)
SSI (S-SSI): surgical site infection
Skin and soft tissue (S-SST)
Other (S-OTH)
:
None of the above, bloodstream infection of unknown origin (verified during survey and no source found)
:
No information available about the source of the bloodstream infection or information missing
Intracranial infection must meet at least one of the following criteria:
Patient has organisms cultured from brain tissue or dura
Patient has an abscess or evidence of intracranial infection seen during a surgical operation or histopathologic examination
Patient has at least two of the following signs or symptoms with no other recognised cause: headache, dizziness, fever (> 38 °C), localising neurologic signs, changing level of consciousness, or confusion
AND at least one of the following:
organisms seen on microscopic examination of brain or abscess tissue obtained by needle aspiration or by biopsy during a surgical operation or autopsy
positive antigen test on blood or urine
radiographic evidence of infection, (e.g. abnormal findings on ultrasound, CT scan, MRI, radionuclide brain scan, or arteriogram)
diagnostic single antibody titer (IgM) or four-fold increase in paired sera (IgG) for pathogen
AND if diagnosis is made antemortem, physician institutes appropriate antimicrobial therapy.
If meningitis and a brain abscess are present together, report the infection as IC
Meningitis or ventriculitis must meet at least one of the following criteria:
Patient has organisms cultured from cerebrospinal fluid (CSF)
Patient has at least one of the following signs or symptoms with no other recognised cause: fever (> 38 °C), headache, stiff neck, meningeal signs, cranial nerve signs, or irritability
AND at least one of the following:
increased white cells, elevated protein, and/or decreased glucose in CSF
organisms seen on Gram’s stain of CSF
organisms cultured from blood
positive antigen test of CSF, blood, or urine
diagnostic single antibody titer (IgM) or four-fold increase in paired sera (IgG) for pathogen
AND if diagnosis is made antemortem, physician institutes appropriate antimicrobial therapy.
Report CSF shunt infection as SSI if it occurs ≤ 1 year of placement; if later or after manipulation/access of the shunt, report as CNS-MEN
Report meningoencephalitis as MEN
Report spinal abscess with meningitis as MEN
An abscess of the spinal epidural or subdural space, without involvement of the cerebrospinal fluid or adjacent bone structures, must meet at least one of the following criteria:
Patient has organisms cultured from abscess in the spinal epidural or subdural space
Patient has an abscess in the spinal epidural or subdural space seen during a surgical operation or at autopsy or evidence of an abscess seen during a histopathologic examination
Patient has at least one of the following signs or symptoms with no other recognised cause: fever (> 38 °C), back pain, focal tenderness, radiculitis, paraparesis, or paraplegia
AND at least one of the following:
organisms cultured from blood
radiographic evidence of a spinal abscess (e.g. abnormal findings on myelography, ultrasound, CT scan, MRI, or other scans [gallium, technetium, etc.])
AND if diagnosis is made antemortem, physician institutes appropriate antimicrobial therapy
Report spinal abscess with meningitis as meningitis (CNS-MEN)
quantitative CVC culture ≥ 103 CFU/ml or semi-quantitative CVC culture > 15 CFU
AND pus/inflammation at the insertion site or tunnel
quantitative PVC culture ≥ 103 CFU/ml or semi-quantitative PVC culture > 15 CFU
AND pus/inflammation at the insertion site or tunnel
quantitative CVC culture ≥ 103 CFU/ml or semi-quantitative CVC culture > 15 CFU
AND clinical signs improve within 48 hours after catheter removal
quantitative PVC culture ≥ 103 CFU/ml or semi-quantitative PVC culture > 15 CFU
AND clinical signs improve within 48 hours after catheter removal
BSI occurring 48 hours before or after catheter removal
AND positive culture with the same micro-organism of either:
quantitative CVC culture ≥ 103 CFU/ml or semi-quantitative CVC culture > 15 CFU
quantitative blood culture ratio CVC blood sample/peripheral blood sample > 5
differential delay of positive blood cultures: CVC blood sample culture positive two hours or more before peripheral blood culture (blood samples drawn at the same time)
positive culture with the same micro-organism from pus from insertion site
BSI occurring 48 hours before or after catheter removal
AND positive culture with the same micro-organism of either:
quantitative PVC culture ≥ 103 CFU/ml or semi-quantitative PVC culture > 15 CFU
positive culture with the same micro-organism from pus from insertion site
Arterial or venous infection must meet at least one of the following criteria:
Patient has organisms cultured from arteries or veins removed during a surgical operation
AND blood culture not done or no organisms cultured from blood
Patient has evidence of arterial or venous infection seen during a surgical operation or histopathologic examination
Patient has at least one of the following signs or symptoms with no other recognised cause: fever (> 38 °C), pain, erythema, or heat at involved vascular site
AND more than 15 colonies cultured from intravascular cannula tip using semiquantitative culture method
AND blood culture not done or no organisms cultured from blood
Patient has purulent drainage at involved vascular site
AND blood culture not done or no organisms cultured from blood
Report infections of an arteriovenous graft, shunt, or fistula or intravascular cannulation site without organisms cultured from blood as CVS-VASC
Endocarditis of a natural or prosthetic heart valve must meet at least one of the following criteria:
Patient has organisms cultured from valve or vegetation
Patient has two or more of the following signs or symptoms with no other recognised cause: fever (> 38 °C), new or changing murmur, embolic phenomena, skin manifestations (e.g. petechiae, splinter haemorrhages, painful subcutaneous nodules), congestive heart failure, or cardiac conduction abnormality
AND at least one of the following:
organisms cultured from two or more blood cultures
organisms seen on Gram’s stain of valve when culture is negative or not done
valvular vegetation seen during a surgical operation or autopsy
positive antigen test on blood or urine (e.g. Haemophilus influenzae, Streptococcuspneumoniae, Neisseria meningitidis, or Group B Streptococcus)
evidence of new vegetation seen on echocardiogram
AND if diagnosis is made antemortem, physician institutes appropriate antimicrobial therapy
Myocarditis or pericarditis must meet at least one of the following criteria:
Patient has organisms cultured from pericardial tissue or fluid obtained by needle aspiration or during a surgical operation
Patient has at least two of the following signs or symptoms with no other recognised cause: fever (> 38 °C), chest pain, paradoxical pulse, or increased heart size
AND at least one of the following:
abnormal EKG consistent with myocarditis or pericarditis
positive antigen test on blood (e.g. Haemophilus influenzae, Streptococcus pneumoniae)
evidence of myocarditis or pericarditis on histologic examination of heart tissue
four-fold rise in type-specific antibody with or without isolation of virus from pharynx or faeces
pericardial effusion identified by echocardiogram, CT scan, MRI, or angiography
Mediastinitis must meet at least one of the following criteria:
Patient has organisms cultured from mediastinal tissue or fluid obtained during a surgical operation or needle aspiration
Patient has evidence of mediastinitis seen during a surgical operation or histopathologic examination
Patient has at least one of the following signs or symptoms with no other recognised cause: fever (> 38 °C), chest pain, or sternal instability
AND at least one of the following:
purulent discharge from mediastinal area
organisms cultured from blood or discharge from mediastinal area
mediastinal widening on x-ray
Report mediastinitis following cardiac surgery that is accompanied by osteomyelitis as SSI-O
Conjunctivitis must meet at least one of the following criteria:
Patient has pathogens cultured from purulent exudate obtained from the conjunctiva or contiguous tissues, such as eyelid, cornea, meibomian glands, or lacrimal glands
Patient has pain or redness of conjunctiva or around eye
AND at least one of the following:
WBCs and organisms seen on Gram’s stain of exudates
purulent exudates
positive antigen test (e.g. ELISA or IF for Chlamydia trachomatis, herpes simplex virus, adenovirus) on exudate or conjunctival scraping
multinucleated giant cells seen on microscopic examination of conjunctival exudate or scrapings
positive viral culture
diagnostic single antibody titer (IgM) or four-fold increase in paired sera (IgG) for pathogen
Report other infections of the eye as EYE
Do not report chemical conjunctivitis caused by silver nitrate (AgNO3) as a health care-associated infection
Do not report conjunctivitis that occurs as a part of a more widely disseminated viral illness (such as measles, chickenpox, or a URI)
An infection of the eye, other than conjunctivitis, must meet at least one of the following criteria:
Patient has organisms cultured from anterior or posterior chamber or vitreous fluid
Patient has at least two of the following signs or symptoms with no other recognised cause: eye pain, visual disturbance, or hypopyon
AND at least one of the following:
physician diagnosis of an eye infection
positive antigen test on blood (e.g. Haemophilus influenzae, Streptococcus pneumoniae)
organisms cultured from blood
Ear and mastoid infections must meet at least one of the following criteria:
Otitis externa must meet at least one of the following criteria:
Patient has pathogens cultured from purulent drainage from ear canal
Patient has at least one of the following signs or symptoms with no other recognised cause: fever (> 38 °C), pain, redness, or drainage from ear canal
AND organisms seen on Gram’s stain of purulent drainage
Otitis media must meet at least one of the following criteria:
Patient has organisms cultured from fluid from middle ear obtained by tympanocentesis or at surgical operation
Patient has at least two of the following signs or symptoms with no other recognised cause: fever (> 38 °C), pain in the eardrum, inflammation, retraction or decreased mobility of eardrum, or fluid behind eardrum
Otitis interna must meet at least one of the following criteria:
Patient has organisms cultured from fluid from inner ear obtained at surgical operation
Patient has a physician diagnosis of inner ear infection
Mastoiditis must meet at least one of the following criteria:
Patient has organisms cultured from purulent drainage from mastoid
Patient has at least two of the following signs or symptoms with no other recognised cause: fever (> 38 °C), pain, tenderness, erythema, headache, or facial paralysis
AND at least one of the following:
organisms seen on Gram’s stain of purulent material from mastoid
positive antigen test on blood
Oral cavity infections must meet at least one of the following criteria:
Patient has organisms cultured from purulent material from tissues of oral cavity
Patient has an abscess or other evidence of oral cavity infection seen on direct examination, during a surgical operation, or during a histopathologic examination
Patient has at least one of the following signs or symptoms with no other recognised cause: abscess, ulceration, or raised white patches on inflamed mucosa, or plaques on oral mucosa
AND at least one of the following:
organisms seen on Gram’s stain
positive KOH (potassium hydroxide) stain
multinucleated giant cells seen on microscopic examination of mucosal scrapings
positive antigen test on oral secretions
diagnostic single antibody titer (IgM) or four-fold increase in paired sera (IgG) for pathogen
physician diagnosis of infection and treatment with topical or oral antifungal therapy
Report health care-associated primary herpes simplex infections of the oral cavity as ORAL; recurrent herpes infections are not healthcare-associated
Sinusitis must meet at least one of the following criteria:
Patient has organisms cultured from purulent material obtained from sinus cavity
Patient has at least one of the following signs or symptoms with no other recognised cause: fever (> 38 °C), pain or tenderness over the involved sinus, headache, purulent exudate, or nasal obstruction
AND at least one of the following:
positive transillumination
positive radiographic examination (including CT scan)
Upper respiratory tract infections must meet at least one of the following criteria:
Patient has at least two of the following signs or symptoms with no other recognised cause: fever (> 38 °C), erythema of pharynx, sore throat, cough, hoarseness, or purulent exudate in throat
AND at least one of the following:
organisms cultured from the specific site
organisms cultured from blood
positive antigen test on blood or respiratory secretions
diagnostic single antibody titer (IgM) or four-fold increase in paired sera (IgG) for pathogen
physician diagnosis of an upper respiratory infection
Patient has an abscess seen on direct examination, during a surgical operation, or during a histopathologic examination
A Clostridium difficile infection (previously also referred to as Clostridium difficile associated diarrhoea or CDAD) must meet at least one of the following criteria:
Diarrhoeal stools or toxic megacolon, and a positive laboratory assay for Clostridium difficile toxin A and/or B in stools
Pseudomembranous colitis revealed by lower gastro-intestinal endoscopy
Colonic histopathology characteristic of Clostridium difficile infection (with or without diarrhoea) on a specimen obtained during endoscopy, colectomy or autopsy
Gastroenteritis must meet at least one of the following criteria:
Patient has an acute onset of diarrhoea (liquid stools for more than 12 hours) with or without vomiting or fever (> 38 °C) and no likely non-infectious cause (e.g. diagnostic tests, therapeutic regimen other than antimicrobial agents, acute exacerbation of a chronic condition, or psychological stress)
Patient has at least two of the following signs or symptoms with no other recognised cause: nausea, vomiting, abdominal pain, fever (> 38 °C), or headache
AND at least one of the following:
an enteric pathogen is cultured from stool or rectal swab
an enteric pathogen is detected by routine or electron microscopy
an enteric pathogen is detected by antigen or antibody assay on blood or faeces
evidence of an enteric pathogen is detected by cytopathic changes in tissue culture (toxin assay)
diagnostic single antibody titer (IgM) or four-fold increase in paired sera (IgG) for pathogen
Gastrointestinal tract infections, excluding gastroenteritis and appendicitis, must meet at least one of the following criteria:
Patient has an abscess or other evidence of infection seen during a surgical operation or histopathologic examination
Patient has at least two of the following signs or symptoms with no other recognised cause and compatible with infection of the organ or tissue involved: fever (> 38 °C), nausea, vomiting, abdominal pain, or tenderness
AND at least one of the following:
organisms cultured from drainage or tissue obtained during a surgical operation or endoscopy or from a surgically placed drain
organisms seen on Gram’s or KOH stain or multinucleated giant cells seen on microscopic examination of drainage or tissue obtained during a surgical operation or endoscopy or from a surgically placed drain
organisms cultured from blood
evidence of pathologic findings on radiographic examination
evidence of pathologic findings on endoscopic examination (e.g. Candida spp. esophagitis or proctitis)
Hepatitis must meet the following criterion:
Patient has at least two of the following signs or symptoms with no other recognised cause: fever (> 38 °C), anorexia, nausea, vomiting, abdominal pain, jaundice, or history of transfusion within the previous 3 months
AND at least one of the following:
positive antigen or antibody test for hepatitis A, hepatitis B, hepatitis C, or delta hepatitis
abnormal liver function tests (e.g. elevated ALT/AST, bilirubin)
cytomegalovirus (CMV) detected in urine or oropharyngeal secretions
Do not report hepatitis or jaundice of non-infectious origin (alpha-1 antitrypsin deficiency, etc.)
Do not report hepatitis or jaundice that results from exposure to hepatotoxins (alcoholic or acetaminophen-induced hepatitis, etc.)
Do not report hepatitis or jaundice that results from biliary obstruction (cholecystitis)
Intraabdominal infections must meet at least one of the following criteria:
Patient has organisms cultured from purulent material from intraabdominal space obtained during a surgical operation or needle aspiration
Patient has abscess or other evidence of intraabdominal infection seen during a surgical operation or histopathologic examination
Patient has at least two of the following signs or symptoms with no other recognised cause: fever (> 38 °C), nausea, vomiting, abdominal pain, or jaundice
AND at least one of the following:
organisms cultured from drainage from surgically placed drain (e.g. closed suction drainage system, open drain, T-tube drain)
organisms seen on Gram’s stain of drainage or tissue obtained during surgical operation or needle aspiration
organisms cultured from blood and radiographic evidence of infection (e.g. abnormal findings on ultrasound, CT scan, MRI, or radiolabel scans [gallium, technetium, etc.] or on abdominal x-ray)
Do not report pancreatitis (an inflammatory syndrome characterised by abdominal pain, nausea, and vomiting associated with high serum levels of pancreatic enzymes) unless it is determined to be infectious in origin
Tracheobronchial infections must meet at least one of the following criteria:
Patient has no clinical or radiographic evidence of pneumonia
AND patient has at least two of the following signs or symptoms with no other recognised cause: fever (> 38 °C), cough, new or increased sputum production, rhonchi, wheezing
AND at least one of the following:
positive culture obtained by deep tracheal aspirate or bronchoscopy
positive antigen test on respiratory secretions
Do not report chronic bronchitis in a patient with chronic lung disease as an infection unless there is evidence of an acute secondary infection, manifested by change in organism
Other infections of the lower respiratory tract must meet at least one of the following criteria:
Patient has organisms seen on smear or cultured from lung tissue or fluid, including pleural fluid
Patient has a lung abscess or empyema seen during a surgical operation or histopathologic examination
Patient has an abscess cavity seen on radiographic examination of lung
Report lung abscess or empyema without pneumonia as LUNG
ALL of the 3 following criteria:
Supervising physician started appropriate antimicrobial therapy for sepsis for at least five days.
No detection of pathogens in blood culture or not tested
No obvious infection at another site
AND two of the following criteria (without other apparent cause):
Fever (> 38 °C) or temperature instability (frequent post-set of the incubator) or hypothermia (< 36,5 °C)
Tachycardia (> 200/min) or new/increased bradycardia (< 80/min)
Capillary refilling time (CRT) > 2 s
New or increased apnoea (s) (> 20 s)
Unexplained metabolic acidosis
New-onset hyperglycaemia (> 140 mg/dl)
Another sign of sepsis (skin colour (only if the CRT is not used), laboratory signs (CRP, interleukin), increased oxygen requirement (intubation), unstable general condition of the patient, apathy)
at least two of: temperature > 38 °C or < 36,5 °C or temperature instability, tachycardia or bradycardia, apnoea, extended capillary refilling time (CRT), metabolic acidosis, hyperglycaemia, other sign of BSI such as apathy
AND
a recognised pathogen other than coagulase-negative staphylococci (CNS) cultured from blood or cerebrospinal fluid (CSF; this is included because meningitis in this age group is usually haematogenous, so positive CSF can be regarded as evidence of BSI even if blood cultures are negative or were not taken)
in order to be consistent with BSI reporting in adults (including secondary BSI), the criterion ‘the organism is not related to an infection at another site’ was removed from the Neo-KISS definition for the purposes of the EU PPS
report the origin of the neonatal BSI in the field BSI origin
if both the case definitions for NEO-LCBI and NEO-CNSB are matched, report NEO-LCBI
at least two of: temperature > 38 °C or < 36,5 °C or temperature instability, tachycardia or bradycardia, apnoea, extended recapillarisation time, metabolic acidosis, hyperglycaemia, other sign of BSI such as apathy
AND CNS is cultured from blood or catheter tip
AND patient has one of: C-reactive protein > 2,0 mg/dl, immature/total neutrophil ratio (I/T ratio) > 0,2, leukocytes < 5/nl, platelets < 100/nl
in order to be consistent with BSI reporting in adults (including secondary BSI), the criterion ‘the organism is not related to an infection at another site’ was removed from the Neo-KISS definition for the purposes of the EU PPS
report the origin of the neonatal BSI in the field BSI origin
if both the case definitions for NEO-LCBI and NEO-CNSB are matched, report NEO-LCBI
respiratory compromise
AND new infiltrate, consolidation or pleural effusion on chest X ray
AND at least four of: temperature > 38 °C or < 36,5 °C or temperature instability, tachycardia or bradycardia, tachypnoea or apnoea, dyspnoea, increased respiratory secretions, new onset of purulent sputum, isolation of a pathogen from respiratory secretions, C-reactive protein > 2,0 mg/dl, I/T ratio > 0,2
Histopathological evidence of necrotising enterocolitis
OR
at least one characteristic radiographic abnormality (pneumoperitoneum, pneumatosis intestinalis, unchanging ‘rigid’ loops of small bowel) plus at least two of the following without other explanation: vomiting, abdominal distension, prefeeding residuals, persistent microscopic or gross blood in stools
Two or more serial chest X-rays or CT-scans with a suggestive image of pneumonia for patients with underlying cardiac or pulmonary disease. In patients without underlying cardiac or pulmonary disease one definitive chest X-ray or CT-scan is sufficient
AND at least one of the following symptoms
Fever > 38 °C with no other cause
Leucopoenia (< 4 000 WBC/mm3) or leucocytosis (≥ 12 000 WBC/mm3)
AND at least one of the following (or at least two if clinical pneumonia only = PN 4 and PN 5)
New onset of purulent sputum, or change in character of sputum (colour, odour, quantity, consistency)
Cough or dyspnoea or tachypnea
Suggestive auscultation (rales or bronchial breath sounds), ronchi, wheezing
Worsening gas exchange (e.g. O2 desaturation or increased oxygen requirements or increased ventilation demand)
and according to the used diagnostic method
Positive quantitative culture from minimally contaminated LRT(18) specimen (PN 1)
Broncho-alveolar lavage (BAL) with a threshold of ≥ 104 CFU/ml(19) or ≥ 5 % of BAL obtained cells contains intracellular bacteria on direct microscopic exam (classified on the diagnostic category BAL)
Protected brush (PB Wimberley) with a threshold of ≥ 103 CFU/ml
Distal protected aspirate (DPA) with a threshold of ≥ 103 CFU/ml
Positive quantitative culture from possibly contaminated LRT specimen (PN 2)
Quantitative culture of LRT specimen (e.g. endotracheal aspirate) with a threshold of 106 CFU/ml
Positive blood culture not related to another source of infection
Positive growth in culture of pleural fluid
Pleural or pulmonary abscess with positive needle aspiration
Histologic pulmonary exam shows evidence of pneumonia
Positive exams for pneumonia with virus or particular germs (e.g. Legionella, Aspergillus, mycobacteria, mycoplasma, Pneumocystis jirovecii)
Positive detection of viral antigen or antibody from respiratory secretions (e.g. EIA, FAMA, shell vial assay, PCR)
Positive direct exam or positive culture from bronchial secretions or tissue
Seroconversion (e.g. influenza viruses, Legionella, Chlamydia)
Detection of antigens in urine (Legionella)
Positive sputum culture or non-quantitative LRT specimen culture (PN 4)
No positive microbiology (PN 5)
A pneumonia is defined as intubation-associated (IAP) if an invasive respiratory device was present (even intermittently) in the 48 hours preceding the onset of infection
Endometritis must meet at least one of the following criteria:
Patient has organisms cultured from fluid or tissue from endometrium obtained during surgical operation, by needle aspiration, or by brush biopsy
Patient has at least two of the following signs or symptoms with no other recognised cause: fever (> 38 °C), abdominal pain, uterine tenderness, or purulent drainage from uterus
Report postpartum endometritis as a health care-associated infection unless the amniotic fluid is infected at the time of admission or the patient was admitted 48 hours after rupture of the membrane
Episiotomy infections must meet at least one of the following criteria:
Postvaginal delivery patient has purulent drainage from the episiotomy
Postvaginal delivery patient has an episiotomy abscess
Vaginal cuff infections must meet at least one of the following criteria:
Posthysterectomy patient has purulent drainage from the vaginal cuff
Posthysterectomy patient has an abscess at the vaginal cuff
Posthysterectomy patient has pathogens cultured from fluid or tissue obtained from the vaginal cuff
Report vaginal cuff infections as SSI-O
Other infections of the male or female reproductive tract must meet at least one of the following criteria:
Patient has organisms cultured from tissue or fluid from affected site
Patient has an abscess or other evidence of infection of affected site seen during a surgical operation or histopathologic examination
Patient has two of the following signs or symptoms with no other recognised cause: fever (> 38 °C), nausea, vomiting, pain, tenderness, or dysuria
AND at least one of the following:
organisms cultured from blood
physician diagnosis
Report endometritis as EMET
Report vaginal cuff infections as VCUF
Infection occurs within 30 days after the operation AND infection involves only skin and subcutaneous tissue of the incision AND at least one of the following:
Purulent drainage with or without laboratory confirmation, from the superficial incision
Organisms isolated from an aseptically obtained culture of fluid or tissue from the superficial incision
At least one of the following signs or symptoms of infection: pain or tenderness, localised swelling, redness, or heat AND superficial incision is deliberately opened by surgeon, unless incision is culture-negative
Diagnosis of superficial incisional SSI made by a surgeon or attending physician
Infection occurs within 30 days after the operation if no implant is left in place or within one year if implant is in place AND the infection appears to be related to the operation AND infection involves deep soft tissue (e.g. fascia, muscle) of the incision AND at least one of the following:
Purulent drainage from the deep incision but not from the organ/space component of the surgical site
A deep incision spontaneously dehisces or is deliberately opened by a surgeon when the patient has at least one of the following signs or symptoms: fever (> 38 °C), localised pain or tenderness, unless incision is culture-negative
An abscess or other evidence of infection involving the deep incision is found on direct examination, during reoperation, or by histopathologic or radiological examination
Diagnosis of deep incisional SSI made by a surgeon or attending physician
Infection occurs within 30 days after the operation if no implant is left in place or within one year if implant is in place AND the infection appears to be related to the operation AND infection involves any part of the anatomy (e.g. organs and spaces) other than the incision which was opened or manipulated during an operation AND at least one of the following:
Purulent drainage from a drain that is placed through a stab wound into the organ/space
Organisms isolated from an aseptically obtained culture of fluid or tissue in the organ/space
An abscess or other evidence of infection involving the organ/space that is found on direct examination, during reoperation, or by histopathologic or radiological examination
Diagnosis of organ/space SSI made by a surgeon or attending physician
Skin infections must meet at least one of the following criteria:
Patient has purulent drainage, pustules, vesicles, or boils
Patient has at least two of the following signs or symptoms with no other recognised cause: pain or tenderness, localised swelling, redness, or heat
AND at least one of the following:
organisms cultured from aspirate or drainage from affected site; if organisms are normal skin flora (e.g. diphtheroids [Corynebacterium spp.], Bacillus [not B.anthracis] spp., Propionibacterium spp., coagulase-negative staphylococci [including Staphylococcusepidermidis], viridans group streptococci, Aerococcus spp., Micrococcus spp.), they must be a pure culture
organisms cultured from blood
positive antigen test performed on infected tissue or blood (e.g. herpes simplex, varicella zoster, Haemophilus influenzae, Neisseria meningitidis)
multinucleated giant cells seen on microscopic examination of affected tissue
diagnostic single antibody titer (IgM) or four-fold increase in paired sera (IgG) for pathogen
Report infected decubitus ulcers as DECU
Report infected burns as BURN
Report breast abscesses or mastitis as BRST
Soft tissue infections must meet at least one of the following criteria:
Patient has organisms cultured from tissue or drainage from affected site
Patient has purulent drainage at affected site
Patient has an abscess or other evidence of infection seen during a surgical operation or histopathologic examination
Patient has at least two of the following signs or symptoms at the affected site with no other recognised cause: localised pain or tenderness, redness, swelling, or heat
AND at least one of the following:
organisms cultured from blood
positive antigen test performed on blood or urine (e.g. Haemophilus influenzae, Streptococcus pneumoniae, Neisseria meningitidis, Group B Streptococcus, Candida spp.)
diagnostic single antibody titer (IgM) or four-fold increase in paired sera (IgG) for pathogen
Report infected decubitus ulcers as DECU
Report infection of deep pelvic tissues as OREP
Decubitus ulcer infections must meet the following criterion:
Patient has at least two of the following signs or symptoms with no other recognised cause: redness, tenderness, or swelling of decubitus wound edges
AND at least one of the following:
organisms cultured from properly collected fluid or tissue
organisms cultured from blood
Burn infections must meet at least one of the following criteria:
Patient has a change in burn wound appearance or character, such as rapid eschar separation, or dark brown, black, or violaceous discoloration of the eschar, or oedema at wound margin
AND histologic examination of burn biopsy shows invasion of organisms into adjacent viable tissue
Patient has a change in burn wound appearance or character, such as rapid eschar separation, or dark brown, black, or violaceous discoloration of the eschar, or oedema at wound margin
AND at least one of the following:
organisms cultured from blood in the absence of other identifiable infection
isolation of herpes simplex virus, histologic identification of inclusions by light or electron microscopy, or visualisation of viral particles by electron microscopy in biopsies or lesion scrapings
Patient with a burn has at least two of the following signs or symptoms with no other recognised cause: fever (> 38 °C) or hypothermia (< 36 °C), hypotension, oliguria (< 20 cc/hr), hyperglycaemia at previously tolerated level of dietary carbohydrate, or mental confusion
AND at least one of the following:
histologic examination of burn biopsy shows invasion of organisms into adjacent viable tissue
organisms cultured from blood
isolation of herpes simplex virus, histologic identification of inclusions by light or electron microscopy, or visualisation of viral particles by electron microscopy in biopsies or lesion scrapings
A breast abscess or mastitis must meet at least one of the following criteria:
Patient has a positive culture of affected breast tissue or fluid obtained by incision and drainage or needle aspiration
Patient has a breast abscess or other evidence of infection seen during a surgical operation or histopathologic examination
Patient has fever (> 38 °C) and local inflammation of the breast
AND physician diagnosis of breast abscess
Disseminated infection is infection involving multiple organs or systems, without an apparent single site of infection, usually of viral origin, and with signs or symptoms with no other recognised cause and compatible with infectious involvement of multiple organs or systems
Use this code for viral infections involving multiple organ systems (e.g. measles, mumps, rubella, varicella, erythema infectiosum). These infections often can be identified by clinical criteria alone. Do not use this code for healthcare-associated infections with multiple metastatic sites, such as with bacterial endocarditis; only the primary site of these infections should be reported
Do not report fever of unknown origin (FUO) as DI
Report viral exanthemas or rash illness as DI
Patient has at least one of the following
clinical signs or symptoms with no other recognised cause
fever (> 38 °C)
hypotension (systolic pressure < 90 mm/Hg)
or oliguria (20 cm3(ml)/hr)
And blood culture not done or no organisms or antigen detected in blood
And no apparent infection at another site
And physician institutes treatment for sepsis
Do not use this code unless absolutely needed
For CSEP in neonates, use NEO-CSEP case definition (see below)
Patient has at least one of the following signs or symptoms with no other recognised cause: fever (> 38 °C), urgency, frequency, dysuria, or suprapubic tenderness
AND
patient has a positive urine culture, that is, ≥ 105 microorganisms per ml of urine with no more than two species of microorganisms.
Patient has at least two of the following with no other recognised cause: fever (> 38 °C), urgency, frequency, dysuria, or suprapubic tenderness
AND
at least one of the following:
Positive dipstick for leukocyte esterase and/or nitrate
Pyuria urine specimen with ≥ 104 WBC/ml or ≥ 3 WBC/high-power field of unspun urine
Organisms seen on Gram stain of unspun urine
At least two urine cultures with repeated isolation of the same uropathogen (gram-negative bacteria or Staphylococcus saprophyticus) with ≥ 102 colonies/ml urine in non-voided specimens
≤ 105 colonies/ml of a single uropathogen (gram-negative bacteria or Staphylococcus saprophyticus) in a patient being treated with effective antimicrobial agent for a urinary infection
Physician diagnosis of a urinary tract infection
Physician institutes appropriate therapy for a urinary infection
Asymptomatic bacteriuria should not be reported, but bloodstream infections secondary to asymptomatic bacteriuria are reported as BSI with source (origin) S-UTI
A urinary tract infection (UCA-UTI) is defined as catheter-associated if an indwelling urinary catheter was present (even intermittently) in the seven days preceding the onset of infection
A microorganism is defined as clinically susceptible, clinically intermediate or clinically resistant to an antimicrobial agent according to the EUCAST clinical breakpoints, i.e. clinical MIC breakpoints and their inhibition zone diameter correlates(20)
a micro-organism is defined as susceptible by a level of antimicrobial activity associated with a high likelihood of therapeutic success
a micro-organism is categorised as susceptible (S) by applying the appropriate breakpoint in a defined phenotypic test system
this breakpoint may be altered with legitimate changes in circumstances
a micro-organism is defined as intermediate by a level of antimicrobial agent activity associated with uncertain therapeutic effect. It implies that an infection due to the isolate may be appropriately treated in body sites where the drugs are physically concentrated or when a high dosage of drug can be used; it also indicates a buffer zone that should prevent small, uncontrolled, technical factors from causing major discrepancies in interpretations
a micro-organism is categorised as intermediate (I) by applying the appropriate breakpoints in a defined phenotypic test system
these breakpoints may be altered with legitimate changes in circumstances
a micro-organism is defined as resistant by a level of antimicrobial activity associated with a high likelihood of therapeutic failure
a micro-organism is categorised as resistant (R) by applying the appropriate breakpoint in a defined phenotypic test system
this breakpoint may be altered with legitimate changes in circumstances
Microorganisms and corresponding antimicrobial agents (bug-drug combinations) relevant for surveillance in humans are defined in the relevant surveillance protocols
See World Organisation for Animal Health — OIE — and European Commission (SANCO) Animal Disease Notification System (ADNS), available at: http://www.oie.int/eng/en_index.htm, and http://ec.europa.eu/food/animal/diseases/adns/index_en.htm#)
This does not include seemingly well birds that have been killed, for example by hunting.
Depression, anxiety, apathy, withdrawal, delusions.
This includes both frank pain and/or dysaesthesia.
The typical appearance of the EEG in sporadic CJD consists of generalised periodic complexes at approximately one per second. These may occasionally be seen in the late stages of vCJD.
See footnote 5.
Tonsil biopsy is not recommended routinely nor in cases with EEG appearances typical of sporadic CJD, but may be useful in suspect cases in which the clinical features are compatible with vCJD and MRI does not show pulvinar high signal.
See footnote 5.
See footnote 5.
When rubella in pregnancy is suspected, further confirmation of a positive rubella IgM results is required (e.g. a rubella specific IgG avidity test showing a low avidity). In certain situations, such as confirmed rubella outbreaks detection of rubella virus IgM can be considered confirmatory in non-pregnant cases.
A close contact is a person who has cared for, lived with, or having had direct contact with the respiratory secretions, body fluids and/or excretions (e.g. faeces) of cases of SARS.
In this context the term ‘health-care worker’ includes all hospital staff. The definition of the health care unit in which the cluster occurs will depend on the local situation. Unit size may range from an entire health care facility if small, to a single department or ward of a large tertiary hospital.
Serological results should be interpreted according to the vaccination status and previous exposure to other flaviviral infections. Confirmed cases in such situations should be validated by serum neutralisation assay or other equivalent assays.
CVC = central vascular catheter, PVC = peripheral vascular catheter
central vascular catheter colonisation should not be reported. A CRI3 (-CVC or -PVC) is also a bloodstream infection with source C-CVC or C-PVC respectively; however when a CRI3 is reported, the BSI should not be reported in the point prevalence survey; microbiologically confirmed catheter-related BSI should be reported as CRI3.
LRT = Lower Respiratory Tract.
CFU = Colony Forming Units.
http://www.eucast.org/clinical_breakpoints/
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