Influenza Surveillance Form for Health Care Providers

Influenza Surveillance Form for Health Care Providers

October 2024 - May 2025
Influenza reporting is voluntary unless it is linked to an outbreak or pediatric death.
* Flu surveillance occurs between from October 2024 - May 2025. Please submit weekly reports by the following Monday.

* Please note: The COVID-19 pandemic is affecting healthcare seeking behavior which impacts data used for ILI surveillance.

Flu activity is defined as:
Influenza-like illness (ILI): An illness characterized with a fever greater than or equal to 100˚F plus a cough and/or a sore throat in the absence of a known cause other than influenza.

A single case of influenza is not reportable unless linked to a pediatric death, but Collin County has a process for schools and health care organizations wanting to report influenza like illness (ILI) and positive lab results for surveillance.
- An outbreak of influenza is reportable.
- An outbreak is a localized increase in a disease, symptom or syndrome that clearly exceeds the expected level.
An outbreak is defined as:
Hospital:
- A sudden increase of cases over the normal background rate
- Three or more healthcare-associated infections of acute febrile respiratory illness (AFRI) or ILI among patients or healthcare workers on the same unit within 72 hours
- One or more healthcare-associated infections of confirmed influenza
Long-term care settings:
- A sudden increase of cases over the normal background rate
- Three or more cases of AFRI or ILI among residents or healthcare workers who are in close proximity with each other (e.g., same area of the facility) within 72 hours
- Two or more cases of AFRI or ILI among residents when there is at least one confirmed influenza case in the facility
Facility Name:*
Week Ending In:*

MonthDayYear
Date
Total Test Performed:*
Were any of the influenza tests positive?*

No (please put 0 in the fields below)Yes (please put quantitative results in the fields below)
The number of specimens that were positive for influenza type A:*
The number of specimens that were positive for influenza type B:*
The number of specimens that were positive for influenza but undifferentiated:*
*1 Not Differentiated Flu: tested positive for flu, but does not differentiate between A or B *2 If confirmed influenza results have been subtyped, please include in comments section (ex: 1 positive H3N2)
Comments:
Should be Empty: