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LABORATORY: COMMUNICABLE DISEASES and STI REPORTING FORM
PERSONAL INFO
Age
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< 1
< 1
1-4
5-14
15-20
21-25
26-30
31-35
36-40
41-45
46-50
51-55
56-60
61+
Sex
Male
Female
Quantity
EW
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Week 1
Week 2
Week 3
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Week 22
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Week 31
Week 32
Week 33
Week 34
Week 35
Week 36
Week 37
Week 38
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Week 42
Week 43
Week 44
Week 45
Week 46
Week 47
Week 48
Week 49
Week 50
Week 51
Year
--Select Month--
January
February
March
April
June
July
August
September
October
November
December
Year
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2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
DISEASES/PATHOGENS
Diseases Reportable under the International Health Regulations
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Cholera
Human Influenza
Pneumonic Plague
Poliomyelitis
Severe Acute Respiratory Syndrome (SARS)
Yellow Fever
Air Borne Diseases
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Adenoviruses
Human Metapneumovirus [hMPV]
COVIID-19
Influenza
Respiratory Syncytial Virus [RSV]
TuberculosisExtraPulmonary - ExtraPulmonary
AFB
TuberculosisExtraPulmonary
Vaccine Preventable Diseases under the Caribbean Expanded Programme on Immunization
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Chicken Pox [Varicella] (clinically confirmed)
Diphtheria
Measles
Meningitis [due to Haemophilus influenzae]
Meningitis [due to Streptococcus pneumoniae]
Meningococcal Infection [due to Neisseria meningitidis]
Pneumonia [due to Haemophilus influenzae]
Rubella [Congenital German Measles]
Vector Borne Diseases
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Chikungunya Virus
Dengue Fever
Dengue Haemorrhagic Fever/Shock Syndrome
Leptospirosis
Malaria
Zika
23
Food and Water Borne Pathogens
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Campylobacter
Ciguatera Poisoning (clinically confirmed)
Ciguatera Poisoning (clinically confirmed)
Cryptosporidium
Listeria
Norovirus
Hepatitis A
Giardia
E. Coli (pathogenic)
Salmonella
Shigella
Staphylococcus (pathogenic)
Taxoplasma
Typhoid and Paratyphoid
Vibrio (excluding Cholera)
Other Diseases
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Viral Encephalitis/Meningitis
HIV
HTLV I&II
Hepatitis B Surface Antigen
Hepatitis C
Syphilis/Rapid Plasma Reagin
TPPA
Gonorrhoea
Chlamydia
Herpes I
Herpes II
Urine Trichomonas Vaginalis
High Vaginal Swab Trichomonas Vaginalis
Leprosy (Hansens Disease)
Meningitis/Encephalitis (not specified)
Rabies (in Humans)
Status
Confirmed
Not Confirmed
Comment
REPEAT
RAPID TEST