動物疫病流行病學調查表(診斷送檢用)（Epidemiological survey of animal diseases (for diagnostic purposes)）

1、動物疫病流行病學調查表(診斷送檢用)（Epidemiological survey of animal diseases (for diagnostic purposes)）Epidemiological survey of animal diseases (for diagnostic purposes)Number: date of investigation: Year Month DateFarm / household / breeding area / checkpoint nameEnable timeThe main livestock (goods). The name of

2、 the person in chargeContact numberZip codeContact addressFarms (households, residential) / basic condition of market / abattoir / epidemic checkpoints and transport1. geographical features: - Alpine mountain - - - - - hilly Pingba valley basin - other:2. recent climate is abnormal: - - is not:3. tr

3、affic: from the main artery: KM; away from residential areas: KM; away from the recent susceptible fauna: KM4. yard area: the number of livestock and poultry houses: the area of each livestock and poultry house:There is no 5. surrounding rivers and lakes: Yes - no:If there is a farm near the sewage:

4、 a free:If there is a wild animal (around 6. wild wild fowl, etc.) - is not:Distribution situation:7. isolation of wild birds, rodents, mosquito and other facilities: - no yes:The 8. group: Livestock - Poultry livestock (meat - - - commodity egg - milk - fur) - mixed9., feeding quantity: before the

5、onset of livestock number: head / only; annual slaughter number: head / only10. feeding methods: - all in all out - whether continuous mixed isolates before: - Yes No11.: - no - polyculture is: - bird and pig - chicken and cattle and sheep - other waterfowl:12. - bath dressing facilities: epidemic p

6、revention approach - production area for house door rubber boots - disinfection tank- regular disinfection - feeding channel and the manure separated a rodent and mosquito facilities13.: - good - raising management level. The general health status is poor; livestock and poultry farms: - good - Gener

7、al - bad14.: feed - feed - feed - production and grain - other crops:15.: - - there is no sewage facilities; animal mortality: harmless treatment facilities: - no yes:The 16. breeders living conditions: - in the field - not in the field: no - is the poultry raising home:17.: - - modern slaughterhous

8、e semi mechanized - Manual; slaughter: ten thousand years / onlySpecification: - - is not slaughter and quarantine / isolation; circle times of sterilization workshop:Source of slaughtered animals:Earcon: no - a head; quarantine certificate: - without a head18. checkpoint: means of transport: licenc

9、e: carrier:Source: animal; shipment: Destination:Earcon: no - a head; quarantine certificate: - without a headhairillnessfeelingconditionMain pathogenic speciesInitial onset timeStart dead timeAge of onsetCourse of diseaseClinical manifestationThe incidence of head, including: young chicks (day / mo

10、nth) head; head of livestock and poultry breeding;Adult: livestock; livestock and poultry; incidence rate:%The number of deaths: head, including: young chicks (day / month) head; head of livestock and poultry breeding;Adult: livestock; livestock and poultry; mortality:%Premature birth / miscarriage

11、/ stillbirth: fossa; stillbirth: 1; mummified foetus: 1; weak offspring: 1Main clinical symptoms:Necropsy; pathological findings:Human infection and diseaseThe incidence of wild animals and other susceptible animalsmorbidityAfter treatmentTreatment andDisinfectionSituationas well asOtherprevention a

12、nd controlMeasuresAndEffectTreatment conditionUse of antimicrobial agents:Use hormone drugs:Use antiviral drugs:Whether to carry out emergency vaccination: - is not:Other symptomatic treatment measures:Therapeutic effect: - - good curative effect has certain curative effect. No obvious curative effe

13、ct - aggravating illnessOther supplements:Disinfection statusLivestock and poultry farms: disinfection time: disinfection times: Disinfectant:Vehicle: disinfection time: sterilization times: disinfectant:Other measures and effectsIs there an epidemic around?A: no - - - the village / town / township

14、streets. The district / county; the occurrence time:Brief situation of the disease:Immune statusVaccine nameManufacturer, date of production and lot numberImmunization timeImmunizing doseImmunization program:Whether to carry out the detection of immune efficacy: - not - is that the monitoring result

15、s of immune:DiseaseillnesshistoryIn the past have been similar: - not - is: time: Type: - - diagnosis; Clinical LaboratoryDiagnosis unit: diagnostic conclusion:Confirmed disease in the past yearSerology:Etiology:Total incidence of disease in the past year: head / only; total incidence%Total deaths d

16、uring the past year: head / only, total mortality,%30 days before the onset of a group of animal epidemics occurred around: A: no - - - the village / town / township streets. The district / county; the time of occurrence of disease types:Brief situation of the disease:30 days before the onset of no

17、infection occurred around / zoonotic disease: A: no - - - the township / town / village street- the district / county; disease occurrence types: occurrence time:Brief situation of the disease:Source of waterSituationDrinking water: tap water - - water - shallow water - deep well water - river stream

18、 - pond, reservoir water - other:Wash water: tap water - - water - shallow water - deep well water - river stream - pond, reservoir water - other:Source of livestock and poultry (poultry / poultry)Local (county):Outside the county:Outside:Self - propagation (hatch): the first time: the introduction

19、of autotrophic; introduction quantity: first / only introduction:Purchase of livestock and poultry within the last 30 daysSource: - livestock and poultry farm - market - livestock Dealers - other:Purchase: time: quantity: source name:Animals: Breed: health status:The mixed group whether there is no

20、isolation: - - - - there is no exception: no:Mixed group: - the same care (households) - neighbor feeding (households) feeding - separate feedingThe latest purchase of feed and raw materialsSource: - market - livestock and poultry farm - feed distributor / agents / feed factory - other livestock and

21、 poultry farmOthers:Purchase: time: quantity: source name:Admission of wild animals 30 days before onsetWild animal species: - - - wild boar; rodents; birds; - otherQuantity: head; only; only;Source:Place of contact with poultry: livestock and poultry coops - enter - around farm buildings - stock an

22、d trough- other:With the frequency of contact point of contact with several times a day - once a day - other:30 days before the onset of suspected pollutants into the situationSuspected contamination / drug / device name:Quantity of suspected contamination / drugs / instruments:Pass or place:Usage a

23、fter shipment:30 days before the onset of OTC related business personnel admissionFull name：Date,Occupation：Contact number：From where:Epidemic area:Changes in feed and rearing methodsAre there 30 days before the onset of feeding / change management: - is not:Are there 30 days before the onset of fee

24、d and raw material change: - - is not:The flow of livestock and poultry products since the 21 day before the onset of diseaseName: Location: quantity: time:Name: Location: quantity: time:Name: Location: quantity: time:Name: Location: quantity: time:Name: Location: quantity: time:Name: Location: quantity: time:Clinical diagnosis and etiological investigationClinically suspected diagnosis:Expert group members:Preliminary conclusions:Preliminary investigation and analysis of epidemic focussamplingSend sampleSituationSerum: portion: anticoag