Front Portion of Surveillance Manual

Manual for the Surveillance of Vaccine-Preventable Diseases


Title Pages

Manual for the Surveillance of Vaccine-Preventable Diseases

Edited by:
Sandra W. Roush, MT, MPH
Linda M. Baldy, MPH

Centers for Disease Control and Prevention
Department of Health and Human Services

Available on the internet at:

This manual is designed to provide general guidance regarding surveillance activities for vaccine-preventable diseases. Because recommendations for use of vaccines may change, readers should consult their local or state health departments or CDC’s Vaccines website at

This manual is not intended to be a therapeutic guide; therefore, while dosages of antimicrobials and immunobiologics are discussed in the context of prophylaxis and treatment for case-patients and contacts, physicians and other healthcare professionals should review the package inserts prepared by the manufacturers to determine appropriate dosages.

Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Public Health Service or the U.S. Department of Health and Human Services.

Suggested citation:
Given the variations in the timing for when chapter updates are made, a Manual edition number is no longer used.  Therefore, it is recommended that the “date reviewed” be used in references/citations. Review/update dates are posted at the end of each chapter as:

Page last reviewed: MM, DD, YYYY

Content source: National Center for Immunization and Respiratory Diseases

This manual was prepared by the Centers for Disease Control and Prevention (CDC), National Center for Immunization and Respiratory Diseases.

We thank colleagues in the National Center for Immunization and Respiratory Diseases, CDC, and others who offered advice, made specific recommendations on format and content, reviewed drafts, or assisted in other ways in the preparation of this manual.

We particularly wish to acknowledge the valuable assistance of the following: Cathy Hogan, Curt Wommack, and Marcie LaRocque.

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National Center for Immunization and Respiratory Diseases

This manual was first developed in 1996 to provide general guidance to state and local health department personnel who are involved in surveillance activities for vaccine-preventable diseases. This manual answers commonly asked questions regarding the surveillance and reporting of vaccine-preventable diseases and provides information on enhancing existing surveillance systems.

Several reference documents, tables, and worksheets have been included in this manual for your convenience and information. The worksheets in this manual are in the public domain and may be copied and distributed for use in public health surveillance activities.

Please forward any suggestions and comments regarding this manual to:

Surveillance Officer
National Center for Immunization and Respiratory Diseases
Centers for Disease Control and Prevention
1600 Clifton Road NE
Atlanta, GA 30333

Phone: 404-639-8741

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ACIP Advisory Committee on Immunization Practices
APHL Association of Public Health Laboratories
CDC Centers for Disease Control and Prevention
CF Complement fixation
CMV Cytomegalovirus
CPHA Commission on Professional and Hospital Activities
CRS Congenital rubella syndrome
CSF Cerebrospinal fluid
CSTE Council of State and Territorial Epidemiologists
DAT Diphtheria antitoxin
DFA Direct fluorescent antibody
DHHS Department of Health and Human Services
DRSP Drug-resistant Streptococcus pneumoniae
DT Diphtheria and tetanus toxoids
DTP Diphtheria and tetanus toxoids and whole-cell pertussis vaccine
DTaP Diphtheria and tetanus toxoids and acellular pertussis vaccine
EBV Epstein-Barr virus
EIA Enzyme-immunoassay
ELISA Enzyme-linked immunosorbent assay
ELR Electronic laboratory reporting
FAMA Fluorescent antibody to membrane antigen
FDA Food and Drug Administration
HA Hemagglutinin
HAV Hepatitis A virus
HBcAg Hepatitis B core antigen
HBIG Hepatitis B immune globulin
HBeAg Hepatitis B e antigen
HBsAg Hepatitis B surface antigen
HBV Hepatitis B virus
HCV Hepatitis C virus
HDV Hepatitis D virus
HI Hemagglutination inhibition
Hi Haemophilus influenzae
Hib Haemophilus influenzae type b
HMO Health maintenance organization
IFA Indirect fluorescent antibody
IG Immune globulin
IOM Institute of Medicine
IPV Inactivated poliovirus vaccine
LA Latex agglutination
MMR Measles-mumps-rubella vaccine
MMWR Morbidity and Mortality Weekly Report
MR Measles-rubella vaccine
MSAEFI Monitoring System for Adverse Events Following Immunization
NA Neuraminidase
NCCLS National Committee for Clinical Laboratory Standards
NCHS National Center for Health Statistics
NCIRD National Center for Immunization and Respiratory Diseases
NCRSR National Congenital Rubella Syndrome Registry
NCVIA National Childhood Vaccine Injury Act of 1986
NEDSS National Electronic Disease Surveillance System
NETSS National Electronic Telecommunications System for Surveillance
NHANES National Health and Nutrition Examination Survey
NHIS National Health Interview Survey
NNDSS National Notifiable Diseases Surveillance System
NVICP National Vaccine Injury Compensation Program
OPV Oral poliovirus vaccine
P&I Pneumonia and influenza
PCR Polymerase chain reaction
PHA Passive hemagglutination
RASH Rapid Surveillance Helper
RET Reportable Events Table
RIA Radioimmunoassay
SIDS Sudden Infant Death Syndrome
SHC State health coordinator
SPSS Supplementary Pertussis Surveillance System
TIG Tetanus immune globulin
TT Tetanus toxoid
VAE Vaccine adverse event
VAERS Vaccine Adverse Event Reporting System
VAPP Vaccine-associated paralytic poliomyelitis
VHSP Viral Hepatitis Surveillance Program
VPD Vaccine-preventable disease
VZIG Varicella-zoster immune globulin
VZV Varicella-zoster virus
WBC White blood-cell count
WHO World Health Organization

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Definition of Terms

Definition of Terms
Attenuated virus A strain of virus whose virulence has been lowered by physical or chemical processes or by repeated passage through the cells of another species.
Breakthrough The appearance of clinical disease in an individual who has previously been vaccinated against the agent causing the disease.
Clinically compatible case A case featuring a clinical syndrome generally compatible with the disease, but for which specific clinical criteria may not have been met unless they are noted in the case classification.
Confirmed case A case that is classified as confirmed for reporting purposes.
Contraindication A characteristic or attribute of an individual that may be temporary or permanent that prohibits the administration of a drug, vaccine, or other therapeutic intervention.
Encephalitis An inflammatory condition of brain tissue caused by a variety of infectious and non-infectious diseases. In varicella, influenza, and measles, this is sometimes referred to as post-infectious encephalitis.
linked case
A case in which the patient has or has had contact with one or more persons who have or have had the disease, and transmission of the agent by the usual modes of transmission is plausible. In general, a case may be considered epidemiologically linked to a laboratory-confirmed case if at least one case in the chain of transmission is laboratory confirmed.
Erythema Redness (or inflammation) of the skin or mucous membranes that is the result of dilation and congestion of superficial capillaries.
Exanthem A skin eruption or rash that may have specific diagnostic features of an infectious disease. Chickenpox, measles, roseola infantum, rubella, and smallpox are usually characterized by a particular type of exanthem.
Immuno-compromised A state in which an individual has either a decreased or absent ability to mount an antibody and/or cell-mediated immune response to infectious agents.
Incubation period The period of time from exposure to an infecting agent to the onset of symptoms of disease.
Laboratory confirmed case A case that is confirmed by one or more of the laboratory methods listed in the case definition under “Laboratory criteria.” Although other laboratory methods may be used in clinical diagnosis, only those listed are accepted for laboratory confirmation for reporting purposes.
Line listing A tool used during epidemiologic investigations to allow investigators to record case information and to review and follow up case reports or conduct data analysis.
Meets the clinical case definition Meets precisely the clinical case definition. Although in clinical practice the diagnosis may be made with the use of other criteria, for reporting purposes the stated criteria must be met.
Primary vaccine failure The absence of seroconversion after vaccination. This is manifest as the occurrence of disease in a vaccinated individual in which the disease occurrence closely resembles that found in natural infection with wild-type virus, i.e., more commonly moderate or severe disease.
Probable case A case that is classified as probable for reporting purposes.
Secondary vaccine failure Loss of immunity acquired after vaccination.
Sentinel event A preventable disease, disability, or untimely death that serves as a warning signal of a possible underlying problem.
Sentinel surveillance Activities focused on monitoring key health indicators in the general population or in special populations. The primary intent is to obtain timely information needed for public health or medical action in a relatively inexpensive manner rather than to derive precise estimates of prevalence or incidence in the general population.
Supportive laboratory results Specified laboratory results consistent with the diagnosis but not meeting the criteria for laboratory confirmation.
Susceptible Being sensitive to effects of an infectious disease, allergen, or other pathogenic agent; lacking immunity or resistance.
Thermolability A characteristic of vaccines that cause them to lose potency when stored or held at temperatures other than that recommended by the manufacturer.
Vaccine coverage The proportion or percentage of persons that have received a vaccine among all individuals in a particular group who are eligible to receive the vaccine.
Vaccine effectiveness The ability of a vaccine to provide protection against disease when used under field conditions (e.g., use of the vaccine in routine practice).
Vaccine efficacy The ability of a vaccine to provide protection against disease under ideal circumstances (e.g., during a clinical trial).