Avian influenza outbreak investigation form COMMERCIAL flocks

Transkripsi

1 Avian influenza outbreak investigation form COMMERCIAL flocks Unique ID (one form per commercial unit investigated) GENERAL INFORMATION Central request Provincial request District request Repeat visit 1 Reason for visit Name of Investigator (cellphone number & Title of Investigator Date of this visit 1: If a repeat visit use the original unique record number LOCATION Name of owner / manager Province District Sub District Village Sub Village GPS of commercial unit Northing Easting BIRDS ON SITE (current numbers/ages, i.e. 1,000/26 weeks old) Layers Broilers Native chickens Ducks Healthy Sick Dead due to illness Culled Healthy Sick Dead due to illness Culled Muscovy Ducks Geese

2 DESCRIBE DISEASE EVENT (start approximately 2 weeks before first death/sign) CLINICAL SIGNS CHECKLIST Body system Presence Duration Describe Gastrointestinal Nervous Musculoskeletal Feathers / comb / skin Sudden death

3 VACCINATION HISTORY Type Manufacturer Ekor Who vacc? Age when vaccinated 1st 2nd 3rd 4th 5th e.g.ai Medion 1,000 Owner 10 days 16 weeks 20 weeks 46 weeks HOUSING SYSTEM Chickens Ducks Deep litter Cage system Bird proof nets Free range Number of houses on site Total Affected VENTILATION SYSTEM Natural Only OPEN HOUSE Chickens Ducks OTHER Natural Only CLOSED HOUSE Natural fan assist Controlled climate SOURCE OF BIRDS Chickens Ducks OTHERS Hatchery Rearer Dealer

4 DIAGNOSTIC TESTS Rapid antigen test result Number of tests Number positive Number negative Type of rapid antigen test Laboratory samples submitted Carcass Blood/serum Cloacal swab Oropharyngeal swab Environmental swab Laboratory tests requested HPAI PCR Virus isolation HPAI serology Bacteriology Anatomic pathology Toxicology Date samples submitted Laboratory accession form number (retrospective information) Laboratory case diagnosis (retrospective information) RISK FACTORS (from approximately 7 days from first mortality) Risk factor Risk existing 1 High risk 1 Visit from poultry collectors Visit from egg collectors Birds received from markets Nearby rice field grazed by commercial ducks flocks Contact with village ducks Contact with village chickens Farm vehicles/equipment? Feed delivered Infected premises <=1km (household or commercial) Vaccination team visit Veterinary/para-veterinary visit Large flocks of wild birds near village Visit by professional agriculture worker (vet, farm adviser etc) 1: Y if applies, else leave blank

5 MAP OF FARM SITUATION (show key risk factors such as other infected places, markets, rivers, etc). HUMAN CASES IN VILLAGE Age Sex Date of symptoms Recovered (Y/N) Date of death Occupation

6 HIGH RISK TRACES ON (since 7 days before clinical signs) High risk trace on Date NO. Source HIGH RISK TRACES OFF (since clinical signs) High risk trace off Date NO. Destination

7 Form Investigasi Wabah Avian Influenza (AI) Informasi Umum Asal Informasi Pusat Provinsi Kabupaten Repeat visit 1 Nama Investigator (HP & ) Title of Investigator Tanggal Kunjungan 1: If a repeat visit use the original unique record number LOKASI KEJADIAN Nama Pemilik Provinsi Kabupaten Kecamatan Desa Dusun/ RT/ RW GPS of commercial unit Northing Easting BIRDS ON SITE (current numbers/ages, i.e. 1,000/26 weeks old) Sehat Layers Broilers Ayam Kampung Unggas Air Sakit Mati karena sakit Culled (dimatikan) Sehat Sakit Mati dikarenakan sakit Culled (dimatikan) Muscovy Ducks Geese

8 Gambaran Kejadian Penyakit (Dimulai 2 minggu sebelum kematian/ sakit pertama) CLINICAL SIGNS CHECKLIST Sistem Presence Lama Kejadian Gambaran Gastrointestinal Nervous Musculoskeletal Feathers / comb / skin Sudden death

9 Sejarah Vaksinasi Type Manufacturer Ekor Who vacc? Age when vaccinated 1st 2nd 3rd 4th 5th e.g.ai Medion 1,000 Owner 10 days 16 weeks 20 weeks 46 weeks Sistem Pemeliharaan Ayam Unggas Air Lainnya Deep litter Cage system Bird proof nets Free range Number of houses on site Total Affected VENTILATION SYSTEM Natural Only OPEN HOUSE Chickens Ducks OTHER Natural Only CLOSED HOUSE Natural fan assist Controlled climate SOURCE OF BIRDS Chickens Ducks OTHERS Hatchery Rearer Dealer

10 DIAGNOSTIC TESTS Rapid antigen test result Number of tests Number positive Number negative Type of rapid antigen test Laboratory samples submitted Carcass Blood/serum Cloacal swab Oropharyngeal swab Environmental swab Laboratory tests requested HPAI PCR Virus isolation HPAI serology Bacteriology Anatomic pathology Toxicology Date samples submitted Laboratory accession form number (retrospective information) Laboratory case diagnosis (retrospective information) RISK FACTORS (7 hari sebelum kematian pertama) Risk factor Risk existing 1 High risk 1 Kunjungan pengepul ayam Kunjungan pengepul telur Datangnya ayam/ unggas air dari pasar Dekat dengan sawah yang ada unggas airnya Kontak dengan unggas air (entog) Kontak dengan ayam kampung sekitarnya Peralatan kandang Pengantar pakan Peternakan terinfeksi<=1km (backyard atau komersial) Kunjungan vaksinator Kunjungan dokter hewan dan paramedis Peternakan komersial yang dekat dengan kampung Kunjungan anak kandang Apakah letak peternakan dekat dengan sungai? 1: Y if applies, else leave blank

11 PETA SITUASI PETERNAKAN ( Daerah terinfeksi, pasar, sungai, dll). Kejadian pada manusia di kampung disekitarnya Umur Sex Tanggal Kejadian Recovered (Y/N) Tanggal Kematian Pekerjaan

12 HIGH RISK TRACES ON (since 7 days before clinical signs) High risk trace on Date NO. Source HIGH RISK TRACES OFF (since clinical signs) High risk trace off Date NO. Destination

13 Form Investigasi Wabah Avian Influenza (AI) (Sektor III/ IV) Informasi Umum Asal Informasi Pusat Provinsi Kabupaten Repeat visit 1 Nama Investigator (HP & ) Title of Investigator Tanggal Kunjungan 1: If a repeat visit use the original unique record number LOKASI KEJADIAN Nama Pemilik Provinsi Kabupaten Kecamatan Desa Dusun/ RT/ RW GPS of commercial unit Northing Easting BIRDS ON SITE (jumlahnya/ umur, contoh: 1,000/26 weeks old) Sehat Ayam Petelur Broilers Ayam Kampung Unggas Air Sakit Mati karena sakit Culled (dimatikan) Sehat Sakit Mati dikarenakan sakit Culled (dimatikan) Muscovy Ducks Geese

14 Gambaran Kejadian Penyakit (Dimulai 2 minggu sebelum kematian/ sakit pertama) CLINICAL SIGNS CHECKLIST Sistem Presence Lama Kejadian Gambaran Gastrointestinal Nervous Musculoskeletal Feathers / comb / skin Sudden death

15 Sejarah Vaksinasi Type Manufacturer Ekor Who vacc? Age when vaccinated 1st 2nd 3rd 4th 5th e.g.ai Medion 1,000 Owner 10 days 16 weeks 20 weeks 46 weeks Sistem Pemeliharaan Ayam Unggas Air Lainnya Deep litter Cage system Bird proof nets Free range Number of houses on site Total Affected VENTILATION SYSTEM Natural Only OPEN HOUSE Chickens Ducks OTHER Natural Only CLOSED HOUSE Natural fan assist Controlled climate SOURCE OF BIRDS Chickens Ducks OTHERS Hatchery Rearer Dealer

16 DIAGNOSTIC TESTS Rapid antigen test result Number of tests Number positive Number negative Type of rapid antigen test Laboratory samples submitted Carcass Blood/serum Cloacal swab Oropharyngeal swab Environmental swab Laboratory tests requested HPAI PCR Virus isolation HPAI serology Bacteriology Anatomic pathology Toxicology Date samples submitted Laboratory accession form number (retrospective information) Laboratory case diagnosis (retrospective information) RISK FACTORS (7 hari sebelum kematian pertama) Risk factor Risk existing 1 High risk 1 Kunjungan pengepul ayam Kunjungan pengepul telur Datangnya ayam/ unggas air dari pasar Dekat dengan sawah yang ada unggas airnya Kontak dengan unggas air (entog) Kontak dengan ayam kampung sekitarnya Peralatan kandang Pengantar pakan Peternakan terinfeksi<=1km (backyard atau komersial) Kunjungan vaksinator Kunjungan dokter hewan dan paramedis Peternakan komersial yang dekat dengan kampung Kunjungan anak kandang Apakah letak peternakan dekat dengan sungai? 1: Y if applies, else leave blank

17 PETA SITUASI PETERNAKAN ( Daerah terinfeksi, pasar, sungai, dll). Kejadian pada manusia di kampung disekitarnya Umur Sex Tanggal Kejadian Recovered (Y/N) Tanggal Kematian Pekerjaan

18 HIGH RISK TRACES ON (since 7 days before clinical signs) High risk trace on Date NO. Source HIGH RISK TRACES OFF (since clinical signs) High risk trace off Date NO. Destination