Get the free The purpose of this form is to provide a worksheet/diary for the case household cont...

Form 2E Smallpox Case Household and Primary Contact Surveillance Form The purpose of this form is to provide a worksheet/diary for the case household contact or other primary contact to record information about such as date of vaccination date of take daily temperature and if they develop a rash or severe adverse reaction* Note The goal is to have the information on Form 2E in a database that can be electronically updated with the date of vaccination for each individual via the vaccination...

(VAXes) as needed. This data should be sent to CDC or the health department to assist in surveillance for outbreaks. If the information has been lost when the document was originally received or when it was updated (with a change in date, new vaccination, new date of injury, or a change in date on vaccine receipt), the new information should be noted on the new document. A household contact is anyone who receives a vaccination or an injection and notifies a health care provider of the vaccination or injection. Information collected on Form 2E can be transmitted electronically from the form to the databases at 3 months after the immunization date (Table 2). A secondary contact is someone who is vaccinated who is an unvaccinated close or extended family member (parent, child, sibling, spouse, and/or live-in partner, or any person who has a close contact). These secondary contacts should still be monitored for reactions to the vaccination. For more information on secondary contacts, refer to the “Secondary Contact Surveillance” section of this report. Table 1 — Table of Contents Table of Contents — Back to top Table 2 — List of Vaccinations and Immunizations for Household and Primary Contact Surveillance and Information for Secondary Contact Surveillance. Vaccine/Immunization Information, 2C: Secondary Contact Surveillance Secondary contact surveillance is recommended whenever a household or primary contact is vaccinated and has a significant rash or severe adverse reaction to the vaccination. This should be done in conjunction with a case household contact or primary contact. Primary Contact, 1: Vaccine-Serum specimens for PCR/ELISA and PCR Geologic testing Serum specimens, to be used for PCR stereotyping and/or immunophenotypic, should be obtained from the primary contact who received vaccinations or received an injection and who presents to the health department with an injury of a clinically significant nature (serious rash, fever, or severe systemic manifestations [, fever, lymphadenopathy with or without jaundice]) within 24 hours of the vaccination and is confirmed to have a rash. A serum specimen can also be obtained from the other household contacts if they also present to the health department with serious acute illness within 24 hours after the immunization or vaccine. Such specimens will not be tested for vaccine virus or virus from the primary contact. However, a specimen taken from the primary contact or additional household contact will be tested if possible.

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