2002D0253 — EN — 27.09.2012 — 005.001

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This document is meant purely as a documentation tool and the institutions do not assume any liability for its contents

►B	COMMISSION DECISION of 19 March 2002 laying down case definitions for reporting communicable diseases to the Community network under Decision No 2119/98/EC of the European Parliament and of the Council (notified under document number C(2002) 1043) (2002/253/EC) (OJ L 086, 3.4.2002, p.44)

Amended by:

		Official Journal
		No	page	date
M1	COMMISSION DECISION of 17 July 2003	L 184	35	23.7.2003
M2	COMMISSION DECISION of 28 April 2008	L 159	46	18.6.2008
M3	COMMISSION DECISION of 30 April 2009	L 110	58	1.5.2009
M4	COMMISSION DECISION of 10 July 2009	L 180	24	11.7.2009
►M5	COMMISSION IMPLEMENTING DECISION of 8 August 2012	L 262	1	27.9.2012

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▼B

COMMISSION DECISION

of 19 March 2002

laying down case definitions for reporting communicable diseases to the Community network under Decision No 2119/98/EC of the European Parliament and of the Council

(notified under document number C(2002) 1043)

(2002/253/EC)

Article 1

For the purposes of submitting data for the epidemiological surveillance and control of communicable diseases under the provisions of Decision No 2119/98/EC, and in particular Article 4 thereof, Member States shall apply the case definitions specified in the Annex.

Article 2

This Decision will be adapted to the extent necessary on the basis of the latest scientific data.

Article 3

This Decision shall apply as of 1 January 2003.

Article 4

This Decision is addressed to the Member States.

▼M5

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ANNEX

1.    EXPLANATION OF THE SECTIONS USED IN THE DEFINITION AND CLASSIFICATION OF CASES

Clinical criteria

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

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 and epidemiological link

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:

—	Human to human transmission : 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

—	Animal to human transmission : 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

—	Exposure to a common source : the fact that a person has been exposed to the same common source or vehicle of infection, as a confirmed human case

—	Exposure to contaminated food/drinking water : 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

—	Environmental exposure : the fact that a person has bathed in water or has had contact with a contaminated environmental source that has been laboratory confirmed

—	Laboratory exposure : 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:

—	Airborne : 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

—	Contact : 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)

—	Vertical : from mother to child, often in utero, or as a result of the incidental exchange of body fluids usually during the perinatal period

—	Vector transmission : indirect transmission by infected mosquitoes, mites, flies and other insects which transmit disease to humans through their bites

—	Food or water : consumption of potentially contaminated food or drinking water.

Case classification

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.

Possible case

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.

Probable case

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.

Confirmed case

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.

Laboratory-confirmed case with clinical criteria

The case meets the laboratory criteria for case confirmation and the clinical criteria included in the case definition.

Laboratory-confirmed case with unknown clinical criteria

The case meets the laboratory criteria for case confirmation but there is no information available regarding the clinical criteria (e.g. only laboratory report).

Laboratory-confirmed case without clinical criteria

The case meets the laboratory criteria for case confirmation but doesn’t meet the clinical criteria in the case definition or is asymptomatic.

2.    CASE DEFINITIONS OF COMMUNICABLE DISEASES

2.1.   ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS) AND HUMAN IMMUNODEFICIENCY VIRUS (HIV) INFECTION

Clinical Criteria (AIDS)

Any person who has any of the clinical conditions as defined in the European AIDS case definition for:

Laboratory Criteria (HIV)

Epidemiological Criteria NA

Case Classification

A.    Possible case NA

B.    Probable case NA

C.    Confirmed case

2.2.   ANTHRAX (Bacillus anthracis)

Clinical Criteria

Any person with at least one of the following clinical forms:

Cutaneous anthrax

At least one the following two:

Gastrointestinal anthrax

AND at least one of the following two:

Inhalational anthrax

AND at least one of the following two:

Meningeal/meningoencephalitic anthrax

AND at least one of the following three:

Anthrax septicaemia

Laboratory Criteria

Positive nasal swab without clinical symptoms does not contribute to a confirmed diagnosis of a case

Epidemiological Criteria

At least one of the following three epidemiological links:

Case Classification

A.    Possible case NA

B.    Probable case

Any person meeting the clinical criteria and with an epidemiological link

C.    Confirmed case

Any person meeting the clinical and the laboratory criteria

2.3.   AVIAN INFLUENZA A/H5 OR A/H5N1 IN HUMANS

Clinical Criteria

Any person with one of the following two:

Laboratory Criteria

At least one of the following three:

Epidemiological Criteria

At least one of the following four:

Case Classification

A.    Possible case

Any person meeting the clinical and the epidemiological criteria

B.    Probable case

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)

C.    Nationally confirmed case

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)

D.    WHO confirmed case

Any person with a laboratory confirmation by a WHO Collaborating Centre for H5

2.4.   BOTULISM (Clostridium botulinum)

Clinical Criteria

Any person with at least one of the following clinical forms:

Food-borne and wound botulism

At least one of the following two:

Infant botulism

Any infant with at least one of the following six:

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

Laboratory Criteria

At least one of the following two:

Epidemiological Criteria

At least one of the following two epidemiological links:

Case Classification

A.    Possible case NA

B.    Probable case

Any person meeting the clinical criteria and with an epidemiological link

C.    Confirmed case

Any person meeting the clinical and the laboratory criteria

2.5.   BRUCELLOSIS (Brucella spp.)

Clinical Criteria

Any person with Fever

And at least one of following seven:

Laboratory Criteria

At least one of the following two:

Epidemiological Criteria

At least one of the following four epidemiological links:

Case Classification

A.    Possible case NA

B.    Probable case

Any person meeting the clinical criteria and with an epidemiological link

C.    Confirmed case

Any person meeting the clinical and the laboratory criteria

2.6.   CAMPYLOBACTERIOSIS (Campylobacter spp.)

Clinical Criteria

Any person with at least one of the following three:

Laboratory Criteria

Differentiation of Campylobacter spp. should be performed if possible

Epidemiological Criteria

At least one of the following five epidemiological links:

Case Classification

A.    Possible case NA

B.    Probable case

Any person meeting the clinical criteria and with an epidemiological link

C.    Confirmed case

Any person meeting the clinical and the laboratory criteria

2.7.   CHLAMYDIAL INFECTION (Chlamydia trachomatis), INCLUDING LYMPHOGRANULOMA VENEREUM (LGV)

Clinical Criteria

Any person with at least one of the following clinical forms:

Chlamydial infection non-LGV

At least one of the following six:

In newborn children at least one of the following two:

LGV

At least one of the following five:

Laboratory Criteria

Chlamydial infection non-LGV

At least one of the following three:

LGV

At least one of the following two:

AND

Epidemiological Criteria

An epidemiological link by human to human transmission (sexual contact or vertical transmission)

Case Classification

A.    Possible case NA

B.    Probable case

Any person meeting the clinical criteria and with an epidemiological link

C.    Confirmed case

Any person meeting the laboratory criteria

2.8.   CHOLERA (Vibrio cholerae)

Clinical Criteria

Any person with at least one of the following two:

Laboratory Criteria

Epidemiological Criteria

At least one of the following four epidemiological links:

Case Classification

A.    Possible case NA

B.    Probable case

Any person meeting the clinical criteria and with an epidemiological link

C.    Confirmed case

Any person meeting the clinical and the laboratory criteria

2.9.   CREUTZFELDT-JAKOB DISEASE, VARIANT (vCJD)

Preconditions

Clinical Criteria

Any person with at least four of the following five:

Diagnostic Criteria

Diagnostic criteria for case confirmation:

Diagnostic criteria for a probable or a possible case:

Epidemiological Criteria

An epidemiological link by human to human transmission (e.g. blood transfusion)

Case Classification

A.    Possible case

Any person fulfilling the preconditions

AND

B.    Probable case

Any person fulfilling the preconditions

AND

C.    Confirmed case

Any person fulfilling the preconditions

AND

meeting the diagnostic criteria for case confirmation

2.10.   CRYPTOSPORIDIOSIS (Cryptosporidium spp.)

Clinical Criteria

Any person with at least one of the following two:

Laboratory Criteria

At least one of the following four:

Epidemiological Criteria

One of the following five epidemiological links:

Case Classification

A.    Possible case NA

B.    Probable case

Any person meeting the clinical criteria and with an epidemiological link

C.    Confirmed case

Any person meeting the clinical and the laboratory criteria

2.11.   DIPHTHERIA (Corynebacterium diphtheriae, Corynebacterium ulcerans and Corynebacterium pseudotuberculosis)

Clinical Criteria

Any person with at least one of the following clinical forms:

Classic Respiratory Diphtheria:

An upper respiratory tract illness with laryngitis or nasopharyngitis or tonsillitis

AND

an adherent membrane/pseudomembrane

Mild Respiratory Diphtheria:

An upper respiratory tract illness with laryngitis or nasopharyngitis or tonsillitis

WITHOUT

an adherent membrane/pseudomembrane.

Cutaneous Diphtheria:

Skin lesion

Diphtheria of other sites:

Lesion of conjunctiva or mucous membranes

Laboratory Criteria

Isolation of toxin-producing Corynebacterium diphtheriae, Corynebacterium ulcerans or Corynebacterium pseudotuberculosis from a clinical specimen.

Epidemiological Criteria

At least one of the following epidemiological links:

Case Classification

A.    Possible case

Any person meeting the clinical criteria for classical respiratory diphtheria

B.    Probable case

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

C.    Confirmed case

Any person meeting the laboratory criteria AND at least one of the clinical forms

2.12.   ECHINOCOCCOSIS (Echinococcus spp.)

Clinical Criteria

Not relevant for surveillance purposes

Diagnostic Criteria

At least one of the following five:

Epidemiological Criteria NA

Case Classification

A.    Possible case NA

B.    Probable case NA

C.    Confirmed case

Any person meeting the diagnostic criteria

2.13.   GIARDIASIS (Giardia lamblia)

Clinical Criteria

Any person with at least one of the following four:

Laboratory Criteria

At least one of the following two:

Epidemiological Criteria

At least one of the following four epidemiological links:

Case Classification

A.    Possible case NA

B.    Probable case

Any person meeting the clinical criteria and with an epidemiological link

C.    Confirmed case

Any person meeting the clinical and the laboratory criteria

2.14.   GONORRHOEA (Neisseria gonorrhoeae)

Clinical Criteria

Any person with at least one of the following eight:

OR

Any newborn child with conjunctivitis

Laboratory Criteria

At least one of the following four:

Epidemiological Criteria

An epidemiological link by human to human transmission (sexual contact or vertical transmission)

Case Classification

A.    Possible case NA

B.    Probable case

Any person meeting the clinical criteria and with an epidemiological link

C.    Confirmed case

Any person meeting the laboratory criteria

2.15.   HAEMOPHILUS INFLUENZAE, INVASIVE DISEASE (Haemophilus influenzae)

Clinical Criteria

Not relevant for surveillance purposes

Laboratory Criteria

At least one of the following two:

Epidemiological Criteria NA

Case Classification

A.    Possible case NA

B.    Probable case NA

C.    Confirmed case

Any person meeting the laboratory criteria

2.16.   HEPATITIS A (Hepatitis A virus)

Clinical 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:

Laboratory Criteria

At least one of the following three:

Epidemiological Criteria

At least one of the following four:

Case Classification

A.    Possible case NA

B.    Probable case

Any person meeting the clinical criteria and with an epidemiological link

C.    Confirmed case

Any person meeting the clinical and the laboratory criteria

2.17.   HEPATITIS B (Hepatitis B virus)

Clinical Criteria

Not relevant for surveillance purposes

Laboratory Criteria

Positive results of at least one or more of the following tests or combination of tests:

Epidemiological Criteria

Not relevant for surveillance purposes

Case Classification

A.    Possible case NA

B.    Probable case NA

C.    Confirmed case

Any person meeting the laboratory criteria

2.18.   HEPATITIS C (Hepatitis C virus)

Clinical Criteria

Not relevant for surveillance purposes

Laboratory Criteria

At least one of the following three:

Epidemiological Criteria NA

Case Classification

A.    Possible case NA

B.    Probable case NA

C.    Confirmed case

Any person meeting the laboratory criteria

2.19.   INFLUENZA (Influenza virus)

Clinical Criteria

Any person with at least one of the following clinical forms:

Influenza-like illness (ILI)

AND

AND

Acute respiratory infection (ARI)

AND

AND

Laboratory Criteria

At least one the following four:

Sub typing of the influenza isolate should be performed, if possible

Epidemiological Criteria

An epidemiological link by human to human transmission

Case Classification

A.    Possible case

Any person meeting the clinical criteria (ILI or ARI)

B.    Probable case

Any person meeting the clinical criteria (ILI or ARI) and with an epidemiological link

C.    Confirmed case

Any person meeting the clinical (ILI or ARI) and the laboratory criteria

2.20.   INFLUENZA A(H1N1)

Clinical criteria

Any person with one of the following three:

Laboratory criteria

At least one of the following tests:

Epidemiological criteria

At least one of the following three in the seven days before disease onset:

Case classification

A.    Case under investigation

Any person meeting the clinical and epidemiological criteria

B.    Probable case

Any person meeting the clinical AND epidemiological criteria AND with a laboratory result showing positive influenza A infection of an unsubtypable type

C.    Confirmed case

Any person meeting the laboratory criteria for confirmation

2.21.   LEGIONNAIRES’ DISEASE (Legionella spp.)

Clinical Criteria

Any person with pneumonia

Laboratory Criteria

Laboratory criteria for case confirmation

At least one of the following three:

Laboratory criteria for a probable case

At least one of the following four:

Epidemiological Criteria NA

Case Classification

A.    Possible case NA

B.    Probable case

Any person meeting the clinical criterion AND at least one laboratory criterion for a probable case

C.    Confirmed case

Any person meeting the clinical criterion AND at least one laboratory criterion for a confirmed case

2.22.   LEPTOSPIROSIS (Leptospira spp.)

Clinical Criteria

Any person with

OR

At least two of the following eleven:

Laboratory Criteria

At least one of the following four:

Epidemiological Criteria

At least one of the following three epidemiological links:

Case Classification

A.    Possible case NA

B.    Probable case

Any person meeting the clinical criteria and with an epidemiological link

C.    Confirmed case

Any person meeting the clinical and the laboratory criteria

2.23.   LISTERIOSIS (Listeria monocytogenes)

Clinical Criteria

Any person with at least one of the following three:

Laboratory Criteria

At least one of the following two:

Epidemiological Criteria

At least one of the following three epidemiological links:

Additional information

Incubation period 3-70 days, most often 21 days

Case Classification

A.    Possible case NA

B.    Probable case

Any person meeting the clinical criteria and with an epidemiological link

C.    Confirmed case

Any person meeting the laboratory criteria

OR

Any mother with a laboratory confirmed listeriosis infection in her foetus, stillborn or newborn

2.24.   MALARIA (Plasmodium spp.)

Clinical Criteria

Any person with fever OR a history of fever

Laboratory Criteria

At least one of the following three:

Differentiation of Plasmodium spp. should be performed if possible

Epidemiological Criteria NA

Case Classification

A.    Possible case NA

B.    Probable case NA

C.    Confirmed case

Any person meeting the clinical and the laboratory criteria

2.25.   MEASLES (Measles virus)

Clinical Criteria

Any person with fever

AND

AND at least one of the following three:

Laboratory Criteria

At least one of the following four:

Laboratory results need to be interpreted according to the vaccination status. If recently vaccinated, investigate for wild virus

Epidemiological criteria

An epidemiological link by human to human transmission

Case Classification

A.    Possible case

Any person meeting the clinical criteria

B.    Probable case

Any person meeting the clinical criteria and with an epidemiological link

C.    Confirmed case

Any person not recently vaccinated and meeting the clinical and the laboratory criteria

2.26.   MENINGOCCOCAL DISEASE, INVASIVE (Neisseria meningitidis)

Clinical Criteria

Any person with at least one of the following symptoms:

Laboratory Criteria

At least one of the following four:

Epidemiological Criteria

An epidemiological link by human to human transmission

Case Classification

A.    Possible case

Any person meeting the clinical criteria

B.    Probable case

Any person meeting the clinical criteria and with an epidemiological link

C.    Confirmed case

Any person meeting the laboratory criteria

2.27.   MUMPS (Mumps virus)

Clinical Criteria

Any person with

AND

At least one of the following three:

Laboratory Criteria

At least one of the following three:

Laboratory results need to be interpreted according to the vaccination status

Epidemiological Criteria

An epidemiological link by human to human transmission

Case Classification

A.    Possible case

Any person meeting the clinical criteria

B.    Probable case

Any person meeting the clinical criteria and with an epidemiological link

C.    Confirmed case

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

2.28.   PERTUSSIS (Bordetella pertussis)

Clinical Criteria

Any person with a cough lasting at least two weeks

AND at least one of the following three:

OR

Any person diagnosed as pertussis by a physician

OR

Apnoeic episodes in infants

Laboratory Criteria

At least one of the following three:

Epidemiological Criteria

An epidemiological link by human to human transmission

Case Classification

A.    Possible case

Any person meeting the clinical criteria

B.    Probable case

Any person meeting the clinical criteria and with an epidemiological link

C.    Confirmed case

Any person meeting the clinical and the laboratory criteria

2.29.   PLAGUE (Yersinia pestis)

Clinical Criteria

Any person with at least one of the following clinical forms:

Bubonic plague:

AND

Septicaemic plague:

Pneumonic plague:

AND

At least one of the following three:

Laboratory Criteria

At least one of the following three:

Epidemiological Criteria

At least one of the following four epidemiological links:

Case Classification

A.    Possible case NA

B.    Probable case

Any person meeting the clinical criteria and with an epidemiological link

C.    Confirmed case

Any person meeting the laboratory criteria

2.30.   PNEUMOCOCCAL INVASIVE DISEASE(S) (Streptococcus pneumoniae)

Clinical Criteria

Not relevant for surveillance purposes

Laboratory Criteria

At least one of the following three:

Epidemiological Criteria NA

Case Classification

A.    Possible case NA

B.    Probable case NA

C.    Confirmed case

Any person meeting the laboratory criteria

2.31.   POLIOMYELITIS (Polio virus)

Clinical Criteria

Any person < 15 years of age with Acute flaccid paralysis (AFP)

OR

Any person in whom polio is suspected by a physician

Laboratory Criteria

At least one of the following three:

Epidemiological Criteria

At least one of the following two epidemiological links:

Case Classification

A.    Possible case

Any person meeting the clinical criteria

B.    Probable case

Any person meeting the clinical criteria and with an epidemiological link

C.    Confirmed case

Any person meeting the clinical and the laboratory criteria

2.32.   Q FEVER (Coxiella burnetii)

Clinical Criteria

Any person with at least one of the following three:

Laboratory Criteria

At least one of the following three:

Epidemiological Criteria

At least one of the following two epidemiological links:

Case Classification

A.    Possible case NA

B.    Probable case

Any person meeting the clinical criteria and with an epidemiological link

C.    Confirmed case

Any person meeting the clinical and the laboratory criteria

2.33.   RABIES (Lyssa virus)

Clinical Criteria

Any person with an acute encephalomyelitis

AND

At least two of the following seven:

Laboratory Criteria

At least one of the following four:

Laboratory results need to be interpreted according to the vaccination or immunisation status

Epidemiological Criteria

At least one of the following three epidemiological links:

Case Classification

A.    Possible case

Any person meeting the clinical criteria

B.    Probable case

Any person meeting the clinical criteria and with an epidemiological link

C.    Confirmed case

Any person meeting the clinical and the laboratory criteria

2.34.   RUBELLA (Rubella virus)

Clinical Criteria

Any person with sudden onset of generalised maculo-papular rash

AND

At least one of the following five:

Laboratory Criteria

Laboratory results need to be interpreted according to the vaccination status

Epidemiological Criteria

An epidemiological link by human to human transmission

Case Classification

A.    Possible case

Any person meeting the clinical criteria

B.    Probable case

Any person meeting the clinical criteria and with at least one of the following two:

C.    Confirmed 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

2.35.   RUBELLA, CONGENITAL (Including Congenital Rubella Syndrome)

Clinical Criteria

Congenital rubella infection (CRI)

No clinical criteria can be defined for CRI

Congenital rubella syndrome (CRS)

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)

Laboratory Criteria

At least one of the following four:

Laboratory results need to be interpreted according to the vaccination status

Epidemiological Criteria

Any infant or any stillborn born to a woman with a laboratory confirmed rubella infection during pregnancy by human to human transmission (vertical transmission)

Case Classification Congenital Rubella

A.    Possible case NA

B.    Probable case

Any stillborn or infant either not tested OR with negative laboratory results with at least one of the following two:

C.    Confirmed case

Any stillborn meeting the laboratory criteria

OR

Any infant meeting the laboratory criteria AND at least one of the following two:

2.36.   SALMONELLOSIS (Salmonella spp. other than Salmonella typhi and Salmonella paratyphi)

Clinical Criteria

Any person with at least one of the following four:

Laboratory Criteria

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.)

Epidemiological Criteria

At least one of the following five epidemiological links:

Case Classification

A.    Possible case NA

B.    Probable case

Any person meeting the clinical criteria and with an epidemiological link

C.    Confirmed case

Any person meeting the clinical and the laboratory criteria

2.37.   SEVERE ACUTE RESPIRATORY SYNDROME — SARS (SARS-coronavirus, SARS-CoV)

Clinical Criteria

Any person with fever or a history of fever

AND

At least one of the following three:

AND

At least one of the following four:

AND

No alternative diagnosis which can fully explain the illness

Laboratory Criteria

Epidemiological Criteria

At least one of the following three:

Case Classification for the inter-epidemic period

Also applies during an outbreak in a non-affected country or area

A.    Possible case

Any person meeting the clinical criteria and with an epidemiological link

B.    Probable case

Any person meeting the clinical criteria AND with an epidemiological link AND meeting the laboratory criteria for a probable case

C.    Nationally 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

D.    Confirmed case

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

Case Classification during an outbreak

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

A.    Possible case

Any person meeting the clinical criteria

B.    Probable case

Any person meeting the clinical criteria and with an epidemiological link to a nationally confirmed or a confirmed case

C.    Nationally 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

D.    Confirmed case

One of the following three:

2.38.   SHIGA TOXIN/VEROCYTO-TOXIN PRODUCING ESCHERICHIA COLI INFECTION (STEC/VTEC)

Clinical Criteria

STEC/VTEC diarrhoea

Any person with at least one of the following two:

HUS

Any person with acute renal failure and at least one of the following two:

Laboratory Criteria

At least one of the following four:

Only for HUS the following can be used as laboratory criterion to confirm STEC/VTEC:

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

Epidemiological Criteria

At least one of the following five epidemiological links:

Case Classification

A.    Possible case of STEC-associated HUS

Any person meeting the clinical criteria for HUS

B.    Probable case of STEC/VTEC

Any person meeting the clinical criteria and with an epidemiological link

C.    Confirmed case of STEC/VTEC

Any person meeting the clinical and the laboratory criteria

2.39.   SHIGELLOSIS (Shigella spp.)

Clinical Criteria

Any person with at least one of the following four:

Laboratory Criteria

Epidemiological Criteria

At least one of the following five epidemiological links:

Case Classification

A.    Possible case NA

B.    Probable case

Any person meeting the clinical criteria and with an epidemiological link

C.    Confirmed case

Any person meeting the clinical and the laboratory criteria

2.40.   SMALLPOX (Variola virus)

Clinical Criteria

Any person with at least one of the following two:

AND

Vesicles or firm pustules rash at the same stage of development with a centrifugal distribution

Laboratory Criteria

Epidemiological Criteria

At least one of the following two epidemiological links:

Case Classification

A.    Possible case

Any person meeting the clinical criteria

B.    Probable case

Any person meeting the clinical criteria and with at least one of the following two:

C.    Confirmed case

Any person meeting the laboratory criteria for case confirmation

During an outbreak: any person meeting the clinical criteria and with an epidemiological link

2.41.   SYPHILIS (Treponema pallidum)

Clinical Criteria

Laboratory Criteria

At least one of the following four laboratory tests:

Epidemiological Criteria

Case Classification

A.    Possible case NA

B.    Probable case

Any person meeting the clinical criteria and with an epidemiological link

C.    Confirmed case

Any person meeting the laboratory criteria for case confirmation

2.42.   SYPHILIS, CONGENITAL AND NEONATAL (Treponema pallidum)

Clinical Criteria

Any infant < 2 years of age with at least one of the following 10:

Laboratory Criteria

Epidemiological Criteria

Any infant with an epidemiological link by human to human transmission (vertical transmission)

Case Classification

A.    Possible case NA

B.    Probable case

Any infant or child meeting the clinical criteria and with at least one of the following two:

C.    Confirmed case

Any infant meeting the laboratory criteria for case confirmation

2.43.   TETANUS (Clostridium tetani)

Clinical Criteria

Any person with at least two of the following three:

Laboratory Criteria

At least one of the following two:

Epidemiological Criteria NA

Case Classification

A.    Possible case NA

B.    Probable case

Any person meeting the clinical criteria

C.    Confirmed case

Any person meeting the clinical and the laboratory criteria

2.44.   TICK-BORNE ENCEPHALITIS (TBE virus)

Clinical Criteria

Any person with symptoms of inflammation of the CNS (e.g. meningitis, meningo-encephalitis, encephalomyelitis, encephaloradiculitis)

Laboratory Criteria ( 15 )

Epidemiological Criteria

Exposure to a common source (unpasteurised dairy products)

Case Classification

A.    Possible case NA

B.    Probable case

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

C.    Confirmed case

Any person meeting the clinical and laboratory criteria for case confirmation

2.45.   TOXOPLASMOSIS, CONGENITAL (Toxoplasma gondii)

Clinical Criteria

Not relevant for surveillance purposes

Laboratory Criteria

At least one of the following four:

Epidemiological Criteria NA

Case Classification

A.    Possible case NA

B.    Probable case NA

C.    Confirmed case

Any infant meeting the laboratory criteria

2.46.   TRICHINELLOSIS (Trichinella spp.)

Clinical Criteria

Any person with at least three of the following six:

Laboratory Criteria

At least one of the following two:

Epidemiological Criteria

At least one of the following two epidemiological links:

Case Classification

A.    Possible case NA

B.    Probable case

Any person meeting the clinical criteria and with an epidemiological link

C.    Confirmed case

Any person meeting the clinical criteria and the laboratory criteria

2.47.   TUBERCULOSIS (Mycobacterium tuberculosis complex)

Clinical Criteria

Any person with the following two:

AND

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

Epidemiological Criteria NA

Case Classification

A.    Possible case

Any person meeting the clinical criteria

B.    Probable case

Any person meeting the clinical criteria and the laboratory criteria for a probable case

C.    Confirmed case

Any person meeting the clinical and the laboratory criteria for case confirmation

2.48.   TULARAEMIA (Francisella tularensis)

Clinical Criteria

Any person with at least one of the following clinical forms:

Laboratory Criteria

At least one of the following three:

Epidemiological Criteria

At least one of the following three epidemiological links:

Case Classification

A.    Possible case NA

B.    Probable case

Any person meeting the clinical criteria and with an epidemiological link

C.    Confirmed case

Any person meeting the clinical and the laboratory criteria

2.49.   TYPHOID/PARATYPHOID FEVER (Salmonella typhi/paratyphi)

Clinical Criteria

Any person with at least one of the following two:

Paratyphoid fever has the same symptoms as typhoid fever, however usually a milder course

Laboratory Criteria

Epidemiological Criteria

At least one of the following three epidemiological links:

Case Classification

A.    Possible case NA

B.    Probable case

Any person meeting the clinical criteria and with an epidemiological link

C.    Confirmed case

Any person meeting the clinical and the laboratory criteria

2.50.   VIRAL HAEMORRHAGIC FEVERS (VHF)

Clinical Criteria

Any person with at least one of the following two:

Laboratory Criteria

At least one of the following two:

Epidemiological Criteria

At least one of the following:

Case Classification

A.    Possible case NA

B.    Probable case

Any person meeting the clinical criteria and with an epidemiological link

C.    Confirmed case

Any person meeting the clinical and the laboratory criteria

2.51.   WEST NILE FEVER (West Nile virus infection, WNV)

Clinical Criteria

Any person with Fever

OR

At least one of the following two:

Laboratory Criteria

Epidemiological Criteria

At least one of the following two epidemiological links:

Case Classification

A.    Possible case NA

B.    Probable case

Any person meeting the clinical criteria AND with at least one of the following two:

C.    Confirmed case

Any person meeting the laboratory criteria for case confirmation

2.52.   YELLOW FEVER (Yellow fever virus)

Clinical Criteria

Any person with Fever

AND

At least one of the following two:

Laboratory Criteria

At least one of the following five:

Laboratory results need to be interpreted according to flavivirus vaccination status

Epidemiological Criteria

Travel in the last 1 week to a region where yellow fever cases are known or believed to have occurred

Case Classification

A.    Possible case NA

B.    Probable case

Any person meeting the clinical criteria and with an epidemiological link

C.    Confirmed case

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

2.53.   YERSINIOSIS (Yersinia enterocolitica, Yersinia pseudotuberculosis)

Clinical Criteria

Any person with at least one of the following five:

Laboratory Criteria

Epidemiological Criteria

At least one of the following four epidemiological links:

Case Classification

A.    Possible case NA

B.    Probable case

Any person meeting the clinical criteria and with an epidemiological link

C.    Confirmed case

Any person meeting the clinical and the laboratory criteria

3.    CASE DEFINITIONS OF SPECIAL HEALTH ISSUES

3.1.   GENERAL CASE DEFINITION OF NOSOCOMIAL INFECTION (OR ‘HEALTHCARE-ASSOCIATED INFECTION’)

A nosocomial infection associated to the current hospital stay is defined as infection that matches one of the case definitions AND

A nosocomial infection associated to a previous hospital stay is defined as infection that matches one of the case definitions

AND

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

3.1.1.    BJ: BONE AND JOINT INFECTION

BJ-BONE: Osteomyelitis

Osteomyelitis must meet at least one of the following criteria:

AND at least one of the following:

Note reporting instruction:

Report mediastinitis following cardiac surgery that is accompanied by osteomyelitis as surgical site infection-organ/space (SSI-O).

BJ-JNT: Joint or bursa

Joint or bursa infections must meet at least one of the following criteria:

AND at least one of the following:

BJ-DISC: Disc space infection

Vertebral disc space infection must meet at least one of the following criteria:

Patient has fever (> 38 °C) with no other recognised cause and pain at the involved vertebral disc space

3.1.2.    BSI: BLOODSTREAM INFECTION

BSI: Laboratory-confirmed bloodstream infection

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:

—

Catheter-related : 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)).

—

Secondary to another infection : 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)

—	Unknown origin (UO) : None of the above, bloodstream infection of unknown origin (verified during survey and no source found)

—	Unknown (UNK) : No information available about the source of the bloodstream infection or information missing

3.1.3.    CNS: CENTRAL NERVOUS SYSTEM INFECTION

CNS-IC: Intracranial infection (brain abscess, subdural or epidural infection, encephalitis)

Intracranial infection must meet at least one of the following criteria:

AND at least one of the following:

AND if diagnosis is made antemortem, physician institutes appropriate antimicrobial therapy.

Note reporting instruction:

If meningitis and a brain abscess are present together, report the infection as IC

CNS-MEN: Meningitis or ventriculitis

Meningitis or ventriculitis must meet at least one of the following criteria:

AND at least one of the following:

AND if diagnosis is made antemortem, physician institutes appropriate antimicrobial therapy.

Note reporting instructions:

CNS-SA: Spinal abscess without meningitis

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:

AND at least one of the following:

AND if diagnosis is made antemortem, physician institutes appropriate antimicrobial therapy

Note reporting instruction:

Report spinal abscess with meningitis as meningitis (CNS-MEN)

3.1.4.    CRI: CATHETER-RELATED INFECTION ( 16 )

CRI1-CVC: Local CVC-related infection (no positive blood culture)

CRI1-PVC: Local PVC-related infection (no positive blood culture)

CRI2-CVC: General CVC-related infection (no positive blood culture)

CRI2-PVC: General PVC-related infection (no positive blood culture)

CRI3-CVC: microbiologically confirmed CVC-related bloodstream infection

AND positive culture with the same micro-organism of either:

CRI3-PVC: microbiologically confirmed PVC-related bloodstream infection

BSI occurring 48 hours before or after catheter removal

AND positive culture with the same micro-organism of either:

3.1.5.    CVS: CARDIOVASCULAR SYSTEM INFECTION

CVS-VASC: Arterial or venous infection

Arterial or venous infection must meet at least one of the following criteria:

Note reporting instructions:

Report infections of an arteriovenous graft, shunt, or fistula or intravascular cannulation site without organisms cultured from blood as CVS-VASC

CVS-ENDO: Endocarditis

Endocarditis of a natural or prosthetic heart valve must meet at least one of the following criteria:

AND at least one of the following:

AND if diagnosis is made antemortem, physician institutes appropriate antimicrobial therapy

CVS-CARD: Myocarditis or pericarditis

Myocarditis or pericarditis must meet at least one of the following criteria:

AND at least one of the following:

CVS-MED: Mediastinitis

Mediastinitis must meet at least one of the following criteria:

AND at least one of the following:

Note reporting instruction:

Report mediastinitis following cardiac surgery that is accompanied by osteomyelitis as SSI-O

3.1.6.    EENT: EYE, EAR, NOSE, THROAT, OR MOUTH INFECTION

EENT-CONJ: Conjunctivitis

Conjunctivitis must meet at least one of the following criteria:

AND at least one of the following:

Note reporting instructions:

EENT-EYE: Eye, other than conjunctivitis

An infection of the eye, other than conjunctivitis, must meet at least one of the following criteria:

AND at least one of the following:

EENT-EAR: Ear mastoid

Ear and mastoid infections must meet at least one of the following criteria:

Otitis externa must meet at least one of the following criteria:

Otitis media must meet at least one of the following criteria:

Otitis interna must meet at least one of the following criteria:

Mastoiditis must meet at least one of the following criteria:

AND at least one of the following:

EENT-ORAL: Oral cavity (mouth, tongue, or gums)

Oral cavity infections must meet at least one of the following criteria:

AND at least one of the following:

Note reporting instruction:

Report health care-associated primary herpes simplex infections of the oral cavity as ORAL; recurrent herpes infections are not healthcare-associated

EENT-SINU: Sinusitis

Sinusitis must meet at least one of the following criteria:

AND at least one of the following:

EENT-UR: Upper respiratory tract, pharyngitis, laryngitis, epiglottitis

Upper respiratory tract infections must meet at least one of the following criteria:

AND at least one of the following:

Patient has an abscess seen on direct examination, during a surgical operation, or during a histopathologic examination

3.1.7.    GI: GASTROINTESTINAL SYSTEM INFECTION

GI-CDI: Clostridium difficile infection

A Clostridium difficile infection (previously also referred to as Clostridium difficile associated diarrhoea or CDAD) must meet at least one of the following criteria:

GI-GE: Gastroenteritis (excl. CDI)

Gastroenteritis must meet at least one of the following criteria:

AND at least one of the following:

GI-GIT: Gastrointestinal tract (oesophagus, stomach, small and large bowel, and rectum) excluding gastroenteritis and appendicitis

Gastrointestinal tract infections, excluding gastroenteritis and appendicitis, must meet at least one of the following criteria:

AND at least one of the following:

GI-HEP: Hepatitis

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:

Note reporting instructions:

GI-IAB: Intraabdominal, not specified elsewhere including gallbladder, bile ducts, liver (excluding viral hepatitis), spleen, pancreas, peritoneum, subphrenic or subdiaphragmatic space, or other intraabdominal tissue or area not specified elsewhere

Intraabdominal infections must meet at least one of the following criteria:

AND at least one of the following:

Note reporting instruction:

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

3.1.8.    LRI: LOWER RESPIRATORY TRACT INFECTION, OTHER THAN PNEUMONIA

LRI-BRON: Bronchitis, tracheobronchitis, bronchiolitis, tracheitis, without evidence of pneumonia

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:

Note reporting instruction:

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

LRI-LUNG: Other infections of the lower respiratory tract

Other infections of the lower respiratory tract must meet at least one of the following criteria:

Note reporting instruction:

Report lung abscess or empyema without pneumonia as LUNG

3.1.9.    NEO: SPECIFIC NEONATAL CASE DEFINITIONS

NEO-CSEP: Clinical Sepsis

ALL of the 3 following criteria:

AND two of the following criteria (without other apparent cause):

NEO-LCBI: Laboratory-confirmed BSI

AND

Note reporting instructions:

NEO-CNSB: Laboratory-confirmed BSI with coagulase-negative staphylococci (CNS)

Note reporting instructions:

NEO-PNEU: Pneumonia

NEO-NEC: Necrotising enterocolitis

OR

3.1.10.    PN: PNEUMONIA

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)

and according to the used diagnostic method

(a)    Bacteriologic diagnostic performed by:

(b)    Alternative microbiology methods (PN 3)

(c)    Others

Intubation-associated pneumonia (IAP)

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

3.1.11.    REPR: REPRODUCTIVE TRACT INFECTION

REPR-EMET: Endometritis

Endometritis must meet at least one of the following criteria:

Note reporting instruction:

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

REPR-EPIS: Episiotomy

Episiotomy infections must meet at least one of the following criteria:

REPR-VCUF: Vaginal cuff

Vaginal cuff infections must meet at least one of the following criteria:

Note reporting instruction:

Report vaginal cuff infections as SSI-O

REPR-OREP: Other infections of the male or female reproductive tract (epididymis, testes, prostate, vagina, ovaries, uterus, or other deep pelvic tissues, excluding endometritis or vaginal cuff infections)

Other infections of the male or female reproductive tract must meet at least one of the following criteria:

AND at least one of the following:

Note reporting instructions:

3.1.12.    SSI: SURGICAL SITE INFECTION

Superficial incisional (SSI-S)

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:

Deep incisional (SSI-D)

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:

Organ/Space (SSI-O)

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:

3.1.13.    SST: SKIN AND SOFT TISSUE INFECTION

SST-SKIN: Skin infection

Skin infections must meet at least one of the following criteria:

AND at least one of the following:

Note reporting instructions:

SST-ST: Soft tissue (necrotising fascitis, infectious gangrene, necrotising cellulitis, infectious myositis, lymphadenitis, or lymphangitis)

Soft tissue infections must meet at least one of the following criteria:

AND at least one of the following:

Note reporting instructions:

SST-DECU: Decubitus ulcer, including both superficial and deep infections

Decubitus ulcer infections must meet the following criterion:

AND at least one of the following:

SST-BURN: Burn

Burn infections must meet at least one of the following criteria:

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:

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:

SST-BRST: Breast abscess or mastitis

A breast abscess or mastitis must meet at least one of the following criteria:

AND physician diagnosis of breast abscess

3.1.14.    SYS: SYSTEMIC INFECTION

SYS-DI: Disseminated infection

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

Note reporting instructions:

SYS-CSEP: Clinical sepsis in adults and children

Patient has at least one of the following

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

Note reporting instructions:

3.1.15.    UTI: URINARY TRACT INFECTION

UTI-A: microbiologically confirmed symptomatic UTI

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.

UTI-B: not microbiologically confirmed symptomatic UTI

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:

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

3.2.   GENERIC CASE DEFINITION OF ANTIMICROBIAL RESISTANCE

Definition

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 ( 19 )

Clinically Susceptible (S)

Clinically Intermediate (I)

Clinically Resistant (R)

Clinical breakpoints are presented as S≤x mg/L; I>x, ≤y mg/L; R>y mg/L

Microorganisms and corresponding antimicrobial agents (bug-drug combinations) relevant for surveillance in humans are defined in the relevant surveillance protocols

---

( 1 ) OJ L 268, 3.10.1998, p. 1.

( 2 ) OJ L 28, 3.2.2000, p. 50.

( 3 ) 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#)

( 4 ) This does not include seemingly well birds that have been killed, for example by hunting.

( 5 ) Depression, anxiety, apathy, withdrawal, delusions.

( 6 ) This includes both frank pain and/or dysaesthesia.

( 7 ) 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.

( 8 ) See footnote 5.

( 9 ) 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.

( 10 ) See footnote 5.

( 11 ) See footnote 5.

( 12 ) 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.

( 13 ) 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.

( 14 ) 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.

( 15 ) 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.

( 16 ) 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.

( 17 ) LRT = Lower Respiratory Tract.

( 18 ) CFU = Colony Forming Units.

( 19 ) http://www.eucast.org/clinical_breakpoints/